Bridging the Gap: Serving Limited English Proficient Clients in Mental Health

1. Serving limited English proficient clients: Collaboration between mental health providers and interpreters Erin Gabrielson, M.A.

2. Introduction • There are at least 49 million limited English proficient (LEP) individuals in the United States 11 million of these individuals are considered linguistically isolated • There are few resources for mental health professionals that address the unique LEP background • There are even fewer resources that address how to work with interpreters as a means of better serving LEP clients

3. Interpreter or translator • What is the difference? • Different types of interpreters ·simultaneous ·consecutive

4. LEP or bilingual • Limited English Proficient (LEP): a person who does not speak English as their primary language and has a limited ability to read, write, speak, or understand English • an individuals who speak English less than “very well” • Bilingual: a person with • (equal) fluency in two • languages • compound bilingual • coordinate bilingual • subordinate bilingual • functional bilingual (U.S. Department of Justice, 2002; Federal Interagency Working Group on Limited English Proficiency, 2008; Marcos & Alpert, 1976; Marcos, 1976)

5. Language and emotion • The emotional content of words is encoded in the language in which the emotional concepts were first learned, i.e. the native/first language • Aspects of personality are altered for some bilingual individuals depending on the linguistic and cultural context in which they are communicating • Less mastery in a language=less emotional connectedness to that language (Thass-Thienemann, 1973; Silva, 2000; Ramírez-Esparza, Gosling, Benet-Martínez, Potter & Pennebaker, 2006)

6. “if they [the client] can understand half of what I am saying…and I can understand half of what they are saying, I tell the interpreter to leave” (Miller, Martell, Pazdirek, Caruth, & Lopez, 2005, p. 30)

7. Use of interpreters • “a challenging compromise” • Important in order to facilitate communication and cultural understanding (cultural brokers)

8. Types of interpreters • 3 broad categories • 5 finer designations (Phelan & Parkman, 1995; Hsieh, 2006)

9. Satisfaction with interpreters (Klein et al., 1980; Baker et al.,1998; Kuo & Fagan, 1999)

10. Why professional interpreters? • Complexity of interpretation process • Difficulties and common errors: omission, addition, condensation, substitution, role exchange, understanding of psychology and psychological vocabulary • Confidentiality and impartiality (Marcos, 1979; Vasquez & Javier, 1991; Marshall et al., 1998; Gracés, 2005)

11. Qualifications of professional interpreters? • 30-632 hours; mode of 40 hours • (1) sound mental health; (2) experience and knowledge with mental health principles; (3) ability to convey affective nuance and emphasis; (4) neutral reputation in the client’s community; (5) professional behavior; (6) ability to deal with one’s own feelings; (7) ability to remain neutral; (8) ability to refrain from offering own opinion; (9) understanding/respect for boundaries and roles; and (10) absence of a dual/prior relationship (Porter, 1999; California Endowment, 2003)

12. The many roles of interpreters (Kaufert & Koolage, 1984; Culross, 1996; Tribe & Raval, 2003; Miller et al., 2005)

13. Clinician and interpreter roles/responsibilities Clinician • Conducting therapy • Briefing/debriefings and supervision of interpreter • Role negotiation Interpreter • Transmitting messages • Facilitating cross-cultural exchanges • Role negotiation (Faust & Drickey, 1986; Avery, 2001; Miller et al., 2005; de Bruin & Brugmans, 2006)

14. The therapeutic triad Interpreter verbal verbal nonverbal nonverbal cultural cultural professional (therapeutic) ClinicianClient nonverbal therapeutic (Baker & Briggs, 1975; Faust & Drickey, 1986)

15. Inter-triad pairing and alliance • 3 distinct pairings within the triad • Alliance does not necessarily develop equally or along the same trajectory among the pairs • Clinicians need to beware of and observe pairing and alliance (overt and covert) • Feelings of being the ‘odd-one-out’ • Seating arrangements may help (Baker & Briggs, 1975; Faust & Drickey, 1986; Wetermeyer, 1990; Amodeo et al., 1997; Bolton, 2002; Miller at al., 2005; Gamulin, 2007)

16. Transference and countertransference • Transference in the interpreted therapeutic triad includes complex emotional reactions • Potential countertransference on both the interpreter’s and clinician’s part • Interpreter countertransference may manifest in a vocabulary choice or register (Faust & Drickey, 1986; Westermeyer, 1990; Mellman, 1995; Miller et al., 2005)

17. Legal and ethical issues • Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations • Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists • Ethical Principles of Psychologists and Code of Conduct (APA, 1991; APA, 2002; Mailloux, 2004)

18. Reducing access barriers • Numerous obstacles in accessing services including delays or denial of services because of language status • Other reasons contributing to the decreased utilization of mental health services: level of acculturation, unfamiliarity with mental health system, lack of information, differing cultural values, alternative approaches to healing, and institutional racism • Often LEP individuals are less satisfied with the services they receive (Acevedo, Reyes, Annett, & López, 2003; Rea, 2004; Snowden, Masland & Guerrero 2007; Raval & Smith, 2003)

19. Applied Scholarship Overview of Dissertation • Identification of relevant literature • Data collection to inform resource development • Clinician recruitment / input questionnaire • Creation of resource manual • Expert reviewers recruitment / analysis of resource • Synthesis and finalization of resource

20. Questions