Psychological therapy with interpreters
What if therapist and patient do not speak the same language? Interpreters are particularly challenged in therapeutic interventions. A glimpse on this special, but not so rare situation.
When Mary*, pregnant, fled to Europe, she hoped that all will turn out fine. But then she suffered not only from a severe post-traumatic stress disorder but also from loneliness and the stress with a newborn baby without a father. So she was prescribed psychotherapy. But as Mary does only understand Swahili, an interpreter was needed.
Distrusting professional discretion
Mary was first absolutely against claiming an interpreter. She was too afraid and ashamed to tell about her experiences in front of any other person than her therapist. "I feared that the interpreter would betray me to the enemy, that they come one night and kill me and my baby." The concept of professional discretion, which also applies to interpreters, she did not trust in.
If you do not speak the language of your counterpart, you already find yourself in a situation of dependence. But just for traumatised persons, it is very difficult to build trust and rely on someone, also in psychotherapy. "I was ashamed, in front of a woman coming from my country, to tell that I was raped and have an illegitimate child. What would she think of me?" Mary worried.
The right choice of the interpreter
Rebecca Nduhiu, Mary's interpreter and cultural mediator, knows the fears of her clients. "It's extremely important to find a suitable interpreter. If the relationship between interpreter and client is not a good one, the whole treatment is useless," she explains.
When choosing an interpreter, it is important to pay attention to gender, age, ethnicity, religion, and cultural and political conviction. Depending on the country of origin of the patient, this selection is more or less sensitive. It is also important that the interpreters have a high degree of cross-cultural sensitivity. "It’s not enough to know the language and the culture of the patient. You must also know very well the language and culture of the therapist, "says Nduhiu.
The interpreter must also provide cultural understanding, and recognise and clarify misunderstandings. "You have to be an expert to speak for both sides. Not recognising certain sensitive situations can affect the whole therapy”, explains Nduhiu. Therefore, these interpreters and cultural mediators are usually for the second generation of immigrants who know both cultures quite well.
Psychological distress for interpreters
What patients tell in therapy is often very stressful for the interpreters who usually have no psychological education. "At first, I had great difficulties to cope and deal with what I heard at these sessions. For example Mary said things about the war that also happened in my own family. It was extremely stressful for me, "says Nduhiu. Yet she could not talk to their family or friends about it because the strict obedience to the medical secrecy is not only a basis of trust for the client but also a legal obligation.
Because of this distress, some interpreters have a little care session after therapy, so they can gain enough distance to the heard things. This is not to be confused with therapy: "It is already fine if you just say ‘man was that brutal what she said!’" laughs Nduhiu.
While in therapy sessions, the interpreter will bond a lot more with the client than in other sessions, however, it is also very important to not bond too much and to maintain a professional distance. Nduhiu says, "Not any interpreter is suitable for therapy sessions, especially those with war trauma. It's a balancing act. "
Therapy in sign language
Not only foreigners need interpreters. Also deaf patients can ask for the services of an interpreter for therapy. Once again, the cultural understanding plays an important role as many deaf clients are members of the deaf community which has its own culture.
Nduhiu clarifies: "If there are language and cultural barriers, the whole therapy has little chance of success, in any language." That is why she also advises people who can read the language of the therapist, or deaf people who can read lips, to still bring an interpreter to therapy. "Here, the patient should be in the focus, not the struggle for words and understanding."
The view of the therapist
To have an interpreter at therapy sessions can also have advantages for the therapist. Here is someone who can bridge the cultural differences and misunderstandings and facilitate. In addition, the slight delay through the interpreting gives the therapist more time to think and to empathise with the situation of the patient. Even non-verbal signs can be observed and analysed more closely.
For such settings, it takes more preparation and the interpreters have to be briefed in advance and sometimes accompanied afterwards as well. However, it is an opportunity for patient and therapist, especially for patients who would otherwise have to do without therapeutic treatments. For Mary, the therapy with an interpreter was the only way to account for her war trauma and to enjoy life in Europe.
* Name withheld
Text: M. Plattner - 06/2012
Translation: MPL – 08/2012