independent

Working with interpreters in therapy

Lorraine Quinn

This study, a summary of research conducted in 2009 as part of my qualification to become a psychotherapist, centred on how counsellors relate to the experience of working with an interpreter. Following initial contact to answer some baseline screening questions, participants had a fifty-minute semi-structured, face-to-face interview with the researcher. At some point in the interview, each participant was asked to describe: their first experience of working with an interpreter; an image to portray the role of an interpreter and, finally, any further observations not yet expressed. There were 11 participants, all from the south of England and from a mix of voluntary, private and NHS sectors. Participants included trainee counsellors on placement, paid professionals with up to 25 years’ experience, client assessors and practitioner supervisors. They worked with clients ranging from non-English speaking recent immigrants through to long-term UK residents with little or no English.

The background to the study drew on a range of psychological and socio-political disciplines. For example, ethno-centric counsellors tend to see cultural differences as deviations from what they consider as global norms which potentially establishes a dynamic before the client enters the room (Eleftheriadou 1994). This is particularly embedded in white cultures, as white helpers tend not to see themselves as having a race (Ryde 2009). Lago and Thompson (1996) and Lago (2006) describe how cultural beliefs affect psychotherapy. The idea that counselling can repeat the colonising process is of concern to Rachael Tribe (1999a) and later she explores the relationship between a culture and its healing rituals (Tribe 1999b). Beiser (2003) describes how collective societies have communal experiences of events, unlike the individualist approach of Western psychology. Although refugees in particular may feel psychologically and socially alienated, the presence of an interpreter can be perceived as a commitment from the dominant culture to hear their story (Tribe and Patel 2007), and generally the interpreter can have a positive affect on a client (Smith 2008).

The variety of the experiences presented by participants started to emerge as early as the screening stage. The question: ‘Is there one word which currently sums up how you see the role of the interpreter?’ brought replies ranging from a single word, such as ‘enabler’ or ‘ally’, to the broader ‘the voice of the client’, ‘too involved to be summed up in one word’ or ‘each relationship is different. Even the same interpreter with different clients is a different dynamic’.

Many interviewees commented that they had not given much thought to the experience of working with an interpreter in the past and the interview process was an opportunity for self-reflection. In this summary (as in the full project report) the first experience that a participant had of working with an interpreter, the images that arose, any additional observations expressed by participants, and the five broad themes commented on by the majority in the course of the interviews are described.

The First Experience
‘Unease’ and related synonyms were, unsurprisingly, common where the counsellor had never worked with an interpreter before, was on a voluntary student placement or felt as though he or she did not have sufficient preparatory supervision. It may be that when ‘therapists first begin working with interpreters they tend to project their own critical superego on to the interpreter…[who]…has a great deal of experience and knowledge against which to assess the therapist’s performance’ (Blackwell 2005: 85).

For some (generally more experienced) counsellors their initial reaction was one of intrigue and curiosity towards a hitherto unknown area of practice; every participant, however, had been prepared to overcome initial reservations with a workman-like attitude to the opportunity. The majority would be happy to repeat the experience; others were clearer that for them personally the presence of an interpreter was not the preferred way of working, but ethically they felt duty-bound to provide access to interpreters for clients who needed them and who would not otherwise engage with counselling. A small minority refused to work with interpreters after their initial experience and their decisions were honoured by their respective agencies.

Images
For the participants who described their experience of an interpreter visually, a common motif was of something that creates diffusion between themselves and the client – mirrors, glass or the refractions caused by water or crystals. Other motifs were characterised by a degree of distance between the client and counsellor – a goldfish bowl with the client and interpreter inside and the counsellor looking in; or the interpreter as a screen, with the client as actor and the counsellor as audience. Another motif was one where details are obscured, as with a speeded–up stream of car headlights, or clouds.

These images suggest that the presence of an interpreter introduces some indirectness in relating to the client, but interestingly, and importantly I think, no participant described the gap between him or herself and the client as complete and absolute in any of the images they used; there was always an element of ‘seeing’ a client, even if the perception was somewhat distorted. This indicates that counsellors (and clients also) have a will to find ways of connecting, albeit imperfectly, despite the difficulties of language.

Additional Observations
The political climate within which mental health provisions are made also raised comment. Britain has a diverse and historic range of cultural identities, together with strong anti-discrimination legislation. The system within which clients currently receive help might not always be described as ideal, but all participants were conscious as individuals of the need to find ways to make their work effective, ethical and as culturally appropriate as possible within available resources. Many expressed their awareness of future developments and the general consensus was that the pressure on services was likely to increase both for native and non-native English language speakers.

One participant regarded IAPT (Increased Access to Psychological Therapies) schemes based around CBT (Cognitive Behavioural Therapy) as potentially counter-productive both financially and clinically if an interpreter was required to translate between client and counsellor. The experience of having to provide group therapy where one group member needed an interpreter had been observed by another participant as difficult for the non-English speaking client in the group, for the interpreter, for the other group members and for the facilitator as well. These two counsellors feared that they would be less able to respond creatively and energetically to fulfil their duty of care to clients who require interpreters and for whom neither CBT nor group work would be appropriate.

Themes
1. ‘They have a job to do and so do I’
Contiguous with self-reflective practice, all participants had a high level of awareness of the dynamics when an interpreter was present. Participants made sense of their work with interpreters by highlighting the interpreter’s obvious ‘role’ – to help the counsellor to understand what the client means when they speak. The role, however, could be a more complex one of ‘cultural broker’, translating both the words and the nuances that accompany them. Participants gave examples of how interpreters explain cultural, social and historical contexts either at the request of the counsellor or spontaneously and how the resulting collaboration contributed to the counsellor’s knowledge base for the future.

2. ‘Complex – for all concerned’
Participants gave examples where the interpreter affected the therapeutic relationship by adding or filtering meaning, misrepresenting the client or the counsellor to the other. Sometimes interpreters assumed roles as client advocate or guardian for example, preventing the client from full self-expression and affecting the counsellor’s perception of the client’s underlying message; or the interpreter formed a natural dyad with the client due to shared language or culture. Participants also described clear instances where the interpreter’s personality had a constructive or destructive impact on the work.

3. ‘Three-cornered models’ and other theoretical orientations
Participants varied in the consideration they gave to links between their theoretical orientation and their experience of an interpreter. There was a wide spectrum of therapeutic traditions among participants and even when participants shared a theoretical approach they understood and expressed their experiences of working with an interpreter differently. An interpreter’s presence can help replay the client’s Oedipal triangle or revive a previously unconscious relationship from the counsellor’s own past. Their influence was variously likened, for example, to the dynamic found within couple’s therapy, TA or the function of a transitional object.

4. ‘Headspace’
Interpreters are generally trained to start translating when a natural conversational pause occurs which can cover a client’s hesitancy or resistance and give them time to select another, possibly less painful topic. Participants who noticed this phenomenon were left wondering whether the client’s pauses were significant or whether the client was simply considerately breaking their narrative into smaller sense units so the interpreter could work more easily. Another observation was that an interpreter makes it virtually impossible to catch any slip of the tongue made by the client. Some understanding of the client’s language helps, and can also be useful for monitoring interpreter accuracy.

The slower pace of an interpreted session allows counsellors to attune better to the dynamics in the room. Some practitioners experience the gaps that occur while the client speaks and before the interpreter begins the work of translation, or the wait while the interpreter translates the counsellor’s words into the client’s language, as a resource that gives them time to think, to process what a client has said or to observe counter-transference in more depth and detail. This space can be especially useful in an initial assessment to build a picture of the client. Alternatively the pauses can create disengagement between the counsellor and the client and thus provide material to be explored in the session because they might indicate the client’s difficulties in life. Some participants felt comfortable in overtly bringing the impact of the interpreter’s presence into a session and others did not, although there was an overall sensitivity among counsellors towards what the presence of an interpreter might reflect of the client’s inner and outer worlds.

5. Responsibility
Participants regularly commented on the level of responsibility they felt to the client when an interpreter was present. This extends for many to a sense of responsibility for the interpreter too. There were some examples cited by participants where a lack of cultural awareness, linguistic competency and human error resulted in confusion and the counsellor took responsibility for making sense of such situations. On the other hand there were occasions when interpreters were perceived as undermining the counsellor’s position and, in response, participants found their own strategies for maintaining their responsibilities as caring professionals.

Interpreter de-briefing and other best practices (Tribe and Thompson 2008; Trivasse 2008) featured strongly, but not for all counsellors. Some establish a personal ‘pool’ of interpreters to work with regularly, who in turn build up experience of working with counsellors over time, freeing counsellors to concentrate more fully on the client; others suggested and implemented policy changes and improvements regarding interpreters in their organisations, and yet others took charge within sessions by perhaps positioning the interpreter physically in relation to the client and themselves.

Conclusion
Participants were profoundly aware that many clients who need interpreters often have chaotic lives and painful histories, quite aside from the language differences and the accompanying isolation from the dominant culture. The client’s presented material, the practical and emotional challenge of working in the presence of a third party, verbal, non-verbal and cultural differences and the professional environment all emerged as some of the individual factors that combine to make the participant’s experience of working with an interpreter different to other therapeutic situations. It was generally understood by participants that the interpreter plays a major role in how clients from other cultures experience not just the counsellor but also the process of counselling, often in a pressured environment where the interpreter does not have the luxury of time to consider, for example, which word best conveys meaning (insofar as direct translation is possible between languages anyway). However Lo and Fung (2003) suggest that directly exploring the client’s use of language is one way to engage more fully with non-English speakers, particularly refugees.

Psychotherapy has been defined as, ‘a communication process in which the different partners construct the reciprocal roles and together construct an interpersonal context within a consensual domain’, (McNamee et al 1992: 43). With the interpreter as a third partner and the number of potential roles the interpreter creates, brings or has projected on to them by the client and/or the counsellor, the communication process of psychotherapy can become more layered (and, I suggest, potentially more healing) than when an interpreter is not present.

The ability to use transference, counter-transference and what is heard, seen and experienced in the room are generally regarded as basic and crucial therapeutic skills. Based on experiences described by participants, my impression is that, potentially, these skills can get bound up into unconscious dynamics within the triad when an interpreter is present. As a result counsellors can feel uncertain in a new therapeutic relationship with a non-English speaking client, at least initially. However, ‘an important, if not crucial move in the process of becoming a therapist is the establishment of a particular domain in one’s sense and experience of oneself, which is that of the inner world and the self.’ (Dryden and Spurling 1989: 191). I would suggest that an interpreter, as well as having a utilitarian job to do, could be a positive addition to the usual processes of counselling, including assessments, therapeutic relationships and supervision. His or her presence has the potential to challenge not just the counsellor’s established way of working, but also perhaps to change aspects of the counsellor’s previously established inner sense of self.

Participants acknowledged that interpreters (consciously or unconsciously) play a part in the work, but differed in the role they understood the interpreters to have, and their importance. Some explicitly saw the interpreter in terms of their theoretical orientation and not surprisingly where the participants all work with clients from different cultures, the culture in which counselling took place often affected the counsellor’s experience of the interpreter. Even if participants sometimes viewed an interpreter as somewhat distorting the therapeutic relationship, for example as described through the imagery that came up, the general consensus was that even then, it resulted in a good enough relationship with clients.

Pragmatically, an interpreter is the only way of reaching some client groups who need services. As outlined earlier, I noticed from the interviews that counsellors often responded to the interpreter’s presence by actively managing the interpreter in a variety of ways, all with the best interests of the client and the counselling process in mind. As a result the interpreter can be a spur to develop new ways of being present to clients and to deepen their understanding of the counselling process professionally and personally, which can then be extended to other client groups.

Themes expressed by participants, such as the impact the presence of the interpreter has on roles in the counselling room and the complexity of the dynamic, are topics reflected in existing research, but the increased sense of responsibility, the notion of headspace and the effect which the triad between the client, counsellor and interpreter has on the counsellor’s understanding of their theoretical approach, are all less well documented and, I think, point to further areas for exploration.

Lorraine Quinn is a UKCP registered integrative psychotherapist with an academic background in linguistics and textual criticism. She currently works as a group facilitator and counsellor for a nationwide mental health network with links to the NHS. She is particularly interested in working with client groups who find it difficult to engage with services, and in the alchemy through which transformation can occur in the transpersonal space created by the client and therapist.

References
Beiser, M (2003) Why Should Researchers Care About Culture Canadian Journal of Psychiatry 48 3)
Blackwell, D (2005) Counselling and Psychotherapy with Refugees London: Jessica Kingsley Publications
Dryden, W and Spurling, L (1989) On Becoming a Psychotherapist London:
Tavistock/Routledge
Eleftheriadou, Z (1994) Transcultural Counselling London: Central Book Publishing
Lago, C and Thompson, J (1996) Race, Culture and Counselling Maidenhead: Open University Press
Lago, C (2006) Race, Culture and Counselling: The Ongoing Challenge Maidenhead: Open University Press
Lo, Hung-Tat and Fung, Kenneth P (2003) Culturally Competent Psychotherapy The Canadian Journal of Psychiatry 48(3)
McNamee, S and Kenneth J Georges, eds (1992) Therapy as a Social Construction London: Sage
Ryde, Judy (2009) Being White in the Helping Professions: Developing Effective Cultural Awareness London: Jessica Kingsley Publishers
Smith HC (2008) Bridging the Gap: Therapy Through Interpreters Therapy Today 19(6) 21-23
Tribe, R (1999a) Therapeutic Work with Refugees Living in Exile: Observations on Clinical Practice Counselling Psychology Quarterly 12(3) 233-243
Tribe, R (1999b) Bridging the Gap or Damming the Flow? Some Observations on using Interpreters/Bicultural Workers when working with Refugee Clients, many of whom have been Tortured British Journal of Medical Psychology 72(4)
Tribe, R and Patel, N (2007) Working with Interpreters The Psychologist 20(3)
Tribe, R and Thompson, K (2008) Working with Interpreters in Health Settings The British Psychological Society (BPS)
Trivasse, M (2008) An Interpreter in the Therapy Room G6 Information Sheet British Association for Counselling and Psychotherapy (BACP)

.Image: Pomegranates by Jason Matthews