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

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

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

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)

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; Ram í rez-Esparza, Gosling, Benet-Mart í nez, Potter & Pennebaker, 2006)

“ 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)

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

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

Satisfaction with interpreters Practitioner Satisfaction with Interpreters: by Interpreter Type Client Satisfaction with Interpreters: by Interpreter Type Professional on-site interpreter (98%)(92.4%) Telephone interpreterFamily member of friend interpreter (74.5%)(85.1%) Family member of friend interpreterBilingual practitioner (62%)(75%) Bilingual practitionerTelephone interpreter (47.4%)(53.3%) Hospital staff or employee (43.6%)40% (Klein et al., 1980; Baker et al., 1998; Kuo & Fagan, 1999)

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; Grac é s, 2005)

Qualifications of professional interpreters? 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)

The many roles of interpreters Minimal Involvement Moderate & Cultural Involvement Extra-therapeutic Roles Neutral/Impartial ‘ translator ’ Black-box Conduit-message transmitter Traditional interpreter, primarily language- focused Cultural broker Bilingual worker Bilingual/bicultural mediator Cultural consultant Manager of cross-cultural encounters Incremental/flexible role shifter Bilingual/bicultural mediator Tool for projection of intercultural relationships Paraprofessional Advocate for client services Clinical collaborator Intermediary Link worker Conciliator Community advocate Embedded agent of the cultural-linguistic community (Kaufert & Koolage, 1984; Culross, 1996; Tribe & Raval, 2003; Miller et al., 2005)

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)

The therapeutic triad Interpreter verbal verbal nonverbal nonverbal cultural cultural professional (therapeutic) Clinician Client nonverbal therapeutic (Baker & Briggs, 1975; Faust & Drickey, 1986)

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)

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)

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)

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)

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

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