Bilingual Therapy Bruce Field, MD Oct. 29, 2007 Photo courtesy of Pat Walker

Bilingual patients Discuss different levels of bilingualism. Review some of the issues in evaluating and providing therapy to bilingual patients. Discuss issues related to psychopathology and bilingual patients. Comments and recommendations.

Bilinguals Larisa is a 29 year old Russian- American female with bipolar disorder. Her English is quite good and she is justly proud of her proficiency and never wants to use an interpreter in the clinic. However, when hospitalized, she insisted that Basil, the Russian interpreter, be called.

Bilinguals Rafa is a 65 year old Guatemalan who was a teacher. He feels trapped living in a nursing home and finds it difficult to form new friendships in MN. He believes his personal assets as are not appreciated. He delicately corrects my Spanish and educates me about his past in Guatemala and troubles here.

Languages 6000 Languages Spoken More than half of people in the world are bilingual Half of languages may disappear in next 30 years

Languages Major step in achievement of separation and individuation. Creates new ways to relate to others. Individual, cultural, national identity can be strongly rooted in the use and maintenance of a particular language.

Spanish spoken at home ,362 1% of US population ,101, % of us population

WHAT PERCENTAGE OF EACH ASIAN/PACIFIC ISLANDER GROUP SPEAKS A LANGUAGE OTHER THAN ENGLISH AT HOME? Asian American Health Forum, Inc. SanFrancisco, CA, April 1989 Percent

Bilingual Subordinate bilinguals -Dominant language -Deficit in non- dominate language -Internal reciprocal translation or encoding Coordinate (proficient) Bilinguals -Native Proficiency in both Gradations

English Proficiency No English Limited English Speaker Subordinate bilingual Pure bilingual

Subordinate Bilinguals Constant concern about word order, pronunciation, grammar, vocabulary Invest more in how rather than what is said. Displace affect to language task. Decrease of affective tone- feeling of unreality.

Subordinate Bilinguals More likely to rely on content of rather than cues. Tend to perceive interviewer and themselves more negatively. Diminished rapport, catharsis Therapists burden to determine between language deficit and psychological processes.

Pure Bilinguals Language Independence- capacity to maintain and utilize two separate languages codes. Reciprocal translation no longer needed Seemingly equivalent words may have different connotations.

Subordinate Bilinguals Discrepancy more likely with conceptual and emotionally charged words. Important when second language was learned. Languages learned after puberty may be stored in overlapping but distinct parts of the brain.

Pure Bilinguals Intra-psychic unavailability of 2 nd language. Detachment Effect. Language specific identities and personalities -Sound different to themselves -Seem different to others 2 nd language as defense

Therapy Some material not accessible in 2 nd language. Highly charged material easier to discuss in 2 nd language. Relationship therapist and provider may change when language changes.

Therapy Therapy in second language can be important language experience for patient. Therapy in second language can help integrate childhood to émigré adulthood.

Psychopathology No consistent findings about whether patients are more symptomatic in first or second language. In stressful situations, people prefer to speak their first language.

Psychopathology Language difficulties easy to confuse with depressive, anxiety and negative symptoms. Speaking a second language can lead to a particular kind of humiliation.

Bilingual Therapist Pure bilingual and ethnically and linguistically matched providers. Coordinate bilinguals. Subordinate bilinguals.

Why bother with Subordinate Bilingual Therapists Insufficient number of linguistically/ethnically matched providers. Practical considerations Patient doesnt like to use an interpreter.

Bilingual Therapists Therapist as transitional or transformational object. Reversal of typical inequality in power and influence which often is exaggerated in work with immigrants. Studies show providers often overestimate fluency in second language.

Recommendations Achieving rapport is key. Use of interpreters often is the best option to overcome the language barrier. Providing psychiatric/ psychological services is possible when provider or patient has less than perfect command of second language, but caution is advised.