STANDARD PRACTICE PAPER

INTERPRETING IN MENTAL HEALTH SETTINGS

Introduction

The Registry of Interpreters for the Deaf Standard Practice Paper provides a framework of basic, good standards for RID members’ professional work and conduct with consumers. This document is intended to raise awareness,

educate, guide and encourage sound basic methods of professional practice. The Standard Practice Paper should be considered by members in arriving at an appropriate course of action with respect to their clinical practice and professional conduct. Members should also be aware that the Standard of Practice Paper may be considered in a court of law as guidelines for your professional practice.

It is hoped that the standards will promote commitment to the pursuit of excellence in the practice of interpreting and be used for public distribution and advocacy.  

 

INTERPRETING IN MENTAL HEALTH SETTINGS

In mental health assessment, testing and treatment, effective communication is essential. When two languages and cultures are involved, this communication issue presents those working in the behavioral healthcare system with additional hurdles to overcome. Interpreting in mental health settings presents a distinct set of challenges. These are delineated in Section A. It also necessitates a specialized set of skills and knowledge, which are outlined in Section B. Lastly, the tasks of interpreting and cross-cultural mediation in the mental health setting may require interpreters to take steps to improve the chances for a successful outcome. This is covered in Section C.

 

Section A - What makes mental health settings different, if not unique?

Ø      The preponderant dependence on language form and content for diagnosis and therapy. Nuances in communication, both affective and paralinguistic, may have significance for differential diagnosis and treatment course. This is combined with the uniqueness of working with individuals who have disfluent¹ and alinguistic² expression. This communication may then be further impacted by cognitive, emotional, behavioral or social factors

Ø      The use of unique terminology and the discussions of symptomatology within therapeutic relationships

Ø      The wide range of behavioral healthcare contexts. These may include out-patient peer-led settings (such as AA or “self-help groups”), outreach efforts (in-the-field), day programs, clinic settings, long-term residential care and in-patient environments. Some of these environments may present potentially volatile or dangerous working conditions.

Ø      The unique quality of the therapeutic relationship and the influence of interpreter presence on its development. This may raise distinctive issues related to confidentiality and vicarious trauma as well as transference and countertransference.³  This, in turn, increases the need for self-awareness on the part of the interpreter and for strategies for managing interference of own biases, judgments and sensitivities.

 

Section B - What knowledge and skills are required for interpreting in mental health settings?

Ø      A Working knowledge of various behavioral healthcare environments and settings as well as knowledge of the mental health clinicians and their roles, their goals, methodologies and theoretical orientations.

Ø      A basic knowledge of psychopharmacology, to include the medications used in the field, their indications for use and effects which may influence the interpreting process.

Ø      A working knowledge of the diagnostic criteria and the taxonomic structure of the current Diagnostic and Statistical Manual of Mental Disorders and other current literature in the field of mental health interpreting.

Ø      The legal and regulatory obligations which apply to interpreters and clinicians.

Ø      The use of multiple interpreting approaches (1st person, 3rd person, narrative, descriptive, simultaneous, consecutive, team interpreting with a CDI)

Ø      The ability to understand and comment on the form of language as distinct from the content of language. In addition, being able to recognize and comment on potentially exacerbating or mitigating factors in the language expression.

Ø      The personal and psychological strength to fit the encounter combined with consistent and critical assessment of one’s skills and the impact of one’s decisions. This would include a comfort level with intensity and strategies for maintaining professional demeanor during highly charged interactions and insight into one’s own mental health. Additionally, the knowledge of self-care techniques and resources to assist with maintaining one’s own mental health.

Ø      The ethical reasoning skills and resources to participate as a team member in the clinical process. As part of this participation, understand the complexities of confidentiality in behavioral healthcare and the boundaries needed to maintain professional relationships, with both consumers and clinicians.

Section C – What can be done to improve the chances for a successful outcome in the mental health setting?

Ø      Communicate with providers about relevant issues of language, culture and the interpreting process, especially those which could lead to misunderstanding or misdiagnosis of consumers. This may include specific information about Deaf culture and communication norms.

Ø      Provide resources about current research, knowledge and specialists in the field of behavioral healthcare and Deafness

Ø      Acknowledge that the presence of an interpreter may impact the development of the therapeutic relationship and develop strategies for mitigating that impact. Specific techniques may include the use of pre- and post-sessions as well as debriefing in specific situations.

Ø      Develop a relationship with a mentor with more experience in this area as well as attending trainings in this practice specialty.

Ø      Accessing available resources on mental health and deafness issues, including the following:

·         The Deaf Wellness Center in Rochester at http://www.urmc.rochester.edu/dwc/

·         The Alabama Department of MH/MR Office of Deaf Services at http://www.mh.alabama.gov/MIDS/index.htm

·         The RID website at http://www.rid.org

·         PUBmed at http://www.pubmedcentral.nih.gov/

·         Minnesota Chemical Dependency Program for Deaf and Hard of Hearing Individuals at http://www.mncddeaf.org/