Working with
Interpreters in Mental
Health Settings
Presentation Prepared by
Yeshashwork Kibour, Ph.D.
Center for Multicultural Human Services
March 27, 2008
Duplication of materials may not be done without prior approval of CMHS
Outline of Presentation
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The need
The population
The tool
Proper Assessment and Assignment
Issues to consider
When it works
Resources
(c) CMHS 2007 Yeshashwork Kibour, Ph.D.
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The Need
• Many of immigrants, refugees, and asylum seekers
overcome numerous barriers and seek mental
health services each year. 46% of Cambodian
refugees (Marshall et al, 2006); 12.5% of
Ethiopians with mental health issues received
services (Fenta et al, 2007).
• CMHS provides services to hundreds of
newcomers annually who speak at least 15 different
languages.
• Newcomer populations pose a particular linguistic
challenge in that mental health and social service
agencies rarely have staff with a linguistic match.
• Challenges of alternatives such as the language
line for mental health services
(c) CMHS 2007 Yeshashwork Kibour, Ph.D.
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The population
• Have suffered traumatic experiences
that impact their mood, thinking, and
sense of safety.
• Overwhelmed with numerous needs
such as housing, education,
employment, etc.
• May define communication differently
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The population cont . . .
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Time and Space *
Fate and Personal Responsibility*
Face and Face-Saving*
Nonverbal Communication*
Have been silenced
*LeBaron (2003)
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The Tool: Interpretation
The interpreter's function is conveying
every semantic element (tone and
register) and every intention and feeling
of the message that the sourcelanguage speaker is directing to the
target-language listeners.
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The Tool cont . . .
• Interpretation is rendered in two modes:
simultaneous and consecutive.
• Whispered interpreting
• Liaison interpreting
• Language line (via telephone)
(c) CMHS 2007 Yeshashwork Kibour, Ph.D.
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The Tool Cont . . .
Simultaneous Interpretation
The interpreter renders the
message in the targetlanguage as quickly as he
or she can formulate it
from the source language,
while the source-language
speaker continuously
speaks
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The Tool Cont . . .
Consecutive Interpretation
The interpreter speaks after the client
has finished speaking. The speech is
divided into segments, and the
interpreter sits or stands beside the
client, listening and taking notes as the
speaker progresses through the
message. When the speaker pauses or
finishes speaking, the interpreter then
renders the entire message in the
target language.
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Proper Assessment and
Assignment
• When unable to communicate above
and beyond simple greetings
• Able to communicate above simple
greetings but not clinical issues or
emotional content
• Critical Need: Initial assessment;
specialist or multidisciplinary
assessment; risk assessment; legal
issues involved; discharge planning.
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Issues to Consider
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Stigma
Confidentiality
Technical language
Interpreter attitudes and beliefs
Flexibility
Accuracy of information
Continuity
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Issues to Consider Cont . . .
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Trust between clinician and interpreter
Professional partners
Provision of cultural information
Block booking
Assessment and accreditation of
interpreters (levels of accreditation)
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When it works: Before
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When it works: Before cont . . .
• Identify appropriate language
• Explore preference for interpreter gender,
dialect, country, ethnicity, etc.
• Schedule enough time before and after
session to touch base with interpreter
• Assess availability of interpreter on an
ongoing bases
• Assess interpreter’s experience or training in
mental health issues
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When it works: Before cont . . .
• Prepare the interpreter on the client and
the agenda for individual session
• Have a brief discussion about
terminology that you may be using that
session
• Discuss what will happen
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When it works: During
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When it works: During
• Introductions, codes of ethics and roles
explained
• Confidentiality
• ▲ seating
• Keep sentences short and pause
• Clinician maintains direction of session
• Keep eye contact with client at all times
• Communicate directly with client “I” and “you”
• Avoid jargon or colloquial language
• Body language
(c) CMHS 2007 Yeshashwork Kibour, Ph.D.
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Challenges Facing Multicultural
populations Needing Mental
Health Services
Having a world view that explains
psychological / health dysfunction differently
Not seeing mental health service providers
as a primary resource for help with
adjustment issues
Not knowing where to go for help in a
fragmented system
Mental health not a priority –dealing with
more immediate survival health issues
(c) CMHS 2007 Yeshashwork Kibour, Ph.D.
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Challenges Cont . . .
Unwillingness to discuss traumatic issues No
insurance or not knowing how to use it
Fear of compromising legal status
Language and other cultural barriers
Lack of trained bi-cultural professionals and
targeted funding
(c) CMHS 2007 Yeshashwork Kibour, Ph.D.
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Causes and Response to Illness
CAUSES OF ILLNESS
• Imbalance in body
• Germs
• Spirit possession
• Loss of soul
• Violation of Taboo
• Intrusion of harmful element
• Divine Decision
• Evil Eye
HOW TO RESPOND
• Restore the balance
• Kill them
• Exorcize it
• Ritual to retrieve it
• Penance
• Remove it
• Acceptance
• Rituals / offerings to turn
influence away
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Sources of Healing
(c) CMHS 2007 Yeshashwork Kibour, Ph.D.
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Psychotherapy
• Psychotherapy practice is enormously
diverse
• The treatment of mental and emotional
disorders through the use of psychological
techniques designed to encourage
communication of conflicts and insight into
problems, with the goal being relief of
symptoms, changes in behavior leading to
improved social and vocational functioning,
and personality growth.
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Psychotherapy redefined
A situation comprising three main elements:
• Firstly, a healing agent who is either a
professional with officially recognized
expertise, or others such as a fellow sufferer
or group of fellow sufferers;
• Secondly a sufferer who is seeking relief;
• Lastly a healing relationship that includes a
structured series of contacts between healer
and sufferer. Frank and Frank (1991)
(c) CMHS 2007 Yeshashwork Kibour, Ph.D.
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Refugees and Immigrants
have often experienced
Traumatic life experiences
Trauma involves two Conditions:
1. Usually involves actual or feared
death or serious physical or emotional
injury.
2. Meaning that the victim ascribes to
the event.
(c) CMHS 2007 Yeshashwork Kibour, Ph.D.
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TRAUMATIC EVENTS ARE EXTRAORDINARY,
not because they occur rarely, but rather
because they overwhelm the ordinary human
adaptations to life. Unlike commonplace
misfortunes, traumatic events generally involve
threats to life or bodily integrity, or a close
personal encounter with violence or death. They
confront human beings with the extremities of
helplessness and terror, and evoke the
responses of catastrophe. The common
denominator of trauma is a feeling of intense
fear, helplessness, loss of control, and threat
of annihilation.
Judith Herman, MD, Trauma and Recovery
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Common Reactions to
Trauma
Physical Reactions
 Nervous energy,
jitters, muscle tension
 Upset stomach
 Rapid heart rate
 Dizziness
 Lack of energy,
fatigue
 Teeth grinding
Behavioral Reactions
 Becoming withdrawn
or isolated from
others
 Easily startled
 Avoiding places or
situations
 Becoming
confrontational and
aggressive
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Common Reactions Cont. .
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Behavioral
Reactions
Emotional Reactions
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Cont . . .
Change in eating habits
Loss or gain in weight
Restlessness
Increase or decrease in
sexual activity
 Fear, inability to feel safe
 Sadness, grief,
depression
 Guilt
 Anger, irritability
 Numbness, lack of
feelings
 Inability to enjoy anything
(c) CMHS 2007 Yeshashwork Kibour, Ph.D.
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Emotional Reactions
Cont. . .
 Loss of trust
 Loss of self-esteem
 Feeling helpless
 Emotional distance
from others
 Intense or extreme
feelings
 Feeling chronically
empty
 Blunted, then
extreme, feelings
Mental Reactions
 Changes in the way
you think about
yourself, the world,
and other people
 Heightened
awareness of your
surroundings
(hypervigilance)
 Lessened awareness,
disconnection from
yourself (dissociation)
 Difficulty
concentrating
(c) CMHS 2007 Yeshashwork Kibour, Ph.D.
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Mental Reactions
Cont..
 Poor attention or
memory problems
 Difficulty making
decisions
 Intrusive images
 Nightmares.
(c) CMHS 2007 Yeshashwork Kibour, Ph.D.
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Coping with Symptoms
Path to Healing
 Confronting the
situation head on
 Act to take care of
things independently
 Learn or develop
special skills
 Call a friend
 Try to see positive
aspects of the
situation
Flags to watch
 Chronically distancing
oneself from the
situation
 Chronically distancing
from oneself
 Escape through
dissociation or
forgetting
 Shaming oneself
(c) CMHS 2007 Yeshashwork Kibour, Ph.D.
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Treatment
Psychoherapy
Interpretation
Social Support
Client
Legal Services
Social Services
Medical Treatment
(c) CMHS 2007 Yeshashwork Kibour, Ph.D.
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Mental Health- Stages of
Recovery
Stage One: Safety
Stage Two: Remembrance and
morning
Stage Three: Reconnection
Stage Four: Commonality
(c) CMHS 2007 Yeshashwork Kibour, Ph.D.
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When it works: After
• Time to clarify
• Time to answer questions
• Reframe and advise on ways to correct
inappropriate behavior on the part of
the interpreter
• Processing time
(c) CMHS 2007 Yeshashwork Kibour, Ph.D.
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Resources
• www.health.state.mn.us/.../immigrant/in
ter.html
• http://www.mmia.org/
• http://www.cmhs.org
• http://www.ncihc.org
• http://www.vtpu.org.au/docs/interpreter
_guidelines.pdf
(c) CMHS 2007 Yeshashwork Kibour, Ph.D.
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Contact information
Yeshashwork Kibour, Ph.D.
Center for Multicultural Human Services
701 West Broad Street
Falls Church, VA 22046
(703) 533-3302x 316
www.cmhs.org
(c) CMHS 2007 Yeshashwork Kibour, Ph.D.
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Working with Interpreters in Mental Health Settings