High quality professional interpretation is a wonderful thing that every patient deserves.
I would always choose to have a professional. Interpreters undergo training and testing. They have a code of ethics and professional standards. It takes true skill to center yourself in the conversation but not participate.
When working internationally in underdeveloped systems, professional interpretation is a rarity and a luxury.
Like now. We don’t have any professionally trained or certified interpreters. We do, though, have a group of 4 bachelor’s nursing students who come through the psych ward every two weeks. Their English is very good, and they often interpret.
The expected hiccups include the students adding their own spin on things, answering for me and/or the client, and starting a conversation with the client. The interpreter ends up being the only person in the room who fully understands what’s being said. This is a problem. If I’m taking a history or conducting a risk assessment, I want an exact translation.
What to do? Sometimes I roll with it. If there’s no risk, I let the student do the session. I act as a back seat driver, giving the students general directions and feedback as we go.
There are other times when I want to be in the driver’s seat. I’ll tell the students, “Today I will do the session. I would like you to interpret only.”
If you’re in that latter situation– working with an untrained interpreter– you’ll need to attend to your client AND the interpreter. Here are my tips.
1. Don’t assume others know the difference between bilingualism and the ability to interpret.
In fact, someone who is bilingual is more likely to be unaware of the difference. They have not had the experience of understanding only one half of the conversation. Educate your co-workers about the importance of quality translation. Brainstorm ways to structure the workload to minimize the use of untrained translators.
2. Do not use family members, friends, or other people personally known to the patient.
Of course there are issues around confidentiality. Also, in a culture where reputation is important, the patient may not be fully honest because they don’t want to be judged. If it’s a culture with hierarchy, the message will certainly be changed based on the interpreter’s position relative to the patient.
3. Keep your statements concrete and concise.
If you statement are too long, the interpreter won’t accurately remember what you said that the beginning. Nuances, metaphors, and abstract concepts aren’t likely to translate well (and are probably too culturally-bound).
4. Offer clear behavioral interventions and check for understanding.
Give instructions one step at a time. When you’re finished, ask the patient to explain back to you what he understands the instructions to be.
5. Realize that the interpreter may either clarify or “soften” the message.
The interpreter may make your (intentionally) vague question more specific. For example, an open-ended question may get closed. He may also clarify vague, ambivalent, or confusing patient statements. This is problematic because the interpreter is choosing what aspects to clarify, and you might not even realize that the patient is feeling confused or ambivalent. Alternately, the interpreter might “soften” your direct questions, for example when assessing for suicide risk.
6. Note if the interpreter is having a personal reaction to the conversation.
When this happens, the interpreter may interact with the patient in an effort to assuage his own discomfort. For example, if you ask the patient to think of a possible solution and it’s taking a long time, the translator may start to make suggestions. Or if you are trying to use silence to create space, the translator may feel uncomfortable and intervene. This is very likely is the patient is crying or otherwise emotional.
7. Assess your interpreters’ language skills prior to the interview.
Have a conversation and gradually increase the sentence complexity, vocabulary difficulty, rate of speech, and amount of abstract content. Where’s the threshold? And will your interpreter speak up when he doesn’t understand?
8. Assess your translators’ maturity and comfort level with emotional content.
Talk about a case example and note the response. Is the translator uncomfortable or nervous? Or is he concerned and compassionate?
9. Prep your translator about what will occur in the session.
If your interpreter knows what to expect and if you’ve provided your rationale, you’re more likely to have accurate translation. During prep, you can also give specific instructions about what you would like the interpreter to do.
10. Be diligent and assertive when interrupting a conversation between the interpreter and the patient.
It will happen. Stop it early and every time.
11. Arrange the seating so that the interpreter sits next to you.
If the patient and interpreter sit next to each other, they will gradually face each other. This makes it more likely that they engage with each other instead of you.
12. Debrief with the interpreter after the interview.
This ensures the translator’s emotional safety and is also a wonderful teaching time. Remember to give some positive feedback. Your interpreter was probably trying very hard to do a good job.
Here is the document that I give to interpreters. Feel free to use it as long as I am credited as the author.
These are my tips so far. And I always want to learn more!
Do you work with lay interpreters? What are your thoughts?