AT CVT, Interpreter Relationships are Key

Tuesday, November 7, 2017

Alyce Eaton is CVT’s research coordinator; Leora Hudak, MSW, LICSW is a psychotherapist with CVT’s Saint Paul Healing Center; EhTa Zar is the client services coordinator for CVT’s Healing Hearts project.

On any given day, a CVT clinician's work spans the globe, as their clients hail from an array of cultural and linguistic backgrounds. They are often asked, “How do you deal with language?” or “Do you speak all the languages your clients speak?” The answer is, of course, no. They do not speak all of the languages our clients speak. CVT clinicians regularly rely on the involvement of professional interpreters.

For each therapy session, the room is set up in what CVT refers to as the “therapeutic triad.” The client and therapist face each other to simulate direct conversation, and the interpreter sits to the side. Many torture survivors arrive at their initial counseling sessions feeling fearful. They often reveal to their clinician that they have difficulty trusting. CVT uses the triad model to alleviate this uneasiness and to demonstrate to clients that they are part of a cohesive team. Interpreters are required to interpret everything that is said in the room, including side conversations or phone calls. Every word matters. Survivors report that they have difficulty trusting others because their trauma occurred at the hands of another person. When clients understand what is being said and do not feel that anything is left out, it helps to increase trust and transparency in the healing relationship.

Each person brings something to the therapeutic triad. The client is the expert in his or her own history and experience. The clinician possesses the technical and professional expertise in his or her field of practice. And the interpreter bridges these two with his or her own expertise in language and the art of interpreting. The client and counselor work to establish trust and safety and to help the client heal from the past. Incorporating an interpreter offers an opportunity for the client to develop another trusting, healing relationship with a person who has been an empathic witness to the story. When trust and empathy are not present between interpreter and client, it can impact the clinical session, no matter how skilled a clinician might be.

Interpreting for mental health appointments across cultures adds a layer of complication that interpreters and clinicians grapple with on a daily basis. Expressions of psychological and emotional distress are deeply embedded with cultural meaning, and it is part of the interpreter’s role to find a way to communicate concepts of distress across cultural barriers, while still adhering to professional boundaries and role expectations. We have found this to be particularly true when working with Karen clients in CVT’s Healing Hearts, Creating Hope project.

The Karen are an ethnic minority from Burma with a distinct linguistic and cultural heritage.  Karen clients often describe their distress with heart-based idioms, such as expressing that they have a “heavy heart” or a “tired heart.”  In this scenario, the interpreter must find the words to communicate this concept in a way that retains the original meaning and that makes sense to the clinician, often a cultural outsider. The clinician, then, must unpack the meaning of these expressions as it relates to a client’s past trauma history and current experience of suffering and healing.

CVT care providers and interpreters have long worked together to understand cultural expressions of distress. Interpreters may ask a therapist, “Can you explain that in a different way?” or let a clinician know when the client has used a cultural expression. They may ask clarifying questions in order to explore the meaning behind a cultural expression. The interpreter and clinician may also take time after the session to consult about what took place or to discuss symptoms in English that simply do not translate across cultures. The theme throughout these strategies is relationship building: clinician, interpreter, and client alike are working in and out of the session to best understand one another. When linguistic and cultural barriers are present, likewise are the relationships and commitments from clinicians and interpreters to make rehabilitation happen.

Look for Part 2 of “At CVT, Interpreter Relationships are Key,” in which a CVT therapist and interpreter will comment on relationship building and cultural expressions of distress.

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