Multilingual environments and interpreter mediation in psychotherapy

Mukesh Chimanlal Nandlal Bhatt

A thesis submitted in fulfilment of the requirements for the degree of Master of Science and the Diploma of Imperial College London

August 2005

Multilingual environments and interpreter mediation in psychotherapy

August 2005

Mukesh Chimanlal Nandlal Bhatt

Abstract
Three psychotherapists attached to the Royal London Hospital and 6 interpreters working with the Medical Foundation for the Care of victims of Torture in London were underwent partially structured interviews for periods of up to an hour. Each was requested to survey their experiences of psychotherapy in the English language through the intermediary of an interpreter or by means of the psychotherapist second language, also English. Interviews from 1 bilingual therapist and 5 interpreters were selected on the basis of audio recording quality for transcription. After transcription, key words and phrases were identified and grouped for similarity of concept. 28 groupings were then identified and classified by theme. The themes are reported, and ranked in order of frequency. The frequency of occurrence of a theme is presumed to signify the relative importance of the theme to the multilingual environment. These are discussed and suggestions for further work provided.

Contents

1.0 1.1 1.2

Introduction.........................................................................................................................................8 Aims of the investigation .................................................................................................................9 Plan of the dissertation .................................................................................................................10

2.0 2.1

Contextual perspectives ...................................................................................................................11 Psychological models ....................................................................................................................11 Models in which language is important...................................................................................11 Manifesting mental illness.............................................................................................................12 Cultural shifts in common........................................................................................................13 Transfer of Language ...............................................................................................................15 Language interpreting for psychotherapy ....................................................................................18

2.1.1 2.2 2.2.1 2.2.2 2.3

3.0 3.1

Case studies .......................................................................................................................................20 Research design and methodology ...............................................................................................20 Questionnaire............................................................................................................................20 Interviews..................................................................................................................................22 Analysis of transcripts..............................................................................................................23 Presentation of themes and thematic content ..........................................................................25

3.1.1 3.1.2 3.1.3 3.1.4

3.2 3.2.1 3.3 3.3.1 3.3.2 3.3.3 3.3.4 3.3.5 3.3.6

Case study 1: The role of the therapist.........................................................................................26 Therapist TA.............................................................................................................................26 Case study 2: The role of the interpreter......................................................................................31 The Medical Foundation for the care of torture victims .........................................................31 Interpreter IB ............................................................................................................................32 Interpreter IC ............................................................................................................................38 Interpreter ID ............................................................................................................................42 Interpreter IE.............................................................................................................................46 Interpreter IF.............................................................................................................................52

4.0 4.1

Discussion ..........................................................................................................................................55 Analysis and cross-comparison of studies....................................................................................55

5.0 5.1

Concluding remarks.........................................................................................................................61 further work ...................................................................................................................................62

6.0 6.1 6.2

Appendices.........................................................................................................................................64 Appendix A: portion of typical interview transcript ....................................................................65 Appendix B: example of grid analysis, thematic classification and ranking ..............................66

7.0

Bibliography and references ...........................................................................................................67

Tables
Table 2.1: Table 3.1 Table 3.2 Table 3.3 Table 3.4 Table 3.5 Table 3.6 Table 3.7 Table 4.1 Thought, language and communication disorder types Cross-categorisation of main themes Themes covered by participant TA qua interpreter Themes covered by participant IB qua interpreter Themes covered by participant IC qua interpreter Themes covered by participant ID qua interpreter Themes covered by participant IE qua interpreter Themes covered by participant IE qua interpreter Overall ranking of identified themes 17 24 26 33 38 42 46 52 56

Appendices
Appendix A: portion of typical interview transcript Appendix B: example of grid analysis, thematic classification and ranking 65 66

AUTHOR DECLARATION
1. During the period of registered study in which this dissertation was prepared, the author has not been registered for any other academic award or qualification. 2. The material included in this dissertation has not been submitted wholly or in part for any academic award or qualification other than that for which is now submitted. 3. The programme of advanced study of which this dissertation is part consisted of: a. Lectures, seminars and colloquia, along with laboratory sessions and relevant research and reading in the degree of Master of Science in Scientific, Technical, and Medical Translation and Translation Technology in the Humanities programme at Imperial College, University of London Mukesh Chimanlal Nandlal Bhatt August 2005

Acknowledgements
I would like to acknowledge numerous people without whom I would never have achieve the work that I present here. In particular, the exacting patience, supervision and encouragement of my tutors, specifically Keith Moffitt, Daniela Ford (ne Panzer), and Mark Shuttleworth at Imperial College. Thanks are also due to Brigit McCarthy and Maria Canete for recognising the importance of the topic and helping me with source material. The Discovery project at St Clements, its patients and therapists for their help and support during difficult times and at all times. My gratitude also extends to the staff and interpreters at the Medical Foundation for the Care of Torture Victims in London for the use of their time, experience and facilities. You know who you are. Thanks are also due to Jill Gander for allowing these interviews, to Annemarie Fox for the initial suggestion to approach the Medical foundation, and to Mausoume, the very knowledgeable librarian for your assistance and access to the library. To anybody Ive left out, please dont be offended. There will be other opportunities. Finally, encouragement and support many friends too numerous to mention also deserves my gratitude, although Bob Rall and Hilary Downes have played a special role in this, my recovery. I would like to dedicate this dissertation to my late family my father, my mother, my brother and his wife - Chiman, Kanta, Kirit and Bhavna Bhatt for all the disappointments that I have ever caused you.

1.0 INTRODUCTION

During Alexander of Macedons purported invasion of India, during which he only reached as far as the Indus river, one of a group of ascetics encamped near Taxila in around 326 B.C.E. is reported to have said that explaining ones philosophy through a wall of interpreters was like asking pure water to flow through mud (reported in Keay (2000), p.76). Psychotherapy in a multi-lingual and multi-cultural environment must often feel like this. The situation is indeed complex, as this news report attests. Another report in the Guardian led to an examination of the role of interpreters in the provision of services for refugees in Britain. This was discussed (Senior, 2002) and dismissed as scaremongering. The paper claimed that NHS psychologists refuse to treat
Klingon interpreter sought for mental health patients May 12 2003, Associated Press Position Available: Interpreter, must be fluent in Klingon. The language created for the "Star Trek" TV series and movies is one of about 55 needed by the office that treats mental health patients in metropolitan Multnomah County, Oregon. "We have to provide information in all the languages our clients speak," said Jerry Jelusich, a procurement specialist for the county Department of Human Services, which serves about 60,000 mental health clients. Although created for works of fiction, Klingon was designed to have a consistent grammar, syntax and vocabulary. And now Multnomah County research has found that many people - and not just fans - consider it a complete language. "There are some cases where we've had mental health patients where this was all they would speak," said the county's purchasing administrator, Franna Hathaway. County officials said that obliges them to respond with a Klingon-English interpreter, putting the language of starship Enterprise officer Worf and other Klingon characters on a par with common languages such as Russian and Vietnamese, and less common tongues including Dari and Tongan.

traumatised asylum seekers. (quoted in Senior, 2002, p.392). In a letter quoted in the same Guardian article, refrred to by Senior, it says that the letter from the Trust had suggested that GPs should wherever possible send cases to specialist voluntary agencies such as the Medical Foundation. A service is being provided, but is little know outside the specialist sector.

1.1 AIMS OF THE INVESTIGATION

The original intent of the investigation was to look at linguistic structures that aid or hinder the process of psychotherapy in a multilingual environment. It was expected that a questionnaire and structured interview would help in identifying those structures which contribute to an understanding of the mechanisms of cultural shifts and transference. These latter two phenomena have been widely reported, but there is distinct lack of rigorous study regarding the their mechanisms. As the study progressed, it became apparent that both interpreters and therapists had other issues that they considered to be more important. Identifying those issues became the focal point of the redirected study. Despite numerous models of interpreting in various environments, such studies have focussed on elucidating a model for the process of actual interpreting. This sadly neglects the context of interpreting, and further ignores the human element which complicates the study of these phenomena. As a result, the study has been redirected towards establishing and identifying those themes and procedures which are of primary interest to the practitioner of the art of interpreting in a real world environment. The study, in looking at the details of each theme as it became identifiable, also builds an order of priority of these needs and experiences of the interpreter.

1.2 PLAN OF THE DISSERTATION

As always, the introduction lays out the basis for this work, showing the need to look at the phenomena of interpreting, followed by the specific aims of the investigation and a plan of the proposed work. Chapter 2 leads the way with rapid review of models from psychology that require an understanding of language and its effects on the mind. This is followed by a description of how mental illness manifests itself both in various cultures, and the effect that mental illness has on the use of language and its everyday expression. A short survey of available literature regarding the use of interpreters in the British National health Service provides an overview of concerns within an institutionalised framework, but alas, very little work appears to have been published on such needs in the community. Chapter 3 sets out the basic methodology used within this study. After a brief description and explanation of problems and solutions, the study proper, split into two case studies are presented, in the form of ranking tables for identified themes, and a paraphrased report in the first person of the interviews in order of ranked theme, in several parts. A general discussion in the form a report on each of the identified themes is presented in Chapter4, and a an attempt made to recognise the context that leads to the theme showing such prominence in interpreter mediated psychotherapy. Finally, the work is brought together with a short summary of the general findings and conclusions, and suggestions given for work. At the end of the work will be found a series of appendices and a list of works consulted.

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2.0 CONTEXTUAL PERSPECTIVES

2.1 PSYCHOLOGICAL MODELS

Jarvis (2001) presents a short introduction to current theories of psychological models. These are primarily that of behavioural psychology, psychodynamic psychology, humanistic psychology, cognitive psychology, cognitive-developmental psychology, social psychology, and of course the genetic and neurophysiology approaches to biological psychology. 2.1.1 MODELS IN WHICH LANGUAGE IS IMPORTANT

Of the above approaches to psychology, language is an important aspect of several but not all these approaches. Note that the behavioural, and biological approaches do not require that language be a significant part of the theory. The other approaches are all known to use language, particularly in order to recognise and treat pathologies of the mind. Psychodynamic psychology is the best known, as first elucidated by Sigmund Freud. Later Lacan extended and revised Freuds ideas, suggesting that language structures the mind, in as much it represents the unconscious to the outside world, defining this a quasi-scientific manner using the Saussurean semiotic concept of a fixed but arbitrary relationship between the signifier and the signified.

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Humanistic psychology is based on the fulfilment of needs. However, the actualisation of a person through therapy is based on the analysis of the speech of patients in therapy. Cognitive psychology is primarily concerned with developing a model of mental thought processes, and is especially concerned with episodic and working memory. The representation of these mental processes in the form a computer-type model is also central to this approach. Language is used as a means of representing these processes. A related psychology is the cognitive-development approach, which is primarily concerned with how reasoning and thinking develop. Here, language is again used as indicative of the development processes within the mind. The last psychological model is the social psychological approach. This leads to a particular approach whereby the mind is seen to be construct of the social environment surrounding. Pathological manifestations and treatments of these illnesses concentrate on relationships between the person and the rest of society, and language is again used as representative of that interaction.

2.2 MANIFESTING MENTAL ILLNESS

Bentall (2003), in his re-examination of the Kraepelinian and neo-Kraepelinian paradigms of mental illness, has surveyed the vast literature that exists in this field, and has collected together a major examination of the differences in cross-cultural therapies and mental illnesses, as well the role of language in psychosis. The following two sections will attempt to collate and identify the common experiences and cultural shifts that occur in mental illnesses and their treatment, and will provide a short summary of language and its presentation and use in mental health and treatment. This will provide an extension and elaboration (based almost entirely on material in Bentall) of themes

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that have not been directly addressed by the interviewees in the case studies, and will therefore stand in the place of a general discussion of issues of which interpreters in mental health may need to be aware. Mental illness is a continuum of symptoms, rather than a manifestation of a specific pathology leading to schizophrenia, manic depression and other mental illnesses according to Bentalls (2003) proposal. Figure 2.1 in Bentall (p.38) provides a general outline of the consensus view of psychiatric classification of mental illnesses. Psychiatric disorders are divided into neuroses and psychoses. Neuroses can be understood in terms of the patients personality and experiences, and consist of phobias, generalized anxiety, obsessions and compulsions, and a neurotic depression which maintains a connection with reality. Psychoses, on the other hand, are ununderstandable and caused by biological abnormalities, and include paranoia (also known as a delusional disorder, manic depression, which further sub-divides into unipolar and bipolar disorders, a tentative schizoaffective disorder and dementia praecox or schizophrenia, which has a variety of subtypes. 2.2.1 CULTURAL SHIFTS IN COMMON

In 1799, (Bentall p.95), a German bookseller read a paper to the Royal Society of Berlin, in which he claimed that hallucinations, in his case induced by stress, could be experienced by the sane. Religious delusions are also a common symptom in mental illness. Glen Roberts (reported in Bentall, p.99-100) examined deluded patients, patients in recovery from delusions, trainee Anglican priests, and ordinary people. A later study found a similar result to the first. The two groups, that of the deluded patients and the trainee Anglican priests, and members of new religious groups

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compared with psychotic patients could not be distinguished on the basis of their religious beliefs(ibid. p.100). Other studies have shown that the delusional ideas are that people are not who they seem to be, that the patient had experienced telepathic communication, that innocuous events had hidden meanings, that the patient was being persecuted, and that occult forces were somehow at work in the real world. In cross-cultural studies (discussed by Bentall, pp.127-128) of the incidence of Schizophrenia, it has been noted that the Afro-Caribbean community in the United Kingdom have particularly high rates of diagnosis as schizophrenics, although the incidence of schizophrenia in the Afro-Caribbean region is no higher than elsewhere in the world. Intriguingly, such incidence of schizophrenia is higher in the children of the first migrants than those of the actual migrants themselves. There is some evidence that experiencing the stress of racial discrimination may be a factor in the incidence of psychotic breakdowns in this community, and it may well be that the same holds true for other groups. Kleinman (in Bentall, p.140) reports on the explanatory models of psychiatric disorder indigenous to China and the Far East. He has shown that Chinese concepts of mood disorder differ markedly from Western concepts. Less emphasis is placed in the Chinese model on psychological symptoms such as low self-esteem, and more on physical symptoms, such as fatigue. Bentall (p. 140) argues that this analysis can extended and is relevant to the European and North American context as much as to Africa or the Far East. He argues further that some diagnostic systems are the product of particular social and historical contexts. Notions of self are also as diverse as the various populations and cultures that exist in the world. Western cultures in modern times appear to regard the self, without being

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able o define it, as a hidden territory, known with difficulty, which must be explored if self-actualization is to be achieved (Bentall, p.200-201.). In individualist societies such as that of North America, the definition is often one in terms of achievements, where collectivist societies define selves in terms of harmonious relationships with other people. Comparisons of delusions across geographical regions and cultures have shown that persecutory delusions are the most common in Europe, the Caribbean, India, Africa, the Middle East, whereas sexual delusions were most common in the Far East. However, cultural, religious and socio-economic factors also influence the type of delusion. Middle and upper class Egyptians have delusions of persecution with secular or scientific themes, whereas the poorer classes appear fixated on religious persecution. Paranoia most often concerns rape in Korea, whereas the Chinese see vampires and poisoning as their lot. Deprivation in the 1930s led to US citizens suffering from delusions of power and wealth, whilst threats of violence are more commonly associated with the US and its mass delusions in recent years (Bentall, p.300). 2.2.2 TRANSFER OF LANGUAGE

In testing schizophrenia patients, a major factor was discovered to be symptoms of cognitive disorganisation, which manifests itself as disturbed speech (Bentall, p.74). In other studies that have been repeated many times with the same results (Bentall, p.184), distractibility was found to be strongly associated with disordered speech. Since children learn the language of their caregivers rather than that of their ancestors, this leads to the suggestion that this ability to speak has a profound effect on all aspects of the human mind. Use of an electromyogram has also shown that any mental process that

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requires the use of words is accompanied by sub-vocalization, in which the muscles of the lips and larynx move without any sound being produced. This of course is likely to have some implication for non-verbal communication. A body of work has looked at the vocabulary that is used to express emotions, including work by Wittgenstein and Skinner (Bentall, p.212). Skinner describes the description of these internal states as arising from the combination of verbal and non-verbal cues. Graham Richards noted that a temperature based psychological language exists which describes arousal states in terms of fire. Depression originally indicated a reduction in cardiovascular function, and was later extended to describe emotional states considered to be the opposite excitation. Citing Russell (1991), English has about 2000 words to indicate various emotions, whereas most languages have only about 200. States that are considered fundamental in English may not exist or have the same importance in another culture. A process of back-translation has also identified that the words depression and anxiety in English and Japanese are not equivalent in meaning, and appear to carry different connotations. Bentall also provides examples of other Japanese words carrying positive values of manipulation and luck, and the limited vocabulary of the Chewong of Malaysia, who have only 7 words to describe emotional states. In terms of non-verbal communication, studies have also shown that patients who suffer from paranoia are often better at recognising genuine emotion, especially surprise and negative affects, from facial expressions, surely a finding of some consequence interpreter mediated therapies.

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Table 2.1: thought, language and communication disorder types (after Bentall (2003), table 15.1, pp. 384-5)

Poverty of speech Poverty of content of speech Pressure of speech Distractible speech Tangentiality Derailment Incoherence (also known as word salad) Illogicality Clanging (or sound associations) Neologisms Word approximations Circumstantiality Loss of goal Perseveration Echolalia Blocking Stilted speech Self-reference Phonemic paraphasia Semantic paraphasia

Andreason (1979, reproduced in Bentall, table 15.1, pp. 384-5) has defined the various types of thought, language and communication disorder which are germane to this discussion. Table 1 lists these. For a complete discussion of these terms, refer to either Bentall, or the original paper by Andreason. It is apparent, although outside the scope of the present work and for reasons of economy of space, that the above types of disorder are likely to have a major effect on any interpreting done in a mental health context.

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2.3 LANGUAGE INTERPRETING FOR PSYCHOTHERAPY

There is remarkably little written on the linguistic and cultural aspects of the use of interpreters in mental health. A recent collection of papers edited by Tribe and Raval (2004) is about the only comprehensive volume of work that the present investigator has been able to find. This volume covers a spectrum of topics. In the following discussion, each paper will be found in the volume by Tribe and Raval, and only the page references will parenthesised. Tribe and Raval (pp.1-7) introduce the volume, providing an overview of each paper, by stating that they had realised that no book providing information concerning working with interpreters existed. The first chapter is presented by Raval as an overview of issues in working with interpreters, and provides succinct summary of the provision of mental health for ethnic minorities, with the presumption that these minorities do not speak English, whereas all therapy is provided in English. There is a powerful need for interpreters as a result of this, and these interpreters require training. In particular, bilingualism is not considered to be the main criterion for interpreting in mental health, but a degree of clinical knowledge is also required. He then goes on to describe a series of perceived problems in translation as communication, with a number of examples drawn from standard clinical practice, not specific to mental health, and highlights the linguistic and cultural problems along with attendant inaccuracies, power plays and non-verbal communication. The role of the interpreter is seen a multi-skilled and multivalent, although there is actually no agreement on the actual role of the intermediary. Finally, a

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number of ethical issues arise when considering introducing a third party into what is essentially a closed, confidential and highly personal environment. Cushing (pp.30-53) considers the organisation and relationship between the clinician and the interpreter in a general medical consultation, whereas tribe (pp.54-68) looks at training issues for interpreters, with further organisational and service provision models discussed by Baylav (pp. 69-77). This is followed by a description of daily life for an interpreter presented by Nijad (pp.78-91). Razban (pp.92-98) provides an interesting example of an interpreters perspective, which echoed by Fox (2001). These authors emphasise the need for briefing before beginning a session, describe the involvement and satisfaction, and also the tension in the workplace. However, impartiality, continuity and trust are seen as especially important by both. Granger and Baker (pp. 99-121) look at the generic role and conflicts arising in the workplace for interpreters in mental health, concluding that interpreters have a wide range of skills, but the remainder of the paper focuses on the negative aspects of organisation and job dissatisfaction. Raval in chapter 8 (pp. 122-134) applies a theoretical model of multi-cultural interaction to the dynamics of the interactive triad, concentrating in particular on the significance of context, multi-cultural theories and meaning, claiming to lay foundation for a theoretical approach to this problem. Messent (pp.135-150) describes the interpreter as a postman, and later as a collaborator who makes meaning. Later chapters elaborate on these themes in the context of the problems of refugees, and are not directly relevant in terms of detail for this report.

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3.0 CASE STUDIES

3.1 RESEARCH DESIGN AND METHODOLOGY

The preferred method of research in this field is through some form of survey, either through a questionnaire, or through interviews. The methods chosen here is the result of the default response of those approached for collaborative information within this project. 3.1.1 QUESTIONNAIRE

A questionnaire was developed initially with a view to rapid and consistent collection of data. The thematic matter covered the background of the respondents, languages within the environment of the respondents within the first six weeks after birth, and languages other than the maternal tongue learned during subsequent growth and education. The duration of and degree of familiarity of these languages was also requested. Subsequent questions requested information on exposure and understanding of counselling and psychotherapy. The respondents were further asked whether they had acted in the capacity of therapist, interpreter or patient, with a view to elucidating information regarding the dynamic of a multilingual environment for counselling and psychotherapy. The respondents were also requested to provide examples of specific language related difficulties that had been encountered in such situations.

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3.1.1.1 Response to questionnaire Although the questionnaire was presented to some 100 possible respondents, both individually and via an electronic distribution list for interpreters and translators not a single questionnaire was completed and returned to the investigator. The overall response to the request for information provided just two respondents, one who ruled himself out of the study on the grounds of nil experience with the type of situation under investigation in the present study. The other respondent was extremely happy to respond but suggested that an interview would provide a better format for obtaining the information required by the study. The overall response to the questionnaire was 2 out of a possible hundred, which corresponds almost exactly to the 2% response normally expected from direct mailings. Both respondents directed the investigator to the medical Foundation fro the Care of Torture Victims in London, as being a possible source of suitable material for the study. It was not possible to investigate the reasons for the lack of response. Of the 20 or so therapists that were approached, most indicated problems with ethicality, indicating that they could not take part in any study that had not been formally approved by a medical ethics board on the grounds of confidentiality towards their patients. Several indicated their willingness to participate given the constraints of confidentiality, however of the seven who agreed, only three eventually provided a response, in the form of an interview. Although some patients were approached, the need for confidentiality and the personal responses to the possible use of the collected information fed the justified or otherwise

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paranoia of the patients. The attempt to provide a balanced study by including patient response to a multilingual situation was therefore abandoned. Given its redundancy, the questionnaire has therefore not been included as supporting documentation. 3.1.2 INTERVIEWS

Interviews were carried out with those respondents indicating a willingness to contribute to the study. In all nine subjects were interviewed. Of three therapists interviewed, two worked in English, although not their first language. The third is involved in supporting therapy and teaching nursing psychiatry. However, audio recordings of two of the interviews were of poor enough quality that transcription was not possible. The remaining therapist interview therefore acts as a control for comparison. The other six subjects were obtained through the good offices of the Medical Foundation for the Care of Victims of Torture, referred to in the remainder of this report as the Medical Foundation for short. The coordinator for interpreting provision agreed to place a request for volunteers in the staff common room at their headquarters in London. Of six immediate volunteers, two were eventually unable to participate for other reasons. Another interpreter was found serendipitously to replace one of these interviewees, and the coordinator also agreed to provide an overview of the procedures concerning the provision and problems of multilingual environments in counselling and psychotherapy. Again, due to the poor quality of recordings, one interview could not be successfully transcribed, leaving 5 interpreter interviews within the study.

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The interviews lasted from 25 minutes to 1 hour 25 minutes. The interviews were recorded on an Olympus Dictaphone using mini-audio cassettes and later transcribed into electronic format on an Apple Macintosh PowerBook G4/1.3 machine running the Mac OS X v.10.3.3 operating system, and Microsoft Office X for OS Xs MS-Word application. Interviews were not formally structured. Although it was made clear to all participants that the main thrust of the investigation was linguistic in nature, each respondent was effectively given permission to bring up any theme or topic during the interview. The investigator directed the interview only insofar as to indicate in broad outline the areas for discussion, which correspond to the subjects developed in the questionnaire above, namely the background of the respondent, experience and understanding of counselling and psychotherapeutic environments, and difficulties, satisfactions and problems encountered during the exercise for linguistic interpretation in such environments. The investigator also requested clarification or expansion of a topic when necessary. These interventions by the investigator have not been transcribed. 3.1.3 ANALYSIS OF TRANSCRIPTS

Each transcript was then examined and key phrases identified. Similar statements were then grouped together in order to help identify the underlying theme. The results from each transcript are then described below, first with an overview of primary themes addressed by the participant, followed by a detailed description of the statements involved. A cross-comparative study of the identified has also been carried, and a fuller description is given in the discussion in chapter 4 following this chapter, thus allowing a fuller and non-formal definition of themes.

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Table 3.1

Cross-categorisation of main themes

Background Basics of psychotherapy Clarification Client response Cultural phrasing Culture and attitude Distance Dynamics of interpreted-mediated psychotherapy Education Feedback Gender Glossolalia Identification Language Living and Training Memory Miscellaneous Misunderstandings and misinterpretations Non-interpreting duties Non-verbal Language Personal attitude Politics and autonomy Psychotherapeutic Interpretation Stigma Support Transference Trust and duplicity Words and phrases

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3.1.4

PRESENTATION OF THEMES AND THEMATIC CONTENT

The content of the various themes identified has been rewritten for ease of presentation, and to ensure the use of appropriate and correct English. It has been necessary to correct and concatenate sentences in order to ensure a clearer reading than that provided within interviews, especially by non-native English speakers. This has required a certain amount of re-phrasing. However, the essence of each statement has been retained. Direct quotes have been minimised where used. The present researcher has reported the results of the interviews from the perspective of the participant, leading to use of first person pronouns. This approach is expected to be controversial. Please refer to the appendices for examples of a transcript and grid analysis and categorisation of key phrases for comparison with the reports below. Researcher comment is limited to the general discussion, and not included under each report. Themes as used are empirical in nature and do not have an a priori definition. Similarly, it is taken as axiomatic, without further justification, that a higher frequency of statement relating to a particular theme is indicative of higher significance. A summary of the themes as categorised within the analysis ids given in Table 3.1. Verbatim transcriptions or quotes from the original have not been included or have been minimised in this report. Both the verbatim transcriptions and the original taped interviews are available for examination under condition of confidentiality. In order to respect the confidentiality of participants, all personal information has been removed or

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fictionalised. Gender, the L1 (notional mother tongue) and English as working language have been retained.

3.2 CASE STUDY 1: THE ROLE OF THE THERAPIST

3.2.1 Table 3.2 Theme Clarification Background Culture and attitude Words and phrases Distance Cultural phrasing Basics of psychotherapy Glossolalia Memory Psychotherapeutic Interpretation Living and Training TOTAL THERAPIST TA

Themes covered by participant TA qua interpreter No. of statements qua therapist qua interpreter Total 6 3 9 6 5 6 5 4 3 3 2 2 0 42 2 2 0 0 0 0 0 0 0 1 8 8 7 6 5 4 3 3 2 2 1 50 %
18 16 14 12 10 8 6 6 4 4 2 100.0%

This participant has an important role in this study. She is a practising psychotherapist who practises in English. Her training in psychotherapy was in a language other than English, and she is considered bi-lingual. She also has experience of interpreting in a psychotherapeutic setting, where she had to suppress her instincts as a trained psychotherapist in order to concentrate on the linguistic aspects of interpreting for a fellow clinician and a patient, without interfering in the procedures of psychotherapy during the session. This case study may therefore be considered as a control for the

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second study, which consists of 5 interpreters without medical qualifications in psychotherapy. As therapist and interpreter, the amount of information provided about her background is significantly higher. This provides a very high significance for the effect of her background in her role both as interpreter and as therapist, with 6 statements on her background out of 42, and 2 out of 8 for each role. The need for clarification ,presumably of unfamiliar terms in English, and the cultural attitudes score particularly high in significance for this subject, underlining her practice of psychotherapy in a nonnative environment. 3.2.1.1 Thematic content as therapist Knowledge of English is of professional level, but has difficulty understanding jokes. She herself has no experience of using interpreters in a psychotherapeutic session although she has interpreted in a non-medical role for a colleague. This interviewee described how she was rated differently in job applications, by being seen as less able than a native speaker of English. However, patients were more accepting and did rated her as better because listening is part of the job, and what the patients expected. The first job in the UK after qualification in her native country was taking down patient histories in English in order to establish proficiency in the language. However, patients preferentially requested her as she was perceived as knowing more than the native English-speaking professionals. As a therapist, she would encourage feedback by constructing hypothesises using inquisitive, tentative, or neutral interrogative sentence structures, such as I understand or I wonder . As an example, one can upon the seeming

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irrationality of a man crawling in the garden. He turns out to be zoologist testing the imprint hypothesis to see if a group of ducklings will follow him. Thus in some cases, no information is better than a partial picture, which can mislead, Examples in Spanish of such constructions include: Entiendo que estoy en lo correcto?, Me parece estoy en lo correcto?, Que significa lo que estas diciendo, puedes aclararmelo and podrias elaborar mas acerca lo que acabas de dicirme. Idioms cause particular difficulty as their use is automatic. As a therapist, she does not take things for granted, and request clarification at all times. Examples recent to the interview included avuncular, references to landings in France and being a hermit. Words that describe things are seen as limited, whereas feelings are different, i.e. they can change. Particular care needs to taken of normal or nonnormal environment, such that, say, insecure used within the context of a new environment is likely to be associated with more emotion. Some people prefer to speak a language other than their native tongue. As an example, she had previously provided therapy for a Brazilian who wanted to speak English in order to maintain a distance. In terms of culture and language, all prejudices have to be removed. These are important considerations, especially where family behaviour and social structure are concerned. There remains the possibility of misinterpretation across cultures. Of particular difficulty are human relationships. The English use of phrases such as I look forward to hearing from you and Please do not hesitate to contact me are more polite. They are however not meant to be sincere, well meaning or well hearted in general usage. In Spanish culture, these mean something in all sincerity. Similarly, a how are you is a noise of greeting, whereas the Spanish expect to hear about peoples

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lives and will expound upon events and experiences. The Spanish continue talking after such a greeting, and indicate thereby that they are approachable and friendly In the UK, a native English-speaker stops because it involves extra effort. This affects confidence and self-esteem, and creates further difficulties in the respondents. Spanish use of sexual connotations is more common e.g. cojones. Swearing, especially using religious references, does not necessarily indicate anger. e.g. ostea the host used in the Christian religious practice of communion is a common expression equivalent to a swear word. Finally phrasing such as We have to stop here as opposed to We end here has to be queried in order to ascertain whether it indicates stop as in to continue, or end as in to finish. The interviewee is a practitioner of psychodynamic psychotherapy, which presumes multiple causes, and is dynamic. It considers rational conscious, and unconscious origins, for decisions, behaviours, wishes and motivations, with a particular emphasis on unconscious motivations. It is a talking therapy in which the relationship between the counsellor and the patient has to be reliable. There therefore must be trust. Lacanian therapy in its original form allowed only therapy in the mother tongue, requiring the therapist to be a native speaker of the patients language. A particular problem is alexitaemia , in which the patient cannot find the words to describe their feelings, and is different from glossolalia, which is garbled or incoherent sound. There is a need to differentiate between a memory of an experience and the recall of something that one has been told. Memory associated with emotion is more detailed

29

than an unreal memory, which results from having been told about an event or the like. The first is semantic memory, the second other memory. Interpretation in both the linguistic and the psychotherapeutic sense is important because communication is both verbal and non-verbal, necessitating that the therapist interpret behaviour. 3.2.1.2 Thematic content as interpreter In the role of interpreter you had to keep checking for any new words and phrases. As a literal, word-for-word translation was not relevant, the participants in a session were always asked to confirm the intent of their utterances, in order to ensure that the translated utterance was not different from that intended. This participant has acted as interpreter for a Spanish-speaking patient, and a native English-speaking clinician. She has also trained European Spanish-speaking therapists in the UK, where she was aware of the small changes in dialect of European and World Spanish. As interpreter, I always checked the meaning by referring it to the cultural context, thus defining and determining the communication. Medical qualifications in psychology and psychotherapy helped and were of the utmost importance in the role of interpreter for a psychotherapeutic where she played a nonmedical role.

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3.3 CASE STUDY 2: THE ROLE OF THE INTERPRETER

3.3.1 THE MEDICAL FOUNDATION FOR THE CARE OF TORTURE VICTIMS

Torture victims arrive at the Medical Foundation through a number of different routes. According to the annual review of the Foundation in 2003-2004, there are three frontline agencies that may refer refugees requiring help onto the Foundation, namely the Refugee Council, the Refugee arrivals project, or the Migrant helpline. Referrals originate from doctors, community health teams, refugee community organisations and immigration lawyers. The Medical Foundation provides a variety of services for refugees and in particular, cares for the victims of torture in a number of different ways. The Medical Foundation has 35 doctors on its staff covering a range of specialities, and publishes authoritatively It also provides physical therapies. 3.3.1.1 Counselling and psychotherapeutic services Psychological support is an important part of the services provided by the Foundation. All caseworkers have counselling experience. After identifying a suitable approach for a client, the client is offered psychological, psychiatric and psychotherapeutic services through its own staff. This includes individual and group therapy, and where possible, family therapy. Practical help is also provided through help and advice on legal, social and housing services, along with a relief scheme for those facing financial hardship. In 2003 the Medical Foundation accepted 2,101 clients from nearly a hundred countries, including Turkey, Iran, the Democratic Republic of the Congo, Eritrea, Iraq, Ethiopia, Kosovo, Uganda, Somalia and Congo (Brazzaville) (Opening Doors, p.8). This is

31

reflected and emphasised in the interpreting services provided by the Medical Foundation in more than 50 languages, where apart from linguistic skills, interpreters value frequently lies in the sensitivity and cultural understanding they bring to clinicians encounters with deeply troubled clients (ibid. p.11). The role of interpreters is described by the Head of Interpreting Services at the Medical Foundation as requiring empathy and sensitivity, as well as a recognised qualification, an ability to engender trust, resilience and maturity: the stories related by clients have a devastating impact on an inexperienced interpreter. They must be willing to develop through training specifically in mental health . Additionally, the non-linguistic role is important in explaining cultural customs, religious beliefs, sexual taboos, and social conventions. family hierarchy and issues such as shame and pride (ibid. p.21). It can be readily seen that the position of interpreter with the Medical Foundation consists of many dimensions. The following case studies expand on some or all of the topics mentioned here. 3.3.2 INTERPRETER IB

Participant IB is a very enthusiastic gentleman, who finds his rewards in the work he does for the Fo8undation. The thems he covered show 10 out of 70 statements to cover his personal attitude and the sheer joy he experiences. His wide ranging experience and long term connection with the Medical Foundation lead him place support and transference as important an significant topics. He is aware of the many issues surrounding interpretation for refugees undergoing psychotherapy.

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Table 3.3 Theme

Themes covered by participant IB qua interpreter %

14.3% 10.0% 10.0% 8.6% 8.6% 8.6% 8.6% 5.7% 4.3% 4.3% 4.3% 2.9% 2.9% 1.4% 1.4% 1.4% 1.4% 1.4% 100.0%

No. of statements Personal attitude 10 Support 7 Transference 7 Basics of psychotherapy (I & II) 6 Identification 6 Language 6 Words and phrases 6 Client response 4 Living and Training 3 Non-interpreting duties 3 Trust and duplicity 3 Dynamics of interpreted-mediated psychotherapy 2 Politics and autonomy 2 Culture and attitude 1 Education 1 Gender 1 Glossolalia 1 Miscellaneous 1 TOTAL 70

3.3.2.1 Thematic content I wouldnt have been here for 16 years if there werent positive aspects. When the call came, fifteen years ago, I was more ready than an ordinary translator, a literary translator because I had that experience of psychiatric abuse. Everyday I use my wits, I come in, I come into the room, no books, no dictionaries, heart, head and feet, and voice. Thats a great honour to be there, and an honour to be able to use your brain, your language capacity in a selfless way. It makes you feel good. That is your interpreters reward. You get terribly loyal to the Foundation. We have caseworkers in their mid-seventies still working. My feeling is people should go home from an interpreting session with me and my therapist, [mentioning], yah, thats a nail in the coffin for the torturers, you know, and thats all we want to do, we want to de-, we

33

want to defuse the power of the torturers. Sometimes you come in tired in the morning, you go out feeling revivified . Youre not just dealing with people whove not only been tortured physically with beatings and truncheons, and things, beatings of all sorts on the feet, all of which have to be very accurately translated., Youre also dealing with people whove been psychologically tortured. If the doctor uses an aggressive tone you do leave out words sometimes. Youre dealing with very traumatised people and when you realise that you help, and the two of you are helping, and Englands helping, and Britains helping, being in Londons helping and you see them beginning to emerge from deep depression. Seeing [the torture] as a play, and realising that youve also been interpreting things as horrific as that brings you up with a start. The downside is ignoring your own needs to some extent, and resenting the four minutes that you get from your own GP. I find it difficult to read newspapers. The interpreter is often under more stress, its also the lack of facilities for debriefing, for counselling. Interpreting was not unconnected with my breakdown. As interpreters, in the same way people have a third eye, you need to have a sympathetic ear, but its also an ear that will calm you down. Triangulation (also known as transference) usually happens between a caseworker and interpreter on to the person, especially outside the room. The triad exists and the caseworkers bend over backwards with some interpreters to understand their English. In the middle is an interpreter with no direct communication between the caseworker and the client. The interpreter however says I interpret for torture victims, not for doctors and therapists. Interpreters who are themselves refugees from the country whose language they are interpreting must have horrific potential for flashbacks. In one

34

instance, a client drew the interpreter aside in the corridor and said I do beat my child, but dont tell the therapist. There is always the example of the woman interpreter in the play the Witness who goes off with the Bosnian client and has an affair with him. In this play, she I did for his therapeutic good. You may be seeing somebody for four or five years sometimes if theyre in depth counselling. Am I again trespassing on the therapists domain if I walk to the tube with a client? Smoking and talking with a client can move him or her on. Informal interpreting in the corridors or outside is not seen as a good thing. But being a mentor is positively encouraged. Become a friends and support community activities. Again, the interpreter in the triangle has no voice and three voices , a bit like the sphinxs question. Knowledge of depression and manias is a very great advantage. Inside knowledge of intrusive thinking can be used to great effect in interpreting for the clients at the Medical Foundation. An awful lot of translators and interpreters may actually be manicdepressive. Translating and interpreting is one of the places we do fit in. Eccentricities are ironed out because of the extra language. And theyve even included schizophrenia, because as the Turks say three languages three persons. Interpretation involves sympathy and empathy, and our people here suffer from justified depression and justified paranoia. [Ordinary] depression symptoms can be very similar. Here, EX-change is what youre doing really with language. You not only move your lips in a different way, but you express your self differently, say things differently, have different personalities, different friends, actually behave differently. Were exchanging brain functions and losing all our voices. Youre interpreting and deleting, so you can get on. Its deliberate memory loss, not just sympathetic memory loss from our clients.

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Mistakes are much more beneficial to the language. As has been said if you really want to understand something translate it into another language and translate it back, As the longest-legged interpreter [of longest standing], there are the usual problems with translation. epilepsy is an international word. Its easier to say je taime, maman than to say I love you, mum, [izdevatsya] in Russian and [akanet] in Turkish have very powerful resonances, not just to mock or to insult. Depressed exists in all three languages Russian and Turkish depressyon, depresya, and the latest one stryess. An English person says Im stressed out, they mean theyre a bit strung out at work. Because the Turkish word order was Thank you very much, I am very well the order in English was I am very well, thank you very much I would say I am very well! The ideal interpreting situation of a session should be the opposite of interrogation to the client. They [remember] as you walk up the corridors, with a bit of fear in your stomach, [associating featureless corridors and interpreter/therapists with interrogators] . Many of my clients say the waiting is the worst. When they attack your brain/with that age-old waiting game/Ill sing through the bars/Let me be free. Similarly, they wait downstairs, but lets hope its not like waiting for an interrogation. Not many can make a living from interpreting. The majority of our interpreters are women. A disaffected interpreter suggested theyre possibly not the number one breadwinner in their household so its easier for them to knuckle under with less work. I started as an interpreter but got taken up as a group worker (very emotional about African children rapping, Turkish woman singing). Working with women and children is different

36

Were all dealing with practical problems, not just the caseworkers. The trouble with therapy here is that each session seems to be 80% practicalities. One Jungian therapist left after a couple of years because he was dealing in practicalities instead of practising his Jungian therapy. Interpretation can develop into a problem-solving situation I dont think its my job as an interpreter to spot duplicity. Im [not] a gullible interpreter, but I am a trusting interpreter, who puts enough effort to interpret the language. We sometimes have to give a probity to the lawyers, who are really only trying to get corroboration for their own assessment. The barrier is interpreting between the client and the caseworker. Many of our interpreters use the phrase Doctor say to distance themselves even more from an aggressive doctor The Medical Foundation and its staff are politically autonomous and neutral. No politician can give them orders. However, whether its a rogue interpreter, or an interpreter such as yourself, neutrality is difficult. You also have responsibilities, and in some ways youre acting as an advocate. I see the Tower of Babel, the twin towers and the twin Buddhas as culturally connected. The cement of culture is after all language and the people in [the Medical Foundation], and willy-nilly, all the people including the doctors whove never had experience of interpreters, are drawn into this wonderful scheme whereby even the most difficult things in the world like rape and torture are communicated, and therefore defused.

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Clients are pretty varied, and they vary from language to language. Russian clients tend to be much more sophisticated, literary and intelligent in the traditional form of that word. A good male interpreter has a role in counselling women and even rape victims. (This whole section is quieter, more emotional, and slower in speech). However, working with children is probably the most difficult type of interpreting. A recent case was difficult to interpret coherently. This was for a person who as recently as a month ago was on Largactol. I dont like the word clients. At the Medical Foundation, what we do vastly more than NHS is therapy.

Table 3.4 Theme

3.3.3 INTERPRETER IC Themes covered by participant IC qua interpreter %

23.5% 17.6% 9.8% 9.8% 7.8% 5.9% 5.9% 5.9% 5.9% 3.9% 2.0% 2.0% 100.0%

No. of statements Words and phrases 12 Dynamics of interpreted-mediated psychotherapy 9 Identification 5 Transference 5 Basics of psychotherapy 4 Education 3 Non-verbal Language 3 Personal attitude 3 Support 3 Gender 2 Living and Training 1 Miscellaneous 1 TOTAL 51

As shown in table 3.3.4, participant IC is very aware of the words and phrases that in use in interpreting for psychotherapy, with 12 mentions out 51 statements in total. 9 of the 51 statements have to do the interplay in a therapeutic session between the client, the therapist and the third body, namely the interpreter. Identification with colleagues

38

and transference on the same are closely are equally significant in this participants view, with 5 mentions each, followed by a fairly high level considering the importance of the basics of the practice of psychotherapy. The educational level of the client, the need for support of the interpreter, issues concerning non-verbal aspects of language and the interpreters job satisfaction as registered by her personal attitude all appear equally significant, with 3 statements each. Finally is an awareness of the sensitivity of gender issues, and of the need for training. 3.3.3.1 Thematic content A Rwandan boy said he was terrified of snakes, so the therapist assumed a phobia of reptiles. The client lacked the confidence correct us, resulting in three wasted weeks. Not being from the same culture, I was at a disadvantage recognising that snakes were the Hutu, and cockroaches were Tutsi. Various cultures report various symptoms differently, so a burning heart in French-speaking Africa is just indigestion, whilst the blood is hot in the head is a headache. A Kurdish colleague was interpreting in Arabic for a Sudanese who constantly referred to being taken to the cinema, which is a metaphor for torture house. In Cameroon, caf-au-lait is a beating they get first thing in the morning and la ville morte is a general strike because the town would be dead. In French, to cope doesnt exist in that peculiar psychotherapeutic context. After discussing it with the client, we settled on cope for dbrouiller in French, or sen sortir. Elsewhere, a judge told the counsellor to ask the plaintiff whether the defendant had actually penetrated the daughter. The court interpreter said converted this to something like the honour of your daughter having been touched. In one session, the wife picked up the metaphor of a fly on the wall very easily, but the husband could not see this

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person being a fly. Here I switched to observer without consulting the therapist, but later pointed out that one has to be very literal, minimising idioms and metaphors. The most important characteristics for an interpreter in mental health here are trust in the process, trust of the client, trust of the clinician, knowing of the language and curiosity about the client. Interpreters are not creative but we just repeat what has been said. I had to pick up the timing, the modes and the moods in order to adjust to the client and equally to the therapist I dont see the triad as equal because its always the clinician who is responsible for the content and responsible for the client. Its not my responsibility and also if the clinician is not there, I have no work. We act as an intermediary. Therapists are inexperienced in working with an interpreter. They experience a sense of exclusion if the client and the interpreter are from the same community. Interaction within a session is mostly directed between the clinician and interpreter. There should be no power struggle between the elements of the triad. The interpreter should be aligned with the therapist. You are not there to advocate for the client. I think the client would see me as a part of the therapy because I dont have the same skin colour. Im an interpreter there for them for the therapist so Im not really there If you actually come from the same culture as the client, there might be expectations which remain unresolved by the interpreter as how the client would perceive the interpreter depending on, for example, the faction or the community within the culture. I dont see clients downstairs because it raises expectations. We had an interpreter who fell in love with one of clients. She had to go but I think the client stayed. I did establish a very strong relationship with one mother who came with

40

four children, by seeing her outside as well. One of the clients had just finished his Alevels in English and told me. No matter how well they speak English, they are still emotionally in the language they started the therapy with. Hes speaking incredibly good English but the therapy is in French. Were always asking ourselves, what is the purpose of therapy? We also ask the purpose of interpreting in psychotherapy. Therapy a process or outcome of improvement, always keeping in mind that the therapy is going to have a successful outcome, that this is not a business meeting. We, as well as the therapist need to understand the level of education of our clients, and to explain at that level. As an interpreter you must use the language as it is talked to you. You must use language in an uneducated or in their highly technical way. Both the clinician and the interpreter use language as their main tool, but in different ways, Our therapists have quite a lot of experience of various cultures in picking up body language and facial language. This is because the clinician has much more time to look at what is actually happening. Once an interpreter didnt turn up but they decided to go ahead with the sessions without the interpreter. The client, his wife and the clinician were leaning in, with total eye contact. This doesnt normally happen. Then the clinician started gesticulating, using very slow words. The male got up and started enacting quite traumatic details about the death of his son. I love language and solving somebodys well being through language is extremely challenging. Its amazing, and its so lovely, I love these things. Its an absolute pleasure to work with articulate clients

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Weve got an interpreters meeting which is monthly, as well as a support meeting facilitated by the clinical psychologist for difficult case work, ethics, not day-to-day running. There is also supervision for those who work in the family unit. We used to have a policy of having psychotherapy interpreters who were the same gender as the client, but no longer. One client used to pass notes to the therapist when we talked about sexual torture, cutting me out. One day, the therapist used some word, the client looked at me, and that was it, he completely accepted me. Were not given training in therapy, although quite a few interpreters have become counsellors, and not therapists. Some of us will never think of becoming therapists or counsellors. I prefer to describe them as a client, not as a patient. 3.3.4 Table 3.5 INTERPRETER ID

Themes covered by participant ID qua interpreter %

21.2% 12.1% 9.1% 6.1% 6.1% 6.1% 6.1% 6.1% 6.1% 6.1% 3.0% 3.0% 3.0% 3.0% 3.0%

Theme No. of statements Language 7 Living and Training 4 Misunderstandings and misinterpretations 3 Background 2 Basics of psychotherapy 2 Culture and attitude 2 Personal attitude 2 Politics and autonomy 2 Transference 2 Words and phrases 2 Clarification 1 Dynamics of interpreted-mediated psychotherapy 1 Education 1 Psychotherapeutic Interpretation 1 Support 1 33
TOTAL

100.0%

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Participant IE regards language as the most important topic in his career as interpreter, with 7 out of 3 statements, followed by training with 4, and misunderstandings and misinterpretations linked to language and culture in third place, with 3 such statements. He considers his background to be of equal importance to an understanding of the basics of psychotherapy, the cultural attitudes of the clients, his own personal attitude towards his current role, and the phenomenon of transference, along with the political autonomy of the organisation and the actual words and phrases used in his work, each with 2 mentions out of the 33 statements made. With a single statement each clarification of client intent is limited to last place, along with the clients educational level, the dynamics of the therapeutic triad, actual therapeutic analysis and support for the interpreter. Details of these themes are provided below. 3.3.4.1 Thematic content If you know a language, you know about the culture, the history, the music, the art, the socio-economic political history and development, everything. Linguistic studies covers counselling and psychotherapeutic vocabulary. Languages differ in how they express something. Some express an emotion using an adjective, others through a verb such as she is depressed or she has depression One has to use metaphorical, not literal interpretation You may have to change the tone, the pitch, the intonation, the register. In literary work, translating a novel or poem, syntax becomes irregular when expressing emotions. This also applies psychotherapeutic work. Sometimes as a result of cultural differences, you may have to add or remove information. An interpreters skill set is the equal of any profession. Linguistic work can cover many hundreds of different prominent disciplines, And I dont believe I would find myself in

43

a position where I would have to pretend. I have no training in counselling and psychotherapy, and the interpreter really needs to be experienced. Some interpreters who are on the national register with plenty of experience can be very wrong. When the person goes to them, he says that I was taken into this dark place blindfolded, handcuffed, and the person says that I was interrogated the interpreter says he was questioned. This is totally wrong as interrogation means being asked systematic questions under pressure, usually in an atmosphere of intimidation and fear. I think a lot of interpreters and translators, use euphemisms inadvertently An example of using euphemisms is that between rape and being sodomised. In English sodomised can also refer to having sex with animals historically speaking, pederasty I think can be the more appropriate term to use and rape to force someone with violence and to sexually abuse someone. Other euphemism include kicking the bucket and pushing up daisies. The Foundation provides training and guidelines on how to interpret. I am familiar with European developments, African developments, N Africa, Middle Africa, Middle Eastern Africa, because it is part of my everyday job here. [The role of the clinician is] precisely what the word says if the practitioner is a psychotherapist, its very likely that they will practise psychotherapy. A psychotherapist is someone who deals with the psyche engages in therapy. If a client has problems then the therapist endeavours to help them come to terms with their problems and make life generally better for them. In some cultures, counselling and psychotherapy has a negative meaning for the client. In the Middle East and in Asia, counselling is a relatively new phenomenon,

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Interpreting and translation can be very complicated, but also can be very simple. Dealing with different cultural values implies dealing with different thought processes and different worldviews. Therapist is are also associated with a non-positive image. The practitioner does not need to be sort very multi-culturally aware. Certain things may be offensive in other cultures. For example, asking on a form whether a woman has children even though she answered unmarried to a question about her marital status is offensive. An interpreters skill set is the equal of any profession. Medical Foundation provide a very good interpreting service and have set a linguistic standard for interpreting. We explain matters to the client according to our legal mandate, which is part of the international covenant against torture. Youre working with someone who has really been badly tortured and the interpreter may subconsciously feel sorry for them. The interpreter might wish to act as an advocate and they may say he was interrogated under pressure whereas the person may have been just asked to wait there for five minutes in order to make a phone call. You have to precisely convey what is from one language into another language, so that the practitioner will know what sort of background the person comes from. Maybe the client has had a couple of PhDs in international law and is capable of distinguishing between detention and remandment (sic). On one project, the phrase Master of the Rolls needed to be translated into a Middle eastern language. It didnt make much sense, so I translated it as a senior judge or the head of the civil section of the court of appeal. So something has to added or cut in order for the translation to make sense. Feedback that we get from the client is important.

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The interpreter learns first what is going on and acts as a bridge. Someone who left school at an early age who cannot write or read may have about a vocabulary of 2000 words when they arrive here. I would usually advise the practitioners to have a briefing with the interpreter before the session starts and after the session terminates. There are all those little subtle differences and issues that can come up within the dynamic of the therapeutic work that the practitioner may not be aware of. Dealing with psychotherapy and with torture it is immensely difficult. 3.3.5 Table 3.6 INTERPRETER IE

Themes covered by participant IE qua interpreter %

22.2% 12.5% 9.7% 8.3% 6.9% 4.2% 4.2% 2.8% 2.8% 2.8% 2.8% 2.8% 2.8% 2.8% 2.8% 2.8% 1.4% 1.4% 1.4% 1.4% 1.4% 100.0%

Theme No. of statements Support 16 Identification 9 Dynamics of interpreted-mediated psychotherapy 7 Transference 6 Words and phrases 5 Education 3 Personal attitude 3 Basics of psychotherapy 2 Client response 2 Gender 2 Language 2 Living and Training 2 Non-interpreting duties 2 Non-verbal Language 2 Stigma 2 Trust and duplicity 2 Background 1 Cultural phrasing 1 Culture and attitude 1 Distance 1 Miscellaneous 1 TOTAL 72

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As shown in table 3.3.5, interpreter IE ranged over a wide range subjects. The highest on the list of concerns is the need that an interpreter in a therapeutic situation has for support, with 16 out of a total of 72 statements dedicated to this. This is followed by identification of the interpreter with client or the therapist, a clear opinion on the dynamics of the triad within a therapeutic session, and the possibility of transference between agents within the triad, each with 9, 7 and 6 statements respectively. Some discussion on specific difficulties with words and phrases , linked to the educational level of the clients resulted in 5 and 3 statements, with a description of interpreters attitude to therapeutic situations and a basic understanding of the dynamics of intermediated of psychotherapy. The interpreter showed an awareness of the response of the client to the therapeutic environment and the sensitivity of gender relations. Mention was also made and demonstrated of general issues concerning language, training requirements for interpreters, the need to translate non-verbal cues. The matter of trust was linked closely tot he stigma experienced in therapy by clients. Finally, the last important themes for this interpreter were the background of the interpreter, the differences in cultural phrasing, and cultural attitudes, and the need to keep a distance between client and authority. Details of these themes are provided below. 3.3.5.1 Thematic content I feel a bit like a bizarre sponge of emotions. You can imagine the sort of stories that we hear on a daily basis. Theyre not the easiest sometimes, so interpreters become part of the story. A lot of things are hidden even within families making it quite difficult for the interpreter or the therapist who ends up carrying quite a burden of secrets. We see a lot of families broken and separated as well. The interpreter helps, reassuring, that becoming part of the life of the bigger picture in Britain, will need a immense amount

47

of patience. Its not easy to tell someone that theyve got refugee status, but that youre going to be homeless in three weeks. I find it difficult because there is a many antiasylum seeker thoughts being spread. I hear this a lot, I wish back in the mountains in danger instead of being here. We feel helpless not being able to change things I found myself suffering from the same things our clients do. I call it a pressure cooker, the pressure is rising, we have our dreams as well. The therapists are much better taken care of. Interpreters are at the bottom of the pyramid There is a great deal of anger in me about these matters. We singly or in twos get supervision on request, but burn-out does happen Enough, its not that I dont care any more, its because our own lives are difficult. We are dealing with people who have been excluded from the bigger picture. We come from a patriarchal society, and see degeneration in Turkish males. The women rise to the amazing challenge of taking care of their kids and their husband, who like another child. They cook clean, buy and learn English much quicker. Sometimes the community continues the persecution experienced in the originating country by persecuting here in subtle ways. You become the voice of a person who has been traumatised, victims of torture, a survivor of torture. The interpreters role becomes a sort of introduction to life here. And sometimes we say thatll start telling you next time we meet about the difficulties youre going to face now. Yesterday I met a chap, he has no money, his legal situation is that he is at the end of his appeals he cant find work it would be illegal he said Im like a dog he said, Im asking these kebab shops at the end of the night, instead of throwing their breads away, he collects them and he says that he is coming from quite a rich in not a monetary way, but rich in soil, they were farmers, they made their butter and they made their milk, they had

48

chickens and animals and fruit and gardens and coming from a place where they wash their apples in a fresh stream and drank the water. There are lots of difficulties that the clients go through, whereas as interpreters we have now learned the system. Everybody is bound to roles and boundaries and rules are much stricter given that we are a human rights organisation. In the therapeutic triad, we interpreters with different therapists, counsellors, psychiatrists, doctors, osteopaths, and physiotherapist from whom we learn and of whom we eventually become critical. Not only do we act as interpreters, but also as cultural advisors. Many therapists give the interpreter a larger role than others who work with stricter boundaries. A therapist may leave the room and use that relationship of the interpreter and the client in the absence of therapist. This triangle is unbreakable and confidential in that information will not go to your husband or your wife without permission. We as therapists, and of course interpreters try to distance ourselves. We have a close relationship with the client. We get into their lives, they get into our lives, and with the therapist, they are part of that triad. We become friends and family of the clients and therapists. But some therapists will not let me talk with client outside the session. Other therapists will leave the room and use the relationship of the interpreter and the client in the absence of therapist. The courts that I worked were completely dehumanised. One therapist puts the chair in a certain place and even wants to know what has been said on the way up the stairs. We have difficulty translating the word client into other languages and use patient or customer equivalents. Interpreters call income support yardom which is actually help or benefit. It also refers to job-seekers allowance, income support, child benefit, housing and the like. None of these translate the Turkish properly. When the therapist asks for

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specific information, I ask in a direct manner but with an apology for asking. [The apology is] part of the culture. A lot of people believe that something inside will never grow again. When you see the families coming together, the children at school, theyre singing their songs and celebrating their holidays just like they used before - these are positive sides. We hug the person whos been granted their refugee status, their hand and say, alright youre safe now, I know some amazing ladies, who can speak and write fluent English, do the shopping and DSS stuff, reading the letters and writing back. With the client, the education level becomes irrelevant and a lot of people come from different backgrounds. It becomes very difficult when theyre illiterate and sometimes there is no option but to explain that there is an established system of paperwork and forms to be completed. Clients will have learnt to speak Turkish as national language. Psychotherapy is a very difficult process for everyone. They all want to forget what happened, and we are saying no, you will not forget what happened. We have to convince our clients that there are no tablets for this and that a talking cure is better. Confidentiality is an issue. Many people fear that what they disclose here goes back to the originating country and jeopardise their families. If trust has already been built up between people, that relationship is continued, retaining secrets that even a husband or wife may not know. Sexual abuse of men is quite common and we find that it is difficult for a male to share even with us male interpreters. Female interpreters will look after females more than the males, but sometimes I have been in the presence of [distressed] females as well as male. It is quite difficult, and sometimes a client will say refuse to speak if there is another man in the room.

50

There is not a single piece of paper where we can write down [all the skills that we need] Most of us we have our own life experiences, and only limited training. Our counsellors are caseworkers as well so there are practical and therapeutic issues to be dealt with. There are times when there is more casework than therapy and the interpreter is more involved. The rewarding side of all this is to see people come out on the other side of the tunnel. Language is still complicated, a tax form or this form or that form, I mean my God, we cant understand the English sometimes. I have had to explain what council is to quite a lot of people, and we all know what tax is, so theoretically this is what people do first and understand later. A lot of our therapists know when the time is ripe and questions can be asked directly. We also translate non-verbal signals. The refugees are not used to therapy because there is a stigma attached to therapy. Psychologists are something the upper classes in cities use. Trust between the client and the interpreter is crucial A lot of the people who come to us have come from communities, villages, and cities where trusting another human being has become quite a blurry issue. There are sexual abuses that women suffer hat are difficult to explain, For example, although its called rape in English and not adultery, it is considered to be adultery. Some things, some taboos are not spoken of because of tradition and the culture. We as therapists, and of course interpreters try to distance ourselves. I have interpreted for various legal institutions, especially courts, which are more open to the closed structure of the Medical Foundation.

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3.3.6 Table 3.7 Theme

INTERPRETER IF

Themes covered by participant IE qua interpreter %

30.0% 25.0% 20.0% 20.0% 5.0%

No. of statements Culture and attitude 6 Dynamics of interpreted-mediated psychotherapy 5 Client response 4 Non-verbal Language 4 Personal attitude 1 20
TOTAL

100.0%

A total of 20 statements were identified as key to the interview by therapist IF. Of these 20, 6 concerned culture and attitudes within culture, while 5 posited the interviewees perspective of the dynamics of interpreter-mediated psychotherapy. Recognition of responses by the client to the psychotherapeutic environment merited 4 mentions, whereas the discussion of the use of non-verbal aspects of language also merited 4. Finally, the personal attitude was mentioned just once, indicting a lower priority for this participant. Details on each of these are given below. 3.3.6.1 Thematic content There is difficulty translating symbols, cultural connotations, and suggestions, with subtle differences between different cultures. It doesnt appear as a misunderstanding or misinterpretation at first, but there are that suspicions that interpreter didnt get it quite right. This misinterpretation can propagate through the therapeutic session and produce uncontrollable consequences An analogy can be made with food. In Japan, dinner guests may be served with Fugu fish in order to impress. However, if the guests do not like the taste, this misfires. The same can be true of misinterpretation. Again, perhaps a client feels upset and doesnt want to show it because it is part of their tradition. This

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gives rise to the question of how this can be translated. One way is to ensure that the clinician is aware of hints on the side that you include in the interpreted statement. However, although in general there is teamwork with trust and understanding within a session, the session consists of the unit of the therapist and interpreter facing the client. The interpreter is not normally excluded, although this is not my experience in the Foundation. If we were mediators, then our role in the dynamic session would be perhaps more useful and fruitful. Otherwise there is no triad of communication, just going around forever in circles. The interpreter absorbs not only the wording and remains at the back and secondary to the therapist, but the interpreter is actually present there with the phrase and with the subtle body language necessary for establishing communication. I take the essence, meaning and the energy of the word or phrase, and I improvise a wording around it. It wouldnt be a word for word translation, but it would create consistency, and recreate the momentum and the energy of the session. It becomes a sort of emotional interpretation. The words counsellor and caseworker, for example dont exist as nouns in Russian and many other languages, so a word needs to created. A clinician has preconceptions that [these refugees] would feel vulnerable. [The clients] become frightened, and frustrated, feeling that somehow they are missing the point. Their main suspicion is to compare their situation to questioning by the Home Office, or the KGB. A client may not want an interpreter present from the same background as him- or herself. An example is Chechen women, which community is very strict, very small and vindictive, leading to loss of status and confidentiality. Sometimes I can see

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that they are bewildered and they want to hide something and not give it away. The question is how to translate this so I have to hint. This is to translate the almost untranslatable. We feel that we can contribute much more to this process, if our translation included emotional, personal and cultural elements. A lot us of feel limited to purely linguistic translation, and yet we are in a human situation which is much more complex.

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4.0 DISCUSSION

Translations, according to A L Basham, merely tarnish more sadly, they have a habit of shying away from the erotic and the explicit (quoted in Keay, p. 151). In keeping with this observation, it is apparent from the case studies presented in chapter 3 that experiences in common help in the process of translation and interpretation in mental health. Similarly, the resolution of successful therapy and rehabilitation requires the thorough understanding of the problems in context of the culture within which they are experienced. Expressing and dealing with problems, as part of the diagnostic, as well as the recovery process, requires in addition the transference of psychotic and recovery concepts from the patient to the therapist, and back again, in this case through the intermediate stage of a translating interpreter.

4.1 ANALYSIS AND CROSS-COMPARISON OF STUDIES

The methodology using a semi-structured interview technique for this study has been presented in detail. Observation and analysis of 5 subjects have been presented. The case studies show that culture and language are important in multi-lingual, and crosscultural environments. Although stating the obvious, there is an indication that each respondent reacts in an idiopathic manner to the situation, whether as a therapist, or as an interpreter, or as a combination of both. A large degree of interpersonal skills is a major requirement for successful interaction between the members involved in a

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therapeutic session. Each respondent has at least experienced the role of interpreter. Each respondent also yearns for a greater contribution to the therapeutic process. Table 4.1 Overall ranking of identified themes.

Rank

Theme

TA IB IC ID IE IF Total

Mentioned by no. of respondents

5 4 5

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

Words and phrases Support Dynamics of interpreted-mediated psychotherapy Identification Transference Personal attitude Basics of psychotherapy Culture and attitude Language Background Living and Training Client response Clarification Non-verbal Language Education Distance Cultural phrasing Gender Non-interpreting duties Trust and duplicity Glossolalia Politics and autonomy Miscellaneous Misunderstandings and misinterpretations Psychotherapeutic Interpretation Memory Stigma Feedback TOTAL

6 0 0 0 0 0 3 7 0 8 1 0 9 0 0 5 4 0 0 0 3 0 0 0 2 2 0 0
50

6 7 2 6 7 10 6 1 6 0 3 4 0 0 1 0 0 1 3 3 1 2 1 0 0 0 0 0
70

12 3 9 5 5 3 4 0 0 0 1 0 0 3 3 0 0 2 0 0 0 0 1 0 0 0 0 0
51

2 1 1 0 2 2 2 2 7 2 4 0 1 0 1 0 0 0 0 0 0 2 0 3 1 0 0 0
33

5 16 7 9 6 3 2 1 2 1 2 2 0 2 3 1 1 2 2 2 0 0 1 0 0 0 2 0
72

0 0 5 0 0 1 0 6 0 0 0 4 0 4 0 0 0 0 0 0 0 0 0 0 0

31 27

10.5% 9.1%

24 20 20 19 20 17 15 11 11 10 7 9 8 6 5 5 5 5 4 4 3

8.1% 6.8% 6.8% 6.4% 5.7% 5.7% 5.1% 3.7% 3.7% 3.4% 3.4% 3.0% 2.7% 2.0% 1.7% 1.7% 1.7% 1.7% 1.4% 1.4% 1.0% 3 1 2 2 2 5 3 3 5 3 2 3 4 2 2 3 2 3 4 5 5

3 3

1.0% 2 1.0% 0.7% 0.7% 0.0% 100 % 1 1 0

0 0 0
20

2 2 0 1

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In a sense the ranking seen above is not necessarily a correct one. It has been observed that 28 themes have been identified by using an empirical process of grouping similar entities together, and establishing the underlying concept. The bias in this approach derives from the instructions and mandate given to the researcher and the interviewees. Although the study is presented as a semi-structured interview report, instructions included the bias whereby the respondents were expected to target their responses towards language and its effects and affects during the psychotherapeutic process. This immediately implies that at the very least, any responses with a linguistic bent will be artificially prioritised, and will appear as far more relatively significant than they really are. The ranking above is a clear one. Of 296 responses in total, the top concern for the interpreters and the therapist is seen to be the use of words and phrases. This is followed by the need for support, the dynamics of a therapeutic session, and then the two loosely related items, transference and identification. Important factors are also the personal attitude that the respondent brings to the job, his or her understanding of the psychotherapeutic process, cultural attitudes and an understanding of language in general. For reasons of space, it is advisable to draw a line, which will allow the discussion to be limited. If an arbitrary threshold of 5% is taken as indicative of the dividing line between the most important and the remainder of these themes, then it can be seen that only nine concepts remain in general.

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Of these nine, only language and identification are mentioned by 3 respondents, transference and support are mentioned by 4 each, and the remainder are mentioned by 5 respondents each. Another way of limiting the discussion is to create higher categories for the classification of themes. In this manner, there is a linguistic and cultural category at least, which consist of 1 8 9 13 14 17 21 24 23 Words and phrases Culture and attitude Language Clarification Non-verbal Language Cultural phrasing Glossolalia Misunderstandings and misinterpretations Miscellaneous 6 7 0 9 0 4 3 0 0 1 6 0 0 0 1 0 1 0 0 0 3 0 0 0 1 6 2 7 1 0 0 0 3 0 12 1 2 0 2 1 0 0 1 2 6 0 0 4 0 0 0 0 5 0
17 15 7 9 5 4 31 5.7% 5.1% 3.4% 3.0% 1.7% 1.4% 10.5% 5 5 3 2 3 2 2 1

3 3

1.0% 1.0% 3

The miscellaneous category has been included here as upon examination it refers to the use of the term client instead of patient. The next category that can be separated out is that which deals directly the psychotherapeutic process, namely the analysis of behaviour, including the dynamics of interaction within a therapy session. This is given below:
3 4 5 7 25 Dynamics of interpretedmediated psychotherapy Identification Transference Basics of psychotherapy Psychotherapeutic Interpretation 0 0 0 3 2 2 6 7 6 0 9 5 5 4 0 1 0 2 2 1 7 9 6 2 0 5 0 0 0 0 24 20 20 20 3 8.1% 6.8% 6.8% 5.7% 1.0% 5 3 4 5 2

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There is a category directly connected with the response of the client undergoing therapy:
12 15 18 26 28 Client response Education Gender Memory Feedback 0 0 0 2 0 4 1 1 0 0 0 3 2 0 0 0 1 0 0 0 2 3 2 0 0 4 0 0 0 0 10 8 5 2 0 3.4% 2.7% 1.7% 0.7% 0.0% 3 4 3 1 0

The next category, although this is not in any order of priority or importance, covers socio-cultural factors:
20 27 16 22 Trust and duplicity Stigma Distance Politics and autonomy 0 0 5 0 3 0 0 2 0 0 0 0 0 0 0 2 2 2 1 0 0 0 0 0 5 2 6 4 1.7% 0.7% 2.0% 1.4% 2 1 2 2

Several factors are responsible for describing the characteristics and wants of the interpreter within the triad.
2 6 10 11 19 Support Personal attitude Background Living and Training Non-interpreting duties 0 0 8 1 0 7 10 0 3 3 3 3 0 1 0 1 2 2 4 0 16 3 1 2 2 0 1 0 0 0 27 19 11 11 5 9.1% 6.4% 3.7% 3.7% 1.7% 4 5 3 5 2

We thus end up with following table categorising the thematic classification described in detail in the previous chapter. 1. 2. 3. 4. 5. linguistic and cultural category the psychotherapeutic process socio-cultural factors response of the client characteristics and wants of the interpreter

These can further described in two groups: one is an impersonal set of processes which are independent of the individual, the other is a set of factors that impact directly on the actors within a therapeutic session. The first group consists of linguistic and socio-

59

cultural factors and the psychotherapeutic process, and can also be described as the factors whereby human society and the wider world impacts on individuals. The second group considers two of the three actors within the session, including the interpreter and the client undergoing therapy, but excluding the clinical therapist.

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5.0 CONCLUDING REMARKS

Counselling and psychotherapy is very dependent upon language. When the situation is complicated by the need to provide therapy in a language other than the mother tongue of the clinician, difficulties arise. In interviews with a multilingual therapist, and with two interpreters, questions of culture and meaning arose first and foremost. A secondary consideration for the interpreters was that of empathy and identification with their patients, leading to a desire to engage in direct application therapy, without the presence of a therapist. The dynamic of the interpreter therapist-patient triad is complex, and leads to questions of ethics and confidentiality in particular, as well the enormous strain of carrying and aiding the burden of illness dumped on to the interpreter without external support. The therapist is seen to be able to distance himself, although this may be as a result good support structure. Having set out with simple aim of establishing linguistic structures that may aid or hinder the process of psychotherapy, this study has diversified into identifying a number of factors themes that are common to therapist and interpreter within the dynamic of a psychotherapeutic session. Using a bilingual interpreter as a control, several interpreters were interviewed. The interviews were transcribed and analysed. The results of the analyses indicated that

61

some 28 broad themes were of concern to the practising interpreter, and that these were mirrored by the bilingual therapist control. The 28 themes showed that of major concern to the interpreters, if the linguistic elements are removed from the analysis, are the support mechanisms available to interpreters and the mechanics of the interactions within a dynamic therapy session. Linked to these are the phenomena of identification of the interpreters self with the client, or in some cases the therapist, and its more extreme manifestation, the phenomena of transference, in which the agent develops an emotional bond or attachment to one or more of the other actors. Of lesser but continuing significance is the need to understand the psychotherapeutic process. Equal to this is the attitude and rewards that agent interpreter. brings and receives from successful application of his or her abilities and competences. The themes were further categorised into 5 domains. These were socio-cultural and linguistic factors, and the psychotherapeutic process itself, seen as impersonal, external factors acting upon the agents within the therapeutic session. This latter delineates the second grouping, that of the interpreter and the client, but at this moment excluding the clinician therapist.

5.1

FURTHER WORK

A fuller, more comprehensive survey of the published literature needs to be done into to correctly contextualise the present work. Also useful would a formal framework within which the present could be analysed and to which canon it could be compared in order to establish the veracity or otherwise of the conclusions drawn here.

62

A possible model relating and separating external factors to the agents within the therapeutic world is suggested by the data and analysis. The model could be developed further if appropriately contextualised within an existing or a novel framework.

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6.0 APPENDICES

64

6.1 APPENDIX A: PORTION OF TYPICAL INTERVIEW TRANSCRIPT

I: Ive actually been beginning to wonder whether an awful lot of translators and interpreters are actually manic-depressives, because it gives us a less structured [insight] M: Well, yes, well, yes, it may well be that, it may well be, that thats one of the places we do fit in, and eccentricities are ironed out because of the extra language, and the Turks say, three languages three persons so theyve got a bit of schizophrenia going on I: 3 languages, 3 persons, wow!

M: When you think about it its not only your lips that move in different way, but you express yourself in a different way, you say things in a different, you do indeed I believe have different personalities, not just you have different friends in that language, but, but you actually comport yourself almost differently and thats why ultimately you do, if you have a, a, one of my poets said if you really want to understand something translate it into another language and translate it back, you know, [] If you have, you know, if you have statement like depressed into your two or three languages, and you know it has a different resonance in all three, thats why they invented the words in Russian and Turkish depression (accented as per the Turkish), depresya, and the latest one thats come through is stryess (accented as per the Turkish/Russian), yes, I know, goes into all languages now, and yet theyll still have a different flavour in each language, um, also people have, you know people have different levels of stress obviously, but its important to get an accurate assessment of the level, you know, for the, the urgency of the case in a sense, and one has to explain that sometimes in more words than you know, one word, you know, like, um, if an English person says Im stressed out, it may just mean you know, that theyre a bit strung out at work or I: M: When you, I mean, youve come up with two excellent examples Good, [] copyright.

I: Could you expand on, say, what depression means in English, Russian and then Turkish, or say whichever way around, or any of the other languages you speak, or have used? M: Well, you see, our people here, youll probably understand this if I develop it right, our people here suffer from justified depression, and I use the word too with paranoia, justified paranoia, which of course is actually a stupid Oxford don, an oxymoron its a real phenomenon, and it has real different origins than psychological distress paranoia in the West, lets say. I dont want to enter into the quantifying of suffering, but that has something to do with it, that a man that has been hit over the head by police truncheons, has come ten days on a lorry to England, finds himself homeless, cant find any friends or relatives and comes her, is suffering, and is suffering from depression is a different kettle of fish to somebody being admitted to the Maudsley from South London, um, with depression the same word you have, and what a field of difference there is in it, so what is interesting is that, that say, lets say that two people are suffering from depression, theyre two different people, but symptoms can be very similar, um you know, as with PTSD symptoms, you know, insomnia, intrusive thinking, and all the farrago of symptoms that you can, you can elucidate from both, both um, I dont like the word clients, I: parties. Sometimes its splitting hairs, and at other times

M: yes, yes, um, but what I think depression can have different origins but can, can have the same effects. Now whether those effects can be treated in the same way, the jury is still out on that I think, um. You know. And what we do vastly more than NHS is therapy, talk therapy, and occasionally people on medication, but not by any manner of means always, and in fact with a recent case Im doing, I find it very difficult to interpret coherently, in fact its impossible to interpret coherently for one person who recently as a month ago was on Largactol, you know, we thought it was all buried along with ones beginning with, ones with z in them, like chlorpromazine and [Amina]zine in [Russia] I: yes, theyre all coming back.

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6.2 APPENDIX B: EXAMPLE OF GRID ANALYSIS, THEMATIC

CLASSIFICATION AND RANKING
Theme Personal attitude Support Transference Basics of psychotherapy (I & II) Identification Language Words and phrases Client response Living and Training Non-interpreting duties Trust and duplicity Dynamics of interpreted-mediated psychotherapy Politics and autonomy Culture and attitude Education Gender Glossolalia Miscellaneous Non-interpreting duties Were all dealing with practical problems, not just the caseworkers. I mean, this is the trouble with therapy here, 80% practicalities a session one Jungian therapist left after a couple of years because he just wasnt practising his Jungian therapy, he was dealing in practicalities interpretation can develop into a problem solving situation Politics and autonomy Politically autonomous and neutral, no politician can them orders. whether its a rogue interpreter, or an interpreter like yourself, neutrality is difficult, but you also have responsibility, and in some ways youre acting as an advocate Gender a good male interpreter has a role in counselling women and even rape victims(this whole section is quieter, more emotional, and slower in speech) working with children is probably the most difficult interpreting Living and Training not many can make a living from interpreting The majority of our interpreters are [therefore] women, and a disaffected interpreter was talking to me that therefore theyre possibly not the number one breadwinner in their household and its easier for them to knuckle under with less work I did come to the group as an interpreter but got taken up as a group worker (very emotional about African children rapping, Turkish woman singing)working with women and children is different No. of statements 10 7 7 6 6 6 6 4 3 3 3 2 2 1 1 1 1 1 % 14.3% 10.0% 10.0% 8.6% 8.6% 8.6% 8.6% 5.7% 4.3% 4.3% 4.3% 2.9% 2.9% 1.4% 1.4% 1.4% 1.4% 1.4%

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7.0 BIBLIOGRAPHY AND REFERENCES

Bentall R P (2003/2004) Madness explained: psychosis and human nature London Penguin books Bond T (2000) Standards and ethics for counselling in action London Sage publications Bowie M (1991) Lacan London Fontana Press Dearnley B (May 2000) Psychotherapy in translation SPMP Bulletin May 2000 19-22 Fall K A, Holden J M, Marquis A (2004) Theoretical models of counselling and psychotherapy New York and Hove Brunner-Routledge Fox K (2004) Watching the English: the hidden rules of English behaviour London Hodder and Stoughton Fox, A (2001) An interpreters perspective n.p. Context 54, 19-20 Gowrisunkur J, Burman E, Walker K (2002) Working in the mother tongue: first language provision and cultural matching in inter-cultural therapy British J Psychotherapy 19, 1, 45-58 Jarvis M (2000) Theoretical approaches in psychology London Routledge Kaufert J M (1990) Sociological and anthropological perspectives on the impact of clinician/client communication Kaufert J M, Putsch R W (1997) Communication through interpreters in healthcare: ethical dilemmas arising from differences in class, culture, language and power J Clinical Ethics 8, 1, 71-87 Keay J (2000) India: a history HarperCollins publishers Laungani P (2004) Asian perspectives in counselling and psychotherapy New York and Hove Brunner-Routledge n.n. n.d. Working with interpreters in (ed. unknown) Clinical psychology, race and culture: a training manual n.p. Opening Doors Annual Review 2003 2004 London Medical Foundation for the care of victims of torture Parvin A (2004) Mental health workers experience of working with Bangladeshi users: A needs assessment study to identify staff training needs and expectations of the Bangladeshi Access Service to be published Raval H (1996) A systematic perspective on working with interpreters Clinical Child Psychology and Psychiatry 1, 1, 29-43 Russell J A (1991) Culture and categorization of emotions Psychological Bulletin 110, 3, 426450 Schwartz A, Schwartz R M (1993) Depression: theories and treatments New York Columbia University Press Senior J (2002) Asylum seekers who cares? The Psychologist 15, 8, 392-3 Solomon M Z (1997) From whats neutral to whats meaningful: reflections on a study of medical interpreters J Clinical Ethics 8,1, 88-93 Tribe R, Raval H (2003) Working with interpreters in mental health New York and Hove Brunner-Routledge Wilkes K (1988) , yishi, duh, um, and consciousness in Marcel A J, Bisiach E, (eds.) Consciousness in contemporary science Oxford Clarendon Press

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