Interpreters' Self-Perceptions of Their Use of Self When Interpreting in Health and Behavioural Health Settings.

Author:Dubus, Nicole
 
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Abstract

This study examines interpreters' self-perception of their use of self when interpreting in health and behavioural health-care settings. Constant comparative analysis was used to analyze the individual, semi-structured interviews of thirty-six interpreters. Interpreters identified specific skills and techniques, that they developed on their own, (1) to create a safe environment for provider and client, and (2) to increase the effectiveness of the intervention. Interpreters are vital members of care teams. Interpreters might be under-utilized if only seen as a language conduit. Embracing interpreters as members of the inter-professional team may hold great promise for addressing challenges in providing culturally effective services.

Resume

Cette etude se penche sur l'auto-perception des interpretes de leur recours au soi dans l'interpretation en milieux de services de sante et de sante comportementale. Une methode comparative constante avait ete employee pour analyser les 36 entrevues individuelles semi-structurees des interpretes.

Les interpretes ont identifie des aptitudes et des methodes specifiques qu'ils avaient independamment developpees afin de (a) creer un environnement rassurant pour le fournisseur ainsi que le client, et (b) accroitre l'efficacite de l'intervention. Les interpretes constituent des membres essentiels d'equipes de soins. Ils risquent toutefois d'etre sous-utilises s'ils sont consideres uniquement comme des intermediaires de langue. Integrer pleinement les interpretes en tant que membres de l'equipe interprofessionnelle est tres prometteur pour aborder les defis relies a la prestation de services adaptes aux particularites culturelles.

When there is not a shared language, interpreters are needed. Meeting the health-care needs of newly arrived immigrants and refugees requires competent language services, as these populations are less likely to have economic, language, and cultural resources to help them navigate through systems of care. The United States has one of the largest foreign-born populations, with many of these foreign born arriving with little prior experience with the language or culture. The American Immigration Council (1) reports that in the United States, 70,000-80,000 refugees arrive each year.

Studies have examined the effectiveness of interpreters in health-care settings when the interpreter has been a family member, a staff worker who is asked to leave her or his job station to interpret, and when the interpreter has been professionally trained. Karliner and colleagues (2) found that clients who worked with professional interpreters received better clinical care. But having a professional interpreter present does not ensure better care is received. Butow and colleagues (3) found that providers who work with interpreters respond fewer times to non-verbal cues and are less responsive to clients' emotional state. This speaks to the need for better training of providers in working with interpreters, and better training of professional interpreters on interpreting non-verbal communication. A number of hurdles prevent providers from working with professional interpreters. Bischoff and Hudelson (4) found that professional interpreters are used less frequently than a client's relative or a bilingual staff member, both of which are perceived to be logistically easier and less expensive to access. Other studies have examined additional factors that impede the effective use of interpreters, including factors such as the availability of interpreting services and difficulty scheduling the interpreter and the client together.

In addition to challenges in working with interpreters, there are hurdles between provider and interpreter. Hsieh (5) has examined the dynamics between provider and interpreter in a number of studies. Her work demonstrated the complexity of this relationship and the importance of developing trust and clear roles between provider and interpreter. Her work also makes a compelling case for deliberately using the interpreter's many possible roles within the visit to the benefit of the client-provider relationship. An interpreter can act as a language conduit, a cultural broker, an advocate, and a support for the client. Brisset, Leanza, and Laforest (6) found in their meta-analysis of the literature that some providers are comfortable having the interpreter use a number of roles within the visit. Several studies such as Kosny et al. (7) examine the provider's experiences working with interpreters. There are few studies, like Hadziabdic and Hjelm (8) that focus on the client's experience of interpretation services, and a small but growing body of literature on the experiences of interpreters. Green, Sperlinger, and Carswell (9) looked at refugees experiences when they worked as interpreters for fellow refugees.

As more remote methods of interpreting (telephonic, video) become more common, studies have sought to evaluate the effectiveness of each of these methods. Studies such as Locatis' (10) show that in-person interpreting is preferred by providers and interpreters more than a remote method, while video is preferred over telephonic. The findings reflect the perception that "much was lost" when not in-person. This suggests that the physical presence of the interpreter with the client and provider is important. Studies have demonstrated that interpreters understand, as Hsieh (11) stated, that they are more "than a robot," and in a different study by Hadziabdic (12) and colleagues, they found that providers feel both burdened and enriched by the quality of the interpretation service. Few studies, though, have examined the interpreter's physical presence as part of the interpreting service. In particular, this study seeks to understand how, if at all, interpreters use themselves as a tool to enhance the interpretation services. As Dewane (13) describes, the use of oneself to enhance service delivery and client trust is most often associated with psychotherapy. The use of self is defined within social work and counselling literature as the "use of personality; use of belief system; use of relational dynamics; use of anxiety; and use of self-disclosure." (14) For social workers...

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