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@Linguist_CIOL OCTOBER/NOVEMBER The Linguist 17 FEATURES Miller and colleagues demonstrated how quickly psychological therapists can feel excluded, and how they can even have competitive feelings towards an interpreter. 3 One of the keys to working successfully with an interpreter is to plan collaboratively to minimise avoidable difficulties. A briefing meeting with an interpreter is important. The therapist needs to establish a collaborative working relationship with the interpreter in which professional trust is established. This will not happen without spending some time together before working with the client. In the briefing meeting the therapist and interpreter can exchange information about working methods and establish the ground rules that will be needed from the outset. In the session itself, the therapist should set the ground rules to establish their authority, presence and trustworthiness in the room. This is important because the initial, natural alliance will often be between the client and the interpreter. Establishing a frame of interaction In the second case, Carlota and her client Viktor speak together in English as the lingua franca, though it is not the first language for either of them. At times, Viktor switches languages and speaks in a language Carlota doesn't understand. Carlota has raised this issue with Viktor. He has explained that sometimes he feels that he needs to express himself in his first language to connect emotionally with what he is saying. They agree to try working with an interpreter. At the first session with the interpreter, Viktor becomes cross because the interpreter is translating everything Carlota says to him, even though he can understand her perfectly. Carlota is feeling lost. She feels she has done the right thing and now the interpreter is messing things up. What should she do? This is another example of how a therapist swings backwards and forwards along the active-passive behaviour continuum. Carlota forgets to set the frame for the interpreting. From the passive position on the continuum, she leaves the interpreter to manage the communication flow and to take decisions about what to interpret, as if she has forgotten that she has the responsibility for the session. She then 'wakes up', notices that the interpreter is making decisions (he has to as he hasn't been given any guidance) and feels cross with him. Viktor is already angry with the interpreter. This situation could have been avoided if the rules of the communication flow had been negotiated in advance. A pre-meeting with the interpreter would have helped. But that is not enough in this case, where the negotiation about the communication flow should have been with the interpreter and the client. The specific challenges and opportunities of interpreter- mediated therapy need to be brought into the room, discussed and evaluated, with decisions made by all three as a shared endeavour. This is the "talking about the talking" we have highlighted in our research. 4 The importance of code-switching This example has the added complexity of a client who regards the ability to code-switch as an important part of his therapy. Not all clients who wish to code-switch will require an interpreter. They may prefer to back- translate for the therapist. But the inclusion of code-switching behaviour in therapy can be very significant for multilingual clients, as words in the mother tongue can signal identity and belonging. Speaking in the native language can happen spontaneously and even unconsciously in a state of emotional arousal. They are typically words from the heart that may have slipped unnoticed into the client's foreign language output. As such, they have no communicative function but signal emotion. The therapist should be aware that the fact that code-switching has occurred is significant and may deserve further attention. Clients who need an interpreter for therapy can spend a long time on a waiting list when therapists feel scared and professionally challenged by the idea of bringing a third person into the relationship. Many interpreters recognise therapists' lack of confidence to work with them and the impact that can have on a session. The dynamics of power and the experiences of exclusion in triadic relationships can be replayed on a loop for all the participants in interpreter- mediated therapy unless careful attention is paid to these dynamics. Triangular relationships inevitably create patterns of inclusion and exclusion. Coping strategies are thus needed to manage anxieties. Each member of the interpreter- mediated triad will bring such strategies into the relationship and some may not be especially functional. Acting out those strategies and dynamics is the work of the client in the room. The therapist and interpreter should have done their own work on this before the therapy begins, so that they feel confident to work with one another to provide an effective service. Training can help. If psychological therapists feel confident to offer interpreter- mediated therapy then clients will get the timely help they need and equal outcomes in healthcare will be more achievable. Notes 1 Costa, B and Dewaele, J-M (2019) 'The Talking Cure – Building the core skills and the confidence of counsellors and psychotherapists to work effectively with multilingual patients through training and supervision'. In Counselling and Psychotherapy Research 19(3), 231-240 2 Boyles, J and Talbot, N (2017) Working with Interpreters in Psychological Therapy. London: Routledge 3 Miller, KE, Martell, ZL, Pazdirek, L, Caruth, M and Lopez, D (2005) 'The Role of Interpreters in Psychotherapy with Refugees: An explanatory study'. In The American Journal of Orthopsychiatry 75(1), 27-39 4 Op. cit. (2019) POWER PLAY The client may get annoyed if the communication flow isn't properly managed IMAGES © SHUTTERSTOCK