2. Literature Review 2
Deficits in Mental Health Interpreting
Abstract
Limited availability of training in the area of mental health interpreting has the potential
to negatively impact the success of mental health sessions with regard to deaf clients. The lack of
mental health professionals’ understanding in the area of American Sign Language and deaf
culture has, as well, the potential to negatively impact the success of interpreting a mental health
therapy session. This literature review will outline the problems associated with mental health
interpreting. The roles of the interpreter and mental health professional will be discussed, along
with qualification flaws, suggested solutions, and recommendations for future research in the
area of mental health interpreting. Questions sought to be answered by this literature review
include the following: what an “adequately trained” interpreter consists of in a mental health
interpreting setting, and what are the negative impacts on deaf and hearing consumers when
using an unqualified interpreter in a mental health setting.
3. Literature Review 3
Introduction
Mental health care is a sensitive area for all consumers involved, including the mental
health professional, sign language interpreter, and patient. When an interpreter is added to the
equation, the situation only gets more complicated. The literature in the area of mental health
interpreting points us in the direction of ill performance (Paone, & Malott, 2008). Factors from
both consumers and interpreters affect the performance of the interpretation and the success of
the mental health treatment. Without sensitivity from all parties involved, mental health services
will suffer in performance. When an interpreter and a therapist are qualified and sensitive to the
cultural and linguistic needs of the deaf client, mental health services will have a higher success
rate (de Bruin, & Brugmans, 2006).
The consumers in mental health settings vary, but they mainly consist of a patient and a
certified mental health professional. Most therapists see using an interpreter as a second-best
solution due to its potentially negative impact on the therapeutic process (de Bruin, & Brugmans,
2006). The interpreter can lessen the contact that the therapist has with the deaf client and can
cause interference with the message. However, when an interpreter and therapist collaborate
effectively, the session can greatly improve in regards to impact and success (de Bruin, &
Brugmans). In order for this to occur, the sign language interpreter must be “qualified” in the
area of mental health interpreting.
It is important to realize that it is humanly impossible to interpret complex mental
health discourse simultaneously with sufficient accuracy to meet the criteria of
back-translation without a period of preparatory education with the interpreter and
client. ASL is too different from English to make such accuracy possible…A
4. Literature Review 4
skilled sign language interpreter does not use the syntactic structure of English to
provide an equivalent interpretation, but the interpreter does need an advanced
understanding of the field of psychology, and fluency in both the target language
(ASL) and the source language (English) (Vernon & Miller, 2001, pg.431).
Problems Associated with Mental Health Interpreting
Due to the sensitivity required for mental health interpreting, many problems can arise.
One problem is the lack of successful interpreter education in the field of mental health. Another
issue is the cultural boundaries between the consumers present. There are also language barriers
between the consumers that hinder the success of treatment. The role of the interpreter can also
be skewed by the consumers and trust is negatively affected when this occurs. All of these
factors point to the interpreter. If the interpreter is well qualified in the area of mental health
interpreting, cultural differences, language barriers, and interpreter roles, confusion may be
successfully controlled and possibly minimized. As Hwa-Froelich and Westby state, “Increased
awareness of variations in communication style and specific cultural differences will facilitate
more accurate and complete interpretation and communication” (2003, pg. 84).
For the purpose of this literature review, focus will be placed on the lack of qualified,
educated interpreters in the field of mental health interpreting. If a counselor does not use sign
language, an interpreter is appropriate for communication between the consumers (Peters, 2007).
Therapists may be tempted to use personnel other than qualified mental health interpreters during
their sessions for several reasons (Paone & Malott, 2008).
Logistical or monetary constrictions and a perception that any bilingual individual
is qualified to be an interpreter may result in the use of bilingual staff, clients, or
5. Literature Review 5
clients’ family members as interpreters in counseling sessions. The majority of
these persons lack professional training, have limited experience interpreting, and
may have limited or no exposure to the profession of counseling. Use of these
persons as interpreters presents several ethical concerns, including the potential to
violate confidentiality. Family members acting as interpreters may withhold or
alter sensitive or key information because of family loyalties or power
differentials (Paone & Malott, 2008, pg. 134).
Generally mental health professionals are not able to communicate effectively in sign
language. This results in the use of an interpreter, but it is important to note that the deaf
consumer makes the final decision on the use of an interpreter (Peters, 2007). When using an
interpreter, confidentiality will always be of great importance, and as Peters states, “Having an
interpreter who is certified through the Registry of Interpreters for the Deaf (RID) provides
assurance that strict adherence to confidentiality is maintained” (2007, pg. 188).
Stress for mental health interpreters is, as well, a huge hurdle to overcome. Some
common causes of stress on the job for mental health interpreters include, “inadequate training
for the realities of the job, lack of professional support after graduation, and interpreting for a
psychologist who knows nothing about deafness…” (Vernon & Miller, 2001, pg. 432). Noting
that two common areas of stress relate to interpreter education, the concept of deficits in mental
health interpreting education programs is supported. Vernon and Miller state that it is important
for a mental health interpreter to be educated in expanding the definition of “facilitate
communication” to relaying information vital to the treatment process of deaf individuals. With
the education in place to support the interpreter in this difficult task, the result will be for “the
good of all parties involved in the mental health setting” (2001, pg. 433).
6. Literature Review 6
The Interpreter
Interpreters that are qualified and trained in the area of mental health interpretation are
able to bridge the gap between the client and the mental health service provider. The interpreter’s
primary role is to aid in the language gap. As Paone and Malott (2008) state, clients who use
interpreters report having “increased willingness to return to counseling” (pg. 131). The service
an interpreter provides during mental health sessions is a positive one. The presence of the
interpreter can aid in the client feeling comfortable, and can help strengthen the trust between the
client and the provider due to improved communication access. “Interpreters can reduce client
isolation by allowing each client to express complex feelings and concepts. In addition,
interpreters can bridge existing cultural gaps by educating counselors regarding the client’s
culture and culturally informed behaviors” (Paone & Malott, 2008, pg. 131)
The Mental Health Professional
Counselors may be challenged when working with deaf consumers for many reasons.
These reasons include the linguistic barrier and the concept of a cultural barrier which was
discussed previously. Along with those barriers, some “counselors may feel threatened by the
presence of a second professional in what they perceive as ‘their’ session” (Paone & Malott,
2008, pg. 134). The complexity of a counselor’s session is not easily interpreted. Errors are
easily committed, even by professionally trained interpreters. Role exchange can occur as well.
When the interpreter takes on the role of counselor while the counselor becomes a bystander,
role ambiguity for the counselor results (Paone & Malott). Counselors also have the job of
interpreting language dysfunction. The interpreter is a key participant in providing cultural and
knowledge-based information in regards to a client’s language skills (Crump & Glickman, 2012).
7. Literature Review 7
Qualification Flaws
The deaf population has a greater occurrence of mental illness than the general
population (Vernon, & College, 2006). Therefore, interpreters need qualifications to interpret in
mental health settings. Psychologists also need qualifications to treat and test deaf patients.
These qualifications should include, but are not limited to, knowledge of deaf culture and the
ability to appropriately utilize interpreter services or be fluent in sign language themselves
(Vernon, & College, 2006). Training psychologists in working with interpreters and exercising
cultural competency will have a large impact on the success of mental health services for deaf
persons while using an interpreter (Whitsett, 2008). Basic guidelines for providers working with
interpreters include the use of trained interpreters, defining the role of the interpreter clearly,
discussing session goals, pre-session briefing, cultural competence training, and post-session
debriefing (Whitsett).
The topic of language dysfunction must also be addressed. Many deaf, mental health
patients have language dysfunction for several reasons. These reasons include neurological
problems, language deprivation, aphasias, and psychotic disorders (Crump & Glickman, 2012).
Mental health interpreters will encounter deaf individuals with language dysfunction and must be
trained adequately to handle the demands of interpreting for such individuals. Crump and
Glickman state that interpreters must be actively assessing the demands of a given assignments,
employ controls when necessary, analyze the situation continuously, and when necessary, change
their interpreting strategies. In order to be successful in such a high-demand area of the
profession, advanced interpreting skills are crucial (2012).
8. Literature Review 8
The lack of successful interpreter education programs is a crucial component of ill
qualified interpreters in the field of mental health. There are two types of interpretation:
simultaneous and consecutive. Simultaneous interpreting consists of the interpretation being
rendered while the source message is still being said. Consecutive interpreting consists of the
source message being rendered, the speaker pauses, and then the interpretation is constructed.
Consecutive interpretation is the preferred method of interpretation in mental health settings
(Hwa-Froelich & Westby, 2003).
Although there are certification programs available to sign language interpreters, no
consistent guidelines for mental health interpreting are available. As Hwa-Froelich and Westby
(2003) state, “Programs or agencies to ensure maintenance of skills, continued education/training
in interpretation, and the creation of post-certification measures of competence for interpreters
for the deaf are lacking” (pg. 79). Education training programs in the college and university
settings are available, but no consistent educational requirements are available to those programs.
This results in ill-uniform instruction. Currently, there are “no federal or national agencies or
organizations that certify interpreters to serve in health-care or educational settings” (Hwa-
Froelich & Westby, 2003, pg. 79).
Suggested Solutions
The Center for Health and Health Care in Schools developed a “practice-based guidance
for working with interpreters in mental health settings” (Whitsett, 2008). This document states
the importance of using trained interpreters and being clear what the role of the interpreter is. It
also lends guidance to debriefing interpreters before sessions and building the appropriate
provider-interpreter team. The accuracy of the interpretation itself is crucial to the success of
9. Literature Review 9
treating clients as well. Health care providers must “use trained interpreters, not bilingual staff or
community members” (Whitsett, 2008). This is where the lack of sufficient interpreter training
programs becomes crucial to the success of mental health treatment of deaf clients.
Interpreting should be viewed as a practice profession, not a technical profession. A
practice profession differs in that it requires regular and direct human service. Dean and Pollard
suggest a problem-based learning philosophy to educate interpreters in all settings (2009). This
means that a learning opportunity is created for the interpreting students and they must engage
and work through the problem. Dean and Pollard’s research suggests that non-traditional
methods of interpreter training are more effective than the traditional didactic strategies of
teaching (Dean & Pollard, 2009).
Observation-supervision training is a strategy which a job-like scenario is mimicked and
the interpreting students must work through the task at hand. This poses an on-the-job-like
experience for new interpreters but does not possess the ability to harm consumers in the process.
This method proved to increase understanding of interpreting tasks and help retain salient
information. Observation-supervision training also helped develop decision-making skills within
an interpreting setting (Dean & Pollard, 2009); these settings include the area of mental health
services. The clinicians offered debriefing sessions and question and answer dialogues with the
interpreting students. This method reported to increase “confidence in employing control choices
in light of mental health work demands” (pg. 13).
There are no randomized controlled trials or published evidence that supports treatments
working with deaf clients and interpreters to date (Munro, Knox, & Lowe, 2008), however,
Munro, Knox, and Lowe conducted a study using constructionist therapy techniques when in a
10. Literature Review 10
mental health setting with deaf persons and interpreters. The study states that the constructionist
therapy with a reflecting team of hearing therapists “has potential to provide a culturally and
linguistically appropriate counseling service for deaf clients consulting with hearing therapists”
(Munro, Knox, & Lowe, pg. 321, 2008). This therapy technique uses a reflective team for both
the therapists and the deaf clients. It allows for the deaf client and therapist to reflect on the
success of the therapy session and used peer supervision to ensure accuracy. This technique
proved successful for all parties involved, including the interpreter (Munro, Know, & Lowe,
2008).
In order for this therapy technique to be successful, the interpreter and therapist must
have a strong working relationship. First, the therapist must shift from the mindset that deafness
is an impairment to the concept of deafness as a cultural and physical difference (Munro, Know,
& Lowe, 2008). With this new mindset in place, the relationship between the interpreter and
therapist can be built. This is done with a clear understanding of each participant’s roles and the
use of therapy that is both culturally and linguistically appropriate (Munro, Know, & Lowe,
2008). As stated previously, pre-session and post-session debriefing with the interpreter and
provider may be necessary to gain an effective professional relationship. Once this commitment
is put in place and followed, deaf clients will notice improvement in their sessions. One deaf
client described such a commitment to be great due to the flexibility it allowed and the feeling of
comfort and acceptance provided through this type of counseling (Munro, Know, & Lowe,
2008).
In the topic of language dysfunction, Crump and Glickman proposed solutions; making
interpretation adjustments is one solution. This can include switching from first person to third
person, switching from signing to gesturing, or requesting the assistance of a Certified Deaf
11. Literature Review 11
Interpreter (2012). There are also controls that can be utilized before, during, and after a mental
health interpreting assignment which the interpreter can be educated on before actively
interpreting in this high demand setting. Pre-assignment controls include conversing with the
therapist beforehand and learning the client’s stability, mental status, and language ability
(2012). The interpreter can also clearly explain their role and potential partnership techniques
that can be used with the therapist. Controls during the assignment include switching
interpretation techniques and voicing strategies. Post-assignment controls include meeting with
the therapist to explain any language phenomenon, and educating themselves with articles and
training classes in relation to mental health interpreting (2012). These techniques are a mental
health interpreter’s survival tools, but rarely are these specialized controls taught in an
interpreting program. Solutions to this problem include more specialized control instruction
within interpreter education programs.
Conclusion
Throughout the literature, the research questions were not answered. The questions that
were asked when beginning this literature review were as follows: what an “adequately trained”
interpreter consists of in a mental health interpreting setting, and what the negative impacts on
deaf and hearing consumers when using an unqualified interpreter in a mental health setting. The
first question was reviewed but requires more research for any conclusive information regarding
the topic. Due to the unclear standards placed on interpreter competency, the general rule is that
an interpreter needs to be certified within the interpreting field and trained within mental health
settings. The research conducted on this topic in the future can answer what training is most
effective with mental health interpreters, and what skills are necessary in order to be considered
“adequately trained” in the area of mental health interpreting. The second question can be
12. Literature Review 12
generalized in response. Negative impacts on deaf consumers when using an unqualified
interpreter include negatively impacted counseling sessions and lower success rates compared to
using a qualified interpreter. Negative impacts on hearing consumers (most likely the mental
health professional) when using an unqualified interpreter include less successful counseling
sessions with deaf clients, lower return rate of deaf clients, and participating interpreters
unsuccessfully taking on the role of a cultural and linguistic mediator during counseling sessions.
Future research in this area can delve deeper into the long term and short term effects of using an
unqualified mental health interpreter.
Due to a high deficit in interpreter training and certifications in the area of mental health
interpreting, the success of therapy for deaf consumers is suffering. Interpreters have the option
of successfully teaming with a therapist in order to achieve a culturally and linguistically equal
playing field for both the therapist and the deaf client. In order to accomplish this, the interpreter
must be qualified in the area of source language and target language fluency, cultural
competence, and professional relationship-building.
Continued research in the area of mental health interpreting is needed in order to get
concrete solutions to the deficits impacting mental health settings with deaf consumers. Studies
thus far have focused on either the therapy technique, or the mental health professional’s
perception on the use of interpreters. Future research can be fielded in the area of interpreter
competence and its effect on the success of therapy sessions. Interpreter competence can be
researched through current interpreting exams and educational programs. Future research in
regards to the success of those interpreter exams and programs can be conducted as well.
Research can also be fielded in the area of competency exams in regards to mental health
interpreting specifically.
13. Literature Review 13
References
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clients. 2011 Journal of Interpretation, 21-36.
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de Bruin, E., & Brugmans, P. (2006). The psychotherapist and the sign language interpreter.
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14. Literature Review 14
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