Reflections from MHIT and RID
It’s been a powerful couple of weeks.
Vibrant and vital disruptions. Our sometimes-volcanic communications leave a great impression on me. New earth being created, old earth being consumed in its delivery and new soil material laid down for hopefully new growth, new life. There is the pain of the battle when it becomes diminishing of others, in the reflections of it in our own pools of light and dark internally, our own growth and change and awakening.
It’s like looking at a photograph of lava flowing into the ocean, the huge cloud of steam, and moving closer to the picture, I see it is actually a mosaic of millions of tiny photographs of faces and flowers and moments in peoples’ lives….all those faces, all that detail. My head and heart spin…
I see the grace so many have held and acted with for so long, often in the face of daily slights and larger injustices; I see the love and caring – valuing of self, language, community, freedom, life force. Wisdom watchers. So much grace, tolerance, faith.
Will the message be lost in translation? Will the language we use vacuum freedom’s air out of the chamber of communication? Behind the vitality of anger, the boldness, the vulnerability, the putting forth the powerful and true, the wounds and passions long held in check, is the humanity. Riding through the eruptions is my new sport and adventure. Privilege and naiveté have given me ‘safe harbour’ and shielded me for so long. The timing is vital for a commitment, as a wounded warrior, to being intact while being open.
I hope for a translation of this into my heart and daily actions, in a way that understands and acts upon change (sometimes, only once the fog or confusion or that special ‘burn’ of a new edge of growth clears). I appreciate that this is not hatred of who I am.
This is the gift of honesty, the courage to put it out there for reflection and action, that when I am of the group who have been and are the oppressors, or whose actions and values have compromised others’, despite my best intentions, I must ‘stand with the accused’ and watch for what is needed, ask, and hold onto my own reactions and defenses until I understand. Put aside the protections I use even without thinking.
And, ask for what I need, to prevent my own diminishment and preserve the opportunity to stay in the conversation.
I work for, hope for, a translation to healing in which we can have and hold and connect with each other in our deepest humanity. It’s bound to be tumultuously critical when basic life rights are at stake. We’ll need the diversity of all our perspectives and cultural / community wealth and wisdom to create this change – perspectives which have been excluded in creating the systems which now are breaking down to make room for the new or re-created. Co-creation.
May I continue to make room for this and hold the space through the tumult of new growth with my own grace, courage, introspection, dialogue and continued deepening of comprehending, taking to heart, and learning to translate into whole communication, connection (past my own awkwardness) and into engagement in the life of all of us as people, languages and communities who truly impact each other. Stay in the conversation.
Will you join me? #doable #RID2013 @streetleverage @HeartOfInterp #vibrantdisruptions
NAD publishes new position paper on Mental Health Interpreting: share your thoughts
Position Statement on Mental Health Interpreting Services with People who are Deaf
The purpose of this position statement is to acknowledge and emphasize the importance and need for specialized sign language interpreting services in the delivery of mental health services to deaf individuals. While direct mental health services are optimal and always preferred, such services are not always available. When there are no direct mental health services, it is critical to ensure effective communication through specialized sign language interpreting services, which must be complete with sensitivity to cultural affiliation and awareness of the dynamics involved, in the delivery of mental health services to people who are deaf.1 The National Association of the Deaf (NAD) wishes to use this platform to increase meaningful access to mental health services by elevating the knowledge, awareness, and sophistication with respect to use of sign language interpreting by mental health professionals, healthcare delivery systems, and deaf consumers. The sections below highlight critical information for mental health providers, interpreters and the deaf community to gain a comprehensive understanding of how to better serve and support deaf individuals.
1 The term deafis to be interpreted to include individuals who are hard of hearing, late deafened, and deaf-blind.
Direct vs. Interpreted Mental Health Services
The NAD recommends that individuals who are deaf be referred to specially trained providers for direct mental health services (see NAD Position Statements on Mental Health Services) whenever possible and that appropriate support services, guided by consumer choice, be made available, if necessary. In situations where it is not possible to find a service provider who is able to provide direct mental health services, or because of consumer preference, the NAD strongly recommends that service providers work collaboratively with qualified sign language interpreters who have specialized mental health interpreting expertise.
The NAD urges mental health professionals, interpreters and the Deaf Community to recognize the unique challenges faced by mental health providers and interpreters working with deaf consumers in mental health settings and to be aware that there is a need for specialized training in order to meet those challenges. The mental health care field is broad and includes both deaf and hearing service providers in the areas of psychotherapy, psychiatry, counseling and social work, psychological testing, substance abuse treatment, forensic therapy, and more. Settings may range from a client’s home, private offices, hospitals and prison facilities.
According to the Registry of Interpreters for the Deaf’s (RID) Standard Practice Paper on Interpreting in Mental Health Settings, “Mental health professionals depend heavily on language form and content for diagnosis and treatment. Nuances in communication, including affective tone and subtleties of language structure, may be significant for diagnosis and treatment effectiveness.” (RID, 2007). While there is great variability in ability to recognition of mental health terms in English by hearing people, a reliable study exploring cultural and linguistic barriers to mental health service access found that deaf participants’ ability varied even more widely (Steinberg, Sullivan, & Lowe, 1998). In addition to understanding terminology specific to mental health settings, interpreters face complex interpersonal dynamics stemming from the symptoms of psychological disorders, diagnostic and treatment goals specific to 2
various mental health settings, as well as the unique communication and therapeutic objectives of each member of the mental health treatment team.
Interpreters are encouraged to adhere to high standards of ethical practice (RID, 2007), which includes ensuring that they have appropriate training in mental health interpreting prior to accepting work in such settings. Interpreters need to be prepared for a variety of group dynamics including but not limited to: hearing clinicians working directly with deaf consumers; hearing clinicians working with deaf consumers and their hearing family members or partners; and deaf mental health professionals with various interpreting needs. These scenarios present their own challenges and complications (Hauser, Finch, & Hauser, 2008) and interpreters would benefit from training and preparation in order to be qualified for such jobs.
Credentials in Mental Health Interpreting
Though the RID lists standards of practice in mental health interpreting, as of early 2012, RID does not have any specialist certification for mental health interpreting.Alabama Mental Health Interpreter Training. (Alabama Department of Mental Health Administrative Code, 2003; Crump, 2012). 2 There are several independent programs focusing on mental health interpreting, but there is no uniformity in those programs. The only known certification program that provides intensive training in mental health interpreting is offered through the
2 See www.rid.org/education/testing/index.cfm
Requirements of Mental Health Interpreters:
While mental health professionals are trained to deal with patients and situations that are emotionally charged, most interpreters are not. As such, interpreters working in the mental health setting must have keen intrapersonal skills in terms of strong awareness of biases and values, triggers, limitations, and potential for countertransference. The ability of the interpreter to self-manage and remain calm during a mental health interpreting assignment is paramount to a successful mental health session for the deaf consumer. Intrapersonal skills can be developed with training, supervision, and peer support, and such skills can guide decisions on accepting jobs in this field. A few aspects of the assignment to consider prior to accepting the job would be: culture, race, gender, religious affiliation, and sexual orientation.
Expertise in Language and Culture
In order to avoid misdiagnosis in deaf consumers, it is critical that interpreters not only have receptive and expressive fluency in American Sign Language, but are extensively trained in mental health techniques. Mental health interpreters must be familiar with and able to utilize different interpreting modalities. Furthermore, the interpreter must be prepared to educate providers on the possible need for longer sessions, the need for appropriate pausing during sessions, or changes in how questions are posed. Providers may rely on interpreters for cultural information. For optimal results, the interpreter’s communication with the service provider and the consumer prior to the first session is critical (Hamerdinger & Karlin, 2003). 3
Some deaf consumers, especially those with a lifetime experience of mental illness, may also have limited language or information deficits. This can make it much more difficult for a provider working through an interpreter to appropriately differentiate between such deficits and symptoms of mental illness. It is important to ensure that the interpreting process does not mask the language deficits of consumers as clinicians rely on accurate interpretation to make inferences about mental processes (Crump & Glickman, 2011).
Confidentiality & Professional Boundaries
Throughout the United States, limited resources often restrict options for interpreter services. Deaf consumers may encounter the same interpreters at general life events or appointments that were present for their mental health appointments. These encounters could create some conflicts or discomfort for both the individual and the interpreter. Maintaining confidentiality becomes even more crucial.
Confidentiality in mental health interpreting requires a level of discernment and critical thinking unique to this setting. The NAD-RID Code of Professional Conduct encourages interpreters to “share assignment-related information only on a confidential and ‘as-needed’ basis (e.g., supervisors, interpreter team members, members of the educational team, hiring entities)” (RID, 2005). While it is important for the interpreter to receive some information on what has been happening with a deaf consumer’s treatment, there must be strict protocols to maintain confidentiality. When communicating in writing, it is imperative that interpreters learn standards of such communication, be aware that such communication may become a part of the client’s official file and understand relevant confidentiality laws such as HIPAA and Federal Regulation 42 CFR, Part 2.
Ethics, Supervision & Peer Consultation
Mental health providers are expected to adhere to high standards of ethical practice.3 In mental health work, there is higher risk for abuse of power, vicarious trauma, boundary crossings, and burnout. As such, providers are encouraged to engage in regular supervision and peer consultation. Interpreters working in such settings need to be held to the same standards and benefit from the opportunity to work with supervisors and/or consult with peers (Atwood, 1986; Fritsch-Rudser, 1986; Dean & Pollard, 2009, 2011; Keller, 2008; Hetherington, 2011; Anderson, 2011). In order to achieve higher standards of supervision in mental health interpreting, the NAD recommends building a pool of experienced interpreters who are qualified to perform supervision and are available to work with new mental health interpreters on a national level.
3 See ethical standard papers at: www.aca.org, www.apa.org, www.socialworkers.org, www.psych.org
Qualified Mental Health Interpreters
The NAD recommends the following qualifications for interpreters working in mental health settings:
1. Fluency in American Sign Language;
2. Fluency in English and register choices;
3. Culturally competent; 4
4. Attending a comprehensive training curriculum for mental health interpreting
5. Mentoring with experienced mental health interpreters (at least 50 hours);
6. Individual or group supervision and peer consultation;
7. High standards of ethical practice; and
8. Knowledge of relevant ethical literature or decision-making models in interpreting.
The NAD recommends that a certification process for specialization in mental health interpreting be set up through nationally recognized means. Alternatively, a standardized portfolio system can be used to emphasize the individual’s specialization in mental health interpreting. It is also recommended that interpreters maintain their skills with continuing education in the area of mental health with every certification cycle (15 hours annually or 60 hours per four year RID certification maintenance program cycle). To achieve this, developing more options for seminars to meet the required 60 hours of continuing education in a four year period in the area of mental health is critical. In order to recruit more interpreters specializing in mental health interpreting, the interpreter training programs are encouraged to provide students at least one class focusing solely on mental health interpreting for a full quarter or semester to capture their interest in this specialization.
In summary, mental health interpreters are an important component in the mental health delivery system for deaf individuals with mental health needs, as they provide auxiliary services when a service provider is unable to deliver direct mental health services or when a deaf consumer requests it. While the field of mental health interpreting has aimed to set higher standards over the past decade, this position paper hopes to raise the standards by defining qualifications, expanding the credentials and requirements for mental health interpreters, as well as addressing the professional boundaries, ethics, supervision, and peer consultation in this profession.
Alabama Department of Mental Health. (2003). Chapter 580-3-24, Mental health interpreter standards. Retrieved from http://www.alabamaadministrativecode.state.al.us/docs/mhlth/3mhlth24.htm.
Anderson, A. A. (2011). Peer Support and Consultation Project for
Interpreters: A Model for Supporting the Well-Being of Interpreters who Practice in Mental Health Settings. Journal of Interpretation, 21(1), pp. 9-20.
Atwood, A. (1986). Clinical supervision as a method of providing behavioral feedback to sign language interpreters and students of interpreting. In M. L. McIntire (Ed.). New dimensions in interpreter education: Curriculum and instruction (pp. 87-93). Proceedings of the 6th national Convention of the Conference of Interpreter Trainers. Chevy Chase MD.
Crump. C. (2012). Mental Health Interpreting Training, Standards, and Certification. In K. Malcolm and L. A. Swabey (Eds.). In Our Hands: Educating Healthcare Interpreters. (pp. 54-76). Gallaudet University Press. Washington, D.C.
Crump, C. & Glickman, N. (2011). Mental Health Interpreting with Language Dysfluent Deaf Clients. Journal of Interpretation, 21(1), pp. 21-36.5
Dean, R. K. & Pollard, R. Q. (2011). The importance, challenges, and
outcomes of teaching context-based ethics in interpreting: A demand control schema perspective. Interpreter and Translator Trainer, 5(1), pp. 155-182.
Dean, R. K. & Pollard, R. Q. (2009, Fall). “I don’t think we’re supposed to be
talking about this:” Case conferencing and supervision for interpreters. VIEWS, 26, pp. 28-30.
Fritsch-Rudser, S. (1986). The RID code of ethics, confidentiality and supervision. Journal of Interpretation, 3, pp. 47-51.
Hamerdinger, S., & Karlin, B. (2003). Therapy using interpreters: Questions on the use of interpreters in therapeutic settings for monolingual therapists. Journal of American Deafness and Rehabilitation Association, 36(3), pp. 12-30.
Hauser, P. C., Finch, K. L., and Hauser, A. B. (2008). Deaf Professionals and
Designated Interpreters: A New Paradigm. Gallaudet University Press. Washington, D.C.
Hetherington, A. (2011). A Magical Profession? Causes and management of occupational stress in sign language interpreting profession. In L. Leeson, S. Wurm, M. Vermeerbergen (Eds.). Signed Language interpreting: Preparation, practice and performance (pp. 138-159). St. Jerome Publishing. Manchester, UK.
Keller, K. (2008). Demand-control schema: Applications for deaf interpreters.
In L. Roberson & S. Shaw (Eds.). Proceedings of the 17th National Convention of the Conference of Interpreter Trainers: Putting the pieces together: A collaborative approach to excellence in education. (pp. 3-16). Conference of Interpreter Trainers. San Juan, PR.
Steinberg, A. G., Sullivan, V. J., and Loew, R. C. (1998). Cultural and
Linguistic Barriers to Mental Health Service Access: The Deaf Consumer’s Perspective. American Journal of Psychiatry, 155(7), pp. 982-984.
Registry of Interpreters for the Deaf (RID). (2005). NAD-RID Code of
Professional Conduct. Retrieved from http://www.rid.org/UserFiles/File/NAD_RID_ETHICS.pdf.
Registry of Interpreters for the Deaf (RID). (2007). Standard Practice Paper
on Interpreting in Mental Health Settings. Retrieved from http://www.rid.org/UserFiles/File/pdfs/Standard_Practice_Papers/Mental_Health_SPP.pdf.
Talking about our work for the purpose of ethical development is an art and a science. It is a practice. This article focuses on one facet of this practice - supervision, specifically one intervention used in supervision, case discussion. Supervision provides crucial improvement for the interpreter, a mirror of the individual’s process, reflecting the effectiveness and ethicality of the work in the light of our colleagues’ experience, eyes, minds and hearts.
When diminished by a conversation about our work, we do not return to that conversation (Parker Palmer). Nor do we learn. Judgment and criticism forestall the opportunity to grow and ‘make it right’. We are more likely to keep our work in the dark, the details obfuscated even to ourselves. Our vision is clouded. We all pay the price.
We must capture our actual experiences in review. We continue to struggle with the very real human costs, fallout from the gaps in our professional development and consideration of each other in our work. Complex understanding of a case brings increased response options, wider responsibility to a greater number of factors as well as compassion and understanding which encompass the entirety of our work.
We in the helping professions show a trend of being hypercritical of our selves …[and others]… (Feasey, 2002). The hypercritical response grows to a tipping point where we are expelled from a process engaged with team and consumers, into some version of a fight/flight response, limiting awareness - of options, thought worlds, culture, and communication dynamics. It preempts our awareness - thus hobbling an effective and ethical decision-making process. This occurs when we are interpreting and in discussion with colleagues.
Case discussion is the opportunity to discover and apply strategies for staying with our decisions and the consequences of those decisions (Dean & Pollard, 2011). It creates a process and a setting which helps contain our inner “What the…!!!?” long enough to engage with the person/task at hand. Guidance and discovery are encouraged, yet are not a tacit approval of decisions that have been or may become harmful or unethical.
As a participant in case discussion during supervision, expect commitment, learning how to do a case presentation, and participation in a reflective process with a qualified facilitator. Commitment is made to brooking both the familiar and unpleasant or unwanted aspects of analysis for the gain of insight.
A facilitator possesses the skills and experience required for supervision - cultural sensitivity, knowledge of the myriad approaches to an interpreter’s professional development and of group dynamics. They provide a framework for “…epistemological curiosity, critical consciousness, non-authoritarian power relations” - (Kennedy & Kennedy 2010).
Facilitation aims for cohesion, maintains the structure of the inquiry, initiates ground rules - a pact the dyad or group realizes and maintains throughout. Confidentiality applies, and feedback focuses “on the value feedback may have to the recipient, not on the value or ‘release’ that it provides the person giving the feedback” (Lehner, 1975).
In preparation, a case synopsis (prospective or retrospective) is provided prior to the discussion. The process of learning case presentation is itself a practice in confidentiality, distinguishing the salient features of a case.
Case discussion strives for accurate reflection and restructures a case review using, for example, the demand control schema for analysis (Dean & Pollard). The discussion develops and models a process, which contributes to the heightening of the collective intelligence. It strengthens relationship to community. It is ultimately participation in a wellspring of shared experience, building upon the natural processes from within each of our communities in a manner both considered and reflective. We develop a common language, gain or hone negotiation skills with colleagues and the people whose communications we hold in trust. We sustain our ethical growth…and we return to the conversation.
*Although I am the one bringing this topic to the table, it is in large part because I have spent time in many of your kitchens of knowledge – my thanks to those from whom I have learned so much, directly and indirectly, whose work precedes and provides our foundation.
Please click to read and join the discussion about the concepts presented in Dennis Cokely's article, Sign Language Interpreters – Complicit in a Devil’s Bargain?
Watch Molly Wilson's video 'Bypass". It is a wonderful piece about interpreters and our relationship with the Deaf community. Good food for thought.
“The true picture of our life and work is incomplete when all are not included. Somewhere in the center between expectations, rules, goals, successes, challenges, different values, all competing for attention, lies the heart of the matter - who we are, what we bring to each situation, and how we are all connected.” -KK
“The ability to remain compassionate and connected to ourselves and others in the midst of demanding situations and challenging times is at the crux of our interpreting profession and well being. It is the heart of interpreting. If we want to move from where we are now to a new level we must start here.” -PC
Write something about yourself. No need to be fancy, just an overview, share your thoughts.