Subject to Interpretation

Arianna Aguilar on Mental Health Interpreting [EP 53]

June 04, 2021 DE LA MORA Institute Season 2 Episode 53
Subject to Interpretation
Arianna Aguilar on Mental Health Interpreting [EP 53]
Show Notes Transcript

'Subject To Interpretation' is a weekly podcast that deep dives into the topics that matter to interpreters.🎙 Hosted by Maria Ceballos Wallis

This week we speak with Arianna Aguilar on Mental Health Interpreting

Arianna graduated in 2000 in Western New York with a communication and graphic arts degree. She honed her interpreting skills through hands-on experience and training in the mental health, education, legal, and child care fields. She currently is a Master Certified Court Interpreter for North Carolina, and is also a Certified Medical Interpreter.  Past experiences include working as a Staff Interpreter for the 11th District of North Carolina, the Federal Public Defender's office and the Johnston County Mental Health Department as an interpreter and consultant. She also has experience in presenting at conferences, including NAJIT and ATA.  Arianna is currently an editor/writer for NAJIT's publication Proteus, and was Editor-in-Chief from 2017 to 2019. She also published a book, Mental Health Interpreting: Unique Challenges, Practical Solutions, which is available on Amazon.

Speaker 1:

Welcome

Speaker 2:

To subject to interpretation, a podcast, which takes us deep into the topics that matter to professional interpreters. I'm your host, Maria. Welcome this program is recorded via zoom in both video and audio. Today, we're going to speak with Ariana Aguila about the difficulties interpreters face. When working in mental health settings, Ariana is has more than 20 years of experience as an interpreter in both medical and legal settings. She's a master certified court interpreter for North Carolina, a CMI, and she is the author of the book, mental health interpreting unique challenges, practical solutions. And she's also an instructor at the LAMODA Institute of interpretations authorship program. Offering a course on the same title. Welcome Mariana . Hello,

Speaker 3:

Thank you for having me.

Speaker 2:

It's a pleasure to have you here. So I want to start with a quote from your book .

Speaker 3:

Okay .

Speaker 2:

People continue to see mental and physical as separate functions. When in fact mental functions, for example, memory are physical as well and are points on a continuum and inseparable one from the other. What is the impact of this distinction?

Speaker 3:

People sometimes just view mental illness as a failing, a weakness that must be overcome when a actuality mental illness has to do a lot with physical , um, physical illness as well.

Speaker 2:

So define mental illness for us. What are mental health disorders?

Speaker 3:

Some of the most common disorders are mood disorders. For example, bipolar schizophrenia, anxiety disorders, ADHD, autism, Alzheimer's all. Those are common conditions.

Speaker 2:

Te tell me about , um, how would you define a mental health disorder? Is this a , um, is this a , a psychological problem? Is this a physical or physiological? A combination of both?

Speaker 3:

It's a combination. Yes, definitely.

Speaker 2:

What stigmas are associated with mental health illness?

Speaker 3:

Well, sometimes people think when they hear the word mental health, they think of something scary and that comes a lot from the popular culture. You know, when they, they talk about mental health in, in movies and stuff like the , the mental health, the mental health client is always very violent and, and aggressive. But in reality, that's not the case. So it can be stigma . It can be, we can use stigmatizing language. For example, instead of saying , um, you are depressed or you are a schizophrenic, a non-stigmatizing way of saying the same thing would be you have depression or you have schizophrenia. So they're not equating the person with the illness. The person is not the illness.

Speaker 2:

And this is a way that , um, healthcare providers , um , try to destigmatize mental health. So how widespread is it? How likely is it that an interpreter will have to work with a, a mental health encounter with a client and provider

Speaker 3:

Very possible because statistics show that one outta four, Americans will develop a mental illness within, in this year, every year. Wow . And it's fact, 46% of Americans will have a smelted illness sometime in their life. So it's something that is, that is common, even though it's not talked about a lot, it is common and it is something that the interpreters will have to face.

Speaker 2:

Now it's also said the CDC says that mental illness such as depression is the third most common cause of hospitalization in the United States, for those who are 18 to 44 years old. And they also say that adults living with serious mental illness die on average 25 years earlier than others.

Speaker 3:

I believe it.

Speaker 2:

So this means just as you said, that interpreters can encounter persons with mental health illnesses in any context. And that includes not just medical but legal education. How do these , um, how do people who suffer from mental illnesses receive services?

Speaker 3:

There's two type two ways to access services. One is voluntarily , uh , where a patient or client I'm sorry, goes to the doctor for example, and presents symptoms and is looking for help. The other way is involuntary, which is exactly how that sounds that they're not voluntarily participating , but they're being required to do so. So those are the two ways to access services.

Speaker 2:

Now you just corrected yourself and you, instead of patient, you corrected yourself to client. Can you tell us , um, why the distinction

Speaker 3:

Well saying that someone is a patient can be stigmatizing for a person who's getting mental health services. So it's preferred to use the word client or consumer,

Speaker 2:

And how is interpreting for a client or consumer with mental health illness, different from other kinds of interpreting

Speaker 3:

Interpreters who work in mental health have to deal with , um, different types of language. For example , um, the person may have Ola , which means they will repeat everything that was said. They'll repeat it, word for word. Um, sometimes their thoughts are disorganized and their speech reflects that, or they can be paranoid for example, and their speech will reflect that. So we have to interpret for these people and keeping in mind what condition they have

Speaker 2:

With regards to disorganized thoughts, where, how, what , where are the risks in having an interpreter provide a more organized strain of thought than is actually being provided?

Speaker 3:

Okay, well, diagnosis for mental health illnesses is done strictly through speech. There's no test that they , they can give you, like there's no blood test that they can give you to diagnose a mental illness. So all of the symptoms are self-reported. So if we correct the speech, for example, let's say the person they ask a question and the person starts talking about something totally unrelated. It's not our job to, to clear up what the person is saying, because if we do that, it'll give the clinician the wrong idea about the person's mental status. So we don't wanna clean up language. We don't wanna omit things, even if they're shocking or unusual speech, those things we have to conserve in our interpretation.

Speaker 2:

Have you ever had a situation where a , um, a mental health client or consumer is using such disorganized speech that you are barely able to follow? What they're saying, let alone interpret how have you handled it?

Speaker 3:

That sometimes happens. For example, I remember I had this one client who they asked him, so what did you do yesterday? And he said, well, there was , uh , a green man in a car. And then we went to the store and then there was the car. He just that's what his whole spiel was. So it was not, it wasn't making sense, but I just interpreted what I could understand. And it, it was clear to the clinician that the person had disorganized thinking because I did not clean up his language or, or, or normalize his response.

Speaker 2:

Now I've also read that one of the techniques that interpreters use in mental health settings is using a descriptive mode. Um , when is it okay to use this?

Speaker 3:

Yes. When the client is speaking very disorganized , um , disorganized manner or example , for example, it has , um, uh , a distinct thought pattern. We can switch to descriptive mode because we can't do it word for word , perhaps perhaps the, the speech is really so disorganized that we can't make sense of it. And so instead of normalizing the speech and making sense of something that doesn't make sense, we just have to switch to a descriptive mode and say things like, like in that case, I , I said, what I interpreted was, well , he's talking about a car and a man and a store. So as, as he was talking and throwing out those words, I just interpreted those words, the ones that I could understand

Speaker 2:

Now, this is completely different. You definitely wouldn't do that in a court setting, the court setting, if that mental health patient , um, or client as , as you have. So aply taught us if that mental health consumer or client has, is doing that. What would you do there instead?

Speaker 3:

Um, I would not cl clean up the language either as court interpreters, we have to interpret everything that is said the way that it is said. So it's not the court interpreter's job to assist the client , um, or intervene on their behalf.

Speaker 2:

It's interesting because I was, I , I was reading that the mental health interpreting is, has a principle based approach. Mm-hmm <affirmative> which balances professional duties with client welfare . And that more than likely comes from medical interpreting and community interpreting versus the strict adherence to the, that imutable professional code that legal interpreters have to adhere to. Is it difficult for you sometimes switching back and forth in your role as a mental health interpreter and as a legal interpreter, especially if you're interpreting for a mental health client in a legal setting?

Speaker 3:

Well, you have to make a distinction between your roles. So the role of the in mental health interpreter or the medical interpreter is different than the role of the interpreter in the legal setting. Um, that imutable code that you're talking about that is so sacred in the, in the legal setting does not really translate well part in the pun , um, over to medical interpreting or mental health interpreting, which can, can involve the interpreter in certain circumstances. Um, and , and , and the interpreter may need to intervene or advocate for the client. So that's the main difference, and we have to separate each role that we have with what we are supposed to do.

Speaker 2:

And it's, and I would say that this is really based on the fact that the legal interpreting in court interpreting to be more specific is a, is, is interpreting that is done in an adversarial setting where yes , ma'am as mental health interpreting and medical interpreting community interpreting, and some sort of legal interpreting actually are meant to promote communication, the benefit of that, that party, rather than just , um, making sure that words are spoken.

Speaker 3:

Yes. And that's one of the , um, cans that we can learn from psychologists, for example, their, their first cannon of code of iCal conduct is , um, beneficial. And non-efficient basically stating that everything that they do is to benefit the client and not to harm them in any way. So the court interpreter, we obviously wanted to do the best job possible for our clients, but we, we don't have the obligation to benefit the, the, the L E . So that's a big difference between the two.

Speaker 2:

And of course, when we say benefit, the LEP, what we're really talking about is to promote the best and clearest , um , path to communication between the parties. Right?

Speaker 3:

Correct.

Speaker 2:

Let's talk a little bit about something you mentioned earlier, which is the forensic interview. Mm-hmm , <affirmative> , uh , as with everything as with medical interpreting, there might be the independent medical examination and there , uh , might be , uh , uh , depositions and all different kinds of things, a forensic interview, if it is being done to determine competency, is it a legal proceeding or is it a mental health proceeding?

Speaker 3:

That's a good question. I would say, unfortunately, that it's both. Okay . Um , <laugh> that , um, because it's being used in a , me in a legal setting, the interpreter has to be able to perform as a legal interpreter at that time. And <affirmative>, and because, like I said before, they diagnose things through speech. So the speech of the client is what dictates their diagnosises . So at a forensic interview, the job of the forensic interviewer is to find competency, for example, or for a child that has been abused or to , to as a fact finding mission. Um, so it just depends on what you're doing and where you're doing it.

Speaker 2:

Ariana, another important subject for interpreters across the board is culture in legal interpreting and court interpreting. We really try to avoid dealing with anything that has to do with culture, but at the root of our job as mental health interpreters, it seems that there is a lot of culture. For example, their culturally bound syndromes, there's communi differences in communication styles, between cultures, for example, it's what is known as high context cultures in which people communicate more implicitly and rely heavily on context. Whereas in low context cultures, they rely on explicit verbal communications. Talk to us about this.

Speaker 3:

Yes. Um, that's a really good point. I, I, I enjoy talking about this subject , um, for high context cultures, like you mentioned before, they, they communicate differently than low context cultures. So for example, the Latino community typically is a high context called communicator and the, the typical American, if we can say that , um , is a low context with communicator. So what does that mean? That means, for example, if you're interpreting for a Latino patient or client , sorry, the , um, and the , the doctor asked the question, well, so when did, when did you start feeling bad? They might say, well, I was born in Mexico. And then I came here when I was 21, I got a job and then on and on and on, so forth and so forth. So the, the doctor can get kind of confused. Like I didn't ask that question or maybe it's a yes or no question. And then the client starts telling a story. So that's a difference in communication styles.

Speaker 2:

It's, it's , it's critical that we understand that different cultures have different types of communication styles, because we always try to E um , we err on the side of caution, which is that we are not cultural brokers, but we do have to be able to identify whether a cultural issue is creating a break in the communication mm-hmm <affirmative> right .

Speaker 3:

Yes. And the idea of not being a cultural broker, actually in other countries of the world , um , for example, in Europe, they see in interpreters as a part of the treating team. And so they see them as cultural brokers. So the interpreter in those countries are more involved. Um, and they study specifically for that as well. So it's not like they're that they're interpreters and they're thrown out into the wolves to do something they're not trained for. No, they they're trained professionals. And like I said, they formed part of the treatment team. So it depends on where you are to , to depend on what your role will be.

Speaker 2:

Now, this brings us directly to how you started out as an interpreter, especially a mental health interpreter. You were 19 years old, right?

Speaker 3:

Yes. Ma'am

Speaker 2:

Tell us about that. And, and tell us about the, the resources that you had at the time when you began working in this setting.

Speaker 3:

I had no resources at all. I basically was hired because I spoke Spanish and that was my qualification for the job. So I had to learn on my own actually. So I read as many books as I could about mental health, like illnesses , um, diagnoses , um, treatment options. I studied everything that I could on my own. And that was one of the reasons that led me to write the book, because I felt that there was not really any, any literature out there that taught me these things. So I figured that I would share what I learned , have learned in the book so that other people can also benefit from that.

Speaker 2:

Now it took you a little while to write the book, right?

Speaker 3:

It did. It was an ongoing process. I, something that I did, and then I picked up on it again after a couple of years. So yes, it's been a process.

Speaker 2:

Do you think that had you not worked in the clinic where you worked in that mental health setting, you might not have become so passionate about mental health interpreting?

Speaker 3:

Yes. Um, I, I grew to love mental health interpreting because I saw the impact that you could have on people's lives. So, and , and in the clinic where I worked, we would follow the patient, the client through several years. So you get to know the person at a more intimate level. And you're , you know, you are told their deepest, darkest secrets. So you have to have a good relationship with them because they're placing that confidence in you that as the interpreter, you're going to be saying everything that they're saying and helping them overcome the communication barriers.

Speaker 2:

Now that brings us if you are working that closely with a, a client or a consumer, then that presents some possible safety issues for you as an interpreter. Could you discuss those?

Speaker 3:

Yes. Uh, a mistake that some interpreters have, have done, and I have seen myself is that they get involved to the point where they overstep their boundaries. So they become the person's case manager, doctor confidant , counselor, everything. I had a , I knew of a colleague that she decided to give her personal number to the client. So when that client later became suicidal, instead of calling the doctor, she called the interpreter. Wow. And the interpreter called me and said, what do I do? And I said, call 9 1 1, what do you mean? What do you do? How did she have your number? So that put her into jeopardy as well as, you know, she should not have over . She should not have overstepped that boundary.

Speaker 2:

We were always told with interpreting, especially in, in , in court, interpreting that you're supposed to have as minimal contact as possible with the party that you're interpreting for. I imagine that in mental health interpreting you still follow some basic guidelines, which include not being alone with a client . Um, having, making sure that you're aware of your environment as far as safety is concerned, where you position yourself physically, if you're in a mental health hospital.

Speaker 3:

Yes. Yes. I mean, we have to use common sense and we have to , to follow all of the requirements of the facility where we're working. So like you said, not never to be alone with the client, even where you position yourself, you always wanna have a clear exit strategy. Um, so you like, you wouldn't put yourself between the door and the client, cause that could become dangerous. And when certain things happen, sometimes they're more volatile than others. For example, if you're at a mental health hospital and someone came in for therapy, but they're determined that they're a danger to themselves and others and they are being taken to the hospital involuntarily, sometimes they can explode. I had one case where it was a teenager and his mother was the one who involuntarily committed him and he blew up. He started throwing things. He started screaming. He started fighting with the officer that was trying to take him into custody. So at that, at that moment, I was like, okay, he could do that. And I'm gonna step out here. <laugh> so, so, you know, you gotta remove yourself from the situation. Sometimes

Speaker 2:

I remember working at a mental health hospital here in Georgia and, and , and I remember that I was assisting a client with interpretation as they were going through a class, teaching them about their rights mm-hmm <affirmative>. And in order for them to be able to appear before the judge for a competency hearing. I also remember it being , um, a little bit frustrating for me in the sense that I was interpreting for this person, but this person was clearly not able to follow the train of thought that was being presented to him. And I, and I knew that as an interpreter, I couldn't do anything other than what I was doing. I really wanted to help this person, but obviously it wasn't my role. And so sometimes with mental health interpreting encounters, you, you might either become frustrated or dissatisfied that you aren't seeing a , an actual outcome, or you're not getting satisfaction out of the communication because you're not getting responses. Does that ever happen to you?

Speaker 3:

Well, it is frustrating, especially if we feel that the , that the doctor or the clinician is not doing a good job, that can be frustrating, cuz we're like, oh, he should have said this. He should have said that. So sometimes, you know, we have better ideas than they do according to us. Right. So <laugh> , so we have to remember that the outcome of the, of the encounter, for example, the diagnoses , the ultimate diagnoses , for example, for something that will , the doctor will determine is not our cross to bear. So the ultimate responsibility for that client is the doctor or the clinician that's treating them.

Speaker 2:

And let's talk a little bit about resources for interpreters who want to become more familiar with mental health interpreting. I have heard you talked about the , um, the Bible , uh , for mental health interpreters, which is actually really , um , used by psychologists and psychiatrists. And that's the DSM mm-hmm <affirmative> in its fifth version. So tell us what this is and why an interpreter should become familiar with this.

Speaker 3:

Yes. The DSM stands for diagnostic and statistical manual of mental disorders, addition five. So basically like you said, it's the Bible of psychia psychiatric diagnoses. So the book explains what are the symptoms to each condition and what are the possible diagnoses that result from that ? And they also have a , a section about cultural bound syndromes, so that can help us a little bit to learn what symptoms and conditions are specific to the culture of the people that we are interpreting for. So it's a really great resource and it's not cheap, but if you're serious about learning about mental health, it's a definitely mu a must.

Speaker 2:

Um, I believe we also spoke about the idea of idioms of distress and that's also included in the DSM. Tell us what that is.

Speaker 3:

Yes. Idioms of distress are specific ways that certain cultures express distress or meaning that they don't feel well. So the book, the DSM five does cover that a little bit.

Speaker 2:

Okay . Um, and what about folk remedies? Does that ever come up in, in conversation in mental health evaluations or interviews?

Speaker 3:

Yes, it does. And we have to as interpreters, know what about, what are the customs of the people that we're interpreting for, for example, I had one case where the, the , the client was talking and the , and the clinician said, so what do you do to relax? And she says, I rub alcohol on my feet <laugh> and the clinician was like, okay, it started writing down something. I knew she was thinking, what is the world? Is she talking about? So I told her, I said, I said, excuse me, but just to let you know, in the Hispanic community, rubbing alcohol, rubbing alcohol is a common is a common practice. She's like, oh, okay. So I helped the clinician see that this was not a case of this was not a mental health symptom. It was just , uh , a practice that they do in their culture.

Speaker 2:

And you also clarified, and you also had the opportunity then to clarify what kind of alcohol they were talking about to right. Make to help the communication move forward.

Speaker 3:

Right.

Speaker 2:

Ariana, what words of advice do you have for interpreters working in mental health settings? As far as self care and avoiding vicarious trauma is concerned.

Speaker 3:

Like I said before, we must have a barrier for ourselves where we know this is my job. And then this is my life. So interpreters need to do practice self care . That includes having a good diet exercise, sleep well, have a hobby learn techniques to , to relax and to reduce stress. For example, guided breathing or guided relaxation is a , is a good tool for interpreters. Also having the ability to talk to other interpreters who are in the same situation can be helpful. Cause they can give you ideas on how to cope or ideas, how to do things differently that maybe we haven't thought about and having that, that barrier of , okay, this is what I do for work. And this is my life. We shouldn't have them overlap so much that we lose ourselves.

Speaker 2:

Confidentiality is an important can of our code of ethics is interpreters, whether it's in the legal or in the medical setting, but there are some exceptions. Could you talk about those?

Speaker 3:

Yes. Uh, the, the , the , the act, the health for health insurance portability and accountability act, which is HIPAA prohibits us sharing personal protected health information to unauthorized people. So obviously we have to follow that directive, but there are occasions where an interpreter would need to intervene. And that would be, for example, if we are told by the client that they want to hurt themselves or hurt someone else, or if we learn about unreported cases of child abuse or elder abuse, those are things that we would need to report

Speaker 2:

Arian Aguilar. Thank you so much for joining us here on subject two interpretation and talking to us about interpreting in mental health settings. Ariana's book is available on Amazon. And of course her self-paced course is also available on the de LA Mota Institute of interpretations website. Thank you for joining us, Ariana . Thank you, Maria. We hope that this podcast has enriched your journey along this fascinating field of interpretation. If you're watching this on YouTube, please share your comments with us below. And if you're listening to us, don't forget to subscribe. So you don't miss our weekly episodes. Take care .