Language, Interpreting and Health
The importance of the mother tongue in psychotherapy is extensively discussed in the literature (Amati-Mehler, Argentieri & Canestri 1990, Santiago-Rivera & Altarriba, 2002). The centrality of words in psychoanalytic psychotherapy is crucial as a pathway to analysts’ and patients’ access to the content and effect of pathogenic unconscious, fantasy, memory and complexes and contribute to an effective therapy.
A meta-analysis of 76 studies found that therapies offered in the patient’s mother tongue were twice more effective than therapies offered in English (Griner & Smith, 2006), with more effectiveness being measured when the therapy included culturally adapted measures. In the macro level, patients who are not proficient in the country’s primary language may encounter barriers to the use of mental health services (Sentell, Shumway, & Snowden, 2007), as well as higher rates of treatment dropout, recurrent and longer hospitalizations, poor adherence to medication and treatment recommendations, lower client satisfaction. Naturally, all these barriers may contribute to health disparities among fragile populations.
When patient-therapists language concordance is not possible, the session should be mediated through an interpreter (Brisset et al., 2014). Based on understanding of the importance of language in psychotherapy, some therapeutic models, e.g. the Cultural Consultation Service (CCS) in Canada, suggests considering the social, cultural and political context of the patient's behavior and symptoms, to provide better diagnosis, assessment and treatment plan (Kirmeyer et al., 2003). In such cases, cultural mediators (sometimes referred to as cultural ‘brokers’) eliminate not only the language gaps, but become go-betweens who sensitize clinical practitioners to patients’ belief systems and encourage patients to “trust” the institutional system. According to Miklavcic and Leblanc (2014) who studied the Canadian CCS mentioned above, cultural brokers can help in assimilating the immigrant’s point of view to the healthcare system and broader society, by offering a more inclusive two-way exchange of the other’s perspective.
Since the triangular encounter of the therapist-patient- interpreter requires specific expertise and preparation, many providers often lack the appropriate training to effectively use interpreters during therapy. For example, a survey among mental health providers in Montreal, Canada, revealed that even when linguistic resources such as interpreters were available, many providers were not aware to issues like the dynamics in the triadic encounter, the possible roles of the interpreter, and key elements for a successful interpreter-mediated intervention (p. 1245).