Health care interpreting is a field that allows researchers to adopt a number of different perspectives.
While some researchers focus on categorizing and studying the consequences of interpretation mistakes in an interpreted health encounter (Flores, 2005; Laws, Heckscher, Mayo, Wenjun, &
Wilson, 2004; Vasquez & Javier, 1991) or on comparing the respective performances of professional interpreters and bilingual staff (Elderkin-Thompson, Cohen Silver, & Waitzkin, 2001; Laws, Heckscher, Mayo, Wenjun, & Wilson, 2004; Moreno et al., 2007; Vasquez & Javier, 1991), other researchers prefer to focus on the whole interaction between patient, provider and interpreter, as well as its relative challenges (e.g. Hsieh, 2006). The interpreter’s language proficiency is just one of many elements to take into consideration for successful linguistic mediation; other equally important factors include the interpreter’s ability to build a triadic relationship by gaining and maintaining the trust of the other two participants. The vital importance of the creation of trust between interpreter and clients during bilingual healthcare encounters is underscored by several scholars (Greenhalgh, Robb, &
Scambler, 2006; Meeuwesen & Twilt, 2011). However, few scholars have taken into account how different categories of interpreter may affect its construction (Hsieh, Ju, & Kong, 2010), or the particular importance of interpreter-client trust in the domain of mental health care (Fidan, 2017;
Boss-Prieto, 2013).
Scholars in this field agree that the use of non-professional interpreters is as widespread as that of professional interpreters – if not more prevalent (Hale, Ozolins, & Stern, 2009). However, few have taken this as their focus. Rather, researchers make this observation following a wider exploration of the different kinds of health care interpreter, conducted using a range of different methodologies and approaches. These studies provide a useful insight into the current reality of bilingual health care.
Boss-Prieto (2013), Messias, McDowell, & Estrada (2009), Meyer et al., (2010) and Brisset et al.
(2014) opt to analyze the different kinds of interpreter in health care, with the intention of highlighting
their respective implications and influence on medical outcomes. Boss-Prieto (2013) and Brisset et al. (2014) further narrow the focus of their research to the sub-field of mental health care.
The study of interpreting in mental health care calls for input and expertise from different fields. It is therefore common to see this topic dealt with in domains other than interpreting studies, and researchers from various fields have taken an interest in the subject: from communication researchers such as Hsieh (2016) and Delizée (2018), to health care providers such as Bot (2005a, 2005b) and Boss-Prieto (2013), who have approached the topic from a more clinical point of view. Although their methodologies and approaches vary, these researchers, with the exception of Delizée (2018), highlight the importance of acknowledging the significant differences between different kinds of interpreter.
Hsieh’s prolific body of research, which has contributed to the visibility of this matter in several areas of study, was a particularly valuable source of information for this project (Hsieh, 2009, 2010, 2013, 2015b, 2016; Hsieh, Ju, & Kong, 2010; Hsieh & Hong, 2010). Hsieh was one of the first researchers to expressly highlight the existence of different kinds of non-professional interpreter, after observing the conflicting findings and unclear conclusions of bilingual health care studies that did not take this into account. Her 2006 study (updated in 2016) is of particular interest since Hsieh examines the different characteristics of each type of interpreter. By explaining the reason why she focused on the categorization of different kinds of interpreter in the first place, Hsieh (2016) indicates how necessary it was for her to increase awareness of the intercultural context and the challenges posed by “the blurred boundaries between culture, language and medicine” (p. 254). In her 2010 study, Hsieh conducted in depth-interviews with interpreters and providers to explore the notion of trust in an interpreted encounter. This work is particularly relevant because although it does not take different types of interpreter as its focus, the kind of interpreter present is identified as a factor influencing the construction of trust. In her 2015 qualitative study, Hsieh analyzed the factors that influence
providers’ choice of interpreters, pointing out how a provider’s wrong (or uninformed) choice of interpreter could contribute to compromised care. This shows yet again the importance of the awareness concerning the existence of different interpreters. The study illustrates that strategies adopted by providers and the outcome of health care encounters can vary greatly depending on the kind of interpreter present (Hsieh, 2015b).
Boss-Prieto’s (2013) study on the development of the therapeutic alliance in a cross-cultural setting takes an approach similar to that of Hsieh. The work finds that human qualities, moral values, and the quality of communication in a “triadic setting” (itself determined by the type of interpreter present), are fundamental for building a positive therapeutic relationship. For Boss-Prieto (2013), the interpreter underpins the relationship between the three parties. The same study observes that according to some professionals “the bond with the interpreter depends on his type” (p. 115), going on to conclude that in light of the above, patients would benefit from being more aware the pros and cons of using each kind of interpreter.
While not directly focusing on mental health, Messias, McDowell and Estrada's (2009) study, based on in-depth interviews with professional and non-professional health care interpreters, explores how the manner in which different types of medical interpreter carry out their role may differ from their
“technical role definition” and “role expectations” (p. 140). The study shows that professional and non-professional interpreters may perceive their roles differently, and that an interpreter’s approach towards the patient or the situation as a whole can vary according to their understanding of their role.
Like Hsieh (2015b), Messias et al. note that health care providers did not expect the same service of all kinds of interpreter. They conclude that health care interpreting would benefit from there being a greater level of understanding of the strengths and weaknesses of each group of interpreter, since this would promote a perception of health care interpreting as not just a language service, but rather as an activity encompassing patient advocacy and, by extension, social justice.
As far as I am aware, whilst the presence of different kinds of health care interpreter has been quite comprehensively covered by the existing literature, knowledge on their respective impacts on a mental health care exchange remains sparse. Only recently have researchers begun to narrow the scope of their research to this sub-field. Although the aforementioned studies have been a rich source of information, no researcher has taken as their central focus the way in which different kinds of interpreter may affect a mental health interaction. This study therefore aims to narrow this gap by consolidating our knowledge on, and thus contributing to our understanding of, interpreted mental health encounters.