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This Standard Practice Paper addresses the unique challenges faced by interpreters working inmental health settings and the skill set needed to successfully meet those challenges. The mentalhealthcare field is broad and includes psychiatric assessment and treatment, group and individualpsychotherapy, counseling, psychological testing, substance abuse treatment and more. RID recommendsthat interpreters working in these settings hold a current RID certification to assure a minimumlevel of interpreting competence and compliance with the NAD-RID Code of Professional Conduct. It isalso recommended that before working in mental health settings interpreters receive training in thisarea.When communication involves two or more languages and cultures, psychiatric assessment andmental health treatment present additional complexities which must be considered and addressed bythe professional team, including the interpreter. For the interpreter, these challenges can be dividedinto three area: the linguistic considerations, delineated in Section A; contextual dimensions, outlinedin Section B; and interpersonal dynamics, covered in Section C. Lastly, there are specific steps that aninterpreter can take to improve the likelihood of success in mental healthcare work. These areaddressed in Section D.Section A – Linguistic Considerations: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, maybe significant for diagnosis and treatment effectiveness. Further, interpreting in mental health settingsfrequently presents the unique challenge of working with individuals who have dysfluent1 or evenalinguistic2 means of expression. Communication may be further impacted by cognitive, emotional,behavioral or social factors. Beyond these complexities associated with language form, there is aunique vocabulary as well as specialized and deliberate techniques of speaking in therapeutic relationships.Interpreters will encounter words and phrases that have a specific psychiatric meaning whichis distinct from how the general public uses these same terms.Interpreting in mental health settings requires the ability to use multiple interpreting approachesincluding 1st person, 3rd person, narrative, descriptive, simultaneous, consecutive, team interpretingand working with a certified deaf interpreter. Equally critical is the ability to recognize and commenton the form of language as distinct from the content of language. In addition, interpreters should beable to recognize and comment on potential exacerbating or mitigating factors affecting impaired languageexpression. Providing commentary on language, culture and the interpreting process is appropriatein many circumstances but should be clearly distinguished from advising or commenting ondiagnosis.STANDARD PRACTICE PAPERIn addition to communicating with providers about relevant issues of language, culture and the interpretingprocess, the interpreter may also need to discuss his or her own linguistic and behavioral choices.It is of the utmost importance that issues that could lead to misunderstanding or misdiagnosis ofconsumers be shared with the clinical team. This may include sharing information about Deaf cultureand communication norms, including dysfluency and potential deficits in a consumer’s fund of information.Interpreters should have a working knowledge of the diagnostic criteria and taxonomic structure ofthe current Diagnostic and Statistical Manual of Mental Disorders, due to the critical role this text playsin the field of mental healthcare. Interpreters also should be familiar with the current literature in thefield of mental health interpreting.Section B – Contextual Dimensions:There is a wide range of mental health settings and services which are provided across the continuumof age, ethnicity and cultural identity. Settings include inpatient and outpatient settings, peer-led settings(such as AA or “self-help groups”), outreach settings (in-the-field), day programs, private clinician’soffices, clinic settings, emergency rooms, forensic and court venues, and long-term residential care settings.To perform effectively in these settings, interpreters require knowledge about the diversity of mentalhealthcare environments, including the goals and norms of specific settings and interventions.Interpreters should be familiar with the types of mental health professionals who are present in varioussettings, their roles, their communication goals and their treatment methodologies. In the most effectiveclinical environments, interpreters are seen as members of the mental healthcare team. An interpreter’sconduct and decision-making therefore should align with the goals and processes of the setting and theclinician(s). Working in the mental healthcare field also entails specific legal and regulatory obligationswhich apply to interpreters as well as clinicians. Interpreters should seek guidance and informationabout how applicable regulations and laws may affect them and influence their conduct.When interpreting in emotionally-charged settings, or when in the presence of people who are experiencinginstability of mood, thoughts and behaviors, interpreters must be able to remain calm, professional,attentive to their surroundings and mindful of their physical safety.Given the importance of medications in psychiatric treatment, the interpreter should have a basicknowledge of psychopharmacology, including the medications commonly used, their indications for useand effects which may influence communication or the interpreting process.As a member of the mental healthcare team, interpreters can also serve as a link to resources whichcan provide the team with information about current research, knowledge and specialists in the field ofmental health with the deaf population.Section C – Interpersonal Dynamics:There is a long-standing recognition of the unique quality and power of the therapeutic relationshipand a growing understanding of the influence of an interpreter’s presence on the development anddynamics of that relationship. This may raise distinct issues pertaining to confidentiality, vicarious trauma,transference, and countertransference3. This, in turn, increases the need for self-awareness on thepart of the interpreter and for strategies for managing the potential interference of one’s own biases,judgments and sensitivities in the therapeutic process.It is essential that interpreters possess personal and psychological strengths necessary to be effectivein mental health work along with the ability to consistently and critically assess one’s skills and theimpact of one’s behavioral and translation decisions. These strengths include comfort amidst intenseemotions, the ability to maintain professional demeanor during highly charged interactions, insight intoone’s own psychological and emotional responses and utilizing resources to maintain one’s own mentalhealth.Mental health services are largely provided by individuals working as part of a team and in the mosteffective service environments, with interpreters included as members of that team. Therefore, the interpretershould be prepared to ethically and effectively function as a team member in the clinical process.This involves an understanding of the complexities of confidentiality within mental health settings andthe need to form and maintain personal and professional boundaries in relationships with deaf and2 Interpreting in Mental Health SettingsInterpreting in Mental Health Settings 3 STANDARD PRACTICE PAPERhearing consumers. Interpreters must acknowledge that their presence impacts the therapeutic relationshipand develop strategies for mitigating the negative consequences of that impact. Specific techniquesinclude holding pre- or post-session meetings with clinicians as well as debriefing in specific situations.Section D – What steps can be taken to improve the potential for a successful outcome in mental healthinterpreting? Pursue opportunities for professional development in this interpreting practice specialtyarea. Increase your knowledge regarding therapeutic interventions, clinical terminology andpsychiatric diagnoses. Stay abreast of the professional literature in the mental health interpretingfield. Develop a relationship with a mentor who has more experience in this area. Develop mutual consultation relationships with mental health service providers and interpretercolleagues. It is within the context of these professional relationships that general discussionsof provider goals and practice methodologies and relevant issues of language, cultureand the interpreting process may be readily explored. Acknowledge that the presence of an interpreter will impact all aspects of mental healthcare,especially the therapeutic relationship. Develop strategies for mitigating the negativeeffects of that impact, such as employing pre and post-session consultations in order tomore effectively align oneself with therapeutic goals. Continue the thoughtful development of self-awareness, including intrapersonal issues,sensitivities, and biases that can unintentionally and unconsciously impact the interpretingprocess and mental health service outcomes. Reduce vulnerability to vicarious or secondary trauma by seeking a healthy balancebetween strong psychological boundaries, empathetic engagement and a philosophy ofdetachment. Incorporate a routine of self-care and develop an intellectual appreciation ofthe field of mental health in order to offset the negative impact of repeated exposure to thepsychological and emotional pain of others. Collect and share resources from the mental health interpreting and mental health servicesand the deaf population. Among such resources are the following: The Office of Deaf Services at the Alabama Department of Mental Health andMental Retardation: http://www.mh.alabama.gov/MIDS/ The Minnesota Chemical Dependency Program for Deaf and Hard of HearingIndividuals at http://www.mncddeaf.org/ The Deaf Wellness Center at the University of Rochester:http://www.urmc.rochester.edu/dwc/ The Registry of Interpreters for the Deaf: http://www.rid.org The APA PsychInfo database: http://psycinfo.apa.org/ The PUBmed literature database: http://www.pubmedcentral.nih.gov/REFERENCES:1 Dysfluent (disfluent) – A lack of proficiency in producing or understanding one’s preferred (best) language.Dysfluency can be gross or extremely subtle. It may be a result of cognitive, educational, or psychiatric difficulties.Examples include echolalia, clanging, neologisms, stuttering, and incoherence.2 Alinguistic – Expression of spoken or signed utterances without a consistent or formal language structure.3 Transference refers to the phenomenon of emotions, perceptions, and behaviors from past relationships biasing aclient’s relationship with his or her therapist (or interpreter). Countertransference refers to the therapist’s (or interpreter’s)past relationships biasing his or her emotions, perceptions or behavior toward his or her consumer(s).