Thesis Presentation Mental health and Deafness: Interpreters’ perspectives on compassion and the development of the therapeutic alliance. LAURA CATHERINE WEDLOCK 2014 COHORT 1
Thesis Presentation
Mental health and Deafness: Interpreters’ perspectives on
compassion and the development of the therapeutic
alliance.
LAURA CATHERINE WEDLOCK
2014 COHORT
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Aims of this presentation
Introduce topic and rationale
Outline aims of research, methods and analysis
Discuss themes generated from the research
Consider service implications/future research
Conclusions/Reflections
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Background
Deaf people are at greater risk of experiencing mental health difficulties than their hearing
counterparts (Fellinger, Holzinger & Pollard, 2012)
Literature has identified a discrepancy between the proportion of mental health difficulties in
this population, and their access to appropriate support.
Many deaf people consider sign language as their mother tongue. However, many mainstream
services fail to understand the need to adapt services to meet the communicative needs of this
group, making services largely inaccessible (Sign Health, 2016).
Although specialist services with trained staff to support deaf people do exist (Beresford, Clarke &
Greco, 2010), there are only 4 services across the UK.
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British Sign Language (BSL) Interpreters
“Interpreting is much more than translating. It is a complex bridge between two cultures” (Du Feu
& Chovaz, 2014)
Interpreter’s can facilitate communication between deaf people and mainstream mental
health services.
However, the role of the interpreter in mental health settings continues to be misunderstood
(Sleptsova, Hofer, Morina & Langewitz, 2014).
Misunderstanding their role leads to services not utilising their experience, leading to less
accessible services.
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Therapeutic relationships and
Compassion
Psychological therapy can be beneficial for individuals with mental health difficulties. An essential component of psychological therapy is the therapeutic alliance developed between clinician and client (Wright & Davis, 1994).
Positive therapeutic relationships have an impact on health and therapy related outcomes (Hovarth, Del
Re, Fluckiger & Symonds, 2011)
A key component in the development of therapeutic relationships is the communication of compassion. Research with hearing populations have identified touch and voice as facilitators to this (Goetz, Keltner & Simon-Thomas, 2010; Simon-Thomas, Keltner, Sauter, Sinicropi-Yao & Abrahmson, 2009)
There is however a current lack of research exploring the development of therapeutic relationships in interpreter mediated relationships, and how compassion is communicated in these relationships.
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The Research
Research sought the perspectives of BSL interpreters
Research Aim: Gain the experiences of interpreters working in mental health settings, to understand how therapeutic relationships are developed and compassion communicated
between a client and clinician in an interpreter mediated communication.
Questions:
What is the role of BSL interpreters in mental health settings and the development of therapeutic
relationships?
What are the barriers and facilitators to such therapeutic relationships?
How is compassion communicated in BSL interpreter mediated relationships?
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Methods
Design
Qualitative Research
Ethic approval sought via FHMREC
Participants
6 women and 1 man
All with over 1 year of experience in
mental health settings
Varied motivation and experience
Representative of professional
demographic: 82% BSL interpreters
are female (Mapson, 2014)
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Pseudonym Gender Years Qualified Motivation Experience:
Mainstream/
Specialist
Fiona F 15 years Previous degree in
linguistics
Mainly Specialist
Paula F 10 years Father worked with deaf
individuals
Mainstream only
Tom M 15 years Interest in languages.
BSL felt like second
nature
Mainly Specialist
Lucy F 16 years Child of Deaf Adults
(CODA)
Mainstream only
Sally F 3 years Night classes Mainly Mainstream
Karen F 16 years Hearing problems as a
child – interest in
Deafness
Mainly Mainstream
Katie F 10 years Night classes Mainly Specialist
Data Collection and Analysis
Semi-structured interviews conducted, lasting approx. 1 hour.
Three conducted via Skype video, two via Skype audio, and two via Telephone.
Analysis conducted using Interpretative Phenomenological Analysis
“Examining how individuals make meaning of life experiences” (Pietkiewicz & Smith, 2014,
p.14)
Transcripts analysed individually; codes generated from transcripts were iteratively
grouped and reviewed to identify final themes
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Results
2 themes generated from data:
Theme 1: Nurturing the triangle of
care
Theme 2: Developing a shared
understanding
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Nurturing the triangle of care
This theme focused on the importance of
collaboration and trust, to nurture a ‘triangle of
care’: A therapeutic relationship that encompasses
client, clinician and interpreter.
All individuals have a role in communicating
compassion: the triangle does not rely on voice.
Interpreters communicate ‘dialogue’, while client and
clinicians display compassion through expression, body
language etc
“Emotional range is just as present in sign… you can
see, feel and hear it” (Tom).
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Client
ClinicianInterpreter
Nurturing the triangle of care (cntd)
Trust is vital in nurturing the triangle of care and must be built up between all individuals – all individuals must feel valued.
Collaboration between individuals leads to familiarity, which can assist the
development of the triangle, leading to positive therapeutic relationships
Continuity aids the triangle of care – but there are various barriers to this
Lack of BSL interpreters
Diminishing quality – spoken language services gaining BSL contracts
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Developing a shared understanding
This theme represented factors that can affect the development of shared understandings
between those in the triangle of care.
Understanding the interpreter role
Interpreters should be viewed as co-facilitators of the therapeutic process.
However interpreters can struggle to explain/defend their role to other professionals.
Clinician’s can feel deskilled by the presence of an interpreter.
Interpreters can subsequently feel like a ‘hindrance’.
Question regarding whether clinicians are threatened by interpreters, or by the fact that they must
adapt their practice.
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Developing a shared understanding (cntd)
Clinician’s who lack Deaf awareness can influence the development of the triangle of care.
Assuming that the interpreter is “some kind of keeper for [the deaf person]” (Fiona)
“Sometimes people with a little bit of knowledge are as dangerous as those without...they bring their
own assumptions” (Fiona).
Need for clinicians to be willing to educate themselves and work collaboratively.
Understanding the need for interpreters to have supervision.
Interpreters channel the content communicated by the client and clinician and can experience
‘Vicarious trauma’.
Evidence that interpreters are being expected to hold and communicate distressing content, but are
not being viewed as part of the clinical team, so are therefore not being provided with clinical
supervision.
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Discussion
Research identified the importance of developing a triangle of care:
The interpreter must be viewed as an equally important part of the therapeutic process, alongside client and clinician.
Compassion is communicated collaboratively between all individuals – each with an important and unique role
Concepts and processes operating in the hearing population cannot directly be applied to deaf populations. Research is therefore vital in improving services and support for this group.
Service and clinicians must be willing to adapt and learn from deaf people, in order to offer a service to them which is useful and beneficial.
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Service Implications
Collaboration must be worked towards in mainstream services:
Clinicians must educate themselves and be willing to adapt their work.
Clients and interpreters must be involved in service development and evaluation.
Clinical psychologists are trained to be eclectic, flexible, and client-focused. Therefore, they
must consider how they can work alongside interpreters to aid their role (E.g. formulation etc),
and work with deaf clients to achieve positive outcomes.
Clinical psychologists are highly banded professionals with a managerial aspect to their role.
They must advocate for interpreters to receive clinical supervision in NHS settings.
Use the potential impact on therapeutic processes and relationships
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Conclusions
The aim of this study was to gain an understanding of the BSL interpreter role in the development of therapeutic relationships, facilitative and disruptive factors, and how compassion is communicated.
Results evidenced the potential for a triangle of care.
Collaboration, trust and continuity facilitate this triangle, whereas lack of Deaf awareness, role disclarity and clinician threat are barriers.
Interpreters have a unique role in the development of therapeutic relationships, and research has rarely before sought their perspectives.
It is hoped that this study has contributed to the evidence base, and encouraged future research and discussion in the area.
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Reflections
Do what you can when you can: The thesis can seem like an overwhelming task – but
breaking it down makes it seem achievable!
Apply for ethics as early as possible – this puts you in good stead for meeting deadlines
As much as possible, enjoy the process! It is a great opportunity to learn about a new
topic, and broaden your knowledge.
Good Luck!
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References
Beresford, B., Clarke, S., & Greco, V. (2010). Referrer’s use and views of specialist mental health services for deaf children and young people in England. Journal of Mental Health, 19(2), 193-201. doi: 10.3109/09638230902968159
Du Feu, M., & Chovaz, C. (2014). Mental Health and Deafness. New York: Oxford University Press.
Fellinger, J., Holzinger, D., & Pollard, D. (2012). Mental health of deaf people. The Lancet, 379, 1037-1044. doi: 10.1016/S0140-6736(11)61143-4.
Goetz, J.L., Keltner, D., & Simon-Thomas, E. (2010). Compassion: An Evolutionary Analysis and Empirical Review. Psychological Bulletin, 136(3), 351-374. doi: 10.1037/a0018807
Hovarth, A.O., Del Re, A.C., Fluckiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy (Chic), 48(1), 9-16. doi: 10.1037/a0022186
Mapson, R. (2014). Who are we? Newsli, 87, 13-15.
Sign Health. (2016). Sick of It Report. Retrieved from http://www.signhealth.org.uk/wpcontent/ uploads/2016/09/Sick-Of-It-Report.pdf
Simon-Thomas, E.R., Keltner, D.J., Sauter, D., Sinicropi-Yao, L., & Abrahmson, A. (2009). The Voice Conveys Specific Emotions: Evidence from Vocal Burst Displays. Emotion, 9(6), 838- 846. doi: 10.1037/a0017810
Sleptsova, M., Hofer, G., Morina, N., & Langewitz, W. The Role of the Health Care Interpreter in a Clinical Setting – A Narrative Review. Journal of Community Health Nursing, 31(3), 167- 184. doi: 10.1080/07370016.2014.926682
Wright, J.H., & Davis, D. (1994). The Therapeutic Relationship in Cognitive Behavioural Therapy: Patient Perceptions and Therapist Responses. Cognitive and Behavioural Practice, 1, 25-45. doi: 1077-7229/94/025-04551.00/0
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