I am often asked how to most effectively work with interpreters. These sessions are awkward because the flow of conversation has to be interrupted. In addition, some Motivational Interviewing skills don’t work well unless the interpreter is skilled in MI. More often than not the interpreter does not understand what you are doing. For example, he may not understand the process of open questioning or of making careful reflections.
Understanding is a two-way street.
If you don’t believe it,
it won’t come out your horn.
The connection between you and the client is still important even with the interpreter there. Use your body language to support engagement. Face the client and maintain eye contact (unless inappropriate in this client’s culture). It is appropriate to maintain your focus on the client during the whole session. When it is done, you could turn to the interpreter and express your appreciation.
Ideally your interpreter is familiar with MI or even trained in it. Since this is rarely the case, let’s look at ways you can improve the flow of a session.
Take a moment to let the interpreter know how you work. For example:
• “I take care with how I word things to my clients. I hope you will carefully translate exactly what I say. I will sometimes repeat something the client says, maybe with different wording. I do this to highlight that topic and hope the client says more. Please say it back to the client, if possible, with the shifted wording I use.”
• “I also find it works well to ask some very open questions such as ‘If you were to make some changes based on what we are talking about, what might they be?’ instead of ‘What are you going to do?’ If possible, word them that way when you hear me do that.” Here is a resource for those who work with Spanish-speaking clients: OpenQuestions-English-Spanish. You are welcome to print this out for your use or to provide to translators.
• “I may ask the client for permission to do something. I find it is important for me to hear back from the person that they are ready for advice, so if I do this, please pass on that question and tell me what she says.”
• If you are using technical terms such as Hemoglobin A1C or hypertension, find out how much the interpreter knows about your content area and if he is prepared to translate important terms. You may need to stop to make sure key words are translated in an understandable way.
• Ask the interpreter to translate directly. For example: “I eat eggs almost every day” rather than “She says she eats eggs almost every day.” A well-trained interpreter will do this. You may need to prompt him to do this. Speak directly to the client. For example: “Tell me what you eat in the morning” rather than “Ask her what she eats in the morning.”
If you often use the same interpreters, find time to chat afterward to ask how it went and what they may need from you. Ask permission to provide feedback on what worked and what didn’t work so well. If they seem interested, you could share the basic skills of OARS. Explain the role of open-ended questions, affirmations, reflections and summaries. Perhaps you could help them brainstorm ways to word open questions in their language.
There are often cultural differences mixed in with the language differences. Interpreters may help you understand cultural aspects of your client. You could even ask a regular interpreter, “What do I seem to misunderstand about the culture of these clients?”
When family members serve as interpreters, this adds an extra layer of complication. The family member may wish to speak for the client. For example: “My mother won’t eat those foods” or “He just eats junk all day.” After thanking the family member for helping out in this way, you could respectfully ask him to allow you to hear directly from the client. You could even preface the session in the same way you would with a non-family interpreter.