Words Apart: The Challenge of Using Interpreters in Psychodynamic Psychotherapy

Communication is a key component of the work performed in any medical field. Mental health professionals in particular depend on language in a crucial way in order to hear and help their patients. Despite the linguistic and cultural diversity of our patient population, there is a dearth of literature on the topic of psychotherapy using interpreters. Few guidelines exist on when to use an interpreter, proper psychotherapeutic technique in working with an interpreter, and education of both the trainees and the interpreters who work in this setting. The available research on these issues has mostly explored the linguistic element of these interactions (Kleinman, 1987; Oquendo, 1996; Westermeyer & Janca, 1997) or impact on common factors in psychotherapy, such as therapeutic alliance and empathy (Björn, 2005; Kline, Acosta, Austin, & Johnson, 1980; Mirdal, Ryding, & Sondej, 2012; Pugh & Vetere, 2009; Raval & Smith, 2003). Psychodynamic psychotherapy with interpreters, however, presents a unique set of challenges that have been essentially ignored in the literature; to the authors' knowledge, there is only one case report (Baxter & Cheng, 1996) of a psychodynamic treatment carried out using an interpreter. Several problematic clinical and ethical dilemmas arise when one considers the question of how to best perform such a treatment.

The complexity of psychotherapy with interpreters begins before the interpreter even walks into the room. When and how an interpreter is offered or requested can have great meaning for a patient. In the case of a narcissistically vulnerable patient, for example, the therapist's request for an interpreter may result in an initial rupture of alliance as the patient feels rejected at a fragile early point in the treatment. Most patients will have feelings and fantasies about an interpreter being present for their treatment. As in any good psychodynamic treatment,