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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Thank you for listening!

ANY QUESTIONS?

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