Foreign Language Interpreters in Mental Health: A Literature Review and Research Agenda

Approximately 20% of the U.S. population speaks a language other than English at home, with at least 8% of the US population demonstrating limited English proficiency (LEP; Bach, Fraser, & Paez, U.S. Bureau of the Census, 2002). In the U.S., the most commonly spoken non-English languages are Spanish (64%), followed by Asian/Pacific Island languages (17%) and other Indo-European languages (16%) (Flores, 2005). Linguistic diversity has also become more geographically distributed in the United States. In Nebraska, 9% of the population speaks a language other than English at home (Shin & Kominski, 2010), an increase of over 40% since 1990. Overall, in the U.S, from 1990 to 2000, there was nearly a 50% increase in the percentage of the U.S population that spoke a language other than English at home (Prendes-Lintel & Peterson, 2007). Given these demographics, it is very likely that most mental health professionals in Western countries will, at least periodically, require the assistance of an interpreter to appropriately evaluate and treat patients. The addition of this third party to clinical encounters raises a number of issues, including the interpreter's impact on potential problems such as diagnostic accuracy, and the clinician-patient relationship, as well as psychotherapy process and outcome. While there are clinical guidelines for working with interpreters, these are based on anecdotal experiences as well as adaptations of medical interpreting (Searight & Searight, 2009). Research on mental health interpreting has not addressed many of the issues arising in clinical practice (Engstrom, Roth, & Hollis, 2010). The current article attempts to organize existing literature on mental health interpreting to establish a summary of contemporary knowledge of the topic which can serve as an impetus for further research and ultimately, evidence-based guidelines for mental health interpreting in clinical practice. In this review, the terms "interpreter" and "interpretation" will be used. "Translation" was deliberately omitted as a search term. The term, "translation" is typically used for written text although it has been used to describe verbatim conversion of the patient's verbalizations to another language (Searight & Searight, 2009). "Interpretation" is typically somewhat broader and often includes attention to the meaning of terms as well as the cultural significance of the content being discussed (Tribe, 2007). The term "translate" is also used when psychological test content is converted to another language. METHOD We conducted computerized literature searches with the key phrases: "foreign language interpreter" paired with "mental health," "psychotherapy," 'psychological assessment," and "psychiatric" as well as "psychological diagnosis" and "psychiatric diagnoses. " Data bases included PsycINFO as well as Medline. Articles obtained were scrutinized for relevant references as well. We included reports that had some empirical component including both quantitative, systematic qualitative studies and some case reports. There were few rigorous quantitative studies. We examined case reports, some of which were included in papers on interpreter guidelines. If, in our judgment, a paper included case examples with specific findings, it was included in the review. We located one edited book (Tribe & Raval, 2003) focusing on general clinical guidelines and recommendations for various specific situations (e.g., war refugees, children) that may arise in practice. The majority of writing in the area focuses upon clinical guidelines for interpreters as facilitators for mental health services. There were a modest number of publications suggesting procedures for mental health professionals working with interpreters (e.g., Amadeo, Grigg-Saito & Robb, 1997; Searight & Searight, 2009; Tribe & Morrissey, 2004). Generally, these guidelines are either adaptations of medical interviewing or based upon the authors' clinical experience. …