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Annmarie FoxAt the Medical Foundation for the Care of Victims of Torture more than 75% of communication with clients relies on the use of an interpreter. Given the intricate interaction between clinician, client and interpreter, the dynamics of the work involved are rather complex.

When I started work at the Medical Foundation, my 'outside' professional colleagues were mostly concerned whether I would be able to cope with the emotional content of the interpreting. Graphic descriptions of torture, intense emotional distress, loss, rape, bereavement and displacement are very difficult subjects to listen to and then to find appropriate and adequate words to render them into another language. Then there are the associative images - the more eloquent and articulate the narrator, the more powerful and intrusive are the images. Dealing with the subject matter has not become easier over the last five years that I have worked at the Foundation.

Another factor to take into account is that, although interpreter and therapist both would describe language as their main professional tool, we come from completely opposite disciplines. Normally, the intimate practice of analysis does not involve an outsider, let alone an outsider as the carrier of words. Interpreting, on the other hand, by its nature, requires three or more people. In my 'outside' interpreting life the duration of the assignments is short-term, temporary and factual. Most of my work at the MF is long- term, emotionally complex and requires close co-operation with clinicians. Consequently, I had to modify my working practice.

Boundaries with clinicians

This for me meant establishing a different set of boundaries from those I use in my other work. A close and trusting relationship often develops between clinician and interpreter, especially in long-term therapy, and this inevitably places the interpreter in a co-therapist position. Whilst this can be a very seductive process, I often have to remind myself that I neither possess the tools nor the structure to assume a role for which I have no training or professional know-how. Nor do I want the responsibility. My responses in pre- and post-session discussions are based on instinct, common sense, life experience and gut-reaction - and not on qualified clinical contributions.

My work boundaries are largely shaped and defined by the relationships that exist between the participating individuals. Some clinicians are tactile and effusive and we greet and say goodbye to our clients with lengthy and warm hugs and kisses. Others are formal and reserved, avoiding any body contact beyond a handshake. Most of the time I try to align my body language to that of the clinician as in most cases my relationship to the client is similar to the one the clinician has with the client. Successful therapy is often determined by a smooth and open teamwork between all concerned in which the bonds and boundaries are well defined. Ideally, in these settings the clinician does not feel threatened and the interpreter does not feel excluded. Trust is paramount - the clinician's trust of the interpreter with the language, the interpreter's trust of the clinician understanding of the cultural issues and taking the right clinical direction and the client's trust in both by simply opening up.

Sometimes, I feel, quite unrealistically in the context of working at the Foundation but not in my 'outside' work, that notebook and pen during sessions would be very useful implements. I have to make instant decisions as to how a question will make sense to the client (and vice-versa) and my translation may vary from what had been asked by the therapist.

Boundaries with clients

Interpreter-client boundaries are more difficult to define because often the client comes from the same sociocultural or ethnic background as the interpreter and their lives might he intertwined outside the Foundation. There could be feelings of envy, jealousy, admiration and expectation that place the interpreter in an entirely different position from that of a linguist facilitating communication. The client might want the interpreter to act as advocate and problem-solver for matters entirely unrelated to their visit to the Foundation. Alternatively, the client may wonder whether the interpreter will keep confidence and not betray him/her.

Because I share no common culture or skin colour with my client group, I might often be considered by them an adjunct to the therapist. This has advantages as well as disadvantages: on the plus side, I feel that my presence is reassuring to the client in as much as I pose no danger or raise doubts of belonging to an enemy faction that could warn the client to withhold information or be on his/her guard. In many instances, my clients have deliberately and adamantly refused to he seen by clinicians or interpreters from their own culture. On the minus side, the client could find it embarrassing or impossible to explain tribal or local customs without the cultural input of his/her fellow country person. For this reason, I try to make myself as familiar as possible with background information, geographical and political details and latest developments in the country of the client.

In one particular case I forged very strong links with a family with whom I particularly identified. Apart from being their constant interpreter throughout their many comings and goings to the Foundation, I also saw them socially with my children. Having clearly overstepped my professional boundaries, I became privy to a great deal of information that could have furthered or hampered their therapy. When the family was referred to a family therapist with whom I had not worked before, I was very concerned about the therapist's perception of my bond to the family and the threat this might pose, to her and potentially to the therapy. I was worried that her attitude to the family might be coloured by my relationship with them, leaving her much as the outsider. My fears were unfounded, largely because of the therapist's skills and her recognition of the exceptional strength of the family. In the sessions I could distance myself sufficiently from the family to remain purely the professional and objective interpreter whilst at the same time giving them comfort, knowing that they had a strong alliance with me. The family has subsequently benefitted enormously from the therapy.

Empathy with the client

I have a profound empathy with some of the clients - this is because of my own family history of persecution, because in my time I have also been a refugee in another country and because my working language at the Foundation is not really the language I was brought up in. I can identify with and understand many of the problems and emotions.

Use of words and metaphors

Many clinicians often use metaphors, proverbs and idioms for which I have to find an approximation if the equivalent does not immediately spring to mind. To search for a literal meaning could completely backfire and cloud the waters if the interpreter breaks the momentum and flow of the session. Unless the issue is of a major importance, in which case I ask for further elaboration, the nuances often get lost during the session. In a recent session when I used the word 'pipe- dream', the therapist, perhaps wondering at the specificity of the word, halted and under her breath she asked 'Did he use that word?' Well, no, he had not, as he literally said 'future projection' but it fitted much better in the context of the meaning of the sentence. These are challenges we often wrestle with and while nuances may sometimes disappear, the meaning always prevails.

In long-term therapy sessions, where collaborations between all parties concerned have been well established, I tend to render the ideas and the meanings. In one-off sessions, such as those for medical report writing or psychological or psychiatric assessments, a verbatim interpretation is called for. For example, when a client says that he is frightened in a small, enclosed and dark space, I will interpret this exactly as it is said and leave it to the doctor whether he wants to term it 'claustrophobic'. Equally, if the client uses frequent repetitions or has difficulty in expressing him/herself, these have to be translated verbatim, as the client's verbal idiosyncrasy could he a valuable indication for the accuracy of the diagnosis. An interesting example of the dilemmas of interpreting appeared in an article in The Linguist, concerning the BBC Monitor Service in Caversham. A few days before he was overthrown in Romania, in December, 1989, Nicolae Ceausescu said 'At this big rally I would like to repeat what I said recently that the expectations of these gentlemen (Western observers) may come true when poplar trees bear apples and osier willows bear carnations.' The equivalent English folk idiom that would have captured the exact meaning and which the interpreter was tempted to use was 'when an orange grows on an apple tree'. Because the literal translation was clear and because of the importance of the historical speech the text remained unchanged. During the night hundreds of paper apples appeared in the poplar trees around the city and a few weeks later the apple and not the orange became the symbol of the revolution.

Annrnarie Fox was born in Transylvania, brought up in Israel and Germany and has been living in England for thirty years. She has been a translator and interpreter at the Medical Foundation since 1995, interpreting mainly for African Francophone countries.

© Annemarie Fox 2001

Reproduced with the kind permission of the author.

This article first appeared in Context (the magazine for family therapy and systemic practice), (54): 19-20, April 2001.

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