SLPs and Interpreters Working Together

Erazo, N. A. (2015, November). Strengthening relationships with interpreters while mastering the art of diplomacy. Paper presented at the annual American Speech-Language-­Hearing Association Convention, Denver, CO.

Session #1357; November 13, 2015 at 10:30am-11:30am MST; Room 607; PDH: 1 hour; Topic area: Cultural and linguistic considerations across the discipline.

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Noé Erazo at ASHA 2015

Good morning everyone, how are you today? I am so excited to be here with you. It has been a real journey to get to this place. This is my first time at ASHA and I am energized by the relationships we are forming. My name is Noé Alonzo Erazo and I am from Houston, Texas. This is my first time in Denver and I love it here. The natural landscape is breathtaking. I want to tell you a little more about myself as I disclose my financial relationships. One, I am the Founder of Olé Noé, LLC, a speech-language materials company that is exhibiting in booth 346 here in the member’s area. Two, I won a business plan competition in Houston and was awarded money to liftoff my business idea into fruition. My appearance here has been made possible thanks to the City of Houston Office of Business Opportunity, Capital One Bank, and the Houston Public Library. Lastly, my non-financial disclosure includes being an interpreter at Lakewood Church, Joel Osteen Ministries. Shout out to Joel and Victoria. I thank you for being here for, Strengthening Relationships with Interpreters While Mastering the Art of Diplomacy. We will visualize the perfect SLP and interpreter relationship to promote a cooperative partnership, discuss the art of diplomacy to gain acceptance into a foreign culture, and review the Community Language Learning Approach by Curran (1972), which encourages SLPs to acquire a new language through the mentorship of an interpreter.

We are going to look at the role of SLPs and interpreters through the lens of clinical sociolinguistic research, historical interpreters, and of course my own experience as an interpreter. I started working as an interpreter back in 2011 at Cole Health, a pediatric speech clinic. Along the way, I got the incredible opportunity to work with over 20 SLPs, 10 SLPAs, and even occupational and physical therapists. The clinic has a neat business model where they have interpreters on-staff all the time, so there is always someone who can interpret. A lot of the patients are Spanish dominant with parents who are primarily monolingual Spanish speakers. I am fortunate to have been trained by interpreter Ana Lilian Castillo, and mentored by SLP Courtney Sanderson on how to provide the best therapy to our patients. As I grew in my position and in my graduate studies in Applied Linguistics, I became more inquisitive on the ideal SLP and interpreter relationship. I began to notice areas for improvement, not just in the information exchange required for excellent therapy, but in the personal dynamics between the two professionals. My findings led me to create a profile of the ideal SLP and interpreter, and in defining them we will consequently also define its opposite profile, the lackluster SLP and interpreter. The idea of looking beyond clinical sociolinguistic research for the roles of each professional was obvious when the U.S. and foreign governments possess such a rich history of employing interpreters for difficult and information-sensitive tasks.

Harry Obst, interpreted for seven American presidents and wrote the book, The White House Interpreter (2010). He chronicles the juicy details of his time as a presidential interpreter and the personality types of each president that led to successes or failures. A good SLP should not be afraid to ask an interpreter for advice, much like President Johnson asked interpreters for advice on foreign leaders and their modus operandi  (p. 22). It is important to ask an interpreter for additional information on paralanguage, such as intonation, eye-contact, indirect language, and body-language. Indirect language is really interesting because you have to read between the lines and also play an indirect language game.

Indirect communication style

While I was living in Mexico as a foreign exchange student I had the experience of living with a host family. This is something I recommend to all, as you can truly live as the locals do. On one occasion, I needed to dress up formally for a presentation at El Tecnológico de Monterrey, but the problem was that my pants were wrinkled and I did not own an iron. I asked my host mother if I could borrow her iron and she was so sweet in telling me that in Monterrey, the fashionable thing to do is wear wrinkled dress pants. Now, I grew up in a Salvadorian-Honduran family, so I am well versed on the art of indirect-communication. I explained that I fully understood that it was the cool thing but that I still wanted to iron them to stand out from my peers. She then insisted that she could iron them for me, and I thanked her for being super accommodating and helping me, but that ironing was a hobby of mine. This went on for five minutes until she acquiesced and let me borrow the iron. This is typical in Spanish, not the unwillingness to let someone borrow an iron, but the indirect nature that is required for keeping face and being polite. You could get lost in a person’s true intent if you are not aware of how indirect communication works, and much more when it is masked by a sweet façade. Because the SLP is not familiar with the intricacies of the foreign language and culture, it is easy to miss signs of insincerity, sarcasm, sadness, nervousness, hesitation, and confusion. As an interpreter, I really would like to tell you as much as possible about my interpretation of the situation. We are able to understand the message in the cultural context that it occurs. This service is not extra, it is simply provided by any good interpreter, but only when asked for it. We do feel like we are imposing on the SLP by providing unsolicited information, but we await for you to open that door. We will go above and beyond to help you and the patient, but we can sometimes fear stepping on the SLPs toes.

Information sharing

Knowledge is power, and Genghis Khan, Caesar, and Alexander the Great knew this by having interpreters whisper the message of captives so that they could decide what to do next (Obst, 2010, p. 56). Fidel Castro has good receptive skills in English, but he would always use an English interpreter to give him extra time to analyze the situation (Elvira, 2013). You can do this too, as your knowledge of the foreign language gets better with practice. You can follow the conversation with a patient or their caregiver while then getting further confirmation from the interpreter. Information exchange is crucial in the SLP and interpreter relationship. The three crucial ingredients for a collaborative partnership include the interpreter’s involvement in the session planning, the interpreter’s active participation in information exchange, and the repair of miscommunication (Isaac, 2005). I think it can be dangerous to get too legalistic about the interpreter’s role and what he or she is not allowed to do. To be clear, the U.S. Department of Health & Human Services (2008) states that HIPAA allows you, the health care provider, to discuss a patient’s health information with an interpreter who is part of the clinic’s workforce or a contracted business associate. Feel at rest knowing that you can confide in your interpreter.

In my experience, I have worked with specific clients that work best under certain conditions. Sometimes an SLP might get the opportunity to work with a new patient whom the interpreter already knows well. Legalism would say that the interpreter simply listen and take orders, without offering any information about the patient to the SLP that might be helpful. I think this is hard because it’s asking the interpreter to be a bystander when they can make a difference. As interpreters who work alongside these patients day in and day out, we learn what works for them and what doesn’t. Certain kids will only talk if you use specific toys, some will do anything you want provided they get to play a computer game or do a specific activity. Other clients really open up when you introduce a specific song they absolutely adore. I always enjoyed when an SLP asked me for advice on what a specific patient liked. Or they may even ask me how a particular patient executes a specific language goal. Let me tell you, the interpreter is the eyes, the ears, and the mouth of the speech clinic. They are afforded the incredible opportunity of working with numerous SLPs and numerous patients; depending on the structure of the clinic of course. Remember that we are there to assist you as best as possible in treating the patient and we believe that any helpful inside information should be passed along without fear of rebuke.

There was an interesting child I worked with who would only talk if you used sticky notes. The SLP, my good friend Laura Behling, was trying something different. She was representing a phoneme with colored paper, sort of like how a piano produces different notes on each key. I told the SLP that this was called the Silent Way, developed by Caleb Gattegno (1963). I had only seen such a method on YouTube videos and didn’t know it was still being used to spark language acquisition. It is a bottom-up method where the patient first works on language at the phonemic level, then proceeds to the word level, and then the sentence level. One day, I worked with the same patient, but with a different SLP. Because there was a last minute reschedule, the SLP did not know about the child’s therapy preferences. What was I supposed to do? Sit there for an hour and watch the SLP struggle to get the child to make one utterance? As a rebellious type of person, I simply mentioned that the patient would work if they used colored sticky notes, thus saving therapy time, helping the patient, and informing the SLP of a new way of doing therapy. Presidential interpreter Obst believes that any helpful information should be provided to the president of the United States (Obst, 2010, p. 204). After all, we wouldn’t want our president to be in an embarrassing situation if we can help it and the same goes with SLPs.

Introducing the interpreter

Presidential interpreter Obst mentions that President Nixon would never return a greeting from interpreters (Obst, 2010, p. 70). This reminds me of the instances when an SLP would not introduce me to a patient or their caregivers. I don’t think it was ever done intentionally, but it did result in myself and other interpreters feeling unappreciated and as invisible as the marginalized ethnic minorities that we were serving. On the other side of the spectrum, President Gerald Ford greeted and shook hands with interpreters and President Lyndon B. Johnson would thank and praise his interpreters privately and in public (Obst, 2010, pp. 67, 87).  I’ve had SLPs who would brag about our abilities and I think it works both ways, certain interpreters would brag about specific SLPs and their craft for sparking language acquisition. We appreciate the craft and the knowledge necessary to bring patients out of their shells. I think that as interpreters, we do long for your recognition and to be seen as equals who are both educated. However, there does exist interprofessional rivalry dealing with power and decision making and I think this is at the core of our misunderstandings. If an interpreter wanted to be an SLP, he or she would work to achieve it. In one instance, I know of an interpreter who did just that. I also know of SLPs who went on to become bilingual service providers after working with interpreters after some time. Others have moved to Latin American countries to acquire a second language.

Choosing appropriate foreign language materials

As we know, the clinician has the final say on materials used and the way that language goals are applied. Dr. Henriette Langdon encourages that we consult with interpreters on the appropriateness of materials (2002). I have found that interpreters make really good judgement calls on whether a specific material is going to work or not. I have been in situations where we were focusing on words that were esoteric or not dialectically appropriate for our patients. Simply asking an interpreter, “what do you think?”, could save you a lot of time by avoiding inappropriate language materials. At the clinic where we worked, we interpreters wanted to be so helpful that we thought of creating a binder or digital library of approved language materials. Unfortunately, this never materialized because of the fear associated with interpreters overstepping their boundaries as mouth pieces. I sometimes wonder what could have been.

It is important to share with interpreters what the language goals are. If we are working on derivational nouns, then I can immediately tell you that translating from English to Spanish is not always going to work. A teacher teaches, but in Spanish a maestro enseña. If you ask us, we are happy to help come up with examples on the spot and let you know whether the materials you have obtained are appropriate in terms of age, language goals, and dialect. As you become more in tune with the interpreter, you will feel comfortable in picking our brains on the tons of language and cultural trivia we possess. As you become more skilled in the metalinguistics of the foreign language, it will be even more important to ask us grammar questions so that we can help you understand the intricacies of the language.

The interpreter as your friend

It is possible to have an interpreter become your confidante. In many instances we can have a great professional relationship as well as have a close friendship. French President François Mitterrand had Prime Minister Margaret Thatcher wait for his favorite interpreter Christopher Thiery, even though there was another interpreter readily available (Obst, 2010, p. 126). This shows how we can form bonds with interpreters. If this is a positive relationship, then a negative relationship is akin to being Fidel Castro’s interpreter. His English interpreter, Frank Vales, was offered food by Castro because it was prepared for him by people other than his security team (Elvira, 2013). The interpreter later realized that he probably served as Castro’s guinea pig to see whether the food contained poison. Castro would eat in front of his interpreters without offering them food, even if the interpreters hadn’t eaten or drunk in hours. Sharing food is a great way to establish a bond with an interpreter. As you work with interpreters, you will share all sorts of things that bring you closer together. Inclusion is the key towards a collaborative partnership.

Sacajawea

Sacajawea and Jean Baptise golden dollarThe story of Sacajawea is powerful and a testament to how strong women are. She was an enslaved pregnant adolescent who was part of the famous Lewis and Clark expedition (Karttunen, 1994). She had been passed on as property twice, from the Minnetaree Indians to her then husband Toussaint Charbonneau. She gave birth and continued in the expedition while taking care of her newborn, much like some SLPs that I know who have had children and then immediately returned to treating patients. Sacajawea was a crucial element in negotiating with the Snake Indians for horses and transporting cargo via boat. One of the stories that stands out to me is the moment Sacajawea spoke up for herself. Lewis and Clark had decided to go see a whale on the coast for its blubber, which they were using as food. When Sacajawea found out that she wasn’t invited, she let it be known with intense conviction that she be permitted to go. She hadn’t travelled a long way not to see the coast or the whale. Her request was seen as reasonable and was granted. Unfortunately, by the time they got there, the whale had already been stripped to its skeleton.

I think the message here is that you should really want an interpreter who has their own voice and is not afraid to stand up for what is right. There shouldn’t be fear in the SLP and interpreter relationship; there should be mutual respect. I think interpreters are golden, and it is no wonder Sacajawea was commemorated on the golden U.S. dollar alongside her son Jean Baptiste, who also went on to become an interpreter. This means that we have two interpreters on U.S. currency and yet I feel that we are still far from appreciating the role of the interpreter as they are respected in other parts of the world. The unfortunate part is that Sacajawea was not paid for her services, her husband was, something which Clark later regretted. Don’t be afraid to break the glass ceiling, sometimes being outspoken is the only way to get what you want. The fact that Sacajawea spoke out symbolizes her fearlessness to overstep her subordinate position into a position of respect. She really surprised the expedition and gained their respect for it.

Recordkeeping

One of the things I would like to see improve is having interpreters help SLPs with recordkeeping and research. The SLP already has a lot on her hands and we get it, from developing the goals, to working long shifts back to back, and having to deal with endless paperwork. This is where we want to help you. We enjoy writing down notes for you while you solve language impairment issues. This is even more important when dealing with a foreign language. We can keep great records of target phonemes or words, including phonemes and words produced by the patient. We are able to liberate your hands while we record any pertinent information you need. It makes us feel useful and it acknowledges our knowledge of the language we are targeting. Ask and you shall receive. I always enjoyed when SLPs would ask me for metalinguistic knowledge. If your interpreter does not know, I think it’s reasonable to request an answer for the next time you see them since they are the foreign language expert. President Johnson did not tolerate a shoddy performance by any professional and had great respect for professional interpreters (Obst, 2010, p. 67). Interpreters have to be knowledgeable about the target language used in therapy. A good interpreter is never finished learning about his or her language. We are constantly learning new words and analyzing the language. If you want to buy an interpreter a gift, buy him or her a notepad; you can be guaranteed that it will be used.

Interpreters as advocates

I want to highlight that interpreters have a code of ethics that they must follow. According to the National Council on Interpreting in Healthcare (2004), interpreters can serve as advocates when a patient’s rights have been violated. Here is a hypothetical situation, if an SLP revokes the right for a patient to receive services in their native language simply because they want the child to assimilate and transition from Spanish dominant to English-only, then this is a federal violation. Or perhaps they revoked the patient’s right to receive therapy in their native language because they dislike working with interpreters and want to have the session all to themselves; this is also a federal violation. An interpreter is fully within their rights to advocate on behalf of a patient when there is clear evidence that the patient was denied any of their rights. If the clinic receives federal funding, then they must rectify the violation in order to avoid losing future funding. An interpreter is within their code of ethics to advocate for a patient even if the company or clinic strictly prohibits an interpreter from interfering in the treatment or diagnosis of a patient.

Mastering the Art of Diplomacy

To me the art of diplomacy refers to the SLPs’ willingness to learn the ways of the target culture. For some interpreters, working in clinical care can be a lot to absorb at first, but we do it. SLPs do a really good job of filling us in on years of communication sciences and speech disorder research, and we are happy to get that education for free. We think that the SLP too can put on the student hat and let the interpreter become the teacher. If the SLP chooses to accept, this could be a beautiful journey towards learning an inside perspective of the target culture, what’s called an emic view with unmatched savoir-faire. If we can help you from seriously embarrassing yourself, then you bet we will. However, we shouldn‘t fear telling you this for your sake. Our relationship should be open. According to presidential interpreter Obst (2010), interpreters would whisper unsolicited advice to President Reagan when he was at a loss for words or because of his hearing difficulties, p. 23. An SLP too might be at a loss for words, for example, a patient might reveal that their parent has died and you might freeze. No fear, we know the perfect formulaic phrase for this: Le acompaño en sus sentimientos (I share your grief). Another example is having to tell a parent that their child has lice. This can be extremely uncomfortable, but a skilled interpreter will know exactly how to approach the situation with tact. Or let’s say that a client began menstruating during therapy, yes, we will know what to do in this case too. We can save your face as well as the patient’s and their caretaker. We know the subtleties of delivering difficult news in a polite manner. All you have to do is say, “I don’t know how to approach the situation without offending, can you help?” We certainly will.

Talking the talk and walking the walk

In terms of speech and diplomatic relations, President Jimmy Carter learned phrases in German that were specially crafted to avoid umlaut vowels and other difficult sounds for English speakers (Obst, 2010, p. 149–150). This showed a willingness to learn about a group’s culture via language. If you want to be accepted into the new culture, you will need to adopt elements from that culture’s language. We can see this when President Barack Obama says Pakistan [ˈpækəstæn] as [ˈpakistan] (Lee, 2009). Friends from Pakistan have told me that they notice this subtlety and that it resonates well with them. President Obama is careful to have his daily briefings include phonetic spellings of names and places and is briefed on how to say them. Not only does this show solidarity, it shows respect for other cultures and their way of life. Obama pronounces the country Chili [ˈʧɪli] as chile [ˈʧile]. Obama even rolls his r’s when saying Puerto Rico. Hillary Clinton too is careful about pronunciation. At her House Committee questioning, she approximated the name for the Libyan Colonel Muammar Gaddafi using a /k/ for the voiceless uvular plosive /q/ used in Arabic. Attempting to use the Arabic pronunciation Qadhafi [qaˈðafi] indicated Clinton’s willingness to relate with Libya and its people. The Pope recently had an interfaith service at the 9/11 memorial in New York City where he greeted leaders from different faiths in their own manner of greeting, whether with a handshake or a bow. This attention to detail makes the Pope a truly cross-cultural figure who understands the importance of fine-tuning communication to his audience. Popes have also been notorious for being polyglots, which is something SLPs can achieve too with motivation and persistence.

Exposing your weaknesses

If your knowledge of a foreign language is weak, you can still use this to your advantage as a tactical skill to lower a patient’s defenses and build trust (Rardin et al., 1988). On the other hand, speaking exclusively in English can display a flair of superiority without a care for learning the foreign language. For example, a diplomat who can speak Hebrew very well might insult an Arab diplomat by talking to him using Hebrew (Baranyai, 2011). It is a sign of good-will to greet a person in that person’s own language. This is especially crucial when working with disadvantaged populations. It will help build solidarity as a community. Miklós Bánffy chronicles in his memoir, The Phoenix Land, that the Hungarian delegation was trying to convince the French president about their cause (as cited in Baranyai, 2011). In their first attempt, they kept things with a Hungarian flavor and the French were not swayed. In their second attempt, they pronounced France with a French accent that invoked the French spirit. Finally, the French changed their perception of the Hungarian’s cause and agreed to their request.

Accepting advice

Interpreters really can be your best friend in avoiding faux pas. In the case of President Carter, his administration refused advice from interpreters at certain points in time (Obst, 2010, p. 161–162). Carter was in Austria to deal with the Russians and was scheduled to make a TV appearance on Austrian TV. Presidential interpreter Obst advised Carter’s administration to thank the Austrian government or at least acknowledge Austria. There was no acknowledgement and the administration was blasted in Austrian newspapers the following day. My mentor Ana Lilian went on a mission trip as an interpreter with SLPs to Ecuador. There, a lady wanted to serve the team breakfast and some of the SLPs thought that they would be helpful by helping her serve. The interpreter asked them to sit down and after they didn’t, she demanded that they sit down immediately so as not to offend the host. In Latin American culture, serving is a sign of respect, so there is no need to get up and help if the host wishes to thank you through this meaningful gesture.

Superstitions

The Hispanic community can be very superstitious too, my grandmother is living proof. We believe in the evil eye so it is not good to overly praise how cute a baby is because we feel that you may be bringing unwanted attention or envy that can attract illness. It is almost impossible not to fall for a baby’s cuteness, but be warned, this could negatively affect your relationship with your patients. This is why it’s good to have open communication with your interpreter so that they can bail you out of messy situations. In this situation, I would advise that the SLP touch the baby’s foot. The physical contact voids any longing you may have had for the baby. This longing could be interpreted as envy and can put parents on edge. Sacajawea told Lewis and Clark to paint the cheeks of people they met with red paint, that this was a sign of peace (Karttunen, 1994, p. 30). I think that if the advice is going to save your life, improve relationships, or make therapy better, you should do it. Faux pas are literally a false step in the wrong direction and once you’ve made it, it is hard to take that false step back.

Ethnography

Part of mastering the art of diplomacy includes knowing about a group’s country, religion, parenting practices, and of course superstitions. A really cool resource is your interpreter, but aside from that, there is also a website that has language manuals for numerous languages and cultural groups. For more information, visit http://languagemanuals.weebly.com/. Here, you can gather a plethora of political information, greetings, grammatical information, cultural trivia, and so forth. With SLPs having such busy schedules, this really is a God sent resource to catch up on everything you need to know, and all during your lunch break. Your best source is still an interpreter because you have them by your side, and may I remind you, their inside information does not cost any extra. Interpreters offer this at whatever rate you pay them, all you have to do is be inquisitive and ask questions.

In order to truly master the art of diplomacy, you have to be moldable and accept the internship that is possible with an interpreter. Have an honest conversation with your interpreter and tell them that you are open to experiencing a cross-cultural lesson that will last a lifetime. In fact, this was a requirement in my graduate program. I had to seek a person from another culture and submerge myself in their everyday lifestyle. This included a new diet, religious services, prayers in a foreign language, greetings, fashion, investigating wedding practices, and so forth. It can be done. Think of it as course that you can’t afford to fail. Another thing I would recommend is shadowing the interpreter in the way they communicate with patients or the caregivers. This includes body language, gestures, proximity in standing or sitting, and even physical touch. Expect to be corrected and be thankful for it.

Speaking directly to the patient

There will be times when an SLP will ask an interpreter to relay a message to a parent instead of the SLP talking directly to the parent. This is a flaw in clinics not providing training for SLPs on how to effectively work with interpreters, and ultimately, it falls on the interpreter to correct in order to maintain cordial relations with all involved. Not talking directly to the patient will lead to distrust, so speak to the patient as if they can understand you and you can understand them. Fake it till you make it. When an interpreter is put in a position of correcting the SLP, it makes them feel uncomfortable. We feel like we are correcting the SLP before we even get a chance to know them. We do not like to start off on the wrong foot either. This can lead to further trust issues between the two, but interpreters are skilled at delivering all sorts of news. Nevertheless, SLPs do need to be open to criticism in order for the mentorship to work. An interpreter is expected to faithfully recreate a message, without omissions, additions, or distortions, and it must be delivered in the same tone of voice, retaining points of emphasis, humor, irony, and relevant nuances (Obst, 2010, p. 42). Ask the interpreter if you need to slow down or speed up, they will let you know otherwise. Even President Reagan accepted unsolicited advice from presidential interpreter Obst on how to deliver a speech in Berlin (Obst, 2010, p. 208). A trust issue that arises is the question, “Is the interpreter interpreting faithfully?” This may not always be easy to figure out, but you can always ask the patient to summarize the message back to you. Asking patients to repeat messages is also good for ensuring comprehension.

The Community Language Learning Approach

Lastly, we discuss the Community Language Learning approach. This style of learning a foreign language was developed by Charles Curran in the 1960s. It is a fusion of social psychology and language acquisition that has had success in reducing speaker anxiety. The way that it works is interesting. You have a group of language learners who say in their native language whatever they wish to learn in the foreign language. The teacher then interprets the native language into the foreign language. The students then repeat the translation, which means that they are paying attention and noticing the nuances (Schmidt & Frota, 1986; Schmidt, 1990). Doing this increases the likelihood of acquiring those language forms. These are all psycholinguistic principles that are essential for second language acquisition.

The students become a community of learners and this provides a non-competitive atmosphere with a sense of involvement and a sense of equality. The teacher does not control the conversation and the content is based solely on what the student chooses. I think that this approach is perfectly suited for the SLP and interpreter relationship, as it is already occurring. In this scenario, the SLP is the student and the interpreter is the teacher. The person who controls the conversation is the SLP. The SLP, the interpreter, and the patient form a community. It is here that the SLP acquires the language that she herself has chosen for her patient. The process is made better through note-taking, which the interpreter can gladly do. The SLP can review these notes at a later time to review the plan of care that she created for the patient.

This approach offers ways for increasing trust between the student and teacher. For example, you can play games together, as you probably already do when doing therapy with the patient. I particularly like the HedBanz game where every player wears a headband with a picture card on it that they can’t see. Any game that includes all three individuals will lead to increased trust. Also, it is normal for the SLP to feel anxiety when learning under the mentorship of an interpreter. Because the interpreter is the foreign language expert, the SLP might block herself from accepting the interpreter’s help due to hostility arising from the anxiety and lack of foreign language skills (La Forge, 1971, p. 54). This psychological conflict is a normal part of the first stages of learning. Do not worry, this is why the interpreter is with you, to mentor and encourage the SLP to excel in therapy and to acquire the L2. Sharing feelings of anxiety and frustration with the interpreter about learning the foreign language can help you lower your defense mechanisms and lead to trust. This is why people often immediately admit a lack of foreign language knowledge when attempting to use that particular language with other more skilled individuals, because it defends their ego and it creates a secure and non-threatening environment in which they can practice (La Forge, 1971, p. 52–53). The Community Language Learning approach will require you to be cognizant of the types of information your patient will learn and subsequently the type of information you will be rehearsing as well.

Foreign language pronunciation

Clinical assessments are serious matter and it is important for an interpreter to be honest if things aren’t running smoothly. I have administered numerous clinical assessments alongside SLPs who spoke the foreign language without my assistance at all. Some SLPs do a fine job and are highly comprehensible, but others were not sufficiently comprehensible. This is where I have stepped in and said politely that the patient is not understanding their prosody or pronunciation. By the age of one, children have already tuned into their native language’s phonemic inventory, which is called “perceptual narrowing” (Werker &  Tees, 1984). This can make it difficult for children and adults to comprehend an SLPs phonemic sounds and intonation if they don’t have sufficient practice in the foreign language. A willing SLP will not be offended by this suggestion and will take the opportunity to see where they were pronouncing things differently. This is called tuning it for “mismatch” and noticing of the mismatch may lead to restructuring of the interlanguage (Færch & Kasper, 1986). On other occasions, SLPs I’ve worked with did possess the necessary language skills to administer the assessment in the foreign language, but were hesitant of expressing that independence. I have pushed SLPs to administer the assessment in the foreign language by simply telling them that I thought they were ready. I’m there for backup just in case and soon enough they do gain confidence. This is a mentorship and it’s a healthy relationship between a student and teacher. So just ask, “Will you be my teacher?”

Becoming a bilingual service provider

Sometimes the SLP will simply be content in not desiring to learn the L2 at all, and that is fine too. Other times the SLP acquires the L2 so well that they can do the entire session without speaking in English at all. ASHA defines a bilingual service provider as someone who can speak or sign another language with native or near-native proficiency in lexicon, semantics, phonology, morphology, syntax, and pragmatics during clinical management (ASHA, 2015). They must have the specific knowledge and skills necessary for the services to be delivered. I know of SLPs that have achieved high-proficiency in Spanish by asking questions and accepting the mentorship made possible by the interpreter, but it doesn’t happen overnight. If you ever do decide you want to go solo, you can take a proficiency test provided by the American Council on the Teaching of Foreign languages, also known as the ACTFL oral proficiency test. ASHA does not require proof, but the option is there if you’d like validation. The research indicates that there is a growing shift away from the native speaker model and more towards comprehensibility. Advantages provided by non-native teachers include a higher level of language awareness (Llurda, 2005) and the ability to predict language difficulties students will encounter in the process of learning (McNeill, 2005). I look forward to seeing how ASHA’s bilingual service provider criteria might change in the future.

Premature independence

Now, I want to warn about the pitfalls of early independence, that is, an SLP doing the entire therapy session in the foreign language without assistance from the interpreter. I have noticed that sometimes this can lead to watered down input for the patient as opposed to comprehensible input for the patient, which is one level above a person’s current comprehension level (Krashen, 1977). The SLP may be speak the foreign language without errors, but it may be too simple for the patient. The patient will require more advanced language forms in order to continue developing his or her language repertoire. This is why it is good to switch some sessions to where you decide to speak in the foreign language 100% of the time, and on other sessions revert to your native language and have the interpreter interpret. This way you can hear for novel ways of saying what you may not have considered before. It is a good way for you too to develop your foreign language skills. Just as an interpreter never stops learning, neither does an SLP.

Morphosyntax acquisition research

When it comes to morphosyntax acquisition, a pitfall that I have witnessed involves a misunderstanding of how to interpret from English into the L2 in speech-language clinical treatment. This is a mistake performed by both SLPs and interpreters. In regards to Spanish, the male and female definite articles are produced with occasional errors by children at age two. According to López Ornat (1994), it is not until age three to four that children have a good grasp of gender agreement with inanimate nouns (as cited in Montrul, 1994). Sometimes, an SLP might simply talk to a patient using single-word utterances, such as “dog” and “cat”. The interpreter might simply say “perro” and “gato” without the articles, or the SLP might be independent in the session and also omit the articles. Either way, this becomes a comprehensible input issue because the patient is not receiving rich input for language enrichment. As mentioned, the Spanish definite articles are crucial in the morphosyntax acquisition process, so use them whenever possible. The simple solution would be to speak in multiword utterances in order to avoid instances where crucial language elements might be left out.

My last tip for acquiring the foreign language used in therapy is the usage of motokinesthetic tactics to retain learned words. If you just learned the word for short sleeve, feel up your arm and repeat the word for it. Incorporate music in your sessions, we all know the wonders of music therapy on stroke patients and children as well. Listening to music in the foreign language will help us tune into the rhythm of the language. As an interpreter, we want to build a strong relationship with you that will lead to excellent patient care, continued self-improvement, and a collaborative partnership. Thank you so much for your attendance. Are there any questions?

Q&A

Q: (Male) Where can I find sociocultural information on Indian people (Asian Indians, East Indians, South-Asian Indians)?

A: I’m not sure about Indian sociocultural information. Li-Rong Lilly Cheng has done great research on Asian cultures. Check the language manuals I referenced in the speech. Visit worldcat.org and do a search for books on the subject using the keywords: ethnography, sociolinguistics, sociocultural, cultural perspectives, etc.

Follow-up answer: Read “Culturally competent care at the end of life: A Hindu perspective” by Shanmugasundaram, O’Connor, and Sellick (2010) in the Journal of End of Life Care, volume 4. Also read “(Asian) Indian health beliefs and practices related to the end of life” by Bhungalia and Kemp in the Journal of Hospice & Palliative Nursing.

 

Q: (Female) How can I work with interpreters from agencies who are set in their ways and don’t want to provide cultural explanations?

A: Talk to them in a friendly manner and explain that this information is really important for you to help the client and establish trust with the client. Show the interpreter a willingness to learn from them and show respect for their cultural expertise.

Follow-up answer: If this tactic does not work, call the agency and explain what your interpreting needs are. The agency’s job is to provide interpreting services through skilled interpreters and cultural brokers. As the customer, you should be able to request an interpreter who can meet your language and cultural needs.

 

Q: (Female) How can I work better with interpreters through video remote services?

A: Before you meet with the patient, conduct a meeting with the interpreter to explain fully the patient’s background and their plan of care, what type of therapy you will do on that day, and the type of guidance you are specifically needing from the interpreter to do an excellent job.

Follow-up answer: Since video remote interpreting (VRI) is a growing and uncharted area in the research, I contacted ASHA’s Survey & Analysis department and ASHA’s Office of Multicultural Affairs (OMA) on future questions in surveys regarding types of interpreters used by members. I received a response from both ASHA’s Senior Research Statistician Dr. Jeanette Janota and ASHA’s Director of Multicultural Resources Karen L. Beverly-Ducker. Both members said that they would include the questions in the mix of submitted questions for the upcoming ASHA surveys. Although space on the surveys is limited, they wrote they would be persistent and find ways to collect this information. Let’s pray that some of the questions submitted will be approved.

Thank you for being part of my seminar, Strengthening Relationships with Interpreters While Mastering the Art of Diplomacy.

 

Further readings

Cheng, L.-R. L. (1991). Assessing Asian language performance: Guidelines for evaluating limited-English proficient students. Oceanside, California: Academic Communication Associates.

Langdon, H. W. & Cheng, L. L. (2002). Collaborating with interpreters and translators: A guide for communication disorders professionals. Eau Claire, WI: Thinking Publications.

Langdon, H. W. & Saenz, T. I. (2015). Working with interpreters and translators: A guide for speech-language pathologists and audiologists. San Diego, CA: Plural Publishing, Inc.

 

References

American Speech-Language-Hearing Association. (2015). Bilingual service delivery. Retrieved from http://www.asha.org/PRPSpecificTopic.aspx?folderid=8589935225

Bánffy, M. (2011). The phoenix land: The memoirs of count Miklós Bánffy (P. Thursfield & K. Bánffy-Jelen, Trans.). London: Arcadia Books. (Original work published in 1932).

Baranyai, T. (2011). The role of translation and interpretation in the diplomatic communication. SKASE Journal of Translation and Interpretation, 5(2).

Curran, C. A. (1972). Counseling-learning: A whole-person model for education. New York: Grune and Stratton.

Elvira, M. (Writer) (2013). Interview with Frank Vales, Fidel Castro’s interpreter. [Television series episode]. In María Elvira: CNN Latino.

Færch, C. & Kasper, G. (1986). The role of comprehension in second language learning. Applied Linguistics, 7(3), 257–274.

Gattegno, C. (1963). Teaching foreign languages in schools: The Silent Way (1st ed.). Reading, UK: Educational Explorers.

Isaac, K. M. (2005). Managing linguistic diversity in the clinic: Interpreters in Speech-Language Pathology. In M. J. Ball (Ed.) Clinical Sociolinguistics. (pp. 265–280). Oxford, GBR: Wiley-Blackwell.

Karttunen, F. E. (1994). Between worlds: Interpreters, guides, and survivors. New Brunswick, NJ: Rutgers University Press.

Krashen, S. (1977). The monitor model for adult second language performance. In M. Burt, H. Dulay, & M. Finocchiario (Eds.), Viewpoints on English as a second language in honor of James E. Alatis (pp. 152–161). New York: Regents.

La Forge, P. G. (1971). Community Language Learning: A pilot study. Language Learning, 21(1), 45–61.

Langdon, H. W. (2002, April 2). Language interpreters and translators: Bridging communication with clients and families. The ASHA Leader, 7(6), 14–15. doi: 10.1044/leader.FTR4.07062002.14

Lee, C. E. (2009, July 3). Obama a stickler for pronunciation. Politico. Retrieved from http://www.politico.com/story/2009/07/obama-a-stickler-for-pronunciation-024466

Llurda, E. (2005). Non-native TESOL students as seen by practicum supervisors. In Llurda, E. (Ed.), Non-native language teachers: Perceptions, challenges, and contributions to the professions (pp. 131–154). New York: Springer.

López Ornat, S. (1994). La adquisición de la lengua española [The acquisition of the Spanish language]. Madrid: Siglo XXI.

McNeill, A. (2005) Non-native speaker teachers and awareness of lexical difficulty in pedagogical texts. In Llurda, E. (Ed.), Non-native language teachers: Perceptions, challenges, and contributions to the professions (pp. 107–128). New York: Springer.

Montrul, S. A. (1994). The acquisition of Spanish: Morphosyntactic development in monolingual and bilingual L1 acquisition and adult L2 acquisition. Philadelphia, PA: John Benjamins Publishing Company.

National Council on Interpreting in Health Care (2004). A national code of ethics for interpreters in health care. Retrieved from http://www.ncihc.org/assets/documents/publications/NCIHC%20National%20Code%20of%20Ethics.pdf

Obst, H. (2010). White House interpreter: The art of interpretation. Bloomington: AuthorHouse.

Rardin, J. P., Tranel, D. D., Tirone, P. L., & Green, B. D. (1988). Education in a new dimension. East Dubuque, IL: Counseling-Learning Publications.

Schmidt, R., & Frota, S. (1986). Developing basic conversational ability in a second language: A case study of an adult learner of Portuguese. In R. R. Day (Ed.), Talking to learn: Conversation in second language acquisition (pp. 237-326). Rowley, MA: Newbury House.

Schmidt, R. (1990). The role of consciousness in second language learning. Applied Linguistics, 11, 129-158.

U.S. Department of Health & Human Services, Office for Civil Rights Headquarters. (2008, September). May a health care provider share a patient’s health information with an interpreter to communicate with the patient or with the patient’s family, friends, or others involved in the patient’s care or payment for care? Retrieved from http://www.hhs.gov/hipaa/for-professionals/faq/536/may-a-health-care-provider-share-information-with-an-interpreter/index.html

Werker, J. F., & Tees, R. C. (1984). Cross-language speech perception: Evidence for perceptual reorganization during the first year of life. Infant Behavior & Development, 7, 49–63.