Mental Healthcare Interpreting Techniques: Lecture 3

Mental Healthcare Interpreting Techniques: Lecture 3

welcome this is the third installation of this 10 part series on mental health interpretation for medical interpreters as previously discussed mental health interpretation requires different set of tools and techniques that you may not be well versed in as a medical interpreter furthermore there are some essential medical interpreting skills that you have to be even better at in mental health interpretation so that’s what we’re going to go over in this course i wanted to start this course off going over what this course will and will not do this is just as important for me in organizing the course and defining objectives as it is for you so to begin with this course will not improve your memory but it will give you some memory tools to practice while interpreting and point you towards resources for further practice this course will not improve your note-taking but it will make sure you know some common note-taking techniques that you may not have heard of as well as give you resources for how to practice note-taking this course will not teach you everything you need to know about simultaneous interpretation for those of you who are not familiar simultaneous interpretation is when you are interpreting at the same time that someone else is speaking whereas consecutive interpretation which is the default mode of interpretation for medical interpreting healthcare interpreting is when a speaker speaks you take notes you listen then you interpret and then someone else speaks or that same person speaks again so you’re given pauses in between utterances to interpret so again this course will not teach you everything you need to know about simultaneous interpreting the form of interpreting in which you are speaking at the same time as someone else however this course will give you i feel a pretty decent introduction to simultaneous interpreting to medical interpreters who may not be familiar with it we will also for those medical interpreters or interpreters who are more advanced and are familiar with simultaneous interpreting we’re also going to go into some more kind of advanced logistics when it comes to simultaneous interpreting as this applies to mental health to give you a better foundation this course will not increase your proficiency in simultaneous interpreting but it will give you the tools to practice simultaneous interpreting as well as set performance benchmarks to strive towards for mental health interpretation and lastly this course will not give you clear-cut black and white right and wrong answers as to when to use one technique or tool over the other that being said this course hopefully will help you understand what tools are appropriate for different tasks as well as examine your own strengths and weaknesses ultimately i hope that this will empower you to make the best decision for you and each unique mental health interpreting scenario so as i’m sure you were able to put together from the last slide we’ll be going over the following note taking simultaneous interpreting and memory but i like to think of mental health interpreting in this way we have simultaneous we have consecutive note taking is part of consecutive interpreting but memory it has to do with everything simultaneous consecutive and note taking as a subset of consecutive whether you’re engaging in simultaneous interpreting or consecutive interpreting memory plays a huge role this is why we’re going to talk about memory as our first mental health interpreting tool but before we talk about memory i’d like us to think about medical interpreting and how mental health interpreting is different from it this is where the true purpose of these tools will begin to really materialize so patients in mental health settings utterances from patients in mental health settings are typically longer because they may be given more of an opportunity to speak openly and often the things they talk about are emotionally charged whereas you might be able to stop a patient in a medical setting from going on a long diatribe about objective physical symptom reporting you may not be able to interject and stop a mental health patient from going on an emotionally charged rant and it also may not be appropriate interpreting for mental health patients with severe psychiatric illnesses can be especially challenging to interpret for because they may have a high level of disfluency and or they may be experiencing reality differently leading to symptom reporting and recounting of events that may not always make sense so in general in a medical setting providers usually they just want to know your symptoms and how and when they started they have little interest in irrelevant information so medical providers generally have this inclination towards objective and quantifiable things they like to ask yes or no questions questions like on a scale from 1 to 10 they like to hear timelines things like that this approach is something that i found psychiatrists also tend to do which makes sense because as we discussed in the last installation of the series psychiatrists are doctors however in mental health interpretation we really don’t know what’s irrelevant and neither does the provider until they hear it so typically a mental health provider kind of has this question floating around in their head what what is irrelevant what is relevant we don’t know but we’re gonna find out together so they have this inclination towards these kind of subjective and nebulous open-ended questions medical providers typically want very concrete answers in most cases phrasing isn’t painstakingly purposeful though it is still important to interpret accurately and completely because lack of precision in phrasing may still yield certain undesirable results that you’re not in charge of controlling so medical providers outside of mental health are more likely to cut patients off to kind of get to the bottom of things and they like to lead the conversation and if long responses do occur in a medical setting in a general medical setting they’re not typically analyzed in detail providers what they’ll do when they hear a long response is they’re going to try and distill necessary information from that long response so we talked about medical providers and the questions that they typically ask now again this is not representative of all medical providers but just kind of narrowing it down making generalizations and trying to really get to the heart of the matter of how mental health interpretation and medical interpretation are different and how the utterances from providers are different so mental health care providers typically the way that they phrase things are laden with purpose in an attempt to elicit a certain type of response or get a certain type of answer mental health care providers also encourage open-ended detailed answers and they pay very close attention to many aspects of those responses and as a result things tend to be more subjective than objective so kind of the opposite of medical interpreting and medical utterances from providers from medical providers so how does this play into memory how does memory play into mental health interpretation in all reality memory is your biggest asset in mental health interpreting because one of the differences between medical and mental health interpreting is that mental health interpreting typically has longer utterances and the qualities of those utterances such as tone disfluency register speech those can be incredibly important to a mental health provider so we have longer things we have to remember and interpret as well as a lot of extra information we need to be processing and remembering to interpret accurately and completely all of this translates to memory being a huge asset to mental health interpreting and as i discussed previously this is integral to both consecutive and simultaneous interpretation so if you find yourself saying at this point oh no i have a horrible memory first off you need to stop that’s not true as an interpreter you likely have a better working memory than most otherwise you probably wouldn’t be able to do what you do this kind of attitude is setting you up for failure and it’s just as damaging to your potential for growth as thinking my memory is perfect and i don’t need to improve it pro tip your memory isn’t perfect and there’s always room for improvement so i’m going to go over some common memory techniques that will help you with your interpretations in general and in mental health interpreting as well as ways that you can actively practice working on your memory as it relates to interpretation so this isn’t necessarily a memory technique but it’s actually really important lack of sleep can affect your cognitive abilities you want to make sure you start off on the right foot with your memory by getting enough sleep if you know you’re going to be interpreting for a long mental health assignment tomorrow you’ll want to make sure you sleep well tonight we should all be on our best game when we’re interpreting regardless of the specialty but self-care is the cornerstone of mental health interpretation a later installation of this series will touch on self-care in more depth but getting a sufficient amount of rest is essential to ensuring you’re setting your memory up for success in fact there is a decent body of research supporting the idea that naps can actually improve your memory napping can boost certain cognitive functions such as memory better than others according to nasa even an ultra short period of sleep that’s as little as six minutes is sufficient to enhance memory processing the big takeaway from this is you need to try and sleep well but if all else fails a nap can’t hurt when it comes to starting your memory skills off on the right foot so now we get to the heart of the matter the real memory tips i’m very proud of myself this is my second slide in a row with a cat on it first we’re going to talk about visualization really quick so the way that i initially memorized the spanish word garapatta which means tick was to imagine a tick hanging on to so the verb agar means to hang on to an animal spata or paw to this day even though i immediately recall the word without having to think about it i still automatically picture something i doodled to remember the term if you’ve never heard the word carrapatta before today and you aren’t a speaker of spanish it was probably nonsensical to you when you first heard it it’s abstract but attaching images gives it meaning and makes it easier to remember there are many different ways to visualize and some memory experts actually have entire systems based on visualizing numbers playing cards and other boring things that are difficult to remember if you’re stuck without a notebook unable to engage in simultaneous this happens to me often in inpatient mental health settings visualization is one of my most powerful tools really picture things as people say them this is also an excellent tool to combine with note taking as you create more and more abstract representations of concepts next up engage the senses visualization works because it engages the senses even if it’s just a mental picture you’re concocting it still activates the visual portions of your brain just like imagining a flavor would light up the areas of your brain responsible for taste and if it’s a good flavor it might even make your mouth water if you find that visualizing isn’t your cup of tea try a combination of other senses do you ever smell something and are immediately flooded by memories this is because the brain begins the memory and coding process via sensory input hearing taste and smell are all good points of reference this is a little strange but i associate the number eight with buddhism because of the eightfold path which is the road map to the path to enlightenment and buddhist philosophy i could easily conjure up an image of the buddha meditating or i could imagine the sound of a singing bowl or bell used during meditation it’s a very distinct sound on its own it may seem silly to have to think so hard about the number eight but if i have a strategy for remembering the other numbers i can easily begin to remember long strings of numbers by utilizing the senses i associate with each one my next tip sounds ridiculous but you gotta be ridiculous the weirder the funnier the more profane the better when it comes to remembering things these are the things that stand out in our minds we’ll stick with my lovely parasite example and get into how i originally got myself to remember the term for laos which is singular for lice in spanish pyojo i literally imagined a little louse hanging off a string of hair in front of someone’s face like tarzan not only that i imagined the laos doing the unimaginable peeing in that person’s eye that laos did what well the spanish word for i is and you certainly don’t want a laos peeing in your it was brilliant and to this day i still sometimes chuckle to myself when someone says piojo i still automatically remember it but that image it’s there it’s stuck now if a provider’s impossibly long name sounds kind of like something funny or profane don’t push that thought out of your mind because it’s quote unprofessional definitely keep it to yourself but use it to help you remember that name now this should be a tip that hopefully we’re all familiar with but chunking is basically splitting things up into easier to remember parts so we go with the phone number 555 seven five three zero nine okay if we remember each one of those numbers separately it’s a little difficult but if we say 555 867 53 09 that’s called chunking that’s splitting things up in these easier to remember chunks doesn’t have to be with numbers it can be with utterances too let’s go with this example i was sitting in my room watching my favorite movie and eating popcorn when all of a sudden my dad burst in and began yelling at me i couldn’t even understand what he was saying because he was so angry it turns out my dad thought i drank the last of the milk and he needed it to make dinner but i didn’t so he can split it up i was sitting in my room watching my favorite movie and eating popcorn you can even visualize this visualize the action so this is where we start combining methods next part all of a sudden my dad burst in and began yelling at me i couldn’t even understand what he was saying because he was so angry you picture that action going on and then the next chunk my dad thought i drank the last of the milk and he needed it to make dinner but i didn’t it’s all about splitting it up and easier to digest and easier to remember chunks and chunking is especially important for note taking which we’ll get to in a bit restructuring i feel like this is actually underutilized a lot restructuring is flipping things around in a way that is more natural or easier to remember of course you can’t do it with anything sequential where the order is incredibly important but let’s say let’s say a provider is explaining a condition and then they rattle off this long list of symptoms at the end now you’re very familiar with this condition and the explanation that was given but the symptoms are very specific and it’s a long list to have to remember now chances are that explanation of the condition that you’re very familiar with won’t fade from your memory as quickly as that really specific list of symptoms if at all possible you may want to interpret the list first then the explanation of the condition especially if you’re interpreting consecutively and can’t take notes again this happens to me often in inpatient settings now as i said if you really want to give your memory superpowers you can combine different memory methods i spoke about combining visualization with chunking you can restructure and engage the senses at the same time if you have a long list to remember and to take it a step further to really make these things go the extra mile you can combine memory methods with other tools in your interpreting toolbox like note taking or simultaneous interpreting some things are just better suited for note taking while other things are better suited for memory tricks and other things are better suited for simultaneous interpreting but how do we practice memory everyone wants to know okay so what do i do to get better we all want actionable things so if there is a memory method a tip that was mentioned that you’re interested in but maybe don’t have a full grasp on do some research on it some other memory methods that i did not mention but that you can definitely look into and are very popular are the linking or story method as well as the memory palace so these are actually tools that folks who are professional memorizers people who memorize entire decks of cards for competitions these are the tools that they use now a lot of these tools are not going to be efficient enough for you to use regularly unless you practice them but once you reach a level of proficiency and start incorporating it into your interpretations you’ll get even better at it through use a lot of folks talk about these brain training apps you’ve probably heard of them they’re called sometimes brain training apps or memory training apps or games and a lot of people wonder if they really work maybe yes maybe no there’s no real consensus among the experts however many of the experts who disagree with the efficacy of such apps state that they can help you to be proficient in tasks that most people aren’t going to find useful like remembering long lists of items basically those apps only make you efficient in the tasks they train you in but we’re not most people we’re interpreters we do a lot of tasks that the typical person doesn’t have to do and some of those tasks in those apps may be beneficial for us to practice so my opinion is it certainly couldn’t hurt but i think shadowing and practicing the mode of interpretation in which you struggle with memory is more likely to yield benefits so what is shadowing well we’ll get into that right now shadowing is useful because the first step to being able to remember something is to listen and pay attention shadowing is repeating back what you hear in the same language so before we even focus on the rendering of your interpretation into the target language you need to remember all the important details of the source language which is why shadowing is a fantastic way to work on this i’ll admit when i hear something and i’m aiming to repeat it my brain is immediately hardwired to spit it back out in spanish shadowing can be strange and feel almost unnatural to some of us but it’s an excellent way to really drill down to finding gaps in your memory skills to really highlight why shadowing is important i’d like to give an example of my stepson completing a math problem he’s 10 so he’s in fourth grade and does a lot of long addition and subtraction i often explain to him the importance of showing his work because if he ends up with an incorrect answer it makes it easier to go back through the steps to find out exactly where he went wrong so shadowing is like going back to step one of interpreting if we have to go back and figure out why our interpretation was incorrect or lacking we have to peel away all these layers and steps shadowing enables us to cut through the fluff of interpreting and really focus on our raw memory and attention skills getting better at shadowing not only improves your memory but your ability to critically analyze speech because an utterance isn’t just meaning register and tone it’s also grammar speed accent disfluency figures of speech and so many other things coincidentally these are all these elements of speech i just spoke about that are usually laden with purpose in mental health interpretation so when it comes to shadowing the way to practice it the way to do it is just to listen and repeat you can shadow consecutively which is a great way to practice your note-taking but you can also shadow simultaneously which helps you build up your decollage which is something we will talk about soon so now that we’ve gone over memory and shadowing let’s move on to the modes of interpretation in medical interpreting we generally stick to consecutive interpreting because it prioritizes accuracy over speed we’re given time to really think about utterances as they occur and are also given time to give our rendering our interpretation of what we heard simultaneous is rarely seen as preferable in medical interpreting except in settings like the emergency room where time is often of the essence i personally engage in simultaneous and in-person medical situations where the rendering of my interpretation must be quick or the patient will be in danger a great example of this is in physical or occupational therapy in which sometimes the rapid delivery of your interpretation can prevent your patient from losing their footing or falling for example now simultaneous prioritizes speed but this can affect accuracy this is why in legal interpreting which is typically conducted mostly in simultaneous mode consecutive interpretation is actually preferred for witness testimony to ensure the highest degree of accuracy of their statement now before we delve in depth into consecutive and simultaneous interpreting in mental health settings we really need to talk about remote mental health interpreting because typically what ends up happening is most mental healthcare facilities or facilities that provide mental health care services they rely on medical interpreters for the provision of their interpretation services so what does this mean for remote interpretation remote platforms and interpreting modalities are optimized for consecutive interpretation not simultaneous interpretation when they’re designed for medical interpretation so we have these mental health facilities or departments utilizing medical interpreters which then utilize remote platforms that are optimized for consecutive medical interpreting it even goes so far as some companies that provide medical interpretation services remotely prohibit their contractors or employees from engaging in simultaneous interpretation ideally remote simultaneous interpretation will occur on what’s called an rsi platform or remote simultaneous interpretation platform such as interprefi kudo voice boxer things like that a lot of people think of zoom for this but zoom is actually a video conferencing platform it now has interpretation add-on features but typically less features than these rsi platforms but more than remote vri video remote interpretation or opi over the phone interpretation platforms designed for medical interpretation so these platforms have additional features that facilitate simultaneous interpretation they’re really designed to replicate conference interpreting booths but these opi vri platforms for medical interpreting typically do not have these features making an already difficult task for the interpreter even more difficult the remote medical interpreter has a hardware setup that is optimized for listen interpret listen interpret not listen interpret simultaneously typically the settings in which rsi or remote simultaneous services are used are conferences or meetings in which they have the audio from the interpreter set up in such a way to where the interpreter can be heard clearly by lep participants in online conferences leps can tune into their language’s audio only just that audio however in a medical or mental health setting for video remote interpretation or vri you have the provider and the patient on the screen the provider and the patient take turns talking hopefully while the interpreter interprets but the interpreter has to compete with the volume of whoever’s speaking which is very difficult to compensate for remotely a very similar thing happens with opi or over the phone interpretation you’re still competing with the volume of the person speaking and then you might even have a situation where both participants are on separate phones so in that case both the speaker and the interpreter will likely be heard at the exact same volume or relatively the same volume by the other participant gets really difficult to engage in remote simultaneous interpretation through a medical interpreting platform so is it possible to engage in remote simultaneous interpretation on a medical interpretation platform i really don’t think that’s the question we need to ask here is it possible to do it well at the end of the day the accuracy and completeness of our interpretations is paramount i truly believe that even the best simultaneous interpreters cannot interpret both accurately and completely with these technological limitations even if your interpretation is rendered perfectly the ability for the patient or provider to hear you with that issue of the competing audio can ruin it as i’ve stated before many of the remote agencies with which i’ve worked list as part of our requirements that we are not to engage in simultaneous interpretation some agencies that offer remote medical interpretation even explicitly state on their website that they do not offer remote simultaneous interpretation that only consecutive interpretation is possible with the platform that they use there’s a reason why legal interpreters typically do depositions on rsi platforms and medical interpreters rely on opi or vri platforms and medical interpreters are typically used in mental health settings especially because interpreters are either sought after by the facility through an agency they have a contract with or because the health insurance company is requesting an interpreter through an agency with which they have a contract until mental health interpreting is considered to be a discipline apart they’ll rely mostly on us medical interpreters to provide those services so the assumed default mode of remote interpreting will be consecutive speaking of the assumed default mode of remote interpreting consecutive interpretation or consecutive interpreting let’s go ahead and talk about consecutive interpretation the default mode for medical interpreting this will be the default and likely only mode of interpretation you will use for remote opi over the phone interpretation or vri video remote interpretation and mental health scenarios however for in-person interpreters is it possible to stay in consecutive the entire time you’re interpreting for a mental health encounter technically yes but i truly believe that the most efficient way to interpret for most mental health assignments is to utilize consecutive and simultaneous when appropriate so if you’re inexperienced and simultaneous and don’t feel comfortable engaging in it you must become incredibly proficient at consecutive interpretation to effectively engage in mental health interpretation and in terms of improving your consecutive interpretations note taking is the best way the best way aside from practicing your consecutive note-taking is in my personal and professional opinion the best way to improve your consecutive interpretations i’ve noticed though that lots of in-person medical interpreters don’t even bring notebooks or take notes now you may be able to get away with this in medical interpreting though i’d argue that it’s not a wise way to go about doing it but to each their own it’s simply not an option again in my personal and professional opinion in mental health interpretation because you have longer utterances there are more qualities of speech to be remembered such as tone disfluency all those things we’ve gone over previously and it’s not really as formulaic or predictable as medical interpreting so if you’re one of those medical interpreters who never ever takes notes you’re going to be very far behind when it comes to what i recommend in this presentation if you’re a remote interpreter chances are you’re a proficient note taker so you have a leg up if you’re still not sold on note taking i’d like you to as bill nye would say consider the following in your short-term memory you can only store six to seven chunks of information whereas if you engage in note-taking it’s almost as if you have this sort of external brain where you can store information and then all you really need to store in your short-term memory are all of those sorts of linking ideas the ideas that tie everything together that you have on the page i consider myself proficient in note-taking and the techniques mentioned thus far in this presentation but i decided to consult with a colleague of mine who i consider to be an expert in note taking you may have heard of her nanji mateo luciano so these are some of her biggest pieces of advice when it comes to note-taking just one note about these techniques as with everything mentioned during this presentation no one is saying you must engage in all of these techniques this is very much along the lines of take what you like leave what you don’t while these suggestions are based on the experiences of two practicing medical interpreters who engage in mental health interpretation and the techniques that work for us we realize not everyone is going to have the same approach and that’s okay because we all have different strengths and weaknesses but don’t knock them until you try them first off you need to know your memory retention limits if you don’t know how long of an utterance you can listen to without taking notes chances are you’re not going to know how long of an utterance you can listen to and interpret while taking notes it’s very important that you know these limits how far can you interpret how long of an utterance can you interpret in the consecutive mode without taking notes and how long of an utterance can you interpret while taking notes you also need to be efficient now being efficient doesn’t just mean doing it quickly it also means that you make efficient use of space so one thing that i’ve noticed is if you’re not making efficient use of space you’re going to have to turn pages more often you’re going to need more space more quickly which means that you’ll have less time to write notes so ideally you should be writing small enough to conserve space but large enough to where you can see what you’re writing another thing that many interpreters do that i personally find helpful is dividing the page you also in terms of being efficient want to write in the language you hear that’s extra cognitive load for us to go ahead and translate what it is that we’re hearing onto paper into our target language next handling repetitions when someone repeats something especially if they repeat it often you need to have strategies for repeating things now when i spoke with nanji about this she called this linking where you draw a circle around the utterance and you draw a line down to show where that utterance is being repeated and you can do this as many times as you need to on the page what i do is let’s say a patient is engaging in echolalia the patient just repeats the same thing over and over again or they have one of those kind of catch phrases that they say every so often you know what i mean is a common one you can just put it in entire quotations just put two quotations if the entire utterance is being repeated another tip that you should already be familiar with is making use of symbols and acronyms so most of your notes should be symbols not words and you can use compound symbols for a variety of purposes you want to make sure to avoid these sorts of ambiguous acronyms such as i have here pt so pt can mean patient it can mean physical therapy i’m sure there are plenty of other things that pt can mean so when you’re writing your notes especially if you’re writing a long string a long utterance you might find that your brain might automatically go to patient when you mean pt especially if you go back to the beginning of the utterance to the beginning of where your notes begin after having listened to a very long utterance that you’ve taken notes on and something that asl interpreters do that’s really interesting this is something that one of my asl interpreter friends spoke to me about is that what they do is they set up this sort of room or space especially if a series of events is taking place in it so you can even use or manipulate symbols for actions that take place for instance around this room so often times when people recall traumatic events it’s amazing the details which they they do so typically and sometimes they may even stop to explain the layout of an area to give you a better idea of how the events took place in that space so then you can mimic on your notes the layout of the space and then you can manipulate symbols you can put symbols in different places to indicate movement to indicate where things happened in mental health interpretation you’re also going to want to use and learn common mental health abbreviations so we have adhd bpd g a d s a d c b t if you don’t know what these acronyms mean you need to learn mental health acronyms the next thing you’re going to want to do again this is something you should be familiar with but you should definitely be chunking and segmenting we’ve spoken about chunking before but this is chunking in terms of note-taking where you split an utterance up into three main ideas especially if it’s not too long of an utterance so kind of at a macro level drawing lines between utterances is a form of chunking or segmentation you also should be considering verticality and shifting you need to group concepts on the same vertical level lists should always be vertical we’re used to writing lists this way and you need to be taking notes on chunks of information not every little teeny tiny detail you need to let your memory fill in sort of logical spots in between and definitely make sure you have spaces between your symbols and concepts otherwise you may think multiple symbols or abbreviations are part of the same concept you need to interpret and lastly this one’s really important and this is why this is especially why i think interpreters need to make sure that they are taking notes you always want to write numbers dates things that are easy to forget or misremember such as names things that you don’t get want to get wrong such as dosages incredibly important things even if you think you’re going to remember it that confidence can be dangerous we often confidently misremember things and last of all practice practice makes perfect when it comes to note-taking and practicing your symbols the more proficient you become with your symbols and abbreviations the faster your note-taking will be meaning the more notes you can take enabling you to capture more details and rely less on your memory so this is our recap at consecutive interpreting how to get better at consecutive interpretation you need to work on your memory skills the more you remember the less notes you have to take you also need to work on your critical listening skills and speech analysis skills i also mentioned this in the memory section shadowing is incredibly helpful for this and can help you pick up on parts of speech that you tend to ignore perhaps in medical interpreting and as a result tend not to interpret but can be incredibly important in mental health interpretation and then of course working on your note-taking skills and practice practice practice note-taking is kind of like developing your own language and if there’s one thing we know about language is if we don’t practice it if you don’t use it you lose it and then on top of it all really to get better at consecutive isn’t really relying on any single one of these skills it’s combining them you need to combine your memory critical listening and note-taking skills and now we’ve come to simultaneous interpreting for many medical interpreters this is the boogeyman in the room the elephant in the room i can relate when i first saw my mentor and interpreting professor interpret in court i was immediately overcome by cold sweats and my heart beat faster as i thought to myself oh my god what did i get myself into i’m happy to report that i am very comfortable with simultaneous interpreting now even as a medical interpreter most of my simultaneous interpreting occurs in mental health settings but occasionally it does serve me well in general medicine settings for me simultaneous itself isn’t what’s difficult it’s determining when to use simultaneous over consecutive interpreting it’s sort of this kind of instinct or reflex that you really have to develop but kelly i have no idea where to start with simultaneous interpreting remember my interpreting professor i mentioned this is exactly how she taught us so the first step is training your brain to talk and listen at the same time remember shadowing well you don’t have to do it consecutively you can also do it simultaneously find something of a reasonable speed that you can talk over in your native language you should be talking over it with a slight delay by doing this in your native language you are effectively limiting your cognitive load step two increase your decollage what’s decollage you ask well in simultaneous interpreting de collage is how long of a pause there is between an utterance and when you begin to interpret it the longer your decollage the more you rely on your memory and the more accurate your interpretations should be step 3 interpret simultaneously into your target language again you want to find an audio recording with a reasonable speed based on your level of experience and how comfortable you are with simultaneous interpreting but this time you’re going to interpret into your target language depending upon how similar your source and target languages are you may find that you have to allow for longer decollage in order to interpret accurately for instance in spanish one of my working languages adjective order is very different than adjective order in english so if i’m hearing a long string of adjectives i need to wait until i hear the entire string of adjectives before i can interpret accurately into whether it be english or into spanish and step four practice often the thing is is that medical interpreters may go long stretches without engaging in simultaneous interpreting depending upon the specialties they’re working in simultaneous interpreting is one of those skills where if you don’t use it you lose it you’ve probably noticed this if you go any length of time without interpreting or speaking one of your working languages you tend to get a little rusty this happens way quicker with simultaneous interpreting i try to practice my simultaneous interpreting at least once per day but i often do this without actively seeking out practice materials some things i interpret over include tv shows podcasts and even youtube videos that my stepson shows me that i’m not particularly interested in it’s actually a great way to make really boring things more engaging it’s also a great way to learn new vocabulary but how about simultaneous interpreting speeds it’s always useful to know at what speed patients and providers generally talk because a lot of practice resources that i’m about to mention will include wpm or words per minute to indicate speaking speed generally speaking while slower recordings are great for practicing you should gradually work on increasing your interpreting speed and in my humble opinion you should aim to be able to interpret an utterance of at least 140 words per minute my normal speaking speed is somewhere around 180 words per minute so 100 words per minute great if you’re just starting out practicing simultaneous interpretation but i’ll be honest with you hardly anyone will speak at this speed or slower it’s actually quite difficult to do at 140 words per minute i would say that’s the low end of the range of quote unquote regular speaking speed in english now 180 words per minute is the higher end of the range of regular speaking speed in english at least from what i’ve noticed again these are not scientifically validated ranges of words per minute these are my observations in my experience interpreting not just in mental health settings but also predominantly in medical settings so when it comes to practicing simultaneous interpreting there are some resources here the first of which is something this is my youtube channel kgh interpretation i’ve actually for the purpose of this training created three simultaneous mental health patient stories at different speeds so you can go to my youtube channel and listen to those different audios and practice with them another good channel to practice with is nucleus medical media they offer i would say beginner to intermediate videos now the nice thing about simultaneous is that it’s an easily transferable skill from one interpreting specialty to the next so in this case with nucleus medical media you can practice with vocabulary you’re probably already familiar with to hone that skill and then you can use that skill in other areas with different vocabulary such as in mental health interpreting we also have ted med so these are some medical topics they’re more intermediate advanced however they do talk about health topics so because this presentation is geared mostly towards medical interpreters i’m going to assume that you’re far more familiar with general medical terminology than mental health terminology so it may be easier for you to start with some of that medical stuff and there’s also this website called speech pool speech pool is specifically designed for interpreters and there’s different levels there’s beginner intermediate and advanced so this is a collection of different speeches to help you practice interpreting there’s all sorts of different topics all over the place and lots of different accents including accents in english from europe from the united kingdom so this might be a bit of a challenge for some folks especially if you’re not accustomed to hearing english from outside of the united states so next we’re going to move on to the good stuff putting all of these techniques into action in medical excuse me in mental health interpreting settings so the first thing when it comes to putting these techniques in in action the most common question i get is when do i switch from consecutive to simultaneous interpreting well nothing short of telling the future will be able to help you know when a patient is about to go on a long uninterrupted rant however you will get better at the ability to anticipate long utterances over time as well as become more adept at handling them and switching between interpreting modes so these are some key indicators that a patient is about to go on a long rant first we have our verbal indicators if you have a patient starting off with in english or in your other working languages equivalent it all started when well what had happened was or even that’s not what happened or let me explain it to you from the beginning i can’t take it anymore because these are usually pretty good indications that someone’s probably about to go on sort of a long rant and you may potentially not have a chance to interrupt or you might not want to interrupt because if someone is in the middle of an emotionally charged utterance stopping them can be well it may change what they’re going to say and it may even make them upset if they’re very agitated and then some non-verbal indicators that a patient is about to go on a long rant or is about to give you a very long utterance that you’re going to need to interpret so these can be things like appearing to hold in emotions or holding back tears can be rubbing their face or eyes no that is if they have no known irritant causing them to do this not if your patient has allergies if you notice that perhaps your patient or the patient you’re interpreting for is shaking they’re breathing rapidly and there are other signs of anxiety before they’re about to speak especially if that’s not in keeping with their general demeanor if their demeanor suddenly changes another thing that makes sense is a sudden change in tone or volume of voice if the patient suddenly stands up or starts pacing the room really any sudden change in affects and what’s funny is well not funny but what makes sense as many of these signs mentioned in the previous presentation about the interpreting in the mental health care system the united states the section on patient safety i go over the stamp acronym the stamp acronym is another good way to kind of keep it in the back of your mind okay my patient may be on the verge of an outburst or they may be on the verge of what we like to call word vomit they’re just about to start saying a whole bunch of things now of course some other instances in which it’s probably a good idea to switch from consecutive to simultaneous if you can is if the patient begins repeatedly ignoring interjections by the interpreter or provider asking them to speak slowly or to speak in shorter sentences or to give the interpreter a chance to interpret if you’re interjecting and they’re not listening you may need to switch to simultaneous in some cases it may also be an indication that a patient is about to start with a long utterance if they’re repeatedly not responding to the provider’s questions or giving one word or i don’t know answers they may not feel comfortable opening up but then all of a sudden their emotions may get the better of them and they may open like a floodgate so like i said previously this doesn’t really have a clear-cut answer it’s really going to be based on how you feel with simultaneous interpretation and kind of your gut feeling in that situation how do you think the situation is going to progress do you think you’re going to have an opportunity to take sufficient notes for what’s about to be said another question i get a lot is what do i do when my note-taking reaches its limit we all have gotten to that point where you’re taking notes you’re taking notes you’re taking notes and you begin to realize this has been going on for quite some time i wonder when this is going to stop am i going to be able to interpret back everything from my notes because ideally the way that you should be taking notes is not taking notes on every single word that’s being uttered but instead taking minimal notes so your memory is able to fill in the gaps and as i stated previously your memory is going to have limits this can be a really tricky place to end up in it’s really not a pleasant place to be when you begin to have that realization that you’ve kind of reached the end of your limits when it comes to note-taking so the first step if you’re beginning to feel like your note-taking is about to reach its limit you don’t really want to get to that point but as soon as you can you want to try to give a non-verbal cue like raising your hand if this cue is recognized by the patient and they continue regardless immediately switch to simultaneous because they likely will not stop if no one sees your non-verbal cue despite repeated attempts attempt to interject verbally if appropriate now it may be appropriate if the patient does recognize your nonverbal cue and you haven’t previously talked about a non-verbal cue or haven’t agreed upon nonverbal cue like raising your hand then it may be appropriate to interject and give a third person interjection or try to interrupt or interject in some way so you can be given an opportunity to interpret something that a lot of interpreters don’t think about is if the utterance is not chronological like a series of events you may be able to switch to simultaneous in that moment and then what you can do is well that utterance has to end sometime so while you’re engaging in simultaneous you’ll be able to interpret everything that’s stated and then your notes will stay on your paper then once that utterance ends or you’re able to end the utterance in some way shape or form you can indicate in third person that you’re going to interpret the first portion of the utterance you took notes on and then interpret from your notes so as long as the utterance isn’t chronological and there isn’t a particular importance to the order in which groups of things are being said you can save those things that you’ve taken notes on for later if you’ve found that your memory serves you well in those instances but what i’ve encountered is that many times neither patients nor providers are accustomed to someone interpreting simultaneously over them and they may stop talking once you begin talking over them to interpret so all the things that i’ve just mentioned verbal cues are certainly an option but in this instance we’re just going to assume that your note taking has reached its limit and for whatever reason let’s say it be an emotionally charged utterance you’re having difficulty interjecting or are unable to provide a verbal cue so how do we handle speech disfluency or irregular or difficult speech pattern so be warned with this where it says reigning in repetitive speech i was tired of using handling or dealing with for these slides so i employed a little bit of alliteration so some of these titles might be a little funny so first off there’s really no right or wrong way to handle repetitive speech so we have some examples here so let’s look at our first example so you have a patient that repeats the same thing often during the course of their speech and you know i always try to be above all else a positive person blah blah blah et cetera et cetera even when my ex-husband would be really mean-spirited and try to always put me down even when people would be really vindictive at work i’d smile because i always try to be above all else the positive person i certainly had these instances where it’s almost as if the patient i’m interpreting for has a catchphrase and they just repeat this thing it’s peppered all throughout their speech now as far as how to handle this there really is no right or wrong answer but it is incredibly important that you don’t omit these things even though they’re being repeated if you’re interpreting consecutively what you can do is you can simply circle the segment of your notes with this phrase draw a line down and then arrow down to the area where you’re currently at taking notes or if you’re interpreting simultaneously you may be able to quickly jot it down if the patient seems to be repeating it often enough to refer back to so our second example this is with a little bit more disfluency so the patient repeats the same thing over and over again completely unresponsive to repeated questions from the provider provider asks how are you patient responds do you see provider says mrs smith i’m asking how you were doing today patient responds do you see provider asks once again mrs smith are you with us the patient responds do you see now this isn’t what we call echolalia because the patient isn’t repeating what the provider is saying but this could still very well be a symptom that’s why if the patient repeats like this it’s still important to keep interpreting it it’s not your job to determine what is and what is not important to interpret you interpret everything so even in this case the fact that they’re repeating the same thing over and over again you still need to interpret it and i would say you need to be careful of your body language if the provider becomes frustrated with you for interpreting repeatedly what the patient says repeatedly it may be appropriate to switch to third person to remind the provider that you must interpret everything this is where a pre-session is really useful if you mention these things in the pre-session there’s no guarantee that they won’t come up again but you’ve kind of nipped the part you can kind of try and nip the problem in the bud before it becomes but when the patient is repeating things like this like i’ve said i keep on saying that i keep on repeating it imagine that on the slide about repetition it’s important to keep interpreting it even if you get tired of saying it it’s up to the provider to take control guide the encounter and really manage these situations wrestling with rambling so our first situation is the patient or provider is not allowing the interpreter a chance to interpret they just keep on going on and on and and on now if the speed’s not too bad you could certainly engage note-taking and then you can do what we actually mentioned in the previous slide if you discover that your note-taking is going on and on and on and on you’re kind of reaching your limits you can mention some of those things that we did on the previous slide but this is actually a really good opportunity for you to switch into simultaneous interpretation another instance is in which the patient or the provider is speaking so fast that the interpreter can’t keep up now it’s not always possible to interject and say can you slow down please especially if we have those emotionally charged utterances sometimes people just have a hard time slowing down they can’t slow down sometimes folks aren’t really in control of themselves in some of these situations so really the summary of this whole slide is your best bet in mental health interpreting your first line of defense for this aside from interjections if interjections are not possible simultaneous interpretation but what if that fast-paced speech that you can’t keep up with consecutively is actually too fast for simultaneous you’re falling behind you can’t keep up that’s happened to me sometimes but what did i do so if it’s too fast for simultaneous really interjection is going to be your best bet so if a patient is speaking so fast that they’re almost incoherent that you’re even having a hard time absorbing everything that’s being said by the patient i have had this happen as well summary interpretation may be your only option i generally don’t recommend summary interpretation at all because it’s not accurate and it’s not complete but sometimes in mental health we have to lean on these less utilized tools because it’s our only option while we’re still trying to do our very best so that’s just an instance where the speech is so fast that it’s difficult to pick anything out it’s difficult to make sense of it but what if we just generally have a patient that’s engaging in incoherent speech so the patient is completely incoherent and you really can’t understand anything if the patient is just making unintelligible noises that’s one situation that can pop up another situation is in which the patient is partially incoherent so you can understand some of what the patient says but a lot of those in-betweens are really unclear you have to ask yourself this question in both of these situations it’s appropriate to ask yourself if asking for a repetition or clarification will result in improving understanding or will it just start you down the rabbit hole now if the patient is completely incoherent asking for repetitions is less likely to be helpful obviously and it may be necessary to switch to third person to notify the provider that the patient is unintelligible however the more coherent the incoherent patient the more likely you are going to be able to successfully ask for a repetition depending upon the situation providing again a summary interpretation may be appropriate being sure to identify portions that you were able to understand this is where note taking actually comes really in handy a lot and many times experienced mental health care providers will kind of guide the patient through these types of situations so for instance let’s say a patient is crying and as a result of crying they’re slurring their words the provider may encourage the patient to calm down before continuing that really your responsibility to be giving those sorts of suggestions to the patient but you can switch to third person and mention the interpreter cannot understand what the patient is saying because they’re mumbling or something along those lines our next example is called parapraxis what is parapraxis well parapraxis is just a fancy word for a slip of the tongue what a lot of us call freudian slips but how do we handle these and i’ll give you some examples in case you’re unclear as to what i’m referring to so the therapist is seeing the patient for the first time in a long time after a string of missed appointments and the therapist says i’m mad you’re here they probably meant to say i’m glad you’re here but in this instance they say i’m mad you’re here this is an example of parapraxis a slip of the tongue or sometimes what we call a freudian slip okay so in english glad and mad rhyme that’s a pretty simple slip up but what if the patient you’re interpreting for says this but the words are completely different in their language there’s no way that those words rhyme in their source language in the language they speak could that be a slip of the tongue is that likely to be a slip of the tongue or is it something else now i’m not saying that you need to completely interrupt the interpreting encounter to break down the linguistic intricacies of an utterance but it may be useful for the provider to know this is great information to incorporate in a post session if you don’t want to ruin the flow of the appointment especially if you’re just going now when it comes to the post session i have a quick quick little tip about that you really need to be careful about how you engage in a post session you don’t want to give the patient the impression that the provider is sort of gossiping about them with the interpreter that can affect the patient’s relationship with the provider and it can also affect the patient’s trust in you as their interpreter so in this particular case with the provider slipping up accidentally saying i’m mad you’re here and they’re clearly happy to see their patient even if they don’t correct their mistake immediately i would say to interpret it then you try to let the patient work it out with the provider so let’s go ahead and say that at the very end of the same appointment the therapist from the previous example goes ahead and apologizes for their slip up and they attempt to confirm with the patient would you still like to see me next week and the patient says with expense that really doesn’t make sense in english does it no but in spanish con mucho gusto means with pleasure with much pleasure versus con mucho gasto gasto is like expense it doesn’t really make sense but people don’t really say that but this is an instance in which these sorts of freudian flips can play out but sound very strange in the other language so if you were to interpret this literally the provider would be like what you need to clarify these sorts of things this is just how it can look to a patient when a provider slips up you also don’t want to interpret patient slip ups in such a way that it gives a false impression to the provider and they could interpret this in one of many ways so using what we’ve gone over so far hopefully you know what to do in a situation like this the patient for whom you are interpreting suddenly starts crying and relaying a traumatic experience that happened to them in their childhood you can understand everything they’re saying but they’re very emotional and aren’t giving you a chance to stop and interpret consecutively what do you do i’m going to allow a brief pause here but you should pause this video if you need some time to think about it try to consider as many angles as you can what if you’re interpreting remotely how about in person you may need to take an honest accounting of your skill set to determine the best course of action for you given your current skill set how can you be better prepared to handle an interpreting situation like this foreign were you able to think critically about this situation and come up with a solution i know exactly what i’d do in person i’d interpret simultaneously in fact the second the patient started to appear distressed i would likely switch to simultaneous in anticipation i don’t want to be caught in the middle of taking notes and then have to switch to simultaneous of course i would do my very best to faithfully convey tone but if the patient is raising their voice i would only raise my voice loud enough to be heard i’m not there to yell or sob as if the patient is sobbing that’s just disrespectful however what would you do if you were interpreting remotely remember we talked about how even if you’re able to give a perfect simultaneous rendering of what the patient says remotely if you’re using a platform designed for consecutive medical interpretation the provider likely won’t be able to hear you or will hear you at the same volume as the patient this leaves long consecutive as your best option but again you need to know your limits if you know okay when i reach the bottom of this page here my ability to interpret for my notes goes off the deep end then you should gently gently try to give some sort of signal verbal or otherwise that you need to be given a chance to interpret something along the lines of the interpreter apologizes but they need an opportunity to interpret and a gentle voice is an appropriate interjection in most cases of course a lot of this goes out the window if the patient is incoherent and doesn’t respond to commands doesn’t respond to repeated interjections by the interpreter but the thing is is if you try to interrupt the patient and the patient doesn’t stop they don’t allow you a chance to interpret you have to try to do your best to continue asking them to give you a chance to interpret again as long as they’re not completely incoherent all while still doing your best to capture as much as you can be transparent with the provider as i mentioned before then the provider can ask the patient to repeat what they said after the point where your note-taking couldn’t keep up we all know patients change what they say the second time around even if the core meaning is still the same the words are often slightly different and sometimes they leave things out think about it this way if you’re telling your friends a story you’re probably not going to tell them the story the same exact way every time it’s not something you do maliciously it’s just you don’t have that story memorized word for word that’s the only way you’d be able to say it exactly the same way this is why interpreting an utterance the first time around is so crucial but again it’s not always 100 possible i truly believe that an in-person mental health interpretation you have to be proficient in consecutive consecutive note-taking and simultaneous interpretation and each situation can call for mixing and matching of different skills here’s what we’ve done we’ve looked at our interpreting toolbox the following skills memory as this big umbrella that affects everything consecutive interpretation and how you can make the most of note-taking to improve your accuracy and completeness and the boogeyman for many medical interpreters simultaneous interpretation it may seem silly that we’ve spent all this time reviewing what are for the most part these sorts of essential techniques and components of medical interpretation that we should all ideally be familiar with however it’s not uncommon for us to sort of fall into this place somewhere between complacency and well rustiness with the skills we don’t use or practice on a regular basis mental health interpreting isn’t easy and that’s not to say that medical interpreting is but rather you must have a solid foundation and these essential tools to successfully engage in mental health interpreting medical interpreters are utilized heavily in mental health settings so we have to be super prepared to handle anything that might come our way playing to our strengths and perhaps leaning a little bit more on those skills that we are not as well versed in to compensate for other skills that we either can’t utilize due to the mode of interpretation or are not as well versed in so that is all for part three of this installation about mental health interpreting techniques part four we’ll delve deep into mental health terminology we’ll also get into some of the best ways to look up mental health terminology perhaps build your own glossary of mental health terminology some of the best practices for not only finding common translations of terms but also finding definitions and best practices for verifying translations of certain mental health terms be sure to stay tuned for part four of the series coming soon

Get CEUs for CCHI/NBCMI Certified Interpreters: https://www.aalb.org/continuing-education

Lecture 3 of the AALB Mental Health Training Series by Kelly Grzech. This is a continuing education series for certified medical interpreters to gain training on the intricacies of interpreting in mental healthcare settings.

0:00 – Introduction
0:35 – Course Expectations
4:04 – Characteristics of Mental Health Utterances
11:15 – Memory Tips: Visualization
12:45 – Memory Tips: Engage the Senses
14:05 – Memory Tips: Be Ridiculous
15:25 – Memory Tips: Chunking
17:04 – Memory Tips: Restructuring
18:44 – How to Practice Memory
23:07 – Modes of Interpretation (Consecutive & Simultaneous)
26:18 – RSI Limitations for the Medical Interpreter
29:32 – Consecutive Interpretation (Is it possible to remain in consecutive for mental health?)
32:37 – Notetaking & Notetaking Tips
40:55 – Simultaneous Interpreting
44:42 – Simultaneous Interpreting Speeds
48:37 – When to Switch from Consec to Simul
55:50 – Qualities of Speech: Repetition, Rambling, Incoherence, Parapraxis
1:07:27 – What Would You Do?