Imagine living in a place where most people don’t speak your native language, including the professionals who are tasked with making sure you’re healthy — both physically and mentally. This creates a barrier that can prevent you from getting the help you need in some of the scariest of life’s situations. In past articles, we’ve explored the vital work carried out by medical interpreters, as well as by bilingual nurses. But now we’re moving from physical health to the equally important world of mental health, in which sensitive topics make skilled interpretation all the more valuable.
We spoke with Katherine Rappenecker, a mental health interpreter at a clinic in Rochester, New York, to learn about her job and how she’s able to help patients who are at their most vulnerable.
Here’s How It Works
Mental health interpreters are generally considered to be at the same level as medical interpreters, and some interpreters work in both capacities. The job requires a particular skill set and training, as it is more difficult than just simple translation.
“I don’t really consider myself a translator,” Rappenecker explains. “Interpreting is a skill that takes a lot more time to master because we’re interpreting something that’s spoken; we’re doing things live, right in the moment; you don’t know what people might say.”
Rappenecker says there are three interpreters at her clinic, who work with a variety of Spanish-speaking patients coming in to see therapists, psychiatrists and nurses. The vast majority of patients, she says, are from Puerto Rico (Rochester has a relatively large Puerto Rican population, which expanded in the aftermath of Hurricane Maria), though a handful are from other Spanish-speaking countries. Only one of the therapists on staff speaks Spanish, so the interpreters are a crucial part of the equation.
Rappenecker knows most of her patients well, but when a new one comes in, she introduces herself and explains how the session will work: “We’ll be interpreting everything that’s said. We interpret in the first person. Everything’s confidential. Please try to look at your provider or therapist.”
Then the session begins. Rappenecker generally tries to employ simultaneous interpretation: in other words, interpreting what’s being said at roughly the same time as it’s being said — just a few words or sentences later. And for this to work effectively, the seating arrangement matters.
“For me to be able to interpret accurately, I need to be able to see the patient,” Rappenecker says. “I need to see their face, their gestures, their body language. I consider myself kind of like a mirror of them.”
There are options for providers who don’t have a mental health interpreter on hand, like a telephone interpretation service, but Rappenecker says patients tend to be more comfortable when a real person is present. She says without interpreters available, patients might be less likely to see a therapist in the first place.
“I think it’s a pretty important job,” Rappenecker says. “We’re providing this kind of bridge between two people so that they can get the help that they need.”
Mental health interpreters have another function that comes up from time to time: the role of cultural mediator. Rappenecker explains that it’s important for interpreters to have an understanding of the culture, in addition to the language.
“Sometimes there are these little bumps that come up with culture,” she says. “So we’ll try to intervene quickly to try to address the cultural barrier.”
Kelsey Krueger, a psychotherapist who often works with Rappenecker, says mental health interpreters provide a crucial service to patients by providing a safe and comfortable atmosphere.
“When you are covering topics such as trauma, abuse, depression, or panic attacks, creating a therapeutic climate that validates human experience is essential,” Krueger explains. “Therapy is personal. People tell me things they have never told anyone. I want to honor that, and Katherine helps me give each and every patient, no matter their origin or language, a chance to feel truly connected.”
What’s The Most Challenging Part Of The Job?
Mental health care providers listen to emotionally tough stories on a daily basis, which would certainly be hard for any empathetic person. But mental health interpreters have to take it a step further; they have to embody those negative emotions, to express them as if they are their own.
Rappenecker explains: “Working in mental health is really hard because you do hear some really sad, really awful stuff, and it kind of sticks with you… You’re speaking their words; you’re trying to portray their emotions, their tone. It wears on you a little bit.”
“We don’t get the same type of training that the therapists do to learn how to deal with it,” she adds.
Interpreting itself, regardless of subject matter, has its challenges as well. The difficulty of listening and interpreting simultaneously is compounded by the need to see and express the patient’s facial expressions and body language, plus the desire for the patient to mostly look at the therapist when talking, rather than the interpreter.
“Interpreting itself is exhausting,” Rappenecker says. “I love it, but it is exhausting, just because of all those tasks that you’re performing at once.”
And The Most Rewarding Part?
For Rappenecker, being able to make a difference in the lives of her patients outweighs all the challenges.
Before she became an interpreter, Rappenecker lived in Spain for nine years and taught English there. While she loved her students, she says she never got the kind of gratification from them that she gets now.
“These people are coming to the clinic because they need help and they want to get better,” Rappenecker says. “They’re really grateful that they can get the help that they need.”
She explains that many Puerto Ricans moved to the area after Hurricane Maria devastated their homes, and they came to the clinic for help.
“After the hurricane, people were not okay. They had lost everything. I think it was a relief for them to be able to be like, ‘Oh, okay… I can get these services and I can deal with my depression, etc.’”
As far as Rappenecker’s concerned, providing a sense of comfort and assistance for patients is what it’s really all about.
“It’s super rewarding just to help the patients and give them a voice.”