IJIE Volume 5(2)

Teaching Mental Health Discourse

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Volume 5 (2) ~ November 2013

ISSN # 2150-5772 – This article is the intellectual property of the authors and CIT. If you wish to use this article in your teaching or in another format, please credit the authors and the CIT International Journal of Interpreter Education.

 Teaching Mental Health Discourse

Mary Thumann and Kendra Smith

Gallaudet University

Correspondence to: Mary.Thumann@gallaudet.edu

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1.       A Discourse Approach to Interpreter Education

This article reports on a semester in which the instructor for the Interpreting Mental Health Discourse(IMHD) course at Gallaudet University worked collaboratively with faculty from the Mental Health Counseling Program. The instructors planned a series of opportunities for the students in both programs to work together to develop their respective skills and to better understand each discipline. Here, we provide an overview of each curriculum and describe our collaboration. It is our hope that this information will provide useful information to aid others in developing similar collaborative relationships.

The Department of Interpretation at Gallaudet University offers three degree programs: Bachelor of Arts in Interpreting (BAI), Master of Arts in Interpreting (MAI), and PhD. The degree programs take a discourse approach, allowing students to gain information about various settings as they learn about and practice interpreting skills. This approach involves focusing on the analysis of language use in different genres of American Sign Language (ASL) and English so that students become explicitly aware of different linguistic features. Students learn that professionals in different settings often have a specific intention behind their word choices and phrases. For example,interpreting students examining the discourse in a mental health setting, learn to recognize specific words, phrases, or questions used by counselors as part of the therapeutic process. Analysis of discourse includes examining language use in conversations, presentations, interviews, and other types of speech genres, while students read and discuss the theoretical notions underlying language use in general.  As they develop content knowledge, students of a particular setting’s discourse also learn the effect of context on language use—that meaning is not identified in words and phrases but is coconstructed by the participants in a situation.

The sequence of courses in the interpreter education program leads students through the progressively more complex cognitive processing skills involved in translation, consecutive interpretation, and simultaneous interpretation. Integrating the learning of cognitive processing skills with setting-specific courses gives students practical opportunities for developing these skills. Students in these courses have observation requirements, read relevant literature, interview professionals, and attend presentations by professionals in the field. As students progress through the program, they gain skills and strategies for learning prepare them to work effectively as interpreters with deaf, hard of hearing, and hearing participants in the particular setting(s).

2.       Department of Interpretation (DOI)

The MAI degree program includes deaf and nondeaf students who possess a range of interpreting experience, from those with no experience to those already certified. All students in the 2-year program are bilingual; some identify ASL as their first language and others identify ASL as their second language. The program of study is as follows:

2.1.     First Semester

The first semester of the course sequence involves a focus on each of the two primary languages of this program, ASL and English (written or spoken). Students identify and analyze linguistic features in their first and second languages, preparing to apply this information and skill to the work of translation and interpretation. They analyze texts and learn to understand nuances as they practice text analysis and meaning construction. With this enhanced awareness of each language, students can be more effective as they begin to translate texts from one language to another (Witter-Merithew, 1987, 2001).

2.2.     Second Semester

In the second semester, students begin to apply what they know about language to setting-specific discourse.

The more contextual knowledge the interpreter has (about the participants, setting, and purpose), the more content knowledge the interpreter has (about the topic, the main ideas, the specialized vocabulary), and the more knowledge of the form of the message the interpreter has (overall organization and coherence), the more effective the interpreter will be in understanding what the speaker intended by the message that was conveyed. (Witter-Merithew, 2001)

The program curriculum includes five settings courses: mental health, legal, business, education, and medical situations. Students start with mental health and legal discourse courses. Because certain practices within the mental health and legal fields (e.g., extensive use of standard written documents) lend themselves to studying discourse through the process of translation (Shaw, Collins, & Metzger, 2006), these courses are well suited to the developmental progression of learning interpretation skills. Students learn about and practice the cognitive skills necessary for translation and, later, consecutive interpretation. In the course on interpreting in the mental health setting (IMHD), students translate written documents (intake forms, release of information forms, etc.) and informational videos prepared for consumers. The process of translation allows students extended time to analyze the source language text, research relevant information, and produce an appropriate equivalent in the target language.

The IMHD curriculum introduces students to various types of mental health settings, professionals who work in these settings, and some of the theoretical approaches in the mental health profession. The course design makes use of many unique opportunities available at Gallaudet University to collaborate with other units on campus. For example, instructors invite faculty, staff, and students affiliated with Gallaudet University’s Mental Health Center and the departments of psychology, social work, and counseling to present or participate in role plays while the students in the IMHD interpret. Interpreting students are encouraged to attend presentations by mental health professionals hosted by other academic departments. In addition to taking advantage of these internal resources, instructors also reach out off campus and invite mental health practitioners from the local community to present in class.

By working on translations, interpreting students develop text analysis skills. They incrementally reduce the time it takes them to analyze the language, and they begin to apply the skills to the work of consecutive interpreting. Although with consecutive interpreting students have less time for text analysis of the source language, they have some time to process the information before producing it in the target language. Students practice interpreting intake interviews or other situations in which questions are asked in one language and responses are given in another.

The ability to analyze and understand the source language without time to do extensive research requires knowledge and practice. Practicing in a mental health discourse class allows students to become familiar with the discourse they are likely to encounter when they interpret in this setting. As they practice comprehension and production of two languages, students apply what they have learned about mental health discourse, focusing on one language at a time. This practice occurs as they observe and, as the semester progresses, interpret role plays while they continue the cognitive processing sequence.

2.3.     Third Semester

In the third semester of the program, the students refine and practice their translation and consecutive interpreting skills while learning and practicing simultaneous interpreting skills. They develop these skills in settings courses , in which they learn the particular discourse of education and business/ government. .

2.4.     Fourth and Fifth Semesters

In the fourth semester students continue to learn and refine simultaneous and consecutive interpreting skills as they are introduced to medical discourse. In addition, students take courses in research and participate in their third professional practice class. This includes a field rotation in which students work with mentors and accept appropriate interpreting assignments. Through course design and planned activities students discuss the decisions they make and are able to apply their increasingly sophisticated cognitive processing skills to their practice. The final (fifth) semester is a full-time internship.

3.       A Developmental Approach to Counselor Training

The Department of Counseling at Gallaudet University offers a Master of Arts in Mental Health Counseling degree. The program curriculum, including formal classes and extensive supervised fieldwork experiences, is designed to prepare graduates to be multiculturally competent counseling professionals able to work skillfully with deaf, hard of hearing, and hearing clients of diverse backgrounds in a variety of settings. To achieve this outcome, the Department of Counseling promotes a learning environment that encourages critical thinking and self-evaluation, inquiry, teamwork, and the discovery of new knowledge and insight, utilizing a combination of didactic and experiential learning opportunities.

The program takes a developmental approach, offering courses in a sequence intended to foster students’ progression from “novice” to “expert” by exposing them to increasingly more advanced learning experiences. As students progress through the various developmental stages, their cognitive skills related to counseling become more sophisticated. Higher levels of cognitive complexity are necessary for optimal performance as a counselor and are correlated with the counselor’s effectiveness and ability to formulate more accurate clinical hypotheses, attend to multicultural dynamics, be empathetic in communication, and be more flexible in the application of counseling methods (Duys & Hedstrom, 2000; Granello, 2000). Higher-order counseling skills are attained, in part, through continuous professional reflection, which includes the ability to look at one’s work with clients, evaluate it, place it in context, and change one’s approach when necessary (Griffith & Frieden, 2000; Neufeldt, 2001). Reflectivity is an extremely helpful learning tool for students as they transition from didactic presentation of knowledge to experiential skills-based work. As described later in this article, the collaboration with the Department of Interpretation has been particularly helpful in providing counselling students additional opportunities for reflection.

4.       Collaboration Across Programs

The departments of interpretation and counseling share an educational philosophy that pairs learning opportunities with developmental needs and encourages faculty to scaffold students as they move from one stage to the next in their learning and skill acquisition. These similarities across philosophies and curricula present a rich opportunity for shared, engaged learning. A collaborative relationship allows the students in both fields to observe, then apply, the skills and knowledge they learn in simulated situations.

This collaboration was initiated in 2009 when the IMHD instructor contacted the counseling department to identify ways interpreting students could observe some of the counseling classes. An agreement was reached to pilot this learning collaboration with first-year students from both departments. The original concept had the students in the IMHD class engaging with counseling students in a mini-course on psychopharmacology. As program faculty reviewed the benefits of this initial collaboration to both groups of students, they identified additional curricular opportunities to expand the pilot.

In the spring semester of 2010, the IMHD instructor met with program faculty from the counseling department to discuss the expanded collaboration. Primary goals for continuing the pilot included providing opportunities for the students who would be future professionals in their respective fields to begin networking with each other and to learn more each other’s professions. Additional goals included providing students opportunities to practice elements of their work with others, to practice making decisions, and to discuss the implications of their decisions with each other. The application of skills learned in their programs, with guidance from faculty, was intended to help them move forward through the developmental stages of their skill-based learning. Students would practice discussing their work and collaborating with others who would be the professionals they are likely to work with after graduation.

The counseling program faculty invited the IMHD students to participate in selected class meetings for two additional skills-based counseling courses:  Advanced Skills and Methods in Psychotherapy and Counseling for Wellness. In the Advanced Skills and Methods class, the IMHD students observed mock counseling sessions, used consecutive interpretation in mock sessions with the support of faculty, and engaged in debriefing sessions with the counseling students.They attended presentations and engaged in activities offered as part of the Counseling for Wellness course.

In the following sections, we describe how the pilot program coordinated the joint experiences of the IMHD course and the Advanced Skills and Methods in Psychotherapy course. This collaboration is a work in progress, as faculty continue to work to build on the successes, address the challenges, and develop additional opportunities for students to work together and learn from each other.

5.       The IMHD Course at Gallaudet University: Pilot Collaboration

In the first few weeks of the IMHD course in spring 2010, the interpreting students were introduced to examples of typical discourse in a variety of mental health settings. Students read articles, listened to guest lecturers from the Gallaudet University Mental Health Center and the counseling department, and watched videos of simulated mental health situations. With each opportunity to gain knowledge about mental health, students also had the opportunity for discussion with professionals in both the interpreting and mental health fields. Guest speakers presented on contextual dimensions of mental health settings (see Registry of Interpreters for the Deaf, n.d.). Students learned, for example, how a counselor’s theoretical orientation informs his or her case conceptualization, treatment planning, assessment, and interventions with the client—thereby also shaping the work of the interpreter. During this initial period, although IMHD students were introduced to roles, responsibilities, and certain competencies pertaining to various mental health professions, they were yet to apply this information to simulated interpreting situations.

As the semester continued, the interpreting students continued to read literature relevant to the mental health field and to translation and consecutive interpreting in general. They reviewed materials used in mental health settings, including intake and release-of-information forms, and informational videos used by some mental health professionals. The students worked in groups to translate sample forms and videos from English to ASL or ASL to English. Working from one language to another, students conducted research that helped them better understand source texts. Group work provided opportunities for students to thoroughly examine and construct meaning from the source language used in mental health settings and to produce appropriate drafts of the translation in the target language.

Presentations from professionals from the university’s Mental Health Center and faculty from the Department of Counseling exposed students to terminology and features of monologic discourse relevant to mental health settings. The presentations were videotaped and added to the collection of information on mental health as well as to the library of materials students could use as they practiced interpreting skill development.

Role plays also became an important component of this collaborative work. This activity allowed students to learn more about and experience potential interpersonal dynamics that can occur in mental health settings (seeRegistry of Interpreters for the Deaf, n.d.). Following an intentional developmental sequence, the first role plays were modeled by mental health professionals playing both therapist and client roles while students observed. The role of interpreter was portrayed by a faculty member who is also a professional interpreter experienced in mental health settings. These professionals modeled appropriate interactions as they demonstrated questions and responses, and interpreting strategies were modeled as well.

The professionals and students debriefed after each role play, and the participants discussed the significance of their language use and strategies (both counseling and interpreting strategies). Observing role plays helped the IMHD students understand the counselor’s intention in phrasing questions in such a way as to elicit specific information from clients. The role plays were designed to allow for increasing involvement of the students as they progressed in the course and in their skill development.

After the midpoint of the semester, the IMHD students attended selected class sessions of the Advanced Skills and Methods of Psychotherapy course, and students from both programs began to apply what they had been learning as they became involved together in role plays. Joint role plays, under the supervision of faculty from both programs, provided structure and guidance for each practicing student. After each role play session, guided group discussion allowed the students to share feedback with each other, allowing interpreting students to see how the counseling students discussed the counseling process, and counseling students to see how the interpreting students discussed and provided feedback on each others’ interpreting work.

In the initial joint role plays, an instructor played the role of a nonsigner, allowing all participants to comment on language choices and options for interpreting. The next step in the sequence of role plays involved using a nonsigner who worked in the local community or at other universities or mental health programs. In these role plays, counseling students took the role of the counselor, and interpreting students took the role of the interpreter. Hearing and deaf participants in the mock counseling sessions now had to rely on the student interpreter for communication. In order to control for privacy and emotional response, the nonsigning professionals played the role of the client, and a professional interpreter was hired to ensure access to communication during debriefings.

Although debriefing sessions started with those who were actually involved in the role play, all students   could contribute to the discussion. Students and professionals discussed counseling issues as well as language and interpreting issues. The participants in the role plays experienced the value of discussing their work with each other as well as with the observers. The interpreting students benefited by observing the discussion of the counseling students with their professor and the nonsigning professional regarding different approaches, the effectiveness of questions, and the process of developing a relationship with the client. This provided additional information and insight into language use in mental health settings.

Interpreting students also had the opportunity to discuss the effect of an interpreter on the counseling session both from the counselor’s point of view and the client’s perspective. Both participants and observers highlighted what worked well and discussed instances in which the intended meaning of the counselor or the client were not accurately conveyed, and shared ideas for improving the interaction. When the group discussed the effectiveness of the interpreter in the mock session, they realized—among other things—how the interpreter’s decisions could interfere with the therapists’ goals. The students considered alternatives for elements of the intereaction such as seating arrangements and the process of explaining the role of the interpreter, and they developed strategies to minimize potential miscommunication: They suggested that the interpreter use the third person when appropriate and request pre- and postsession meetings with the mental health professional in order to discuss areas of concern.

Students began to understand the importance of pre and post-session meetings in  clarifying the therapist’s goals, language use issues, and interpreting processes. Because this information was often new to the students, debriefing provided numerous opportunities to discuss the significance of decisions made during a therapeutic session.

Pre- and postsession meetings between the therapist and the interpreter were also the subject of role plays, allowing student interpreters to practice explaining their role to the therapist. Students experimented with the options of the counselors explaining the interpreter’s role and the interpreters explaining their own role. In additional role plays, the student counselors practiced approaches by which they remained in charge of the entire interaction with the client.  Students came to see how the therapy session can be negatively or positively affected depending on the handling of the initial meeting of the therapist, client, and interpreter. The novice interpreters and counselors thus had many opportunities to practice and develop effective ways for therapists to achieve their goals when an interpreter is involved.

Feedback following the simulated sessions was often very specific regarding whether or not an interpretation was equivalent to the goals and intent of the therapist and client. For example, in a role play in which the therapist carefully selected the words she used to ask a question, the student interpreter used a phrase that he thought was equivalent, but in the postsession discussion, the therapist was able to clarify her intent with the specific wording she chose. The novice interpreter had the opportunity, with faculty guidance and group discussion, to see the effect of his word choices. The students in both classes discussed alternatives for interpreting the question as well as alternative questions that would allow the therapist to get the information she needed. Throughout this discussion, the fact that interpreting is not a process of replacing words in one language for words in another language was reinforced for the counseling students and the interpreting students as well.

Although both groups of students found it beneficial to observe the other group’s debriefing, each group also had time for their own debriefing without members of the other group present. This allowed each group of students to have in-depth discussions on issues specific to their disciplines, as well as to focus on ways to improve their own work. Students developed a better understanding of their work as well as the expectations of the students from the other discipline. Interpreting students became aware that the specific language mental health clinicians use in their questions and comments is critical to the outcome of the therapeutic process.

In the last week of this settings course, the interpreting students begin learning about and trying out simultaneous interpreting. Simultaneous interpreting requires more cognitive processes to be active at once, and interpreters have less time to think about the source and target languages. Students began working with the monologic presentations that had been recorded earlier in the semester. Using these videos as the source allowed the students to practice a new skill with material that was already familiar to them. With guidance from the interpreter educator, the students continued to develop the skills necessary to interpret simultaneously.

6.       Benefits of Collaboration

The collaboration between the departments of interpretation and counseling yielded many benefits while demonstrating one of the basic tenets in the taxonomy of learning: If you can teach others what you have learned, you are better able to understand and internalize the information yourself. Faculty in the respective programs were able to create opportunities for both groups of students to increase insight into their work and to examine their roles metacognitively. Students from both departments were exposed to increasingly complex tasks within a supportive structure that allowed them to integrate new material and skills in a way optimal for their corresponding levels of development. Working in this way, the interpreting and counseling students moved forward through some of the developmental stages more quickly than would have happened otherwise.

Additionally, this collaboration provided opportunities to educate students in addressing issues that may arise in their careers, as well as prepared them to discuss or explain their work to others not knowledgeable about either counseling or interpreting. Given the likelihood that these students’ professional worlds will continue to overlap, this experience was an effective way for them to be introduced to each other and to understand how they might work together in the future. Finally, because there are deaf students in the interpreter education program, this provided both deaf and hearing counseling students with the opportunity to experience working with deaf interpreters, hearing interpreters, and deaf or hearing counselors. Inherent in these activities was the added benefit of expanding the awareness of the work of deaf interpreters in arenas in which this group of professionals has not typically been utilized to date.

6.1.     Benefits to Interpreting Students

This learning approach allowed interpreting students to develop an understanding of the types of questions asked by therapists and others in mental health settings. They also came to understand that counselors intentionally select specific words, phrases, and questions as part of the therapeutic process. At this early stage in their development as interpreters, the interpreting students were exposed to a wide variety of situations, and they learned approaches for assessing each one and for discussing expectations in order to best meet the needs of all participants.

The collaboration across disciplines also helped to dispel some of the interpreting students’ misconceptions regarding mental health; interpreting students saw that there is much more to mental health and mental health discourse than they previously thought. They gained a deeper understanding of and an appreciation for various therapeutic approaches, as well as for pre- and postsession meetings as vehicles for understanding the goals for each counseling session.

Collaborating with the Advanced Skills and Methods in Psychotherapy class allowed the interpreting students to apply what they had learned about mental health discourse during earlier, didactic portions of the course. The opportunity to practice their craft with students from the counseling department “in vivo” also allowed interpreting students to see the potential effects of their approach to interpreting and to participants in a setting. Students also saw firsthand some of the implications of less-than-effective interpreting work.

6.2.     Benefits to Counseling Students

The collaborative approach benefited the counseling students as well, especially because it exposed them to the interpreting process. This component had previously been overlooked in the counseling program curriculum. In fact, Gallaudet University’s counseling alumni had often reported feeling underprepared to work with interpreters in counseling settings upon entering the field after graduation. The collaboration also provided opportunities for counseling students to reflect on their counseling work, thus advancing the students’ cognitive complexity.

The counseling students brought with them many misconceptions about the work interpreters do. Most students believed that an interpreter “shows up for work, does their job, and leaves.” Through this collaborative experience, the counseling students witnessed and learned about the work required for interpreters to prepare for an assignment.  They gained awareness of the challenges involved in interpreting their specific language strategies into another language. Practicing with the interpreting students taught them about the process of interpreting and required them to think explicitly about their nonverbal behaviors and the intentionality of their word choices and sequencing, and to plan their approach purposefully. They came to realize the value of holding pre- and postsession meetings to share with the interpreter critical elements of their specific therapeutic approach and session goals. .

 

Learning together and performing role plays with students from another discipline provided early opportunities for these students to experience and manage the client–counselor relationship with a third person involved. They were able to practice introducing the interpreter to the client, explaining the interpreter’s role, and managing and maintaining control of the counseling session with an extra person present. Students’ used higher-order thinking in these activities, enhancing their understanding of their own practice. In sum, the counseling students gained an appreciation for the complexity of the interpreting process, sharpened their counseling skills, and learned how to work collaboratively with an interpreter for the good of the client and the success of the counseling treatment.

6.3.     Benefits to Others

Gallaudet University is fortunate to belong to the Consortium of Universities of the Washington (D.C.) Metropolitan Area. Taking advantage of the consortium, the counseling students gained experience explaining the use of interpreters and some aspects of deaf culture and other relevant issues to individuals outside the Gallaudet University community. This benefits the community at large as well as students from other colleges and universities. Guests from the community or other university programs also reported on the benefits for them, particularly regarding multicultural counseling.

For programs in areas where there are no other universities to involve in collaborative relationships, members of local community mental health agencies, professionals in private practice, and deaf community members can be recruited to participate in appropriate course activities.

7.       Authors’ Reflection

The collaboration between the IMHD and counselling courses proved to be beneficial in many ways, not only to the students but also to the faculty and other professionals working with them. It provided opportunities to involve and educate various constituents in the community as well as future professionals in both fields.

Role plays involving students from both courses—although students regarded these as one of the most beneficial elements of the collaboration—required the greatest consideration. The instructors had to carefully determine the content as well as the selection of appropriate participants; as students progressed through their learning, instructors assessed their eligibility for more complex situations and roles. Instructors remained aware of the potential for  real issues to be brought forth and had protect the students in both programs. Involving nonsigning professionals allowed students to work with individuals who use a different language, but having to ensure communication access for everyone complicated these role plays and the subsequent discussions.

In addition to the extra effort required to manage the role plays, other challenges arose. Interpreting students studying the discourse of mental health settings need an overview of the many approaches and theories to counseling and psychotherapy in order to place their interpreting work in context. Understanding these can be challenging even for first-year counseling students; they were more so for students outside the discipline. Future such collaborations may be more successful by providing the interpreting students simply with a theoretical introduction to the process of counseling and by reinforcing that the joint program in no way prepares them to be professionals in other disciplines.

The sequencing in both programs presented its own challenges. At the time of the collaboration, both groups of students were in the beginning stages of their development. The counseling students were thus not as aware as they would become later in the program of the effect of their language choices or that there is a deliberate, intentional approach to working with clients. This may have hampered our ability to expose interpreting students’ ability to the full spectrum of counseling discourse, but it was nonetheless a good experience for the interpreting students—after all, professional interpreters work with other professionals in all stages of their development. Eventually, all students were able to realize the importance of being intentional with language use, and the interpreting students were able to ask questions in the guided discussions about options for translating or interpreting those questions. Collaboration with a group of counseling students at a more advanced stage in their development would provide a different range of experiences for students in both programs. There are likely additional benefits to having second-semester interpreting students work with third- or fourth-semester counseling students rather than having the students come together at the same point in their respective programs.

The challenge of such collaboration in a smaller university is coordinating the course sequence in the curriculum of each department, because each course is usually taught only once a year. Inviting other departments such as social work or psychology to join the collaboration would augment opportunities for interpreting students. Interpretation faculty may also arrange to have mental health professionals participate in role plays conducted separately from those with the counseling class(es).

 

8.       Summary

Collaboration is key for educating future consumers and professionals of both interpreting and mental health services. At Gallaudet University, students from both disciplines benefited from enhanced joint learning opportunities, as well as from time in their own groups to process and discuss freely the joint work they did—which also afforded each group the opportunity to consider how their work was viewed through the lens of the other.

Interpreter educators and their students, whether they work with spoken or signed languages, benefit from collaborative work with other programs, from which they gain opportunities to work with professionals and future professionals in other fields, to discuss their work and the reasons for the decisions they make as they interpret or translate, and to learn about other disciplines. Although the programs discussed in this article are in the somewhat unique position of having deaf students, other interpreter education programs can invite professionals from the deaf community to participate as both therapists and as clients in role plays. And although these programs are graduate level, the collaborative approach can be used in undergraduate programs. Moreover, such collaboration is not limited to interpreting in the mental health setting: Courses in interpreting the discourse of legal, business, and medical settings can benefit from collaborative projects with students in those corresponding disciplines as well.

References

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Witter-Merithew, A. (2001). Understanding the meaning of texts and reinforcing foundation skills through discourse analysis. In C. Nettles (Ed.), Tapestry of our worlds: Proceedings of the 17th National Conference of the Registry of Interpreters for the Deaf (pp. 177–192). Silver Spring, MD: RID Publications.