Imaginal reliving is often a bit simpler than written narratives when we are working via an interpreter. Here, we set up reliving in the same way as usual i.e. asking the client to speak in the first person, present tense, closing their eyes if they are comfortable to, and talking us through the trauma step by step in as much detail as possible until we reach a pre-agreed safe point. With an interpreter, we also ask that they speak in chunks of a sentence or two at a time, giving the interpreter time to translate what they have said before they continue. This can take a bit of practice, but will hopefully be how we are working together in the rest of the session too. Sometimes reliving in this way can be quite helpful, slowing the client down and we will notice quickly if they start dissociating as they will either stop talking or stop waiting for the interpreter!
On the other hand, there might be times where we want to ‘turn up the volume’ on the memory and not distract the client too much by talking. For example, if someone is quite cut-off when they talk about the trauma or struggle to access the memory. In these examples, if we already know the content of the memory, we might just ask them to relive the trauma in their own language without interpretation. If we want to make the memory work less immersive, we would ask them to pause more often to allow translation, ask them more questions or even ask them to do the reliving in English if they speak a little. These versions of reliving ‘turn down the volume’ which can be useful if clients are dissociative or get very distressed when they activate the memory.
Some therapists are able to use simultaneous translation, where the client speaks uninterrupted and the interpreter sits next to the therapist, translating quietly. We have found this difficult in practice, as it can be tricky for the interpreter to keep up, and it is harder for us to interject with questions if we need to.
When we introduce updates, we might discuss these ‘outside’ the memory. We then relive the relevant hotspot and ask the client to introduce the update, with the interpreter translating for us. However, we often repeat this without much interpretation, except perhaps a prompt to bring in the update, so that we don’t distract the client too much from the memory.
Narrative writing and timelines are still possible, but we’ll need an interpreter who is happy to help write the trauma story (some interpreters are told not to write by their agencies or prefer not to). Here, we add a written translation line by line as we write the client’s story. Either they write it, and the interpreter writes it in English underneath, or they dictate it and we write it in English, with the interpreter writing it in English for us. There are tools which can help us here, such as Google Translate and, if we are working over video, some software will create subtitles in various languages but these need checking by a skilled interpreter, as they are prone to mistakes.
For timelines, we might map it first in English and then ask the interpreter to translate key words that help the client to identify the key memories or hotspots. We sometimes make timelines more visual (also a good tactic for clients with limited literacy) by finding pictures on the internet that represent key memories symbolically (don’t choose anything too triggering) e.g. a key to denote a time of imprisonment or a flying bird to represent being freed. Narrative exposure therapy (NET) which was developed for use with refugees, uses a rope or ribbon laid on the floor with rocks to represent traumatic events and flowers for positive events. The goal of the timeline is primarily to put traumatic events in order and to identify particular memories or hotspots to come back to, so this can be achieved without words.
When we are working on traumatic memories via an interpreter, there are a couple of important things to remember. One is to look after your interpreter. This includes explaining before the session that you are going to be asking for a detailed account of traumatic events and checking how they feel about that. We also explain that the client may become upset which is to be expected and often part of processing difficult memories. This is important because interpreters sometimes try to minimise client distress by modifying our questions and, since we need direct translation, this can muddy the waters. Many interpreters have lived in the same country of origin as our clients and may have had their own traumatic experiences. Translating these word-by-word, in the first person can understandably be upsetting for our interpreters, so we also take time after a session to check how they are feeling. Even just a few minutes debrief can give them the chance to express any difficult feelings and for us to normalise and support them in that. In Beverley Costa’s excellent practice paper on working through interpreters (well worth a read), she includes a quote from an interpreter saying “We are not machines. We are not Google Translate”.
We also need to remember that working through an interpreter means the client is having to disclose their traumatic experiences to more people, which can be hard for them especially if they feel shame. We always remind our clients that the rules of confidentiality cover our interpreters as well as us – they will not repeat anything they hear in the session outside it. We also try to stick with the same interpreter throughout treatment (ideally by block-booking them), as long as we have ascertained that the client is happy with this interpreter (be prepared to change if not). This helps them to build up a relationship based on trust which will hopefully facilitate difficult disclosures.
Lastly, on a practical note, we will often need a longer session time for all interpreter-mediated sessions but especially for memory work as we don’t want to run out of time. We also need to book the interpreter for a bit longer than the session so we have time to chat before and afterwards.
These guidelines are similar for sign language interpretation although of course written work does not need adaptation. Clients will also need to keep their eyes open during reliving.
References
Costa, B. (2022). Interpreter-mediated CBT–a practical implementation guide for working with spoken language interpreters. the Cognitive Behaviour Therapist, 15, e8.
Practice points
· Imaginal reliving can go ahead through an interpreter as usual, asking the client to speak in chunks and adjusting as needed
· For narrative writing, the interpreter writes a translation under the narrative
· Timelines can also be used, translating key words or using pictures to represent memories or hotspots
· We need to remember to support our interpreter as they are translating upsetting material, preparing them before the session and debriefing afterwards
· The client will also be disclosing to two people rather than one, so we remind them of confidentiality and try to block-book their preferred interpreter
· We will need longer sessions for interpreter-mediated sessions, especially for trauma memory work.