Bilingual Therapy

Bruce Field, MD Oct. 29, 2007

Photo courtesy of Pat Walker

Bilingual patients Discuss different levels of bilingualism. Review some of the issues in evaluating

and providing therapy to bilingual patients.

Discuss issues related to psychopathology and bilingual patients.

Comments and recommendations.

Bilinguals Larisa is a 29 year old Russian-

American female with bipolar disorder. Her English is quite good and she is justly proud of her proficiency and never wants to use an interpreter in the clinic. However, when hospitalized, she insisted that Basil, the Russian interpreter, be called.

Bilinguals Rafa is a 65 year old Guatemalan who was a

teacher. He feels trapped living in a nursing home and finds it difficult to form new friendships in MN.

He believes his personal assets as are not appreciated.

He delicately corrects my Spanish and educates me about his past in Guatemala and troubles here.

Languages

6000 Languages Spoken More than half of people in the world are

bilingual Half of languages may disappear in next

30 years

Languages Major step in achievement of separation

and individuation. Creates new ways to relate to others. Individual, cultural, national identity can

be strongly rooted in the use and maintenance of a particular language.

Spanish spoken at home

199042,362 1% of US population

2000 28,101,052 10.7% of us population

WHAT PERCENTAGE OF EACH ASIAN/PACIFIC ISLANDER GROUP SPEAKS A LANGUAGE OTHER

THAN ENGLISH AT HOME?

0.5

40.6

55.9 59.9 63.269.7 72.5 72.5

77.4 80.7 81.9

0

20

40

60

80

100

Haw

aiia

n

Japa

nese

Indi

an

Filip

ino

Sam

onan

Kor

ean

Chi

nese

Thai

Laot

ian

Vie

tnam

ese

Cam

bodi

an

10.2% Overall Population Average

Asian American Health Forum, Inc. SanFrancisco, CA, April 1989

PercentPercent

Bilingual Subordinate bilinguals -Dominant language -Deficit in non- dominate language -Internal reciprocal translation or encoding

Coordinate (proficient) Bilinguals -Native Proficiency in both

Gradations

English Proficiency

No English

Limited English Speaker

Subordinate bilingual

Pure bilingual

Subordinate Bilinguals

Constant concern about word order, pronunciation, grammar, vocabulary

Invest more in how rather than what is said.

Displace affect to language task. Decrease of affective tone- feeling of

unreality.

Subordinate Bilinguals

More likely to rely on content of rather than cues.

Tend to perceive interviewer and themselves more negatively.

Diminished rapport, catharsis Therapist’s burden to determine between

language deficit and psychological processes.

Pure Bilinguals

Language Independence- capacity to maintain and utilize two separate languages codes.

Reciprocal translation no longer needed Seemingly equivalent words may have

different connotations.

Subordinate Bilinguals

Discrepancy more likely with conceptual and emotionally charged words.

Important when second language was learned.

Languages learned after puberty may be stored in overlapping but distinct parts of the brain.

Pure Bilinguals Intra-psychic unavailability of 2nd

language. Detachment Effect. Language specific identities and

personalities

-Sound different to themselves

-Seem different to others 2nd language as defense

Therapy Some material not accessible in 2nd

language. Highly charged material easier to

discuss in 2nd language. Relationship therapist and provider may

change when language changes.

Therapy Therapy in second language can be

important language experience for patient.

Therapy in second language can help integrate childhood to émigré adulthood.

Psychopathology No consistent findings about whether

patients are more symptomatic in first or second language.

In stressful situations, people prefer to speak their first language.

Psychopathology

Language difficulties easy to confuse with depressive, anxiety and negative symptoms.

Speaking a second language can lead to a particular kind of humiliation.

Bilingual Therapist

Pure bilingual and ethnically and linguistically matched providers.

Coordinate bilinguals. Subordinate bilinguals.

Why bother with Subordinate Bilingual

Therapists Insufficient number of

linguistically/ethnically matched providers.

Practical considerations Patient doesn’t like to use an interpreter.

Bilingual Therapists

Therapist as transitional or transformational object.

Reversal of typical inequality in power and influence which often is exaggerated in work with immigrants.

Studies show providers often overestimate fluency in second language.

Recommendations

Achieving rapport is key. Use of interpreters often is the best option to

overcome the language barrier. Providing psychiatric/ psychological services

is possible when provider or patient has less than perfect command of second language, but caution is advised.