Post on 26-Mar-2015
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.