Transcript Bilingual Patients - World Mental Health Day

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 RussianAmerican 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
 1990

1% of US population
 2000

42,362
28,101,052
10.7% of us population
WHAT PERCENTAGE OF EACH ASIAN/PACIFIC
ISLANDER GROUP SPEAKS A LANGUAGE OTHER
THAN ENGLISH AT HOME?
Percent
72.5
80.7
81.9
Cambodian
63.2
72.5
77.4
Vietnamese
55.9
60
59.9
69.7
Thai
80
Chinese
100
40.6
40
20
Korean
Samonan
Filipino
Indian
Japanese
Hawaiian
0
10.2% Overall Population Average
Asian American Health Forum, Inc. SanFrancisco, CA,
April 1989
Laotian
0.5
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
unavailability of 2nd
language. Detachment Effect.
 Language specific identities and
personalities
-Sound different to themselves
-Seem different to others
 2nd language as defense
 Intra-psychic
Therapy
material not accessible in 2nd
language.
 Highly charged material easier to
discuss in 2nd language.
 Relationship therapist and provider may
change when language changes.
 Some
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.
