What inspired me to write about self-care for medical interpreters?
This weekend I went on my first road trip from Nashville, Tennessee to Birmingham, Alabama to attend ITAA’s Second Annual Conference for Professional Interpreters. ITAA stands for The Interpreters and Translators Association of Alabama and the conference they put on was one of the most wonderful conferences I’ve ever attended. The speakers were truly inspirational, the talks were relevant and informative and everything was extremely well-organized. Not to mention the fact that I attended the conference with my good friends from the medical interpreter training course, unexpectedly ran into our instructor Dennis Caffrey from the very same course, and met two new Russian colleagues – it can get a bit lonely for Russian interpreters here in Nashville!
As I was on my way back to Nashville, I found my thoughts returning to one of the topics from the conference: a talk titled Self Care: Meeting the Challenge given by Darren Reed, an ASL-English-Spanish medical interpreter and interpreter trainer from Jackson, Mississippi. Soon, the podcasts I downloaded for the road trip were forgotten as my friends and I were deep in discussion about why self-care was so important and how we could get better at making sure it happens. I decided that this was a worthy topic for my blog.
Why is self-care for medical interpreters so important?
Like with any job, interpreters experience work-related stress, but they also face many challenges that are unique to their profession. The following list of potential stressors and challenges facing medical interpreters contains some of the factors I experienced personally and some I learned about in the course of my training. I would love to hear from other interpreters – comment below or use the Contact page on this blog to drop me a line and I`ll include your ideas in this post. The list may seem daunting but it serves an important purpose. Crezee I. et al (2015) put it very well when they wrote that if interpreters can identify potential sources of stress early on, they can neutralize or decrease the negative effects by practicing self-care and thus potentially prevent professional burnout and other long-term negative consequences.
According to the definition by the Vicarious Trauma Institute,
“Vicarious Trauma is what happens to your neurological (or cognitive), physical, psychological, emotional and spiritual health when you listen to traumatic stories day after day or respond to traumatic situations while having to control your reaction. “
The italics in the last sentence come from the source of this definition, but I also think it this is an important consideration for interpreters – we do have to control our reactions and there is no room for outward displays of emotion as we focus on conveying the message just as it was told to us. There are several other terms that are used almost interchangeably with the term vicarious trauma. The one that speaks to me the most is the definition of secondary traumatic stress by Dr. Charles R. Figley (1995), who has done a lot of research into ‘the cost of caring’. He defines it as
“The natural consequent behaviors resulting from knowledge about a traumatizing event experienced by a significant other. It is the stress resulting from wanting to help a traumatized or suffering person.”
The reason the latter definition resonates with me is that it includes not only traumatized but also suffering people. Some cases we interpret for don’t necessarily include trauma but do put us next to patients and their loved ones who are suffering. Moreover, secondary trauma is multiplied by the very nature of the interpreter’s job. When speaking at the recent ITAA conference, Melissa Fridlin Murrell, owner, and interpreter at Deep South Language Services and Language Access Consultant for Alabama Language Access Project, summarized the issue perfectly. She said that while providers will typically hear a patient recall a traumatic experience once, an interpreter will not only hear the message, but process it, translate it into another language, and then relay it to the provider, all the while using the first person! Add to that the fact that an interpreter cannot afford to get distracted or tune out something that might be distressing for them to hear: in order to do our jobs, we need to interpret the message completely and accurately and that means listening intently and getting every detail right.
As part of my research for this blog post, I came across this fascinating clinical research on the effects of client trauma on interpreters. When talking about the impact of vicarious trauma on interpreters, among other things the paper (Lor, 2012) described one of the research subjects experiencing ‘modified survivors guilt’, that is, a situation where an interpreter feels like they can’t complain about their own lives when they hear first-hand about the terrible things other people have experienced. I can definitely relate to that. I have experienced that feeling when you get upset over something, say your new expensive and supposedly waterproof boots being ruined after a walk in the rain and suddenly feeling extremely selfish for worrying about something so trivial when only this morning you saw a mom cry because she was told her child suffers from a progressing degenerative disease. My colleagues described feeling the exact same thing after a particularly upsetting patient encounter.
So how do you cope with the modified survivor’s guilt? I don’t think I have the answer and this is something I’m still trying to figure out. I vividly remember a day when I was interpreting at a hospital located near a lake. I had a 3-hour gap in my schedule for that day, and it being a beautiful summer day I decided to take advantage of my proximity to the lake and rent a kayak for an hour. I made sure to pack a change of clothes when I was getting ready for work that day and, as I was driving to the hospital, I was congratulating myself on being pro-active in planning self-care activities. However, I was feeling something very different when I was done with my last morning appointment. The patient had an appointment with a doctor. and then a social worker, and was facing an unimaginable number of difficulties with their health, family life and finances. It seemed inconceivable that, after hearing all that, I would just get on with my day and go kayaking and then enjoy eating my sandwich on a sunny dock. How could I enjoy my day when the patient was suffering so much? I almost didn’t go anywhere. The thought that shook me out of my misery and guilt was that by not going, I wasn’t actually helping that patient. However, by not taking care of myself I was running the risk of an emotional burnout, which could mean I was no longer able to be a healthcare interpreter and thus not able to help anyone – neither this patient nor others that need interpreters to access healthcare and other services. So I made myself go kayaking and it did help me feel better and relax, and I was able to go to my next appointment with a fresh perspective.
As for dealing with secondary trauma, in particular, the trauma brought on by the interpreter using the first person as they interpret, a reader of the blog brought this video to my attention. In this video, Marjory Bancroft, the founder of Cross-Cultural Communications (CCC), talks about exceptions to the national standards of interpreting in the first person. Among other special circumstances, such as interpreting of children, the elderly, and out of control situation, she discusses switching to the third person in order to protect the interpreter from vicarious trauma when they interpret graphic and/or disturbing content. Marjory recommends using your judgment to determine when the switch is necessary and switching back to the first person as soon as it is appropriate. However, this exception does not apply to court interpreting, where using the third person is not permissible.
If you think the description of vicarious trauma in this post sounds all too familiar, you might want to read more about vicarious trauma here or have a look at this self-score measure of the negative and positive effects of helping others who experience suffering and trauma. This resource is free and available in English and 23 other languages.
Identifying with patients and re-traumatization.
This is something closely related to secondary trauma and something I have experienced personally. I was interpreting for a patient undergoing chemotherapy infusion. The appointment was over 4 hours long, with a lot of downtime (the patient was napping while receiving the infusion), which left me with plenty of time for my thoughts to wander. I thought about the patient’s family members, who were accompanying her and suddenly I started imagining myself in their shoes and thinking about how hard it would be for my family to get here all the way from Russia if they wanted to be with me or how awful it would be if this happened to a member of my own family. The train of thought caused me a lot of distress but I found it very hard to stop. I am fortunate in that as of now, however distressing, all this is hypothetical for me. There are other situations that I felt hit very close to home and here lies another potential stressor for medical interpreters: re-traumatization, which is reliving a past traumatic experience that is triggered by encountering a similar situation. This might be an illness that an interpreter or their loved one has suffered from in the past or is suffering from now or the loss of a loved one. Another situation where re-traumatization may be likely is interpreting for refugees or asylum seekers with whom the interpreter may have a shared culture, history and previous experience of trauma (Splevins et al., 2010).
The unpredictability of income and schedule (for freelance interpreters)
This stressor is rather self-explanatory. Working as an independent contractor, you might have to juggle assignments from several agencies, or experience lean periods when assignments are scarce.
When I moved to Seattle, Washington, the situation was totally different from Nashville, Tennessee where I was working before. Unlike in Nashville, there are plenty of Russian interpreters around. Like all the other freelance interpreters, in order to maximize my chances of getting assignments, I signed up with several agencies, which presented challenges of its own. One stressful situation is accepting a shorter assignment in the middle of the day and then not being able to schedule anything else around it or having to decline an offer for a much longer assignment on the very same day (and not all the other days that week that are completely open!) thus losing out on a larger fee.
Another source of stress connected with income is, of course, taxes. Depending on where you live, I suggest you figure out what is expected of you sooner rather than later so that you do what needs to be done on time and don’t scrabble to compile a year’s worth of expense a week before filing taxes or realize you missed a deadline for paying your quarterly estimated taxes.
The continuous need to learn
This is not about having to get CEUs in order to renew your certification and I love learning so I actually consider this an upside of the job. However, colleagues have reported stress related to having to read up on a rare procedure or condition the night before an appointment so I thought I should include this potential source of stress in my post.
How do we practice self-care?
As the profession grows and develops, there are more and more resources for interpreters wanting to learn more about self-care, including workshops and seminars, this open call, and articles like this one and this one. In fact, information on self-care does not have to be about interpreters specifically – everyone needs to find ways to take care of themselves and there are thousands of articles like this one on Buzzfeed.
In this post, I want to talk about some things that I personally found helpful.
Don’t overbook yourself (and bring a snack!)
Because of the unpredictability of scheduling for many freelance interpreters, when assignments are offered, interpreters might feel like they shouldn’t decline them and should take on everything that is offered to them – after all, who knows when another opportunity will present itself? This frame of mind makes it hard to take time off. I have been dealing with this for the last 10 years both as an interpreter and a freelance language teacher. Every time I had a request for a lesson or an interpreting assignment, my first instinct would be to say yes. I have had to force myself to slow down and think: can I really fit this lesson/interpreting assignment into my schedule? Do I have enough time throughout the day to eat, drink, visit the bathroom, exercise or have a break? Will I get enough sleep? These considerations might seem trivial, but what good are you as an interpreter when you can’t concentrate for lack of sleep or pain in your shoulders that are stiff with tension?
I also find it hard to concentrate when I`m hungry, and dehydration can give me a headache. Knowing this, I always carry a water bottle, and I always have snacks in my car and in my bag that I can eat on the go if I don’t have time for a sit-down meal or in case I get pulled into an assignment unexpectedly. I was definitely glad to have some emergency snacks in my bag when, instead of going home for the day, I ended up spending 7 hours interpreting for childbirth. My go-to snacks are protein bars, peanut butter-filled pretzels from Trader Joe’s and… baby food pouches. I know it’s weird but when you really truly have no time but you must eat or your stomach will play the songs of humpback whales at top volume, a pouch of banana/apple/blueberry puree might just save the day!
Yoga incorporates several things that are almost always included in any publication on self-care: exercise, mindfulness, and breathing. My favorite kind of yoga also includes pet therapy (which is a fancy name for my dog stealing my yoga mat or head-butting me for attention when I`m doing planks).
And I can’t overstate the importance of slow, deep breathing: I almost fell off my sofa when I was trying deep breathing exercises after a particularly stressful day and I actually felt my heart slow down its manic rhythm. Also useful for grounding yourself during difficult encounters (just do it unobtrusively) and for a brief post-encounter meditation session where you are focusing on your breath. No chanting or squatting in uncomfortable positions is necessary.
Do something creative
While debriefing and talking to other interpreters are invaluable self-care tools, it also helps to do something that is NOT about interpreting, healthcare, courts or any other aspect of your job. I found that classes like Paint and Sip are a good way to switch off and have a good time with your friends.
Or get an adult coloring book – they are supposed to have an added bonus of helping with mindfulness. Or go to a singing class! (also good for breathing!). In this video called “A Day in the Life of Real Interpreters”, director Sydney Pollack talks about the making of his movie the Interpreter and interviews real-life UN interpreters. I remember being surprised when one of the interpreters said that quite a few UN interpreters play music in their spare time. Indeed, Nicole Kidman’s character plays the flute.
Mr. Reed ended his talk at the ITAA conference by playing some upbeat music and inviting the audience to respond. Everyone had their eyes closed for a while so we were free to try out some dance moves without worrying about feeling shy. It felt really good to let go and get silly by coordinating dance moves with my friends. And if, like me, you are a fan of Grey’s Anatomy, you`ll remember that the main characters coped with difficult life situations by dancing it out. So here’s my final piece of advice – dance it out!
Being in a ‘helping’ professions has its price. We help others and we love it – but we should also remember to help ourselves by recognizing the warning signs that we are stressed, exhausted or are suffering from vicarious trauma, and by practicing self-care to both prevent and mitigate long-term consequences for our physical and mental health. Some commonly recommended techniques for self-care include debriefing, breathing exercises, exercise, and meditation. I recommend experimenting with what works best for you and making sure you are as committed to taking care of yourself as you are to helping others!
Crezee I. et al. Teaching Interpreters About Self Care, 2015. International Journal of Interpreter Education 7(1), 74-83. Retrieved from http://www.cit-asl.org/new/teaching-interpreters-about-self-care-7-1/
Figley, C. R. (1995). Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the
Traumatized. NY: Brunner/Mazel.
Lor, M, “Effects of Client Trauma on Interpreters: An Exploratory Study of Vicarious Trauma” (2012). Master of Social Work
Clinical Research Papers. Paper 53. Retrieved from http://sophia.stkate.edu/msw_papers/53
Splevins, K.A., Cohen, K., Joseph, S., Murray, C., & Bowley, J. (2010). Vicarious posttraumatic growth among interpreters. Qualitative Health Research, 20(12), 1705-1716
The Cost of Caring – Vicarious Trauma in Interpreters. (2019, April 22). Retrieved from https://www.nimdzi.com/the-cost-of-caring-vicarious-trauma-in-interpreters/.
What is Vicarious Trauma? (n.d.). Retrieved from http://www.vicarioustrauma.com/whatis.html