Doctor: “Tell him to hop up on the exam table… Now, has he had these symptoms for a while? Ask him if he’s taken anything for it…” (Wait, why is the doctor talking to me and not the patient? What do I do now?)
Patient: “Oh dear, that doctor looks too young to be practicing medicine… Wait, did you just interpret this? Why would you do this?” (Oh no! Now the patient won’t trust me!)
If you are a professional medical interpreter, chances are that you have encountered similar situations. If you are only just starting out in the profession, somebody might have warned you about these things happening. Yes, on an ideal interpreting assignment, the doctor and patient speak in utterances of reasonable length and at a reasonable pace, not saying anything they wouldn’t want to be interpreted, all the while making eye contact and speaking directly to each other. In real life, things may not go so perfectly – and not because people involved don’t want us to do our jobs, but rather because they might not have worked with interpreters before and therefore might not know the best way to fully utilize the help of a professional interpreter. They might also have concerns about having another person present at a doctor’s appointment – one that is not wearing scrubs or a white coat and at first glance does not look like part of a healthcare team. As a result, patients might be reluctant to divulge sensitive information in the presence of an interpreter. The list goes on.
As interpreters going into a healthcare encounter, we can either hope that none of the above happens, or we can help ensure that conditions are created that enable us to interpret to the best of our abilities and allow us to do our job – that is, enable people to communicate as if they were speaking the same language. One way to make this happen is by having a pre-session.
Why is self-care for medical interpreters so important?
The nature of a medical interpreter’s job
Like with any job, interpreters working in healthcare settings experience work-related stress – but we also face many challenges that are unique to our profession. We are there for many important moments in people’s lives – from babies being born to people receiving life-changing diagnoses. Whether this is a happy event or a time of sadness, as interpreters we have to put aside our emotions and focus on maintaining a professional demeanor and professional boundaries. Often, however, the emotions that get put aside are never revisited, even though we all know that bottling things up never works in the long run.
Another difficulty that stems from the nature of our work as conduits of information is the fact that, during interpreting assignments, we witness people dealing with very difficult situations – from being victims of domestic abuse to grappling with a terminal diagnosis to people struggling to afford food for themselves and their children. As human beings, and those working in helping professions, we can’t help but feel compassion for those we interpret for and to want to help. But our code of ethics is very clear on interpreters’ need for maintaining the boundaries of their professional role and refraining from personal involvement. Consequently, witnessing such situations and being unable to do anything aside from fulfilling our interpreting duties can make an interpreter feel helpless and frustrated.
The proverbial saying ‘A problem shared is a problem halved’ reflects the need we have to talk about what’s bothering us. However, observing HIPAA regulations means that we have to be very careful with what we disclose about our daily work and this can make it difficult to know what is okay to talk about when you’ve had a difficult encounter.
In addition, there are many medical interpreters who, like myself, work as freelancers. In fact, according to a report by CSA Research titled The State of the Linguist Supply Chain: Translators and Interpreters in 2020, 75% of interpreters and translators worldwide are self-employed. Being an independent contractor can be great for many reasons – from the variety of work to the flexibility in arranging one’s schedule. However, freelance interpreters can sometimes feel isolated – after all, we don’t really have a supervisor to offer us support or a team of colleagues to lean on. Having said that, I am fortunate in that there is at least one agency I work with that I would not hesitate to call to debrief after I’ve had an emotionally challenging assignment or to ask for guidance on ethical dilemmas (unfortunately, not all my appointments are through them.) And I do have a wonderful group of fellow interpreters that I can count on for support and encouragement on any day of the week – even if this support mostly happens through our phones as during our working days we rarely intersect long enough to chat. To sum up, those of us working as independent contractors don’t have a built-in support system and have to be resourceful in creating their own.
There’s been a growing awareness of vicarious trauma being experienced by interpreters alongside other members of helping professions. 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? The best answer I can come up with is the oxygen mask metaphor. You know how on airplanes, during safety instructions, we’re told to put our own oxygen mask on before helping others? I had to remind myself of that once. 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. During the appointment, the patient disclosed that they were 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 as I concentrated on not tipping over or running into other kayakers, I felt myself start to let go of the day and relax. Eventually, I was able to face 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, there is one solution that might help – it should, however, be used sparingly and judiciously. 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. There might be days when you can’t find a single job, days when you are offered multiple assignments, but they clash and you can only take one. There are days when you accept a short assignment in the middle of the day and then can’t schedule anything else around and have to decline a 5-hour job being on the very same day (and not all the other days that week that are completely open!) thus losing out on a larger fee. Then there are days when you get up at 5 am but instead of going home in the evening, you accept a childbirth assignment – because who doesn’t want to have a 12-hour long assignment and to see a baby born?
Another source of the 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.
How do we practice self-care?
Raise awareness of the need for self-care
Crezee I. et al (2015) writes 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. We already looked at some potential sources of stress – now let’s look at what to do about it.
As the profession grows and develops, there are more and more resources for interpreters wanting to learn more about self-care, 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.
Take a class on self-care and vicarious trauma
There are many workshops and classes offered as part of continuing education as well as being presented at conferences. It would be difficult to try and maintain a calendar of onsite events happening around the US, so I will leave the job of keeping an eye out for such opportunities up to the readers. Instead, I would like to direct your attention to a series of free online courses offered by MasterWord. Thanks to their generosity, you can take the following courses free of charge:
Vicarious Trauma: Healing from Within. From the description on the website: “This presentation introduced participants to techniques, tools and resources to create balance within, help you adhere to professional standards or ethical requirements, and minimize or mitigate the effects of vicarious trauma.”
Decrease Stress & Become More Present. From the description on the website: “This presentation is designed for language professionals to deliver strategies for maintaining our optimal physical, mental, and emotional health.”
Vicarious Trauma: The Ethics of Selfcare. From the description on the website: “Interpreting can carry significant costs for the interpreter, and our ability to do our work with integrity and impartiality depends on the care with which we attend to our own mental and physical health. Long known to social service providers as a significant cause of personal and professional impairment, vicarious trauma is the experience of the symptoms of trauma by those who witness trauma or assist victims. In this conversation and meditation, we will discuss the risks of our work and provide simple practices to ensure that we remain healthy, competent, engaged professionals.”
After a difficult encounter, you might need to debrief. Depending on the setting, you might have an opportunity to debrief with a provider, with your supervisor, or with your colleagues. Regardless of whom you’re talking to, make sure the conversation is not happening in a public area and that no confidential or identifiable information is shared. And if you find that you are feeling overwhelmed, consider seeking professional help.
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 due to a 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 12 hours interpreting for childbirth. My go-to snacks are protein bars, peanut butter-filled pretzels from Trader Joe’s, protein shakes and… baby food pouches. I know it might sound somewhat unconventional, but when you really truly have no time but you must eat, a pouch of apple sauce that you can inconspicuously consume while waiting for the elevator 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 was absolutely stunned 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.
You could also get an adult coloring book – they are supposed to have an added bonus of helping with mindfulness. Music is also a well-known stress reliever. Do some karaoke, join a choir or go to a singing class! (also good for breathing!). You could also learn to play a musical instrument. 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.
Dance it out
A few years ago, I attended a talk titled Self Care: Meeting the Challenge given by Darren Reed, an ASL-English-Spanish medical interpreter and interpreter trainer from Jackson, Mississippi at the Interpreters and Translators Association of Alabama Conference. 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 feeling shy (we could literally dance like nobody was watching!). 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
For a list of podcasts related to medicine in English, see here.
For recommendations for TV shows medical interpreters, click here.
For recommendations of books for medical interpreters, click here.
For a list of blogs, podcasts and YouTube channels for interpreters, click here.
For recommendations for Russian-language podcasts and medical books click here and here.
Know of other resources for interpreters by interpreters that you think should be added to this list? Comment below!
If you’re on Facebook, consider joining my Facebook group, Interpreters and Translators in Washington State, which welcomes interpreters working in the Pacific Northwest and elsewhere to join and participate in this wonderful online community!