Transcultural Psychiatry
• Frame for interpretation:
– Danish administrative law: provides legal framework
to ensure adequate communication with the patient
– Medical oath: states that doctors should show care
and concern for all patients irrespective of
background
– Geneva Declaration (WMA): the health of the patient
is the primary concern of the doctor
Transcultural Psychiatry
• The interpreter as a person
• Attention should be paid to:
– relation to the patient
– sex
– age
– educational level
– personal traumata
– ethnicity
– religion
– political affiliation
Transcultural Psychiatry
• Use of interpreters (I):
– Respect for the interpreter as a colleague
– Difficulties in specific terminology
– Need for specialist education
– Feedback to interpreter/bureau about quality
– Preparation of the interpreter for the contact
– Debriefing subsequently
Transcultural Psychiatry
• Use of interpreters (II):
– Continuity contra shift of interpreter
– Placing of interpreter between therapist and patient
and direct communication to the patient
– Avoid to let the interpreter wait/be alone together
with the patient
– Respect for duration of interview
– Ethical rules for interpreter
– Avoid family members to patient
Transcultural Psychiatry
• Use of interpreters (III):
– Direct address not address in third person
– Use of metaphors or proverbs
– Attention paid to that congruent words/ idioms not
always exist
– Contrasts between interpreter and patient (sex,
politics,etc)
– Patient mistrust towards interpreters – in particular
in refugees
– Technical difficulties in translation
– Debriefing and preparation of interpreters
Transcultural Psychiatry
• Conversation with patient of other ethnic
background:
– Therapist cannot assume common background with
patient
– Prejudice and preconceived ideas about each other
– Differences in traditions and norms for the
communication of feelings
– Differences in norms and ideas about treatment
– Differences in expectations to the therapeutic
relation
Transcultural Pschiatry
• Differences between therapist and patient
regarding e.g.
– culture
– sex
– language
– social background
• may result in “inappropriate” therapeutic
interventions and give rise to lack of
communication
Transcultural Psychiatry
• Patient-therapist relation:
– Prejudice and expectations to each other
– Direct contact contra dialogue
– Authoritarian contra democratic form
– Different traditions what are acceptable regarding
gifts, acknowledgement, etc.
Transcultural Psychiatry
• In order to optimize communication attention
should be paid to:
– gender roles and expectations
– religious affiliation
– professional position
– cultural set of values
– social background
– language competence
– Hegemann 2001
Transcultural Psychiatry
• Issues related to:
– the interpreter as a person
– the therapist
– the patient
– the patient-therapist relationship
– external factors
Transcultural Psychiatry
• Patient related obstacles:
– preconceived ideas about the interpreter
– hoping for benefits by offering gifts, etc to the
interpreter
– challenging the language competence of the
interpreter
– trying to obtain an unprofessional alliance
– refusing contact with a given interpreter
Transcultural Psychiatry
• Issues related to external factors:
– work as interpreter in different settings
– contact with patient outside clinical setting
– breaking confidentiality