Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Switzerland.
Transcult Psychiatry. 2023 Aug;60(4):626-636. doi: 10.1177/13634615221119383. Epub 2022 Sep 9.
Psychiatric assessments of non-native migrant patients facilitated by an interpreter pose specific communication challenges to all participants. In this study, we developed an original interdisciplinary approach to the verbal and non-verbal practices in this triadic activity. The aim was a data-based description of challenges for clinicians and interpreters, and the identification of relevant strategies. We filmed, transcribed and translated 10 interpreter-mediated consultations focused on the psychiatric assessment of the patient. Subsequently, we submitted the consultations to clinical, interactional sociolinguistic, and interdisciplinary analyses. We identified six challenges for interpreters and clinicians engaged in psychiatric assessments: barely comprehensible and confusing speech, speech about emotions and subjective perceptions, sensitive remarks in relational terms, conclusive clinician interventions, interruptions during interpreter renditions, and non-verbal communication. Attempts by the interpreter to avoid relational offenses (protection of positive face) and to defend the participants' autonomy (protection of negative face) play a major role in these challenges. So does an insufficient awareness of mutual needs by the clinician and the interpreter. We identified specific strategies of inter-professional metacommunication for each challenge. Clinicians and interpreters should be aware of the challenges they may face in triadic psychiatric assessments. They should take a reflexive stance towards their common practices and may consider using metacommunication tools to reach better communicational and clinical outcomes.
由口译员协助对非母语移民患者进行精神评估，这给所有参与者带来了特殊的沟通挑战。在这项研究中，我们针对这种三方活动中的言语和非言语实践，开发了一种原始的跨学科方法。目的是基于数据描述临床医生和口译员所面临的挑战，并确定相关策略。我们拍摄、转录和翻译了 10 次口译员介导的咨询，重点是对患者的精神评估。随后，我们将咨询提交给临床、互动社会语言学和跨学科分析。我们确定了从事精神评估的口译员和临床医生面临的六个挑战：几乎难以理解和令人困惑的言语、关于情感和主观感知的言语、关系方面的敏感言论、临床医生结论性的干预、口译员翻译时的中断以及非言语交流。口译员试图避免关系冒犯（保护积极面子）和捍卫参与者自主权（保护消极面子）的尝试在这些挑战中发挥了重要作用。临床医生和口译员对彼此需求的认识不足也是如此。我们为每个挑战确定了特定的专业间元沟通策略。临床医生和口译员应该意识到他们在三方精神评估中可能面临的挑战。他们应该对自己的共同实践采取反思的立场，并可能考虑使用元沟通工具来实现更好的沟通和临床结果。
