Oquendo M A
Columbia University, New York, New York, USA.
Psychiatr Serv. 1996 Jun;47(6):614-8. doi: 10.1176/ps.47.6.614.
Use of a patient's second language in psychiatric evaluation and treatment has a variety of effects. Patients frequently undergo psychiatric evaluation in their second language, yet competence in a second language varies depending on the phase of illness. Evaluation of bilingual patients should ideally be done in both their languages, preferably by a bilingual clinician or by a monolingual clinician with the help of an interpreter trained in mental health issues. Cultural nuances may be encoded in language in ways that are not readily conveyed in translation, even when the patient uses equivalent words in the second language. The monolingual clinician may clarify these nuances through consultation with a clinician who shares the patient's first language and culture or with an interpreter. In psychotherapy, patients may use a second language as a form of resistance, to avoid intense affect. Therapists may use language switching to overcome this resistance and to decrease emotional intensity, if necessary. Psychotherapy can also be affected by the attitudes toward speaking that are part of the patient's culture. Discussions with bilingual and bicultural consultants can elucidate these effects for the therapist who is unfamiliar with the patient's culture.
在精神科评估和治疗中使用患者的第二语言会产生多种影响。患者经常用其第二语言接受精神科评估，然而第二语言能力会因疾病阶段而异。理想情况下，对双语患者的评估应该用两种语言进行，最好由双语临床医生或在心理健康问题方面受过培训的口译员协助的单语临床医生来进行。文化细微差别可能以翻译中不易传达的方式编码在语言中，即使患者在第二语言中使用了等效的词汇。单语临床医生可以通过与使用患者母语且具有相同文化背景的临床医生或口译员协商来阐明这些细微差别。在心理治疗中，患者可能会将使用第二语言作为一种抗拒形式，以避免强烈的情感。如有必要，治疗师可以通过语言转换来克服这种抗拒并降低情感强度。心理治疗也可能受到作为患者文化一部分的对语言表达态度的影响。与双语和双文化顾问的讨论可以为不熟悉患者文化的治疗师阐明这些影响。
