Complex Emotional Reactions within the Therapist/Client/Interpreter
Triad
Zoe Silber, Linda Pazdirek, Melissa Caruth, & Ken Miller
Presented at the annual meeting of the American psychological Association,
1. Transference and countertransference: how to apply these to the therapeutic
triad?
When we originally began to explore the nature
of the emotional reactions that occur in the triadic relationship, we attempted
to frame them within the clinical terms “transference” and
“counter-transference.” As we applied
these terms to our data, however, we found that it became rather problematic to
do so, due to the nature of the triadic configuration within the therapy
session.
In a traditional, dyadic therapeutic relationship, the terms can be applied in a relatively straightforward manner. “Transference” generally refers to any emotional reaction that is experienced by the client toward the therapist, which involves the re-experiencing or re-emerging of conflict from the client’s past experiences. “Countertransference” refers to any reaction that is evoked in the therapist by the client that plays on conflicts or emotions from the therapist’s past.
However, the addition of a third party makes these terms somewhat difficult to apply. It is necessary to question which term applies to emotions, on the part of the client, that are directed toward the interpreter. Likewise, it is unclear what, precisely, to label the emotions that are experienced by the therapist toward the interpreter. Most problematic, perhaps, is the question of what to call the emotional reactions that are experienced by the interpreter him or herself – both toward the client and toward the therapist.
Furthermore, the ethnicity or
gender of the interpreter may play a role in evoking emotion in the client that
are not necessarily transferential in nature.
It is necessary to take into consideration that many of the clients who
are using interpreters in therapy have recent histories of torture and other
extreme trauma. It becomes problematic
and reductionistic to frame emotions that are evoked by racial or political
history, or by the clients’ history of torture, as transference. As we explored
the emotional reactions that occurred within the therapeutic triad, we became
aware that sometimes, the emotional reactions seemed clearly to be stemming
from an individual’s past experiences.
At other times, the emotion was evoked seemed to be more a result of the
very nature of the therapeutic triad, or a result of political differences, or
was due to the presence of a dual relationship between the client of the
interpreter. Furthermore, we became aware that within the triadic
configuration, there are times when the emotions of all three parties come into
play simultaneously.
With refugee clients and interpreters, the racial and political tensions that may exist between the pair are a very real concern. One therapist describes a situation in which a client became, in the therapist’s words, very sadistic to a client based on ethnic differences. This resulted in the interpreter becoming very angry at the client. Eventually, the client stopped coming to therapy altogether.
Here, a therapist describes the way in which political differences can have an effect on the therapeutic process:
“Sometimes, somebody has given you something historical, and the interpreter knows that it is wrong, you know? [The interpreter says] ‘No, no, he wasn’t thrown out of power during that, it was two years earlier.’ …You have to train your interpreters to stay out of those things, but it happens, you know, where they are on opposite sides of the political fence, and you can sense [the tension] sometimes. That is when you need to get a new interpreter, when you can feel that there is too much.”
2. Why we chose to move away from those terms.
Furthermore, in conducting our interviews with the therapists, we spoke to individuals who adhere to many different theoretical orientations, some of whom were uncomfortable with using the terms transference and countertransference. Furthermore, we became aware that different therapists conceptualized these terms in different ways. This, combined with the above difficulty in determining exactly how these terms should be applied to emotion that involves the interpreter, prompted us to move away from said terminology. Instead, we have chosen to use the term “complex emotional reactions” in our discussion, which is less specific to any theoretical orientation, and better describes the reactions that we are discussing.
3. Two Categories of Reactions:
Interpreters’ Reactions and Therapists’
Reactions.
Today, I would like to discuss two different categories of complex emotional reactions that appeared within our data, the reactions of the interpreters, and the reactions of the therapists. I will highlight a few of the more common themes that emerged in our interviews.
Therapists' reactions
Some of the therapists to whom we spoke mentioned that they felt alienated by the client– interpreter relationship, as if the bond that was shared between the two, in some ways, excluded the therapist. One therapist describes feeling as if the client’s emotions were sometimes directed more toward the interpreter than they were to the therapist herself:
One thing is that in terms of transference, that there seems to be a lot of transference, really strong transference from the client to the interpreter, and sometimes I actually feel kind of left out, so that I am missing the transference to me, especially in the beginning (female, 44).
Another therapist voiced concern about being
excluded from of certain interactions as a result of the shared language of the
client and the interpreter, and the barrier created by the therapist not
speaking their language. He stated:
“It gets even more complicated because the client can speak to the interpreter, and may well be voicing some of their reactions to me to the interpreter, knowing that I won’t be privy to those discussions. The interpreter, I think, certainly chose to not share some of what the client was saying about me to me, for whatever reason, and I don’t know what they said. (Male, 34)
Conversely, there is also often a sense that the therapist and the interpreter are working as a team. Several therapists voiced feelings of relief and gratitude for the presence of another person, acting as a witness, particularly when they were hearing stories of extreme violence. One therapist stated:
“I remember countless times when you would hear something that would just be like a punch in the gut, and there would just be this shock, you would think “I could never hear something more shocking in my life.” It was traumatizing…and having the interpreter there with you was so immensely comforting because you know that you could process it together….there was sort of this implicit understanding between the two of you that you had both witnessed something very profound.” (Female, age 30)
Another therapist stated:
“I found myself caring very much for the translators and the patients, feeling almost in some ways as if they [the interpreters] are my collaborators. I feel very dependent on them in some ways, so it makes me very involved with them, you know, giving them a lot of power in a way and depending on them to help me help this person…” (Female, age 44)
As
was previously mentioned, many therapists and interpreters form a relationship,
both professional and personal, that extends outside the therapy sessions. Although
this alliance between the therapist and the interpreter is often beneficial to
the therapeutic triad, it can also be problematic. Here, one interpreter describes a situation
in which she feels that the therapist’s emotions toward her came into play in a
way that affected their working relationship, and the therapeutic dynamic,
negatively. She describes how she and
the therapist with whom she was working started to become friends, and how the
dynamics of their outside interactions began to bleed over into their
relationship within the therapy room:
“I think he had these expectations of me to be there for him as a close friend, whereas I was sort of running around frantically and trying to get these other things done. I think that, for a couple of sessions, he had a hard time concealing that he was upset with the fact that I was not, sort of, paying more attention to our friendship. What was strange was, sort of, entering into, I guess, a more formal setting and then having that at the back of my mind.” (Female, age 28)
Many therapists voiced having occasionally experienced feelings of anger and frustration that were directed toward the interpreters, particularly in situations where the interpreter stepped out of the role of merely translating words, and interjected his or her own emotions or opinions within the therapy session. Also, therapists mentioned that they sometimes became frustrated with the interpreters as a result of feeling that they were not translating the client’s words in their entirety.
“For example, we had an interpreter, a Bosnian interpreter, for our group, who was not trained as an interpreter. She wasn’t a psychologist, she wasn’t a physician. She had a background in nursing, but she wasn’t a very good interpreter. She would choose not to say certain things that she didn’t herself want to deal with, when they were saying things like that, or she would make commentary on what other people were saying…That was a really frustrating experience and I think it sort of broke up the whole cohesiveness of the group.” (Female, 30)
Several themes regarding the emotional reactions of the interpreters also emerged.
Many interpreters spoke of feeling uncomfortable in the session, particularly when the therapy session evoked their own past experiences of war or violence. Here, one Bosnian interpreter describes how hearing the clients’ stories of war and violence evoke his own emotional memories:
“It depends on the experience
[that the client is describing] because I have some horrible experiences myself
and that moment when people start to talk about close experiences as mine, I
just go sad inside. It’s just like you
remember it alone….You just feel sad about it.
But in that moment, when somebody’s talking about that situation, you’re
not able to do something by yourself.
It’s for me the most worst situation in what I think can happen. It feels…like you are just coming back to,
and visiting, that moment.” (Male, 29)
The therapists whom we interviewed also spoke about sensing discomfort on the part of the interpreters, and spoke about how interpreters’ emotions came into play in the sessions. At times, it appears that the interpreters projected their own discomfort on to the client, telling the therapist that they didn’t think the client was ready to handle emotionally charged material.
Interpreters were also reported to have strong reactions, often of frustration, to the therapy process itself. These seemed to stem mainly from unfamiliarity with the techniques that were being used. Here, a therapist describes a situation in which an interpreter challenged her in session, as a result of not understanding her therapeutic technique. The therapist describes working with a traumatized client, who was dissociating, and the difficulty that she encountered with the interpreter when she attempted to ask the client a question that would bring him back into the present moment:
“I have had interpreters …question me. [The interpreter said to the client] “Well, she wants me to ask you what color her shirt is…I don’t know why, that’s really stupid.”
The therapist describes her own emotions as a result of the interaction, illustrating how the emotions of one member of the triad can affect everyone in the room. She states: “Well, it was frustrating as hell, and I had to stay completely grounded, and not even let that show, because I didn’t want to trigger the client….” (Female, 39)
Both therapists and interpreters described situations in which the interpreter
became uncomfortable as a result of the client’s emotions and behavior that
were directed at the interpreter, both within and outside the therapy
session. Here, one interpreter describes
a situation in which a client’s strong emotions toward her led to the client
contacting her outside of therapy, and she, the interpreter, became afraid:
“[It] actually turned into a sort of a strange situation, because the client was – and this is not my own interpretation, this is a psychiatrist’s interpretation and the psychotherapist’s interpretation – was becoming psychotic, and was calling me and sort of propositioning me, and you know, wanting to marry me and all kinds of interesting things….I think, initially, the only thing that we had in common was the language, and it created this sort of bond where I became the outlet for a lot of these different things that he was going through…. It became scary…For a while I was actually very frightened of him and frightened of going to the center because of that whole situation.” (Female, 28)
Here, a therapist describes a situation in which she became aware of the emotional interplay between a client and an interpreter, and the ways that these emotions affected the therapeutic dynamic:
“I can think of one time very
clearly…where the client developed a love transference towards the
interpreter. It was very difficult for
the interpreter because he was not trained in that; he was trained as a
physician so he was uncomfortable with it, so he changed in the therapy room.
He became sort of stilted for a while and sort of disconnected from her and he
was very afraid of her transference towards him. They were both married… I think…that his
feelings were kind of scary, too, like “I have never thought of being with
anyone other than my wife.” So, all
these issues came up where it did kind of seem like they were acting our some
marital dynamics of their own marriages.” (Female, age 30)
I have highlighted a few of the
more common themes that emerged within our interviews.
Within the therapeutic triad, complex
emotional reactions occur in all three parties – the client, the interpreter,
and the therapist. Overwhelmingly, our
data indicated that both therapists and interpreters felt that better training
would be beneficial in learning to avoid the pitfalls that can occur as a
result of these reactions.