Thursday, August 15, 2013

PsychoBabel




A few days ago, I was listening to an interview with Omara "Bombino" Moctar, a Tuareg musician who was on his first tour of the U.S.  He speaks French but not English, so an interpreter was employed to ask him about his experience, and in particular about the presumed difficulty of connecting with an American audience when he doesn't speak their language.  His wonderful response was (as interpreted), "We don't need to understand one another in order to understand each other."

Bombino's statement resonated for me because, in one of my work settings where I'm a supervisor, we've gotten some resistance to using professional interpreters for Spanish-speaking families when bilingual clinicians aren't available.  (I should add that the children we treat almost all speak English; if not, we do assign only bilingual therapists.)  We've had a high degree of successful outcomes for treatment utilizing interpreters; many of these clients have been able to terminate in half the time recommended by the particular treatment protocol in which interpretation is at issue.


While the developer of the modality has been open to the idea of using interpreters, the main push back we've gotten has been from bilingual clinicians and some trainers with whom we consult.  The presumption is that, if a clinician can't speak the parents' language, s/he cannot possibly grasp the nuances necessary for treatment of the child that involves the primary caregiver.

In clinical psychology programs we have copious trainings in appreciating and honoring cultural diversity, and are induced to become aware of and confront our own cultural biases.  It occurred to me that what we might have here with this push back was another kind of bias.  One that could not imagine or acknowledge that there's more to being an effective therapist than understanding the words.  That not understanding the language has, even, perhaps some advantages: potentially more attention to behavior and affect, or fewer assumptions about shared values and hence more openness to learning about the culture of any particular family.

As a bilingual supervisee (originally from Uruguay, raised in Canada) had edified me, the dialect of Spanish you speak can be crucial.  He explained that he would use different words and a different dialect for a Mexican family, for example, than he would for one from Guatemala or other countries.  In some cases a word could be offensive to one Latin group but precisely appropriate to another.  I wondered how many of the bilingual clinicians on our consultation conference calls were as sophisticated with the language as he--or a professionally trained interpreter.

But this whole discussion brings me to my larger point.  The therapy room is an intersubjective space.  Therapist and client each have their organizing principles that commune and collide and are co-influenced.  We have transference and countertransference.  But therapists also try their best to, as Bion put it, enter the therapy room without memory or desire.  We try to see the client, to understand him or her and reflect that back.  That is the essence of empathy.  A good therapist is one who will truly listen and observe and wonder.  Who will be, as I so often exhort my supervisees, endlessly curious, and invite the client (and parent!) to be curious about his or her behaviors as well.  To riff off of William Blake, the road of wondering leads to the palace of wisdom--or what we psychodynamic therapists refer to as insight--which is both the foundation for and the springboard to change.

I recall a related situation when I was just starting out as an intern.  One of the first clients I was assigned was a 14-year-old boy who, his mother suspected, was smoking marijuana, which she believed was at the root of some behavioral issues.  During intake the boy's mother inquired if I had any teen children of my own.  I asked about the question behind the question to elicit her concern (it's interesting that when you do this and discussion of fears and anxieties ensue, clients usually forget about their original query--it becomes irrelevant.)

But this mother was adamant that she didn't see how I could possibly help her son if I didn't have a teen-ager myself.  Perhaps she feared that I was an inexperienced therapist (which I was!) and she felt entitled to a "real" one; perhaps it was also her way of conveying how helpless and pressured she felt--since that was how she was making me feel (countertransference!).  In any case, I disclosed that I did not have a teen son or daughter, and then I offered an analogy.  I gently asked the mother if, in the event that she needed a cardiologist, would she only feel confident being treated by one who had experienced a heart attack?  (Lame, I felt in retrospect, but my supervisor actually deemed it apt when I brought it up in group.)  I don't recall the mother's response, but in any case the client was transferred to another intern at the parent's request, and I'd be dishonest if I didn't admit I felt somewhat relieved at not having to work with that parent.


I truly believe that our clients will tell us everything we need to know about them, regardless of how different we may seem.  That is, as long as we're both both open to dancing with each other, so to speak.  I also believe that, to reprise the title of A.O. Scott's New York Times review of Alejandro González Iñárritu's wonderful film Babel, "emotion needs no translation."

And speaking of film and language barriers, first timer Zachary Heinzerling won the documentary director award at Sundance this year for his film Cutie and the Boxer, about the relationship between two married Japanese artists,  Ushio and Noriko Shinohara, whose language he doesn't speak.


In an article in the Los Angeles Times, Heinzerling describes his filmmaking technique with this couple, in which he practiced what I'd describe as Keatsian Negative Capability. He allowed himself to sit with ambiguity, to be "relatively absent," not asking them to repeat or to clarify things, and instead elicited, witnessed, and shaped a story from "a conversation they were having with each other" (he would film them and only later have their dialogue translated).  Like a therapist, he created a space for Ushio and Noriko to play. Heinzerling says that the film was never intended as a form of therapy for the couple, but it has changed how they view their long relationship.  I expect it changed Heinzerling as well.



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