TY - JOUR

T1 - A balancing act

T2 - how interpreters affect the therapeutic alliance in psychotherapy with trauma-affected refugees—a qualitative study with therapists

AU - Hanft-Robert, Saskia

AU - Lindberg, Laura Glahder

AU - Mösko, Mike

AU - Carlsson, Jessica

N1 - Publisher Copyright: Copyright © 2023 Hanft-Robert, Lindberg, Mösko and Carlsson.

PY - 2023

Y1 - 2023

N2 - Objective: The therapeutic alliance (TA) has the highest predictive value concerning the success of psychotherapy. The presented study aimed to explore how the presence of an interpreter affects the TA when working with trauma-affected refugees. Method: Semi-structured interviews were conducted with seven psychologists working in an outpatient clinic specialized in mental health care for migrant and refugee patients with trauma-related mental health problems in Denmark. Interviews were transcribed verbatim and analyzed using a structuring content analysis approach. Results: TA has been described as a dynamic therapist-interpreter-patient alliance triangle consisting of three distinct but highly intertwined and mutually influential dyadic alliances. Specific factors affecting the quality of the TA were identified, e.g., interpreter being emotionally attuned yet not overly involved; interpreter being barely visible yet present as a human being. Characteristics of trauma-affected refugee patients affecting the TA formation were also identified, e.g., a high level of personal distrust, different understandings of mental disorders and psychotherapy, stigmatization, perceptions of authorities. Conclusion: The presence of interpreters was perceived ambivalently and the formation of a good TA seems to be a balancing act. Based on the findings, recommendations for forming and maintaining a good TA in interpreter-mediated psychotherapy are provided.

AB - Objective: The therapeutic alliance (TA) has the highest predictive value concerning the success of psychotherapy. The presented study aimed to explore how the presence of an interpreter affects the TA when working with trauma-affected refugees. Method: Semi-structured interviews were conducted with seven psychologists working in an outpatient clinic specialized in mental health care for migrant and refugee patients with trauma-related mental health problems in Denmark. Interviews were transcribed verbatim and analyzed using a structuring content analysis approach. Results: TA has been described as a dynamic therapist-interpreter-patient alliance triangle consisting of three distinct but highly intertwined and mutually influential dyadic alliances. Specific factors affecting the quality of the TA were identified, e.g., interpreter being emotionally attuned yet not overly involved; interpreter being barely visible yet present as a human being. Characteristics of trauma-affected refugee patients affecting the TA formation were also identified, e.g., a high level of personal distrust, different understandings of mental disorders and psychotherapy, stigmatization, perceptions of authorities. Conclusion: The presence of interpreters was perceived ambivalently and the formation of a good TA seems to be a balancing act. Based on the findings, recommendations for forming and maintaining a good TA in interpreter-mediated psychotherapy are provided.

KW - interpreter

KW - psychotherapy

KW - refugees

KW - therapeutic alliance

KW - trauma

UR - http://www.scopus.com/inward/record.url?scp=85161055245&partnerID=8YFLogxK

U2 - 10.3389/fpsyg.2023.1175597

DO - 10.3389/fpsyg.2023.1175597

M3 - Journal article

C2 - 37260954

AN - SCOPUS:85161055245

VL - 14

JO - Frontiers in Psychology

JF - Frontiers in Psychology

SN - 1664-1078

M1 - 1175597

ER -