Stress and Trauma in
the Field of Behavioral Health Interpreting

BY Afaf SteierT

More than ever, psychological therapy is a necessity in the 21st century. Between COVID-19, artificial intelligence (AI), and war, people are scattered around the world as immigrants and refugees, worried about their similarly stressed families back home. Despite the rapid development of translation studies over the last 20 years, the psychology of translation is still underdeveloped as a scholarly discipline. As a consequence, there are no proper psychology courses for future specialists that might provide insight into translators’ and interpreters’ professional activity and aid them in performing their jobs.

In 2022, we’re seeing the hopeful end of one crisis – COVID-19 — and the beginning of another — war. We are becoming aware that we live in a small world. Face-to-face social interactions with our neighbors are less frequent than they used to be, and those interactions — a quick chat, a check in, perhaps even helping if we fell ill — may have been important for mental health. COVID-19 played a role in us distancing from each other, losing touch, no longer connecting on a personal level. Modern-day AI advancements are accelerating this trend.

Consequently, more individuals — even among the younger generation — are seeking help from specialized psychologists to understand their fears, to balance life and work, to manage a fulfilling and productive existence in our often-lonely world. Add to this the increasing number of immigrants who have their own specific issues. About 26% of the US population is made up of immigrants, all of whom face the stresses of adapting to a new culture. At the same time, many are also grappling with the traumas of war, poverty, and natural disasters.

Relevance of small companies in psychological interpreting and translation services

Behavioral health services is a great niche for small-business language service providers (LSPs), as it’s a real service requiring experienced professionals. Small, entrepreneurial businesses are flexible and motivated enough to customize and localize their services for behavioral health services.

However, psychological assessments present more challenging work than one might expect. Instructions have to be translated and localized culturally, offering precise language for patients to follow. Furthermore, therapists can sometimes repeat unmodified questions to get the right assessment. Following ISO standards for translation, the assessment questionnaire is translated, proofread online, back-translated, and tested in clinical settings on patient groups not speaking the local language. It’s a lengthy process. But it’s important to ensure translated assessments are effective for use in behavioral health.

For interpreting, usually Behavioral Alliance, a healthcare company, or a governmental agency contracts with companies. It is best when it’s a small business, paying attention to detail and customer service, placing the orders with the same interpreter to continue treatments and ensure confidentiality.

Speaking of confidentiality, patients must trust both the interpreter and the therapist for the sessions to be productive. The interpreter needs a complete understanding of all information — including confidential material that must remain so — to ensure the patient can share all their thoughts without hesitation.

Behavioral mental health interpreters, who are medically certified, should also pay special attention to their own support structures. Medical interpreter associations should consider support groups as important as credits and training courses.

Consider the studies found in the article Emotional and Psychological Effects on Interpreters in Public Services. Along with individual experiences, the article shows that intense, challenging situations are often a part of public service interpreting (PSI). Studies carried out in humanitarian NGOs highlight the necessity to develop psychological- and emotional-support resources. One of the first steps is increasing awareness and recognition among PSIs, employers, and service providers of the risks presented by negative psychological or emotional effects.

The article also points out the lack of studies regarding the emotional impact on the interpreters who deal with pain, death, or loss. According to the EMSI and the University of Alcalá, NGO volunteers (usually untrained interpreters) helping immigrants, asylum seekers, and refugees indicated the varied and difficult scenarios most of them face — often in environments like police stations, hospitals, government offices, schools, and more. This also demonstrates the emotional and psychological impacts on their work and the need for preparation. One area all the surveys acknowledge are the negative impacts on workers: stress, anxiety, low self-esteem, poor-quality interventions, depression, emotional dysfunction, work absenteeism, and a change of profession.

The most frequent symptoms that accompanied PSIs are nightmares, depression, and insomnia (eight out of 10 workers in the refugee program required psychiatric treatment). PTSD-like symptoms, more specifically described as vicarious trauma, require particular attention. Vicarious trauma results from empathetic engagement with survivors of displacement, torture, abuse, and more. Anyone who engages empathetically with such survivors is potentially affected, including doctors, other health professionals, and interpreters. A high case load of trauma victims is associated with an increased risk of symptoms of vicarious trauma.

The recommendations are as follows:

  1. Make doctors aware of these pressures, allowing time for the interpreters to share their feelings and emotions and to confront their reactions.
  2. Allow interpreters time to share their feelings and emotions.
  3. Organize regular debriefing and support groups.


Without a solid grounding in mental health, interpreters who work with psychotherapists can actually do more harm than good. Untrained interpreters may, for example, censor psychotic, profane, or sexual content out of fear, embarrassment, or a desire to “protect” the client. They may also make subjective decisions about what the client means, discuss the therapy with outsiders, or omit vital information about traumatic events and feelings because they have similar experiences.

Despite the challenges, PSIs perform vital, necessary work. Well-trained interpreters can make a huge difference in treatment outcomes, according to Katherine Porterfield, PhD, a senior psychologist at the Bellevue/NYU Program for Survivors of Torture.

“It’s almost like a skilled interpreter becomes invisible, and the language starts to flow between you and the client,” she said. “It’s wonderful to have a person be a bridge between two people who don’t speak the same language in a way that allows psychological care to take place.”

Make the interpreter’s job easier by speaking in short phrases or words that are easy to process, but maintain your meaning. Remember that certain western metaphors might not make sense in another language. Try to build a natural rhythm of speech.

“You don’t want it to be stilted or awkward or really slow or too fast,” said Maryam Kia-Keating, PhD, a psychology professor at the University of California, Santa Barbara, who has worked with refugee families. “They’re not just tape recorders. They’re human beings, and they’re bringing in their cultural expertise.”

To help maintain your clients’ comfort, try to keep the same interpreter throughout treatment, Kia-Keating added.

“They’ll have a better understanding of what’s going on in the case,” she said.

At the same time, interpreters must learn to practice self-care strategies and engagement with others to relieve accumulated stress when handling behavioral health interpreting sessions.

Over the years, behavioral health studies have given us good hints and recommendations on how to properly train and support interpreters to be part of the therapeutic team. It makes a big difference to help each other in a professional way, making the best out of the triangular relationship between medical professional, interpreter, and patient. Ultimately, it’s all for the patient’s benefit to be treated with dignity.

Afaf Steiert is president and founder of Afaf Translations, where she works as a conference Arabic interpreter and oversees all translation services at Afaf Translations. She speaks five languages and has good knowledge of all Arabic dialects. She obtained her M.Sc. in plant molecular biology from the University of Basel, Switzerland.



Subscribe to stay updated between magazine issues.

MultiLingual Media LLC