PT29 Work across different languages in family and systemic therapy

Overview

This standard is about promoting communication and mutual understanding when you do not share a language with a client. It takes account of cultural differences that may influence the therapeutic process. The language includes signed language. Interpreters play a very particular and important part in this system, since an exact translation between languages does not exist. Therapists avoid using children and other family members as interpreters unless there is a good therapeutic reason. The therapist needs to be very self-aware of their own cultural position, assumptions about culture and discrimination and the impact this may have on the therapeutic work. This standard describes therapeutic practice that has been shown to benefit families and other clients engaged in family and systemic therapy. (See reference in the additional information section on page 3.)To apply this standard, practitioners also need to take account of the multiple problems and complex co-morbidities that clients may bring to therapy. Family and systemic therapy should be offered as part of an explicit and structured approach agreed within the treatment team and with the client and the system. Users of this standard will need to ensure that practice reflects up to date information and policies. This standard should be understood in the context of the Digest of National Occupational Standards for Psychological Therapies. Version No 1

Knowledge and Understanding

You will need to know and understand:

Culturally sensitive practice

how to access translation and language services
the significance of your own cultural assumptions, prejudices and stereotypes
the character of your own cultural assumptions and habits
how to transparently discuss cultural assumptions and be open to alternative world views
dominant and alternative constructions of identity
how to use interpreters and others in facilitating the contribution of family members with special needs and those whose first or spoken language is different from that in which the therapist works
how cultures construct different world views and experiences
your own cultural position about culture and other issues of diversity and discrimination and the impact your position has on the work
how to engage with the client where there is potential for distance due to different world views between you and the client
how to identify cultural themes and explore different meaning and perspectives within the client’s cultural framework

The therapeutic relationship
ethical, non-oppressive and anti-discriminatory practices
how to form and maintain collaborative relationships in age and culturally appropriate ways with everyone in the system
how to make use of self and relational reflexivity to enhance therapeutic relationships

Risk
the assessment of risks to individuals and the risks they pose to others and in a range of settings

Systemic principles that inform the therapeutic approach
the personal, family and cultural factors and interactions between those factors that shape the individual
the influence of power relationships and different socio-cultural contexts on the development of meaning, relationships and behaviour for the client and the therapist

Basic principles and rationale of systemic approaches
the various systemic models and other related concepts and their limitations
theories of systemic change and clients’ theories of change
the assumptions contained in the various systemic models

Performance Criteria

You must be able to do the following:

identify the different and preferred languages spoken within the family and the challenge this presents for you, the team and the agency you work for
use an interpreter with the agreement of the family when you, the team and the family do not have a shared language
identify any political or cultural issues that might adversely affect the capacity of the client to fully engage with the interpreter
allow adequate time, when using an interpreter, to:

negotiate their role in advance of each session
develop a positive working alliance and clarify roles with them as a member of the team
take into account possible difficulties in translation and negotiate permission to talk about this
obtain immediate and ongoing feedback from the interpreter about difficulties in communication
after each session assess with the interpreter complexities in translating and their observations on the clients’ communication
work with the interpreter to process their own responses to the session using a third party
appreciate the implication of the interpreter’s membership of both client’s and professionals’ cultures

reduce the risk of verbal and non-verbal communication errors by identifying the specific differences and nuances that each language brings and being attentive to assumptions from your own frame of reference
explore how first and subsequent languages constrain and allow the client to express themselves and respond emotionally
be attentive to the meaning of the client’s use of different languages and when they choose to use them
communicate with the client verbally and non-verbally in ways that try to negotiate between cultural differences that exist between you and them
demonstrate to the client your desire to achieve mutual understanding and your curiosity about their beliefs, problems and strengths and ways of seeing their world
recognise and negotiate gaps and differences in meaning to work towards a shared conceptual agreement between all members of the team and the client and the wider system
explore the impact of children translating for parents and differences in fluency in the host country’s language among family members and the wider system
give each member of the system the opportunity to communicate and show an interest in every person and their respective communications, taking the intellectual and linguistic capacity of the client into account

Additional Information

This National Occupational Standard was developed by Skills for Health. This standard is derived from research reported in Roth, A., Pilling, S. and Stratton, P (2009) The competences required to deliver effective Systemic Therapies. Centre for Outcomes Research & Effectiveness (CORE) University College London. This standard has indicative links with the following dimension within the NHS Knowledge and Skills Framework (October 2004): Dimension: Core 1 Communication