The Son in the Interpreter's Chair
You are an English-speaking counselor at a community mental health center. Fatima, 58, was referred by her primary care physician for "depression and unexplained pain." She resettled from Somalia three years ago, speaks Somali at home, and has limited English. The agency's two trained interpreters are booked for two weeks, so the receptionist schedules Fatima's son Ahmed, 19, to interpret. In the session Fatima describes burning in her chest and constant fatigue, and says the pain began after her eldest daughter's marriage "split the family." When you ask about her mood, Ahmed answers for her: "She is fine, she just worries too much, it's nothing." Fatima looks at the floor. She then asks whether what she says will reach her husband, who handles the family's affairs. The intake form you must complete asks her to rate her depression from 1 to 10 and to name a "primary treatment goal for herself."
1. What do you do about the interpreter arrangement, and why?
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The son should not interpret, and the reason is accuracy and safety, not etiquette. A family interpreter filters - "she is fine, it's nothing" is the filter in action - and the arrangement reverses roles for a 19-year-old who may hear things a child should not hear about his mother's marriage and body. It also censors exactly the material that matters when the disclosure concerns the family itself. The ACA Code and the multicultural competencies point the same way: with limited English proficiency the counselor arranges a qualified interpreter and does not use a minor or family member except in an emergency. Practically, I reschedule within the week and book a staff interpreter; if the appointment cannot wait, I use a telephonic interpretation line and document it. I frame the change to Fatima and Ahmed as a clinic standard for accuracy, not as distrust of the family, and I confirm the interpreter is trained in mental health terminology and is not a member of Fatima's own community, which matters for confidentiality in a small diaspora.
2. How do you handle the son answering for her, the husband's question, and the individualized intake items?
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Both the son answering for her and the husband's question are information, not interference. In many collectivist family contexts the family is the unit of care, and a husband's involvement may be an expectation, a protection, or a constraint - I need to learn which, for this family. The error would be to insist on Western individualism ("this goal is yours alone") and equally to hand the session over to the husband. With the interpreter present I ask Fatima directly, say "I want to hear her words first" when Ahmed interjects, and watch her face for the answer she is not giving aloud. On confidentiality I get concrete rather than abstract: "Who in your family should know you come here? What may I say if your husband calls?" and I document her answer. The 1-to-10 rating and the individual goal presuppose a shared metric and a private self, so I use a translated PHQ-9 if the agency has one, ask how the pain shapes her days, her prayers, and her role in the family, and record her phrasing. Somatic presentation is how distress is expressed, not evidence that it is absent.