Medical interpreting is a communicative activity participated by at least three parties in medical settings: the provider, the patient and the interpreter. Being the mediator between the provider and the patient (Alexieva, 1997/2002), interpreters need to render the source utterances initiated by one primary party to the other.
Therefore, without the presence of all three parties and source utterances given by primary parties, what the interpreter does cannot be considered interpreting.
Comparing this definition with the four interpreters’ roles explored in section 2.2, advocates who assume the role of one of the primary parties, act on behalf of him/her and no source utterances are given by primary parties cannot be regarded performing interpreting. On the other hand, clarifiers and culture brokers clarify or explain explicit and implicit messages or social background of primary parties to facilitate mutual understanding. These behaviors make the target utterance not equivalent to primary parties’ explicitly expressed source utterance, which is the way a conduit interprets. However, clarifiers and culture brokers in fact render even more faithfully the meaning and feeling of primary parties than conduits. It is because they make the
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rendition more complete by involving primary parties’ implicit, unclear messages and social factors, which are crucial factors of accurate rendition (Avery, 2001). Since clarifiers and culture brokers play the role of a mediator and render the source information explicitly and implicitly expressed by primary parties, it is argued that they perform interpreting. In order to distinguish different types of interpreting, rendition simply based on primary parties’ explicitly expressed utterances is labeled as narrow-sense of interpreting as opposed to broad-sense of interpreting in which interpreters make clarifications or include primary parties’ implicit or unclear messages and social background in the rendition. The mentioned concepts in this paragraph can be visualized as Figure 2.1.
Figure 2.1 Different Types of Interpreting and Medical Interpreters’ Roles Source: compiled by this study
Neutrality, compiled by this study, can be demonstrated by user-centered, preference free and non-judgmental attitudes. There are three reasons supporting that neutrality is significantly important. First, it conforms to service user’s expectations on interpreters (Vasquez & Javier, 1991; Alexander et al., 2004; Mesa, 2000; Kelly, 2008). Interpreters’ codes of ethics also highlight its importance (Dysart-Gale, 2005;
NCIHC, 2004). Second, it facilitates faithfulness of interpreting for that interpreters Medical Interpreting
Mediated Setting Non-mediated Setting
Non- Interpreting
Advocate Broad Sense of
Interpreting
Clarifier Culture Broker Narrow Sense
of Interpreting
Conduit
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do not project their own values, emotions and bias onto service users (NCIHC, 2004;
Hale, 2007), which may distort speaker’s meanings. Third, it avoids consequences that interpreters cannot be responsible for. Adopting non-neutral attitudes so to replace main points and meanings in the source utterance with interpreters’ own may cause unexpected and undesirable ripple effects (Kelly, 2008). For example, acting on behalf of patients might reinforce their reliance upon the interpreter, cost the interpreter his/her job or lead to legal responsibility (Roat, 2011). Inadequate communication is also a contributor to erroneous diagnoses and improper treatment that may threaten patients’ lives (Avery, 2001) and impact businesses of healthcare providers and institutions (Kelly, 2008). As a result, being neutral is vital and is argued to be medical interpreters’ appropriate level of involvement.
This study aims to understand how to demonstrate empathy in medical
interpreting and explain the inconsistent views on medical interpreters’ roles. Since empathizers are required to understand the other people accurately like medical interpreters and hold the three attitudes of neutrality, which will be given more elaborations in Chapter Four, this study intends to use empathy theories to answer the research questions. By exploring the definition and communicative skills of empathy and developing the empathy models applicable to medical settings, the first and second research questions could be answered respectively. Moreover, these answers could facilitate the study to further examine each role of medical interpreters. If the role expresses empathy to both primary parties, it is argued that it demonstrates the attitudes of neutrality. Then it is possible to explain primary parties’ different views on non-conduit roles, to argue for interpreter’s proper line of involvement and to answer the third research question. Empathy theories are consequently reviewed in the next chapter.
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Chapter Three Empathy
3.1 Introduction to Empathy
This study aims to answer the following questions: the ways of demonstrating empathy in medical interpreting and its implication to roles of medical interpreters.
Literatures of psychology are reviewed because empathy is a subject of psychology in which researchers take various approaches to analyze, define and explore the concept.
In fact, ever since the beginning of forming the concept of empathy, psychological nature has been embedded in it (Duan & Hill, 1996). According to Wispé (1987), empathy originates from Einfühlung, a term used in German aesthetics, implying the projection of one’s feelings into an external object, particularly a work of art. Later, a German psychologist Lipps applied Einfühlung to psychology in 1903. Duan and Hill (1996) said that Einfühlung was considered a process for people, not only to project emotions to aesthetic objects, but also to know and interact with each other through projection and imitation of feelings. The implication is to know about others by feeling the other’s inner emotion, not understanding the other’s experience (Barrett-Lennard, 1981).
The English term empathy is derived from Greek empatheia, constituted by “in”
(en) and “suffering” (pathos) (Colman, 2001, p.241). Titchener made the translation from Einfühlung in 1909, which he defined as a “process of humanizing objects, of reading or feeling ourselves into them” (Titchener, 1924, p.417; cited from Wispé, 1987). His emphasis on the perception of others’ feelings had been significantly influential to empathic theories in psychology until Mead (1934) included a cognitive factor into empathy: the capability of understanding (Deutsch & Madle, 1975; cited from Duan & Hill, 1996). Though Mead did not directly write about empathy, he
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wrote “the given individual’s ability to take the roles of, or ‘put himself in the place of,’ the other individuals implicated with him in a given social situation” (Mead, 1934, p.218; cited from Wispé, 1987), which has clear implication linked to empathy.
In recent studies of psychology, cognitive empathy or role taking and affective empathy or emotional contagion are both included in specialties of
counseling/psychotherapy, social psychology and developmental psychology, though different names are given (Gladstein, 1983). Cognitive empathy refers to “intellectual understanding of another’s experience” while affective empathy means “the
immediate experience of the emotions of another person” (Duan & Hill, 1996, p.263).
However, each of these three specialties has its own literatures and focuses on empathy (Gladstein, 1983). Some social and developmental psychologists consider empathy as an ability to understand the others’ experience or to show the others’
experience vicariously (Duan & Hill, 1996). According to Gladstein (1983), social psychology studies focus on the relation between empathy and altruistic behavior, pro-social behavior or the development of measurement of the ability, etc. while developmental psychologists are mainly interested in how empathy differs in age, gender, social intelligence, hostile behaviors and so forth. On the other hand, major counseling/psychotherapy psychologists hold the view that empathy is either a cognitive-affective state to sense other’s experience or a process comprising multiple stages (Duan & Hill, 1996). Apart from the effort of giving clear definition of the concept of empathy from different perspectives, counseling/psychotherapy studies also explore how empathy is demonstrated in general interpersonal communication, such as mental health settings (Gladstein, 1983).
Since it is a pioneering study attempted to apply results of empathy research into medical interpreting, and there is time limitation on conducting this study, narrowing the scope of literature review is more practical. Because mental health setting is
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covered in the scope of medical interpreting service and prominent contributors to detailed elaboration of empathy are Carl Rogers, Barrett-Lennard, and Kohut who are classified into the specialty of counseling/psychotherapy (Duan and Hill, 1996), it is argued that literature of counseling/psychotherapy is more applicable to medical interpreting than the other two specialties. Consequently, more exploration of this specialty will be given.
Two psychotherapists, Carl Rogers and Heinz Kohut, have been recognized as pioneers in studying the concept of empathy (Bohart & Greenberg, 1997; cited from Håkansson, 2003). According to Corey (2001), Rogers is the leading therapist of client-centered therapy while Kohut belongs to psychoanalysis therapy with Freud as the initiator. Client-centered therapy and psychoanalysis therapy are two of the different theories in the field of psychotherapy. Although these theories have different approaches, both of them aim to help the client. Kohut contributes significantly to modern psychoanalytic theory but he is not greatly influential to psychological
academia (Wispé, 1987). The emphasis of psychoanalytic approach is to empathically understand the client’s unconscious experience; on the other hand, Rogers emphasizes on empathizing with others’ current perceptions and emotions (Håkansson, 2003).
Since medical interpreting involves participants’ conscious experiences, and studies of Rogers and his students on empathy have been considered the most persistent studies (Wispé, 1987), it is better to take Rogers’s approach on empathy research in this study instead of Kohut’s. As a result, Rogers’s and his successors’ important theories will be reviewed in the following sections.
The distinction between empathy and sympathy has been one of the significant issues in the study of empathy (Eisenberg & Strayer, 1987). When Titchener coined the term empathy, he already noticed the similarity between empathy and sympathy in etymology (Wispé, 1987). Wispé (1986), whose definition of sympathy has been
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regarded as the most widely adopted one (Eisenberg & Strayer, 1987), defined that
“sympathy refers to the heightened awareness of another’s plight as something to be alleviated” (p.314). In the process of sympathy, “the pain of the sufferer is brought home to the observer, leading to an unselfish concern for the other person” (p.320).
According to Wispé (1986), sympathizers place emphasis on communion and thus would take whatever actions to alleviate others’ negative emotions. Actions taken out of sympathy imply that sympathizers agree with the other, which is different from empathy. Consequently, Wispé said that “sympathy does not facilitate accurate assessments… [and] can lead to closer emotional identification and to peremptory rescue actions in the patient’s behalf” (p.319). On the other hand, Wispé defined empathy as a process in which one self-aware person tries to understand accurately the subjective experiences of another person without prejudice. Empathizers are non-judgmental and client-centered. They do not lose their own identity, which Wispé referred to Barrett-Lennard’s saying in 1962 that they are well aware that the feelings belong to the client. Wispé used a case to clearly distinguish sympathy from empathy:
sympathizing with a murderer might be difficult but one could empathize with him/her in the purpose of understanding him/her accurately while disagreeing with his/her actions. Differences between the two are compiled as Table 3.1.
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Table 3.1 Differences between Empathy and Sympathy
Empathy Sympathy
Essence A way of “knowing” A way of “relating”
Main concern
Accuracy; whether one constantly check with the other and guided by the received response
Communion; how to open oneself to another’s subjective
experiences
Goal To understand the other person The other person’s “well-being”
Active/
Passive
Empathizer “reaches out” for the other person
Sympathizer is “moved by” the other person
Implication I act “as if” I were the other person (Rogers, 1975, p.3)
I am the other person. (Macfie, 1959, p.213)
Response 1. Express understanding of the other’s experience with some level of emotional detachment 2. Provide a broader perspective
that extends beyond the other’s situational distress
1. Circumscribe to express compassion for the other’s distressful condition 2. Change the topic of
discussion to alleviate other’s distress
Attitude Non-judgmental Judgmental, which reflects one’s perceptions
Focus of Interaction
Client or patient-centered / We substitute ourselves for the others
Diverts from the client / We substitute others for ourselves Preference Not implying agreement, but
understanding and acceptance
Side with and support the other’s point of view
Boundary The self never loses its own identity
Self-awareness is reduced Source: compiled by this study from Wispé (1986), Egan (1998) and Clark (2010)