Conduit, the role that involves in the mediated communication the least in Avery’s (2001) incremental intervention model, “requires the interpreter to perform in a neutral, faithful, and machine-like manner” (Hsieh, 2006, p.721). Roy
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(1993/2002) listed interpreter’s non-neutral behaviors, including “to introduce topics, change topics, ask questions of their own, interject their opinion or give advice”
(p.347), which covers the tasks of all non-conduit roles. In addition, Kaufert &
Putsch (1997) argued that interpreters should adopt non-neutral roles such as culture broker or advocate. These arguments show that a conduit is the only role being described neutral. Non-conduit roles that take purposeful actions other than faithfully interpreting the primary parties’ explicitly expressed utterances are not neutral. In other words, these studies consider making judgments on what actions to take and supplementing information other than primary parties’ explicit message are non-neutral behaviors. However, other studies accept non-neutral non-conduit roles such as clarifier and culture broker based upon user expectations and interpreter’s codes of ethics while an advocate is considered controversial. Why non-neutral roles are viewed differently? What does neutrality mean?
In Oxford Advanced Lerner’s Dictionary of Current English (2010), the word
“neutral” means “not supporting or helping either side in a disagreement,
competitions, etc…deliberately not expressing any strong feeling…” (p.1027). In APA Dictionary of Psychology (2007), neutrality refers to a manner of behavior adopted by the therapist who “does not express judgments of right and wrong or suggest what is proper behavior on the part of the client” (p.629). These definitions show that
neutrality includes three attitudes: user-centered, preference free and non-judgmental.
User-centered attitude refers to that no suggestions are given by the neutral person and thus the client’s autonomy is respected. Preference free attitude means that the neutral person does not side with any of the participating parties in a communicative activity while non-judgmental attitude indicates that the person expresses no judgments.
Deliberately not to express any strong feeling or emotional detachment is also mentioned in the definition of neutrality at the beginning of this paragraph. This
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concept is included in non-judgmental attitude in this study because it facilitates the neutral person not to express judgments. More explorations of these three attitudes will be given in the sub-sections of this section. In addition, all of these attitudes have to be demonstrated in one interaction so that the communicator can be neutral. The reason is that he/she cannot abandon one of the attitudes without violating the other.
For example, it is impossible for a communicator to be judgmental on the user while putting the user at the center. The communicator can neither side with the user without making judgments on the user and his/her experience. Moreover, in
three-party communicative activities like medical interpreting, interpreters holding the three attitudes of neutrality toward one of the primary parties is not neutral. Instead, whether the interpreter is neutral or not is dependent on holding these attitudes toward both of the parties.
All of the attitudes mentioned above are major conditions of empathy (Wispé ,1986), as will be illustrated in Table 3.1. It is therefore argued that
empathizers are neutral. In Chapter Three, it will also be elaborated that deciding how to express empathy (Egan, 1975) or making the other person’s implicit message explicit is regarded as empathy (Carkhuff, 1969). These behaviors are thus argued to be neutral, which is different from the point of view in studies of medical interpreting as mentioned at the beginning of this section. The difference can be visualized as Table 2.2. While non-neutrality refers to making judgments on the other or his/her experience in studies of empathy (VandenBos, 2007), it is used to describe an
interpreter who takes any action other than what the primary parties explicitly express in studies of medical interpreting. In other words, non-neutrality in medical interpreter studies indicates a broader scope of actions than the scope indicated in studies of empathy.
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Table 2.2 Neutrality in Medical Interpreting and Empathy
Difference Topic
Express Service User’s Explicit Message
Express Service User’s Implicit Message
Medical Interpreting Neutral Non-Neutral
Empathy Neutral Neutral
Source: compiled by this study
This study adopts the definition of neutrality in empathic theories and argues that neutrality, referring to the three attitudes mentioned above, can explain the
inconsistent views on medical interpreters’ roles. In other words, it is argued that roles of conduit, clarifier and culture broker are neutral while an advocate is not. Since neutral attitudes are essential conditions of empathy (Wispé ,1986), empathy theories are adopted to examine each role’s neutrality. If the role expresses empathy with service user(s), it demonstrates neutral attitudes. More elaboration will be given in section 4.1.3.
In the rest of the section, more studies of interpreting related to attitudes of user-centered, preference free and non-judgmental are elaborated. These attitudes will be used to compare with attitudes of empathizers in Chapter Four.
2.3.1 User-Centered
Avery (2001) argued that interpreters should be granted to interfere in the
communication when misunderstandings may take place, but he also emphasized that interpreters should “stay in the background and to support communication and
relationship building directly between patient and provider” (p.9). Choosing the least intrusive role that is already able to overcome communicative barriers is recognized as a major principle. Codes of ethics also affirm the centrality of primary parties
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(NCIHC, 2004; Dysart-Gale, 2005).
Since interpreters are secondary instead of primary party (Alexieva, 1997/2002), it is inappropriate for them to take over the interaction. Alexander et al. (2004) found that patients do not want their interpreter to his/her personal interests in front of theirs.
Mesa’s (2000) survey also showed that providers expect interpreters not to take over their place. Vasquez and Javier (1991) even viewed interpreters assuming the role of primary parties as mistakes, such as replacing provider’s questions with their own and answering patient’s questions directly. According to Hale (2007), these actions
exclude primary parties from making decision for themselves and hinder accurate diagnosis. The effectiveness of patient’s treatment plans is also decreased because these behaviors have been identified as the contributors that minimize patients’
compliance to the plans.
Primary parties’ autonomy is respected when they are placed in the focus of communication. Though Avery (2001) supported interpreter’s involvement when necessary, he argued that primary parties are “the ultimate resolution of the encounter”
(p.9). They have the right to speak for and make decisions for themselves (NCIHC, 2004). Mesa’s (2000) survey on patients also found that 95% of the respondents expect interpreters to respect their values and beliefs. As a result, interpreters are not in a position to make decisions, give advice, counsel or persuade either party.
2.3.2 Preference Free
Interpreters are expected to treat both primary parties equally instead of taking sides (Kelly, 2008). In Mesa’s (2000) survey, healthcare providers expressed their concerns that if patient’s family members or acquaintances assist interpreting, their interests may surpass the importance of faithful rendition. However, it is found that when provider and patient have conflicts, some interpreters take the side with
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providers (Cambridge, 1999; Bolden, 2000; cited from Hsieh, 2006). Interpreter’s preference leads to primary parties’ mistrust (Hale, 2007) and lack of will to communicate (Wadensjö, 1998).
Neutrality is a notion that relates to primary parties’ perception (Wadensjö, 1998;
Marcus, Dorn & McNulty, 2011). Hence, when interpreter’s communication style aligns with one of the parties than the other, the party that finds his/her style not adopted by the interpreter may perceive the interpreter non-neutral and biased (Wadensjö, 1998). Cambridge (2004) said it is the interpreter’s responsibility “as
‘alter ego’ of each speaker” (p.50); therefore, interpreters should faithfully interpret the verbal and non-verbal information as well as the communicative style of the source utterance. Since medical interpreting is in dialogic mode where the role of speaker and addressee are assumed by different parties in turn (Gentile et al., 1996), interpreters have to regularly alter their communicative style to be aligned with the speaker. Adopting the style of one of the parties is non-neutral.
However, there are times when one of the primary parties intends to form an alliance with the interpreter. Avery (2001) argued that an interpreter should concentrate on placing primary parties at the center of the communication,
consciously avoid being involved in a partisanship with one of the parties and lead their expressions to each other. It is interpreters’ duty to take the interests of both parties and the healthcare goal into consideration during the interpreting service.
2.3.3 Non-Judgmental
As defined in the APA Dictionary of Psychology (2007), neutrality is
demonstrated by non-judgmental attitude, which also refers to a non-critical attitude.
People with this attitude act without prejudice either against the content of the
messages or parties in medical encounters. However, it does not mean that interpreters
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are not allowed to have opinions, but to avoid projecting these personal perceptions, beliefs or even biases onto one of the parties as if it is their reality (NCIHC, 2004). In order to do so, interpreters must be well aware of their opinions and constantly examine how their opinions affect their assignment so that they can fulfill their obligations, which as Hale (2007) stated are to prevent their feelings, points of view, convictions, interests, biases or values from intervening in the major goal of faithful interpreting. If they are unable to be non-judgmental, they should report it to the parties and transfer the case to other professionals (NCIHC, 2004).
Under no circumstances should interpreters make a decision to alter the meaning of source utterance because they perceive the messages are personally offensive or make them uncomfortable (NCIHC, 2004). NCIHC (2004) said that though it is not easy to detach from the expressions and interactions between primary parties, interpreters are required to have this capacity. Some people misconceive detachment as indifferent to the patient. On the contrary, NCIHC (2004) argued that detachment is the demonstration of understanding and accepting the patient’s needs and respecting their autonomy. Providers also link the level of detachment with interpreter’s
professionalism (Hale, 2007).
Losing neutrality, according to Keller and Sticker (2004), may lead to
countertransference, which indicates “feelings that arise in the therapist in response to the patient… [because of] a displacement onto the patient of feelings, beliefs, or impulses that were experienced previously by the therapist toward another person”
(p.233). The concept, first introduced by Freud in psychotherapy, is identified as an obstacle to therapists’ neutrality. It is argued that the therapist can only apprehend accurately and work effectively with the patient if he/she is neutral; therefore, countertransference feelings should be restrained or removed. Corey (2001) added that this inappropriate feeling hinders objectivity and is triggered by therapists’ own
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needs. Contertransference may happen to medical interpreters toward either side of the primary parties and impact interpreting assignment as well. Davou (2007) said that though the trigger of subjective emotion varies significantly between individuals depending on their experiences and histories, interpreters’ cognitive capacities are decreased because of negative emotions. Roat (2011) warned that if interpreters with countertransference may find themselves “strongly attracted to a patient, wanting to take care of a patient, or particularly angry with a patient” (p.105), they are advised to consult a supervisor confidentially to examine how their internal opinions and
conflicts affect their jobs.