SPECIAL POPULATIONS
Challenges of mental health
Andy Cornes
Clinical Social Worker, Rivendell Adolescent Unit, Thomas
Walker Hospital, Sydney, NSW, Australia.
Jemina Napier
Research Fellow and Coordinator, Auslan Interpreting
Program, Department of Linguistics, Macquarie University,
Sydney, NSW, Australia.
Correspondence: Mr Andy Cornes, Thomas Walker
Hospital (‘Rivendell’), Hospital Road, Concord West,
Sydney, NSW 2138, Australia.
Email: andrew.cornes@liverpool.gov.uk
An earlier version of this paper was presented to the
‘Ethics and Deafness’ conference, Renwick College,
Sydney, March 2004.
interpreting when working
with deaf patients
Andy Cornes and Jemina Napier
Objective: The aim of this present paper is to highlight some of the issues
faced by therapists and sign language interpreters when working with deaf
patients.
Conclusions: Key issues include linguistic, interpreting and role challenges,
and potential threats to the therapeutic alliance. Recommendations are made
in relation to preparation strategies and training for sign language interpreters
and therapists.
Key words: deafness, interpreting, sign language, therapy.
A
s a clinical social worker who specializes in working with deaf chil-
dren and adolescents, and a sign language interpreter with exten-
sive experience in mental health settings, we have collaborated
on various mental health-related projects. These include curriculum design
for training interpreters and counsellors, translation of psychiatric assess-
ment instruments from written English into Auslan, and face-to-face family
therapy sessions involving deaf adolescents. Through these experiences, we
have identified various issues and challenges faced by therapists and inter-
preters when working in therapeutic contexts with deaf children, adolescents
and their family members. The aim of this present paper is to provide an
overview of these issues and challenges for consideration by professionals
in the mental health field. We will ‘set the scene’ by considering Australian
Sign Language (Auslan) and the Deaf community, and Auslan interpreters.
We will then proceed to explore issues around interpreting in the thera-
peutic context, particularly in relation to linguistic, interpreting and role
challenges. We conclude with a series of recommendations to ensure the ef-
fective outcome of therapy with deaf people when working with interpreters
and the establishment of an appropriate ‘therapeutic alliance’.
AUSLAN AND THE DEAF COMMUNITY
Signed languages are natural languages, unique to every country. Signed and
Australasian Psychiatry • Vol 13, No 4 • December 2005
spoken languages have different structures and modalities.1 When we refer to
modality, we mean that spoken languages are linear languages (i.e. one word
is produced after another), and signed languages are visual–spatial languages
(i.e. use the modality of three-dimensional space, where more than one sign
can be produced at the same time because of the use of two hands). Signed
languages have their own complex grammatical structures, vocabulary, so-
ciolinguistic variation and discourse rules.2,3 Australian Sign Language was
indirectly recognized by the federal government in the Australian Language
and Literacy Policy,4 and has come to be known as ‘Auslan’. The first Auslan
dictionary was published in 1989,5 and a range of Auslan research publica-
tions have appeared since that time.6−11
The majority of Auslan users are deaf people for whom assisted lis-
tening, lip-reading and speech is not enough. This group comprises
native signers (deaf people born to deaf parents) and non-native signers
403
 (deaf people who learn a signed language as a second
language later in life). A commonly cited figure in the
literature refers to 1 per 1000 of the average popula-
tion being deaf sign language users (as opposed to the
general hearing impaired population, who might not all
use sign language). A survey by Hyde and Power found
that there were almost 16 000 deaf people in Australia
using sign language as their first or preferred language,
and who therefore made up the Australian Deaf com-
munity.12 More recently, based on census and school
enrolment figures, Johnston estimated that there are ap-
proximately 5–10 000 deaf sign language using people in
Australia.13 Hearing people also use sign language: some
may have deaf parents and therefore grow up as native
users of a signed language. These people are often re-
ferred to as CODAs (children of deaf adults) and grow
up to be bilingual.14 Other hearing people using sign
language are relatives, partners, friends and work col-
leagues of deaf people, who inevitably learn a signed
language in order to better communicate with those
affected. The final group of hearing people who use
sign language are those professionals working with deaf
children and adults, such as interpreters.
DEAF PATIENTS AND MENTAL HEALTH
PROVISION
In recent years, there has been a growing recognition of
deaf individuals constituting a linguistic minority with
different cultural values and beliefs.15,16 This paradigm
shift has informed clinicians in relation to how therapy
is framed with deaf patients.17–20 In contrast to other de-
veloped countries, in Australia there are no specialized
psychiatric facilities for children, adolescents and adults
who are deaf. Deaf individuals with mental health prob-
lems are a geographically widespread small community
that cannot access specialized mental health workers at a
local level.21 Aside from the few exceptions where hear-
ing therapists are fluent signers, clinicians must rely on
Auslan interpreters to assess and treat this population.
AUSLAN INTERPRETERS
Because deaf people cannot access spoken English, in-
Australasian Psychiatry • Vol 13, No 4 • December 2005
terpreters are needed to facilitate communication be-
tween deaf and hearing people in a range of settings;
Auslan interpreters can be found working in educa-
tional, legal, medical, employment and conference sit-
uations, to name but a few. The professionalization of
sign language interpreting has led to the establishment
of sign language interpreting associations and related
codes of ethics all over the world,22,23 and the devel-
opment of interpreter training courses.24 Consequently,
research on sign language interpreting has outlined as-
pects of the role and communication management of
interpreters,25 linguistic errors (miscues) produced by
interpreters,26 cross-cultural communication techniques
of interpreters27 and a range of ethical and linguistic
challenges for sign language interpreters in different set-
tings.28 In Australia, very little research has been con-
404
ducted on Auslan interpreting. Nonetheless, the few
studies carried out include: an analysis of the linguis-
tic coping strategies used by Auslan interpreters,29 a sur-
vey of occupational overuse syndrome experienced by
Auslan interpreters30 and a survey of Auslan interpret-
ing demand and supply.31
INTERPRETER’S ROLE
The role of any spoken or signed language interpreter is
to facilitate communication between two or more par-
ties that do not share the same language, and to en-
sure that all parties have equal access to the content
of interactions. Interpreters are expected to abide by a
Code of Ethics, which maintains their professional be-
haviour through the key tenets of accuracy, confiden-
tiality and impartiality. Over time, there has been more
recognition of the holistic nature of interpreting and
the interpreter’s role, which encompasses the need for
interpreters to account for differences in participants,
cultural backgrounds, norms of discourse and commu-
nication protocols, as well as language base. Thus, in-
terpreting is regarded as a ‘discourse process’,32 with
the interpreter present being a participant within the
interaction,33 rather than a mere ‘conduit’ who chan-
nels information. Clark and Karlin have succinctly de-
fined the specific role of mental health interpreters: ‘The
mental health interpreter will, as far as possible, accu-
rately convey the content of messages between mental
health care providers and patients, and consult with care
providers on matters limited to their expertise relating
to language, communication, assistive technologies and
Deafness’.34
INTERPRETING IN THE THERAPEUTIC
CONTEXT
In the spoken language interpreting field, several stud-
ies have explored linguistic, interpreting and role chal-
lenges within medical interactions between medical
specialists and patients, whereby the dynamics of the
interaction are influenced by the interpreter’s presence,
thus causing potential conflict between ethical codes
and actual practice.35,36 These studies have highlighted
the notion of an interpreter being ‘invisible’ or ‘neutral’
is not realistic and the importance of acknowledging
the interpreter’s presence within medical interactions.
Studies of sign language interpreters working in medical
settings have identified similar issues.37,38
Bot39 and Wadensjö40 have acknowledged that
the dynamics of interaction in mental health settings
are already very sensitive, and can be exacerbated by
the presence of an interpreter. Several papers have rec-
ognized the challenges for signed language interpreters
working in mental health settings.41−43 In a previous
article, we discussed the dynamics of interpreters and
therapists working together and suggest that interpreters
adopt an ‘interactive-therapeutic’ model of interpreting
in order to ensure that the goals of a therapy session are
preserved.44
Various mental health professionals have highlighted
the prevalence of mental illness among deaf people,
and cultural and ethical challenges of working with deaf
adults and children, especially when the professional is
hearing and does not use sign language.45−49
Here, we attempt to draw together the various issues that
have been discussed in the literature, and indicate partic-
ular challenges for interpreters and professionals in the
therapeutic context. Cromwell has referred to ‘therapist-
centred’ or ‘interpreter-centred’ issues in this context.50
However, we would like to focus specifically on linguis-
tic, interpreting and role challenges, and use illustrative
cases from our clinical experiences.
ISSUES FOR SIGN LANGUAGE
INTERPRETERS AND THERAPISTS
WORKING WITH DEAF PATIENTS
Linguistic challenges
Because there are few deaf people working as profes-
sionals in the mental health field, an Auslan vocabu-
lary does not exist for mental health terminology. In
1997, the British Society for Mental Health and Deafness
published a mental health sign vocabulary dictionary,
which was collated by a group of deaf mental health
professionals.51 We have not yet reached that stage in
Australia, which means that interpreters often need to
explain certain concepts using more than one sign, be-
cause there is no one exact sign choice. Therefore, when
a therapist carefully frames a question in a neutral man-
ner, the impact may be lost if the interpreter explains a
concept and perhaps manipulates a response. For exam-
ple, if a clinician asks ‘how is your mood?’, a culturally
effective interpretation in Auslan would normally be:
‘You feel how? Happy? Sad? Good? Bad? Your m-o-o-d
what?’
The reader will notice immediately that the spoken and
signed versions are different with the signed version con-
taining more information. Clinicians have to be mind-
ful of possible ambiguity in a Deaf person’s response
if the interpretation is too literal (possibly leading to
misunderstanding) or too leading (possible shaping the
patient’s response).
Interpreting challenges
According to the Code of Ethics,† key tenets relate to
interpreters rendering ‘accurate and faithful interpre-
tation’ and accepting work ‘within (their) own limita-
†
The Code of Ethics for Auslan interpreters is ‘owned’ by the Australian Sign
Language Interpreters’ Association. The key tenets of the Code are similar to
those found in Codes of Ethics for spoken and signed language interpreters
in other countries. Therefore, it can be assumed that all interpreters adhere to
the same ethical principles, regardless of the languages used.
tions’. The second tenet is premised on the interpreter
making a cogent choice about whether or not they
are able to interpret in a particular situation, based on
their experience, skills and qualifications. The situation
is complicated because interpreters are only provided
with sparse details relating to potential work in men-
tal health settings in order to respect patient confiden-
tiality; ergo interpreters are denied the opportunity to
know if they are able to do the job. Mental health in-
terpreting tends to involve highly challenging and of-
ten provocative material that will impact on the persons
present. We have made a clear distinction between what
we term ‘linguistically out of depth’ and ‘emotionally
out of depth’.44 The former relates to skills and expe-
rience, while the latter relates to the emotional reac-
tion interpreters may have in counselling scenarios. In
Australia, ‘there is a shortage of sign language inter-
preters in general, and few are familiar with psychi-
atric terminology and phenomenology’.21 Difficulties
processing the emotional impact of the therapeutic ma-
terial will have clear consequences on the quality of in-
terpretation. As Harvey states, ‘interpreters, as human
beings, would be expected to perceive inaccurately and
therefore interpret inaccurately content that is highly
emotionally loaded for them’ (p. 307).52 Recently, when
discussing an alleged rape in therapy, a sign language
interpreter did not use the conventional sign for ‘rape’
and instead fingerspelled the word ‘molest’. The deaf
patient did not understand the word molest and the
therapeutic opportunity to explore the issue was lost
at that time. These interpreter errors may occur more
frequently than we know, but of course are not ob-
served unless a clinician is fluent in the host and tar-
get languages or the interpreter indicates that there is a
problem.
Role challenges
Although interpreters are expected to abide by a Code
of Ethics, which governs their role as communication
facilitator, our experience tells us that many interpreters
‘step outside’ of their conventional role in therapeutic
contexts. This can occur for a variety of reasons, such
as feeling uncomfortable with the content, commenting
Australasian Psychiatry • Vol 13, No 4 • December 2005
on a deaf patient’s linguistic capabilities, and reasons to
do with the Deaf community as a linguistic and cultural
minority group.
Threats to the therapeutic alliance
In treating a deaf patient, the role of the therapist may
easily be confused. Common misunderstandings can
centre on maintaining good eye contact (the deaf patient
will be looking mostly at the interpreter). Of course, the
most useful tool a hearing therapist has is audition, that
is, listening skills. The process of joining the patient in
therapy is thought to be the single most important pre-
dictor of the success or failure of therapy, independent of
the type of therapy offered, and has been investigated ex-
tensively.53,54 Large-scale clinical trials have found that a
405
 positive alliance is a significant predictor of a successful
outcome.55,56 This centralizes the role of the therapeutic
alliance (the working relationship between therapist and
patient). The therapeutic alliance can be conceptualized
as bonding and agreement on tasks or goals,57 or the pa-
tient regarding the therapist as helpful and feeling that
therapy is a collaborative process.58 If, however, the deaf
patient is focusing more of their attention on the inter-
preter in order to access the message, there is a danger
that the patient will ally with the interpreter rather than
the therapist.59
Duffy and Veltri state that therapy using sign language
interpreters can work, but only if the patient wants to
change and work on issues, the therapist respects Deaf
culture and sign language, and the interpreter recog-
nizes and studies the complexity of the mental health
setting.60
RECOMMENDATIONS
A review of the literature indicates there are a range of is-
sues and challenges faced by interpreters and therapists
when working with deaf people. Many of these issues
could be easily resolved through improved communica-
tion and training, and others will be better understood
with more research. All discussions have relied on anec-
dotal descriptions of interpreter/therapist experiences;
thus, there is a need for empirical evidence to support
our understanding of the issues and challenges identi-
fied. Nevertheless, we offer the following recommenda-
tions drawn from our clinical experience.
1. Interpreters and therapists take the time to prepare
for sessions, and also take the opportunity to de-
brief after each session, to ensure that: (i) therapeutic
goals are clear; (ii) linguistic and cultural issues can
be discussed; and (iii) emotional and psychological
reactions can be shown and discussed.
2. The development of specific guidelines for the ap-
plication of the Code of Ethics to interpreting in
mental health settings, to account for the specific
dynamics of interpreting in this context.
Australasian Psychiatry • Vol 13, No 4 • December 2005
3. Specialist training for therapists, which includes
knowledge about the cognitive, social, emotional
and psychological development of deaf people.
4. Specialist training for interpreters, which includes
counselling theories and practices, with opportuni-
ties to practice interpreting in therapeutic contexts.
5. Experienced therapists and interpreters work in col-
laboration with Deaf community organizations to
provide information/psychoeducation workshops
to members of the Deaf community, and to inform
them of the role of the therapist, the purpose of,
and techniques used in, therapy, and the role of in-
terpreters and families in the therapeutic process.
406
6. Empirical research is undertaken, which analyses
the impact of the sign language interpreter’s pres-
ence on the dynamics of therapeutic interaction,
and in particular on the therapeutic alliance. Re-
search should focus on communication and turn-
taking management, interpreter interference and in-
terpreting strategies.
REFERENCES
1. Meier RP, Cormier K, Quinto-Pozos D, eds. Modality and Structure in Signed and Spoken
Languages. Cambridge, MA: Cambridge University Press, 2002.
2. Lucas C, ed. The Sociolinguistics of Sign Languages. Cambridge: Cambridge University
Press, 2001.
3. Sutton-Spence R, Woll B. The linguistics of British Sign Language: An Introduction.
Cambridge: Cambridge University Press, 1999.
4. Dawkins J. Australia’s Language: The Australian Language and Literacy Policy. Canberra:
Australian Government Printing Service, 1991.
5. Johnston T. Auslan Dictionary: A Dictionary of the Sign Language of the Australian Deaf
Community. Maryborough, Victoria: Deafness Resources Australia, 1989.
6. Branson J, Miller D. Language and identity in the Australian deaf community: Australian
Sign Language and language policy. In: Liddicott T, ed. Language and Language Education.
Melbourne: National Languages Institute of Australia, 1991.
7. Branson J, Toms J, Bernal B, Miller D. The history and role of fingerspelling in Auslan.
In: Bos HF, Schermer GM, eds. Sign Language Research 1994. Hamburg: Signum, 1995;
53–68.
8. Johnston TJ. Spatial syntax and spatial semantics in the inflection of signs for the marking
of person and location in Auslan. International Journal of Sign Linguistics 1991; 2: 29–62.
9. Johnston T. Nouns and verbs in Australian Sign Language: an open and shut case?
Journal of Deaf Studies and Deaf Education 2001; 6: 235–257.
10. Schembri A. The Structure and Formation of Signs in Auslan (Australian Sign Language).
Renwick College Monograph No. 2. North Rocks, NSW: North Rocks Press, 1996.
11. Schembri A. The representation of motion events in signed language and gesture. In:
Schulmeister R, Reinitzer H, eds. Progress in Sign Language Research: In Honor of
Siegmund Prillwitz. Hamburg: Signum, 2002; 99–126.
12. Hyde M, Power D. The use of Australian Sign Language by deaf people. Sign Language
Studies 1992; 75: 167–182.
13. Johnston T. W(h)ither the Deaf community? Population, genetics and the future of Auslan
(Australian Sign Language). American Annals of the Deaf , 2003; 148: 358–375.
14. Preston P. Mother Father Deaf: Living Between Sound and Silence. Cambridge, MA:
Harvard University Press, 1994.
15. Brennan M. The visual world of BSL: an introduction. In: Brien D, ed. Dictionary of British
Sign Language/English. London: Faber and Faber, 1992; 1–133.
16. Power D. Language, Culture and Community: Deaf People and Sign Language in Australia.
Occasional Paper No. 4. Brisbane: Centre for Deafness Studies and Research, Griffith
University, 1996.
17. Harvey MA. Psychotherapy with Deaf and Hard of Hearing Persons: A Systemic Model.
Hillsdale, NJ: Lawrence Erlbaum, 1989.
18. Corker M. Counselling – The Deaf Challenge. London: Jessica Kingsley, 1994.
19. Glickman N. The development of culturally deaf identities. In: Glickman NS, Harvey MA,
eds. Culturally Affirmative Psychotherapy with Deaf Persons. Mahwah, NJ: Lawrence
Erlbaum Associates, 1996; 115–153.
20. Leigh IW, ed. Psychotherapy with Deaf Clients from Diverse Groups. Washington, DC:
Gallaudet University Press, 1999.
21. Cornes AJ, Wiltshire CJ. Still waiting to be heard: deaf children in Australia. Australasian
Psychiatry 1999; 7: 313–318.
22. Rodriguez ES, Guerrero AR. An international perspective: what are ethics for sign lan-
guage interpreters? A comparative study among different codes of ethics. Journal of
Interpretation 2002; 49–61.
23. Tate G, Turner GH. The code and the culture: sign language interpreting – in search of the
new breed’s ethics. In: Harrington FJ, Turner GH, eds. Interpreting Interpreting: Studies
and Reflections on Sign Language Interpreting. Gloucestershire: Douglas McLean, 2001;
53–66.
24. Pollitt K. The state we’re in: some thoughts on professionalisation, professionalism and
practice among the UK’s sign language interpreters. Deaf Worlds 1997; 13: 21–26.
25. Roy C. A sociolinguistic analysis of the interpreter’s role in simultaneous talk in a face-
to-face interpreted dialogue. Sign Language Studies 1992; 74: 21–61.
26. Cokely D. Interpretation: A Sociolinguistic Model. Burtonsville: Linstok Press, 1992a.
27. Mindess A. Reading Between the Signs: Intercultural Communication for Sign Language
Interpreters. Yarmouth, ME: Intercultural Press, 1999.
28. Harrington FJ, Turner GH, eds. Interpreting Interpreting: Studies and Reflections on Sign
Language Interpreting. Gloucestershire: Douglas McLean, 2001.
29. Napier J. Sign Language Interpreting: Linguistic Coping Strategies. Coleford, UK: Douglas
McLean, 2002.
30. Madden M. The incidence and impact of occupational overuse syndrome on sign language
interpreters in Australia. Unpublished Doctoral Dissertation, Griffith University, 2001.
31. Ozolins U, Bridge M. Sign Language Interpreting in Australia. Melbourne: Language
Australia, 1999.
32. Roy C. Interpreting as a Discourse Process. Oxford: Oxford University Press, 2000.
33. Wadensjö C. Interpreting as Interaction. London: Longman, 1998.
34. Clark K, Karlin B. Developing a model training program for mental health interpreters.
In: Brauer B, Marcus A, Morton D, eds. Proceedings of the First World Conference on
Mental Health and Deafness, October 22–24, 1998, Gallaudet University, Washington,
DC (on-line). Available at: http://mhdeafintl.gallaudet.edu/proceedings1/proc1toc.htm.
Retrieved 30 March 2004.
35. Angelleli C. The visible co-participant: the interpreter’s role in doctor–patient encounters.
In: Metzger M, ed. From Topic Boundaries to Omission: New Research on Interpretation.
Washington, DC: Gallaudet University Press, 2003; 3–26.
36. Whitworth A, Sjardin H. The bilingual person with aphasia: the Australian context. In:
Lafond D, Joanette Y, Ponzio J, Devigiovani R, Taylor SM, eds. Living with Aphasia:
Psychosocial Issues. San Diego: Singular Publishing Group, 1993; 130–149.
37. Metzger M. Sign Language Interpreting: Deconstructing the Myth of Neutrality. Wash-
ington, DC: Gallaudet University Press, 1999.
38. Sanheim LM. Turn exchange in an interpreted medical encounter. In: Metzger M, ed.
From Topic Boundaries to Omission: New Research on Interpretation. Washington, DC:
Gallaudet University Press, 2003; 27–54.
39. Bot H. The myth of the uninvolved interpreter interpreting in mental health and the
development of a three-person psychology. In: Brunette L, Bastin G, Hemlin I, Clarke H,
eds. The Critical Link 3: Interpreters in the Community. Amsterdam: John Benjamins,
2003; 27–36.
40. Wadensjö C. Interpreting in crisis: the interpreter’s position in therapeutic encounters.
In: Mason I, ed. Triadic Exchanges: Studies in Dialogue Interpreting. Manchester: St
Jerome, 2001; 71–86.
41. Harvey M. The influence and utilization of an interpreter for deaf persons in family
therapy. American Annals of the Deaf 1982; 27: 821–827.
42. McCay V, Miller K. Interpreting in mental health settings: issues and concerns. American
Annals of the Deaf 2001; 146: 429–434.
43. Turner J, Klein H, Kitson N. Interpreters in mental health settings. In: Hindley P, Kitson
N, eds. Mental Health and Deafness. London: Whurr, 1998; 297–310.
44. Napier J, Cornes AJ. The dynamic roles of interpreters and therapists. In: Austen S,
Crocker S, eds. Deafness in Mind: Working Psychologically with Deaf People Through
the Lifespan. London: Whurr, 2004; 161–179.
45. Glickman N, Gulati S. Mental Health Care of Deaf People: A Culturally Affirmative
Approach. Mahwah, NJ: Lawrence Erlbaum, 2003.
46. Gutman V, ed. Ethics in Mental Health and Deafness. Washington, DC: Gallaudet Uni-
versity Press, 2002.
47. Hindley P, Kitson N, eds. Mental Health and Deafness. London: Whurr, 1998.
48. Porter A. Sign language interpretation in psychotherapy with deaf patients. American
Journal of Psychotherapy 1999; 53: 163–176.
49. Wilson EM. Needs of deaf people in counselling: experiences of clients and counselors.
Deaf Worlds 1996; 12: 2–10.
50. Cromwell J. Considering the use of sign language interpreters in therapy. In: Brauer B,
Marcus A, Morton D, eds. Proceedings of the First World Conference on Mental Health
and Deafness, October 22–24, 1998, Gallaudet University, Washington, DC (on-line).
Available at: http://mhdeafintl.gallaudet.edu/proceedings1/proc1toc.htm. Retrieved 30
March 2004.
51. British Society for Mental Health and Deafness. Sign Language in Mental Health. London:
BSMHD, 1997.
52. Harvey MA. Toward a dialogue between the paradigms of family therapy and deafness.
American Annals of the Deaf 1985; 130: 305–314.
53. Horvath AO, Symonds BD. Relation between working alliance and outcome in psychother-
apy: a meta-analysis. Journal of Counseling Psychology 1991; 38: 139–149.
54. Lambert MJ. Psychotherapy outcome research. In: Norcross JC, Goldfried MR,
eds. Handbook of Psychotherapy Integration. New York: Basic Books, 1992; 94–
129.
55. Krupnick JL, Sotsky SM, Simmens S et al. The role of the therapeutic alliance in psy-
chotherapy and pharmacotherapy outcome: findings in the National Institute of Mental
Health Treatment of Depression Collaborative Research Program. Journal of Consulting
and Clinical Psychology 1996; 64: 532–539.
56. Connors GJ, Carroll KM, DiClemente CC, Longabaugh R, Donovan DM. The therapeutic
alliance and its relationship to alcoholism treatment participation and outcome. Journal
of Consulting and Clinical Psychology 1997; 565: 588–598.
57. Bordin ES. Theory and research on the therapeutic working alliance: new directions. In:
Horvath AO, Greenberg L, eds. The Working Alliance: Theory, Research, and Practice.
New York: Wiley, 1994; 13–37.
58. Luborsky L. Therapeutic alliances as predictors of psychotherapy outcomes: factors
explaining the predictive success. In: Horvath AO, Greenberg L, eds. The Working Alliance:
Theory, Research, and Practice. New York: Wiley, 1994.
59. Villeneuve S. The forces at work in a psychotherapeutic relationship that involves inter-
pretation. The Critical Link: a journal dedicated to interpreting in the social, healthcare
and legal sectors 2004; 2: 14–20.
60. Duffy K, Veltri D. Working with interpreters in the mental health setting. In: Brauer B,
Australasian Psychiatry • Vol 13, No 4 • December 2005
Marcus A, Morton D, eds. Proceedings of the First World Conference on Mental Health
and Deafness, October 22–24, 1998, Gallaudet University, Washington, DC (on-line).
Available at: http://mhdeafintl.gallaudet.edu/proceedings1/proc1toc.htm. Retrieved 30
March 2004.
407