Interpreting in Mental Health Sessions and Psychological Evaluations: What to Arrange Before the First Appointment

In mental health work, how a patient speaks is part of the clinical evidence. Clinicians listen for where the patient hesitates, what words they cannot find, and whether their thoughts connect from one sentence to the next, and they use that to judge mood, how the patient is thinking, and risk. That is true in therapy, in psychiatric appointments, and in psychological evaluations. When the patient speaks another language, all of it reaches the clinician through the interpreter, and research finds that evaluation in a patient’s non-primary language “can lead to incomplete or distorted mental status assessment.” This article covers how to arrange interpreting so the clinician hears the patient as the patient speaks.

You Have to Be Able to Trust the Interpreter

The interpreter has to be someone you can trust: qualified, rendering what is said as it is said, and telling you when the speech is disordered. Without that, when an answer comes out jumbled, you cannot tell whether the patient said it that way or the interpreter got it wrong.

That matters most in an evaluation. In an ordinary conversation, the aim is understanding, so an interpreter may render what a person says so that it is understood. In an evaluation, the patient’s exact words are the data, including answers with the words in the wrong order, and the evaluator forms an opinion that others will rely on.

A relative is a poor substitute. One small study found relatives minimizing or amplifying a patient’s symptoms. For federally funded health programs, Section 1557 of the Affordable Care Act also bars requiring a patient to bring their own interpreter and limits reliance on accompanying adults, minor children, and staff who are not qualified.

What to Consider When Booking the Interpreter

• Specify the language and dialect. Dialect matters more when the clinician is listening for how the patient speaks.
• Use video, not phone, for remote sessions. Mental health appointments are among the encounters where telephone interpreting is not appropriate.
• Confirm confidentiality in writing. Settle the agency’s confidentiality and privacy terms before the first session.
• Book time on both sides. Allow time before the session for a briefing and 10 to 15 minutes after for a debrief.
• Book the same interpreter for a series. Over time you learn how the interpreter renders speech, and the interpreter gets to know the patient and the clinician. If their renderings are normally clear and exact, a jumbled answer is more likely the patient’s. With an interpreter you do not know, you have no baseline to compare it against. Ask the agency to reserve one interpreter and name a briefed backup.

What the Clinician Should Do at the Start of the Session

If you are an attorney arranging an evaluation, ask the evaluator to do these.

• Brief the interpreter first. Explain the purpose of the meeting and agree on a signal, such as a code word, that either person can use to stop it.
• Say what the appointment is for and how to handle unusual speech. In a counseling conversation, the aim is communication. In an evaluation, the patient’s exact words are the data. Ask the interpreter to render them as said, including repetition, hesitation, and sentences that do not hold together, and to tell you when the speech is disordered, so you are not left guessing whether the problem is the patient or the interpretation. A blanket instruction to interpret “verbatim” does not work, because word-for-word equivalence is not how interpreting is done.
• Seat the three of you in a triangle, so the patient and clinician face each other. Speak directly to the patient, using “I” and “you” rather than “ask him.”
• Tell the patient the interpreter will interpret everything. A side remark in the patient’s own language will not stay between them and the interpreter.

What the Clinician Should Do After the Session

Spend a few minutes with the interpreter, away from the patient. The interpreter has repeated everything the patient said, including the hardest parts, and mental health interpreters can experience secondary or vicarious trauma. This is a short check-in, not therapy. It lets the interpreter raise a word with no direct equivalent, a phrase with a cultural meaning you should know about, or a moment they found confusing, and it lets you ask how they are doing after a crisis or distressing material.

The interpreter carries the evidence. Use an interpreter you trust, brief them first, and debrief afterward, so the clinician gets the patient’s own words. Kaplan Interpreting Services provides mental health and behavioral health interpreters for clinics, behavioral health programs, and the law firms and courts that arrange psychological evaluations, in person and by video. Share the language and dialect, the type of appointment, and the schedule.

Not clinical or legal advice. Requirements vary by program and jurisdiction. Much of the guidance cited here comes from the UK and Australia and is not binding in the United States. The Section 1557 rule is the only binding rule cited.