There is evidence that when interpreters are necessary and used well and appropriately in therapy, the benefits for both client and therapist include greater understanding, better engagement and more accurate cooperation (Faust & Drickey, 1986; Tribe, 1999). D'rdenne et al(2007) report that cognitive–behavioural therapy (CBT) resulted in significant improvements in routine clinical outcomes of three groups of patients with post-traumatic stress disorder: refugees who required interpreters; refugees who did not require interpreters; and English-speaking non-refugees.

The pragmatic approach of CBT, especially the option to use its behavioural component rather than techniques such as Socratic dialogue and the downward arrow procedure (vertical descent technique), make it possible to conduct CBT successfully through interpreters.

The role of the interpreter in therapy is complex and there have been many debates about the interpreter's effect on the therapeutic alliance, empathy and transference. Orlinsky et al(1994) see therapy through interpreters as a group process, whereas Raval (2003) describes the interpreter as potentially encompassing the roles of translator, bilingual coworker, cultural broker, cultural consultant, advocate for the service user, intermediary, conciliator, community advocate and link worker. At their worst, therapy sessions conducted through an interpreter can be described as the blind leading the blind; at their best, the interpreter can help understanding and enhance the therapeutic relationship. Fear of breach of confidentiality, especially if the interpreter is from the patient's community, has been voiced; and if a family member takes on the interpreting role, there are often many conflicts of interest (Rathod et al, 2010).

Factors that determine the type of interaction and success of interpreted CBT

The training and experience of the interpreter is an important consideration. In the successful study mentioned above (d'rdenne et al, 2007), the interpreters had at least 1 year's experience in healthcare interpreting. The researchers closely matched patients to interpreters in terms of gender, ethnicity and any political sensitivity, and the same interpreter was used throughout treatment, unless the patient requested a different one. Untrained and inexperienced interpreters, such as family members, friends or support staff, make more errors in interpreting, and the use of trained professional interpreters and bilingual healthcare providers can improve patient satisfaction, quality of care and outcomes (Flores, 2005).