The languages of therapy.
Jul. 1st, 2002 04:48 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
rivkaWhen you train as a psychologist, you learn a new language: one with new words and phrases (euthymic, anhedonic, ideation, oriented times three, restricted affect) and new definitions of common words and phrases (reliable, valid, normal, object). Everyone knows that - people make fun of the jargon, or complain that they can't understand their own psychological report. So that much is obvious.
What's less obvious - or was to me - when you're in training is the other new language you need to learn in order to be any good as a therapist at all. Part of it is being able to do on-the-fly translations from psych jargon to colloquial English - that's how evaluate the negative cognitions and develop a rational response becomes find your negative thoughts and argue back. But it goes further. The other part of it is learning the jargon of the world in which you practice. Not the medical world, the civillian world.
Last year on internship, I did a rotation in the Psych ER. I once interviewed a patient in front of a third-year psychiatry resident from Africa. His English when talking to other professionals was good - he'd been practicing in the US for three years - and yet after my interview he said to me: "I was impressed by your style, and the way you managed to establish rapport with the patient and gather information, but I have some questions for you. What is dealing, what is tricking, what is dope-sick?"
I cannot imagine practicing for three years in an inner city and not knowing how its residents describe their common activities. I made it my business to know. My clients in Iowa, where I trained, didn't complain about being dope-sick - that's a word I learned for Baltimore, just as I learned that the word cocaine, unmodified, always refers to crack cocaine - which is not what they call it in Baltimore anyway. (Here they call it rock or ready rock.) Just as I made it my business to learn that in Baltimore dope is not a generic term for drugs but a specific term for heroin, that speedballs don't have amphetamines in them, that an ambo takes you to the hospital, that hacking is riding in or driving an illegal cab, and that hustling doesn't necessarily involve prostitution.
My major resource for this was The Corner, a profoundly depressing book by a couple of guys who spent a year on a Baltimore drug corner getting to know people. That's where I learned about the different equipment involved in a drug injection, so that now when I ask people about needle-sharing I also ask if they share cookers or cotton or rinse water. That's where I learned how to recognize nodding. I also learned from my patients - either through following context cues or through simply saying "I don't know what that is." My point is that if you care enough to learn, the language lessons are there.
Why does it matter, if patients are willing to provide definitions and able to understand standard English? The African resident would have asked that patient if she was selling drugs, engaging in prostitution, and experiencing withdrawal symptoms, and she certainly would have understood him. But I think it would have created a distance.
I'm different enough from my patients already - I'm young, and white, and middle-class, and highly educated, and have never been a hard drug user. They can tell that I'm not part of their culture, but I still owe it to them to at least show intelligent familiarity with that culture. They can tell I haven't been there, but at least I can convey that I know where there is.
What's less obvious - or was to me - when you're in training is the other new language you need to learn in order to be any good as a therapist at all. Part of it is being able to do on-the-fly translations from psych jargon to colloquial English - that's how evaluate the negative cognitions and develop a rational response becomes find your negative thoughts and argue back. But it goes further. The other part of it is learning the jargon of the world in which you practice. Not the medical world, the civillian world.
Last year on internship, I did a rotation in the Psych ER. I once interviewed a patient in front of a third-year psychiatry resident from Africa. His English when talking to other professionals was good - he'd been practicing in the US for three years - and yet after my interview he said to me: "I was impressed by your style, and the way you managed to establish rapport with the patient and gather information, but I have some questions for you. What is dealing, what is tricking, what is dope-sick?"
I cannot imagine practicing for three years in an inner city and not knowing how its residents describe their common activities. I made it my business to know. My clients in Iowa, where I trained, didn't complain about being dope-sick - that's a word I learned for Baltimore, just as I learned that the word cocaine, unmodified, always refers to crack cocaine - which is not what they call it in Baltimore anyway. (Here they call it rock or ready rock.) Just as I made it my business to learn that in Baltimore dope is not a generic term for drugs but a specific term for heroin, that speedballs don't have amphetamines in them, that an ambo takes you to the hospital, that hacking is riding in or driving an illegal cab, and that hustling doesn't necessarily involve prostitution.
My major resource for this was The Corner, a profoundly depressing book by a couple of guys who spent a year on a Baltimore drug corner getting to know people. That's where I learned about the different equipment involved in a drug injection, so that now when I ask people about needle-sharing I also ask if they share cookers or cotton or rinse water. That's where I learned how to recognize nodding. I also learned from my patients - either through following context cues or through simply saying "I don't know what that is." My point is that if you care enough to learn, the language lessons are there.
Why does it matter, if patients are willing to provide definitions and able to understand standard English? The African resident would have asked that patient if she was selling drugs, engaging in prostitution, and experiencing withdrawal symptoms, and she certainly would have understood him. But I think it would have created a distance.
I'm different enough from my patients already - I'm young, and white, and middle-class, and highly educated, and have never been a hard drug user. They can tell that I'm not part of their culture, but I still owe it to them to at least show intelligent familiarity with that culture. They can tell I haven't been there, but at least I can convey that I know where there is.
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Date: 2002-07-02 07:11 am (UTC)Re:
Date: 2002-07-02 07:15 am (UTC)