Therapy Across Languages
BABCP Conference, July 23rd 2014
Dr Beverley Costa, CEO
Mothertongue multi-ethnic counselling service
Mothertongue multi-ethnic counselling
• Culturally and linguistically sensitive professional
counselling service for people from black and minority
ethnic communities
• Counsellors, patients and NHS professionals reported
dissatisfaction with agency interpreters who were not
trained and supervised to work in a Mental Health context
• Mothertongue responded by creating training for
interpreters and clinicians in collaborative working , a
training DVD and a dedicated Mental Health Interpreting
Service which is funded by the local CCG and Health
Training to work effectively with an interpreter
• The importance of working collaboratively with an
• If clinicians don’t feel confident they will find ways to
avoid this work
• Consequences are that:
1. Patients who need an interpreter get pushed down the
waiting list
2. Therapists expect the therapy to be problematic
3. Therapists’ anxieties are left unresolved and reacted upon
rather than understood and creative solutions found
Some fears of the interpreter
Emotional overload
Role in the therapeutic relationship
Lack of knowledge/context
Clinician’s competence
Some fears of the clinician
Am I being translated accurately?
Will there be enough time?
Trust e.g.confidentiality,reliability,consistency
Can I establish a rapport/connection with client?
Staying in control of the session
Some fears of the client
• Will the interpreter know my family?
• Will they tell anyone else?
• Will the interpreter judge me as we are from the same
• Will we be political enemies?
• Will they translate me accurately?
Karpman’s Drama Triangle
• Persecutor
• Rescuer
• Victim
Even though only one is called victim, all three
originate out of and end up back at the position of
The therapeutic frame
• Anxieties are elicited when working in a mental health
context. When an interpreter is involved, anxieties are
often magnified, not least because there is another person’s
anxieties and another set of relationships to consider in the
• The therapeutic frame (Milner: 1952) refers to the microand the macro- levels of structures which enable anxieties
to be contained and worked with productively in mental
health settings. Essential for safety.
• Dynamic administration (Foulkes: 1975) refers to the
essential administrative tasks which contribute to the
therapeutic containment and potential for transformative
experiences that therapy can provide.
Mothertongue MINI Good Practice guide for
clinicians when working with interpreters
Explain your method of work and expected outcome to interpreter
Let interpreter know if you will be using any specific terminology
Introduce yourself and the interpreter. Think how you will manage beginnings and endings of sessions.
Set the ground rules including confidentiality and the fact that everything spoken in the room will be translated
Arrange seating so that everyone can see each other
Clarify that you, the clinician, have ultimate responsibility for the session. It is necessary that the interpreter feels able to trust
you to hold that responsibility
Speak directly to the client
Be aware of cultural differences
Ask for clarification if there is misunderstanding
Allow enough time for de-briefing at the end.
Work collaboratively together with interpreter to form a counselling/therapy team
Speak in small chunks so that the interpreter can translate accurately
Use of jargon
Referring to the client in the third person
Giving responsibility for the session to the interpreter
Speaking in unmanageable chunks
Leaving the interpreter and the client in the room alone together
Having a private conversation with the interpreter in the client’s presence
Expecting the interpreter to be a general assistant or to look after the client
Interfering with the interpreting process if you have some knowledge of the language
Outline: Therapy Across Languages
• Ideas about multilingualism and therapy
• Examples of research with multilingual therapists and
• Practical Implications
• Over 300 languages are spoken by schoolchildren in
London (Burck, 2004: 315)
• Era of super-diversity for languages (Vertovec, 2007)
• In the UK, 1,298 are able to conduct therapy in more than
one language out of a membership of 7,085 UKCP (2012)
Some relevant ideas from Linguistics
• Bilinguals’ emotional responses to moral and political
dilemnas in dual languages : (Panayiotou,
2004)((Rajagopalan, 2004)
Primary language and emotions
Learning a language early promotes heightened emotionality
of native language compared to additional language because:
Family context of learning
First language learning co-evolves with emotional
regulation systems
Native language has greater connections with
subcortical brain structures which mediate arousal
(including amygdala-mediated learning)
Understanding the untranslatable
“Every language contains its own naïve picture of the world
including its own ethnopsychology”
( Apresjan, 1974)
Multilingualism and implications for therapy,
with illustrations from our research
I feel like a huge part of me just doesn’t go to therapy with
me. I have different personas with each language I speak so
only speaking in English in therapy isn’t helpful. If I have to
translate into English… it just isn’t the same for me.
Implications for therapy
“…if an individual’s other languages are ignored in the
relationship altogether, significant aspects of their experience
and of themselves might never be brought forth in their
relationship” (Burck, 2005:130)
Not all therapists regard the ability to switch languages in
therapy as necessarily positive
Kraph, E. E. (1955) considered that the choice of the
languages to work in (for polyglot clients) was not always
therapeutically beneficial – the client might choose the
language that caused the least amount of emotional
Perez Foster (1996:262) summarises the dual functions of the
language operations in the psyche of defense and
expression as: “the power of bilingualism to both ally itself
against the experience of psychic pain and to work in
transformative adaptation toward the development of new
self experience.”
Client (L1 Greek, L2 English) self report
“I think when I talk about emotional topics I tend to codeswitch to English a lot. I remember when I was seeing a
psychologist in Greece for a while I kept code-switching
from Greek to English. We never really talked about this (
…) To my mind it may have been some distancing
(JM Dewaele, 2010)
Emotional Expression
“Sometimes the acquisition of a new language can provide a
person with the “right expression” for a particular sentiment,
and thus can be used as a coping mechanism to express
emotionally loaded experiences. ……a second language
served as a vehicle to become more self regulated by finding
ways to verbalise feelings that were once censored or
restricted by external forces”
Imberti P. Exploring and understanding the Language Experience of the Non- EnglishSpeaking Immigrant. Families in Society: The Journal of Contemporary Social Services;
2007: 71
When speaking in English my therapist
assumed that I suppress emotions and advised
me to let myself go.. then she changed into
Spanish and noticed that I do not suppress
emotions at all.
Speaking about topics which I was ashamed
of. It is a way to put facts in the distance.
Protective function of second /subsequent
• A language learned after the early childhood years can
serve as a protective psychic defence, de Zulueta, F.
• It can help clients to talk about traumatic events. If, for
example, trauma happened in one language an individual
may be able to talk about it in one of their other languages
with a lessening of the emotional intensity, which makes it
Language in which trauma is recalled
• The Tehrani, N. & Vaughan,S. (2009) article: Lost in
translation- using bilingual differences to increase
emotional mastery following bullying. Counselling and
Psychotherapy Research. Vol.9. No.1, explores the use of
language switching in a bilingual client in order to increase
emotional mastery after a traumatic experience:
• strategic use of bilingual identity for « repair »
• Separate processing areas keep the intensity of feelings in
one language separate from the experience of retelling the
events in the other language.
• This is partly explained by reference to Dufour and Kroll’s
(1995) identification of two separate language stores in the
brain for first and other languages.
I felt more comfortable speaking about
traumatic events in my non-native tongue. I
feel that in my particular case I was able to
let go of pain easier thus.
I remember being given permission/being
asked to express a traumatic incident in the
language in which it happened. This I found
very liberating.
Our research conclusions
A multilingual client is different from a monolingual client
Most multilinguals feel different in their different languages
Language switches in therapy are more frequent when the emotional
tone is raised
Clients feel that switching languages helps them to self-regulate
proximity and distance to/from feelings
Language -switching in therapy could allow them to express
themselves more completely
Multilingual clients’ experiences of therapy
– a complex picture
“Pisser dans un violon” v“Let the lips share it”
My therapist did not understand my L1, however she asked
me to talk about my childhood which seemed irrelevant in the
therapy in English, however when I mixed in some words
from my L1s, it started to make more sense talking about my
childhood. As if English language did not let my memories
come back efficiently enough, and I just needed some key
words in L1 to bring memories back
Some of the issues identified with bilingual IAPT
and other therapists
No terms or appropriate language
Client expectations from the relationship
Concern about taking things too fast
Finding one’s professional identity
Feeling a fraud
Maintaining their therapeutic footing when
working in a shared “other” language
Managers’ expectations and the realities of
working therapeutically in multiple
Some tips for working therapeutically across
1. Train your clinicians to work with interpreters and work
to a Code of Practice
2. Invite clients’ languages into the room even if you don’t
understand them ( get the client to back translate for you
so you can understand)
3. Set up a support/supervision group for your therapists
who are working in more than one language
4. Attend to when bi/multilingualism can be used
strategically for:
• Repair (especially in trauma work)
• Expression
• Exploration of identity
Speaking like falling
….The problem with English is this: You usually can’t open your mouth
and it comes out just like that – first you have to think what you want
to say. Then you have to carefully arrange those words in your head.
Then you have to say the words quietly to yourself, to make sure you
got them okay. And finally, the last step, which is to say the words out
loud and have them sound just right.
But then, because you have to do all this, when you get to the final step,
something strange has happened to you and you speak the way a drunk
walks. And because you are speaking like falling, it’s as if you are an
idiot, when the truth is that it’s the language and the whole process
that’s messed up. And then the problem with those who speak only
English is this: they don’t know how to listen; they are busy looking at
your falling instead of paying attention to what you are saying.
• We need new names, by No Violet Bulawayo, Chatto and Windus
Suggested Reading
Burck, C. (2004). Living in several languages: implications for therapy. Journal of Family Therapy,
26, 314-339.
Burck, C. (2005). Multilingual Living: Explorations of Language and Subjectivity. London: Palgrave
Amati-Mehler, J. Argentieri, S. & Canestri, J. (1993). The Babel of the Unconscious, Mother
Tongue and Foreign Tradition. Madison: International Universities Press.
Perez Foster, R. (1996). The bilingual self: duet in two voices. Psychoanalytic Dialogues, 3, 69-121.
Hoffman, E.(1989).Lost in translation: A life in a new language. New York: Penguin Books.
Dewaele, J.-M. (2010) Emotions in Multiple Languages. Basingstoke: Palgrave Macmillan.
De Zulueta,F. ( 1984) "The implications of Bilingualism in the study and treatment of psychiatric
disorders: A Review", Psychological Medicine 14:541- 57.
De Zulueta,F. (1990) "Bilingualism and Family Therapy", Journal of Family Therapy 12: 255-65.
Costa B. A working model of a community based, culturally sensitive counselling service, in
Psychotherapy and Culture by Zack Eleftheriadou, Karnac Books 2010
Costa, B. & Dewaele, J.M. (2012) Psychotherapy across Languages: beliefs, attitudes and practices
of monolingual and multilingual therapists with their multilingual patients, Language and
Costa, B. & Briggs, S. (In Press) Service-users’ experiences of interpreters in psychological therapy:
a pilot study DOI 10.1108/IJMHSC-12-2013-0044.
Costa, B. (2014) Counselling in many tongues. Therapy Today Vol. 25/4, 20 -23
Dewaele, J-M., Costa, B. (2013) Multilingual Clients’ Experience of Psychotherapy Language and
Psychoanalysis, 2013, 2 (2), 31-50

Crossing Cultural Borderlands