Bilingual Therapists Research Articles

Linguistic sensitivity in family therapy: A review of language adaptation strategies for enhancing therapeutic engagement

Language plays a pivotal role in family therapy, shaping the therapeutic process and influencing client engagement and outcomes. This review explores the significance of linguistic sensitivity in family therapy and examines various language adaptation strategies aimed at enhancing therapeutic engagement. Drawing upon existing literature, this paper synthesizes key findings and offers insights into effective approaches for addressing linguistic diversity within therapeutic contexts. Understanding the cultural and linguistic backgrounds of clients is essential for promoting inclusivity and facilitating effective communication in family therapy. Cultural competence encompasses not only an awareness of diverse cultural norms and values but also proficiency in navigating linguistic nuances. By recognizing the impact of language on therapeutic interactions, therapists can foster a more inclusive and empowering therapeutic environment. The review identifies several language adaptation strategies that therapists can employ to enhance therapeutic engagement with diverse client populations. These strategies include linguistic matching, which involves adjusting language patterns and communication styles to resonate with clients' linguistic preferences. Additionally, the use of culturally relevant metaphors, idioms, and storytelling techniques can facilitate deeper rapport and understanding between therapists and clients. Furthermore, the review discusses the importance of employing interpreters and bilingual therapists to bridge language barriers effectively. It emphasizes the need for clear communication protocols and the importance of training therapists in language adaptation techniques to ensure ethical and effective practice. Moreover, the review highlights the role of technology in language adaptation, such as the use of translation software and teletherapy platforms with multilingual capabilities. Leveraging technology can broaden access to therapy and support linguistic diversity in therapeutic settings. Linguistic sensitivity is fundamental to promoting inclusivity and effectiveness in family therapy. By adopting language adaptation strategies and embracing linguistic diversity, therapists can cultivate a more responsive and culturally competent approach to working with diverse families. This review underscores the importance of ongoing research and training initiatives to further enhance linguistic sensitivity within the field of family therapy.

Language as power in the therapy room: A study of bilingual (Arabic–English) therapists' experiences

AbstractThe topic of language as power (LaP) in individual therapeutic encounters has thus far been overlooked, and as bilingual therapists have the ability to use more than one language in the therapy room, their experience of LaP is a compelling research area that this paper attempts to explore. This qualitative, inductive, phenomenological study used interviews and interpretative phenomenological analysis to explore five bilingual Arabic–English‐speaking therapists' experiences of LaP in the therapeutic encounter. The study identifies two overarching themes: (a) the emergence of identity and power from language and (b) comparisons of power in the English and Arabic languages. Within these themes, the study finds that therapists experience LaP through multiple avenues: self‐disclosure, intersectionality, being transported to different identities and expressions of power and power of expression in Arabic–English. These multiple avenues illustrate the complexity of LaP in the therapeutic encounter. The study sheds light on an underexplored area in psychotherapy, illuminating an important area for psychotherapists and training institutions to consider when working with clients.

M(other) tongue: An exploration of the impact on power dynamics for the therapist working in English as a second language

AbstractThis research explores the experiences of bilingual therapists whose first language is not English and who are therefore working in English as a second language, with native‐speaking English clients. Existing literature suggests that the therapeutic relationship is inherently unbalanced, with the therapist constructed as the more powerful. This is particularly true of psychodynamic therapy—the researchers' own modality—in which the therapist withholds self‐revelation. However, the power balance can shift in the client's favour, particularly if they hold knowledge about their therapist. Our research focusses on how bilingualism as an inherent self‐disclosure might result in shifting the power in the therapeutic dyad when the client is perceived as the more competent native speaker. This research aims to contribute an alternative to the prevailing view that linguistic difference is merely challenging. Qualitative semistructured interviews generated narrative transcripts from six participants, which were analysed thematically. Three themes emerged, demonstrating how the therapists experienced their difference in terms of power shifts: my difference is an inherent vulnerability; my difference is a tool; and my difference is unspoken. When experienced as a vulnerability, therapists' bilingualism results in a power struggle. Working with this vulnerability can facilitate the alliance and create a sense of equality. This brings bilingualism as a tool into focus. Almost all participants experienced a lack of recognition of this aspect of their diversity in training and supervision. Most participants acknowledged that it remained unspoken between them and their clients.

Scaling-up Child and Youth Mental Health Services: Assessing Coverage of a County-Wide Prevention and Early Intervention Initiative During One Fiscal Year

PurposeIn the U.S., the percentage of youth in need of evidence-based mental health practices (EBPs) who receive them (i.e., coverage rate) is low. We know little about what influences coverage rates. In 2010, the Los Angeles County Department of Mental Health (LACDMH) launched a reimbursement-driven implementation of multiple EBPs in youth mental health care. This study examines two questions: (1) What was the coverage rate of EBPs delivered three years following initial implementation? (2) What factors are associated with the coverage rates?MethodsTo assess coverage rates of publicly insured youth, we used LACDMH administrative claims data from July 1, 2013 to June 30, 2014 and estimates of the size of the targeted eligible youth population from the 2014 American Community Survey (ACS). The unit of analysis was clinic service areas (n = 254). We used Geographic Information Systems and an OLS regression to assess community and clinic characteristics related to coverage.ResultsThe county coverage rate was estimated at 17%, much higher than national estimates. The proportion of ethnic minorities, individuals who are foreign-born, adults with a college degree within a geographic area were negatively associated with clinic service area coverage rates. Having more therapists who speak a language other than English, providing care outside of clinics, and higher proportion of households without a car were associated with higher coverage rates.ConclusionHeterogeneity in municipal mental health record type and availability makes it difficult to compare the LACDMH coverage rate with other efforts. However, the LACDMH initiative has higher coverage than published national rates. Having bilingual therapists and providing services outside the clinic was associated with higher coverage. Even with higher coverage, inequities persisted.

Implementing Parent-Teen Motivational Interviewing + Behavior Therapy for ADHD in Community Mental Health.

Despite the promise of psychosocial interventions for adolescent Attention Deficit Hyperactivity Disorder (ADHD), there are no studies that examine their implementation in community mental health contexts. In this study, we evaluate the implementation of community-based Supporting Teens' Autonomy Daily (STAND), a parent-teen Motivational Interviewing + Behavior Therapy intervention for adolescents with ADHD. Adolescents with ADHD (N =225), who were clients at four community mental health agencies, received treatment from 82 therapists. There was double randomization of adolescents and therapists to STAND or Usual Care (UC). Nearly all therapists randomized to STAND completed the training and regularly attended supervision, rating STAND as acceptable and lower burden than UC practices. In the STAND group, MI competence and implementation were lower than in university trials (benchmark range, 19.5% for reflection to question ratio to 83.1% for technical globals). MI integrity in the STAND group was significantly higher than UC across most MITI indices. Content fidelity was adequate in STAND's engagement and skills phases (76.4-85.0%), but not its planning phase (24.4%). Therapists commonly neglected weekly review of goals and home practice and deviated from manualized pace and sequencing of therapy tasks. Learning MI was more challenging for bilingual therapists and therapists with more years of experience. STAND was delivered with higher integrity in earlier sessions and office-based sessions. Discussion identifies future directions for exporting adolescent ADHD interventions to community settings. Patient outcome data for this trial is presented elsewhere. Trial Registration: NCT02694939 www.clinicaltrials.gov .

Caregiver Attendance as a Quality Indicator in the Implementation of Multiple Evidence-Based Practices for Children

Objective: This study investigated a quality indicator for children’s mental health, caregiver attendance in youth psychotherapy sessions, within a system-driven implementation of multiple evidence-based practices (EBPs) in children’s community mental health services. Method: Administrative claims from nine fiscal years were analyzed to characterize and predict caregiver attendance. Data included characteristics of therapists (n = 8,626), youth clients (n = 134,368), sessions (e.g., individual, family), and the EBP delivered. Clients were primarily Latinx (63%), male (54%) and mean age was 11; they presented with a range of mental health problems. Three-level mixed models were conducted to examine the association between therapist, youth, service, EBP characteristics and caregiver attendance. Results: Caregivers attended, on average, 46.0% of sessions per client for the full sample and 59.6% of sessions for clients who were clinically indicated, based on age and presenting problem, to receive caregiver-focused treatment. Following initial EBP implementation, the proportion of caregiver attendance in sessions increased over time. Caregivers attended a higher proportion of youth psychotherapy sessions when clients were younger, had an externalizing disorder, were non-Hispanic White, and were male. Further, higher proportions of caregiver attendance occurred when services were delivered in a clinic setting (compared with school and other settings), by bilingual therapists, and the EBP prescribed caregiver attendance in all sessions. Conclusions: Overall, the patterns of caregiver attendance appear consistent with evidence-informed practice parameters of client presenting problem and age. Yet, several improvement targets emerged such as client racial/ethnic background and service setting. Potential reasons for these disparities are discussed.

"Thank You for Including Us!" - Introducing a Community-Based Collaborative Approach to Translating Clinic Materials.

When working with clients in another language, having culturally relevant and properly translated clinic materials is vital to effective clinical practice. Not having them presents a barrier for bilingual therapists and their clients. This paper reviews common translation methods and introduces a multi-level, community-based approach for translating clinic materials for non-English speaking clients. Informed by decolonizing practices, this five-tier method includes members from the target community as cultural brokers to verify the accuracy and nuances of language for their cultural group, as well as a constant comparative method to ensure methodological rigor in the process of inclusion. We present community member's feedback and recommendations, as well as discuss advantages and challenges of using this collaborative culturally responsive translation method.

One Language and Two Mother Tongues in the Consulting Room: Dilemmas of a Bilingual Psychotherapist

The purpose of the present study is twofold: first, to explore the bilingual therapist's experience of working in a second language; and second, to explore the major functions of language within the therapeutic setting. Interpretative phenomenological analysis is used to explore in depth the experience of 16 bilingual therapists of different professional orientations: psychoanalysts, psychotherapists, counselling psychologists, clinical psychologists and counsellors. Semi‐structured life‐world interviews were employed in accordance with the exploratory nature of the research. Four major themes were identified: ‘Listening and understanding the client’; ‘Interventions and interpretations’; ‘Potential impact of language on the therapeutic encounter: Therapist's point of view’; and ‘Therapist's experience of self’. The data demonstrated differences in the understanding of functions of language within the therapeutic setting among psychotherapists. The importance of the symbolic functions of language in therapeutic discourse is discussed. In addition, the specifics of language within the therapeutic encounter are explored and outlined.

Testimonios, A Mental Health Support Group for Latino Immigrants in an Emergent Latino Community.

Latino immigrants face many stressors before, during, and after migration to the U.S., but there are few mental health services available to help them cope with this transition. We established free group sessions moderated by bilingual therapists to address the unmet mental health needs of Latino immigrants.

A healing journey of the bilingual self: In search of the language of the heart

ABSTRACTThis article examines the clinical challenges that occur in the treatment of the bilingual Latino/immigrant client with a bilingual therapist who speaks both Spanish and English. Language plays a crucial role in the therapeutic process, especially when therapy takes place in the client’s second language with a bilingual therapist. Several theorists established a firm view that the mother tongue was the language of emotions and the second, the language of distance and detachment. A case composite vignette will introduce language switching as a defensive function for the bilingual client and as a therapeutic tool for the clinician. The work of Winnicott, who provides a framework in which to think about language from an object relations perspective, is discussed. The concepts and dilemmas described are applicable to other bilingual clients and clinicians.

Walsh, S. D. (2014). 'The bilingual therapist and transference to language: language use in therapy and its relationship to object relational context.'. Psychoanalytic Dialogues, 24, 1, 56-71.

Walsh, S. D. (2014). 'The bilingual therapist and transference to language: language use in therapy and its relationship to object relational context.'. Psychoanalytic Dialogues, 24, 1, 56-71.

Lost and Gained in Translation: The Impact of Bilingual Clients' Choice of Language in Psychotherapy

Bilingual clients in psychotherapy with bilingual therapists have choices as to which language to use. Psychoanalytic case studies suggest that the use of the second language, learned post childhood, reduces access to deeper emotional material and is mainly viewed as a defensive manoeuvre leading to intellectualizing detachment. Linguistic and neurological studies support the view that the use of the second language can lead to a reduced degree of emotionality in the recall of memories. However, this paper suggests that there is a different and enabling dimension to such clients' language choices. Their own and their therapist's bilingualism and biculturalism open a transferential field where language choices are mapped onto deeper inter‐ and intra‐psychic conflicts and can thus allow access to them rather than defensively hide them. Case material from work with bilingual clients is explored to illustrate this.

Language switching by bilingual therapists and its impact on the therapeutic alliance within psychological therapy with bilingual clients: a systematic review

A systematic review was conducted to evaluate the empirical literature exploring the role of language switching in therapeutic engagement for bilingual therapists working with minority ethnic clients who share the same native language. The review identified three main themes of research focusing on: the training needs and professional development of bilingual therapists; the emotional aspects of language use; and the use of language switching and its perceived effects on the therapeutic process. The review indicates that language switching may be a useful therapeutic strategy for bilingual therapists when working with bilingual clients. Findings indicate how language switching may strengthen the therapeutic alliance and enhance client self-disclosure. They also highlight gaps in the training needs of bilingual therapists. Limitations of the reviewed studies are considered, with discrepancies in recruitment processes and sampling as prominent factors that have impacted upon the generalisability of findings...

A response to Nguyen’s article, ‘Identification: A qualitative study of the experiences of bilingual therapists with their monolinguals and bilingual clients’

Noticing a certain lack of reflections directly related to language per se, I emphasise and discuss the importance of language issues in any bilingual or multilingual therapy. I try to illustrate this both with some of the existing literature on the subject and by offering my own take on some of the comments made by the interviewees.

Identification: a qualitative study of the experiences of bilingual therapists with their monolinguals and bilingual clients

We now live in an increasingly diverse society, and many of our relationships are with people who do not necessarily share our first language. This study investigates such relationships when they occur between therapist and client. The purpose of the study was to explore the experiences of therapists conducting counselling in English when that was their second or subsequent language. Nine counsellors/psychotherapists, born outside the UK and for whom English was their second language, were interviewed and asked about their work with English monolingual clients and bilingual clients, with particular reference to the therapeutic alliance. Data were analysed thematically from interview transcripts using Interpretative Phenomenological Analysis (IPA) principles. This paper focuses on findings related to two key themes which share certain developmental features associated with the early mother–infant relationship: (i) identification and (ii) over-identification. These themes are explored in relation to psychodynamic developmental theory and to previous studies. The participants’ bilingualism was found to be a part of the therapeutic alliance with their clients. The study has implications for theory, practice and future research.

The Bilingual Therapist and Transference to Language: Language use in Therapy and its Relationship to Object Relational Context

Through the concept of transference to language, this paper examines the clinical impact of language-related selves of a bilingual therapist, the origin of which is based on the idea that language develops in an object relation context.

Telephone-Based Cognitive-Behavioral Therapy for Latino Patients Living in Rural Areas: A Randomized Pilot Study

Objective: This pilot study tested the effectiveness of culturally tailored, telephone-based cognitive-behavioral therapy (CBT) for improving depression outcomes among Latino primary care patients living in rural settings. Methods: A total of 101 Latino patients at a rural family medical center who met criteria for probable major depression were randomly assigned to enhanced usual care or eight sessions of CBT delivered by phone by trained bilingual therapists from the community. Blinded study assistants assessed depression symptom severity, using the Hopkins Symptom Checklist (SCL) depression items and the Patient Health Questionnaire-9, and patient satisfaction after six weeks, three months, and six months. Mixed-effects models were used to estimate intervention effects over time. For cross-sectional analyses, attrition weights were used to account for missing data. Results: In intent-to-treat analyses, patients who received CBT by phone were more likely to experience improvement in depression scores over the six-month follow-up period compared with patients who received enhanced usual care (β=−.41, t=−2.36, df=219, p=.018, for the SCL; and β=−3.51, t=−2.49, df=221, p=.013, for the PHQ-9). A greater proportion of patients in the CBT group than in the group that received enhanced usual care achieved treatment response at three months (p=.017), as indicated by a 50% improvement in SCL depression score or a score <.75, and reported high satisfaction with treatment (p=.013). Conclusions: Although limited by small sample size, pilot results suggest culturally tailored, telephone-based CBT has the potential to enhance access to psychotherapy in an underserved Latino population with little access to mental health services. (Psychiatric Services 62:936–942, 2011)

Living in Two Languages: A Bilingual Couple Therapist’s Experience of Working in the Mother Tongue

This paper describes the clinical experience of a bilingual therapist with a bilingual couple who presented with difficulties around their sexual intimacy and requested that therapy be carried out in their shared Greek mother tongue. The work was conducted in an English external linguistic environment. The paper shows that the use of the mother tongue can facilitate a linguistic connectedness which goes beyond the actual words used during the couple therapy session and extends further into their metaphorical and symbolic meaning. Clinical material from the initial meeting illustrates how some early attachment experiences and memory traces were emotionally and linguistically enhanced by being carried out in the mother tongue. It highlights how the intrinsic cultural and linguistic associations can begin to be understood and clinically addressed within that framework. The linguistic phenomenon of ‘language independence’ – the simultaneous access into and proficient use of the therapist’s two separate language systems – is shown to have had a profound impact on the clinical work and on understanding powerful countertransference processes in the therapy.

Telephone-Based Cognitive-Behavioral Therapy for Latino Patients Living in Rural Areas: A Randomized Pilot Study

This pilot study tested the effectiveness of culturally tailored, telephone-based cognitive-behavioral therapy (CBT) for improving depression outcomes among Latino primary care patients living in rural settings. A total of 101 Latino patients at a rural family medical center who met criteria for probable major depression were randomly assigned to enhanced usual care or eight sessions of CBT delivered by phone by trained bilingual therapists from the community. Blinded study assistants assessed depression symptom severity, using the Hopkins Symptom Checklist (SCL) depression items and the Patient Health Questionnaire-9, and patient satisfaction after six weeks, three months, and six months. Mixed-effects models were used to estimate intervention effects over time. For cross-sectional analyses, attrition weights were used to account for missing data. In intent-to-treat analyses, patients who received CBT by phone were more likely to experience improvement in depression scores over the six-month follow-up period compared with patients who received enhanced usual care (β=-.41, t=-2.36, df=219, p=.018, for the SCL; and β=-3.51, t=-2.49, df=221, p=.013, for the PHQ-9). A greater proportion of patients in the CBT group than in the group that received enhanced usual care achieved treatment response at three months (p=.017), as indicated by a 50% improvement in SCL depression score or a score <.75, and reported high satisfaction with treatment (p=.013). Although limited by small sample size, pilot results suggest culturally tailored, telephone-based CBT has the potential to enhance access to psychotherapy in an underserved Latino population with little access to mental health services.

What are the perceived needs of Pakistani women in the North west of England in relation to physiotherapy, and to what extent do they feel their needs are being met?

Objective To gain an insight into the needs of female Pakistani service users in relation to physiotherapy. Design A qualitative research design was utilised, drawing on ethnographic traditions and including ethnographic interviews. The interviews were transcribed and the data were analysed using thematic analysis. Setting A venue of the service user's own choosing in one geographical area of the North west of England. Participants Six, Pakistani, Muslim female patients who had recently received physiotherapy from a range of specialisms. Five participants came to the UK from Pakistan, and one participant of Pakistani heritage came to the UK from East Africa. An interpreter was used in four of the six interviews. Findings Four main themes emerged from data analysis: issues of gender; language issues including the subthemes of crosscultural communication, time and materials; role of exercise; and acquiescence. Conclusions It appears that physiotherapy provision for female patients with Pakistani backgrounds may be failing to meet their needs, which may affect compliance. In order to address these issues, culturally competent health care needs to be provided and the following points are worthy of consideration: • offering service users the choice of gender of therapist and, where appropriate, the provision of single-sex exercise group sessions; • longer appointment times for service users where English is not their first language, and the recruitment of bilingual therapists. Written instructions, in English, with pictures should be provided; • therapists should have some understanding of the culture of their local community to enable them to incorporate the patient's culture into their management; and • there may be a need to explore service provision where a high proportion of female Pakistani service users are failing to attend physiotherapy appointments.