Psychotherapy across Languages: beliefs, attitudes and practices of monolingual and multilingual therapists with their multilingual patients

  • Beverley Costa Mothertongue
  • Jean-Marc Dewaele University of London


The present study investigates beliefs, attitudes and practices of 101 monolingual and multilingual therapists in their interactions with multilingual patients. We adopted a mixed-method approach, using an on-line questionnaire with 27 closed questions which were analysed quantitatively and informed questions in interviews with one monolingual and two multilingual therapists. A principal component analysis yielded a four-factor solution accounting for 41% of the variance. The first dimension, which explained 17% of variance, reflects therapists’ attunement towards their bilingual patients (i.e., attunement versus collusion). Further analysis showed that the 18 monolingual therapists differed significantly from their 83 bi- or multilingual peers on this dimension. The follow up interviews confirmed this result. Recommendations based on these findings are made for psychotherapy training and supervision to attend to a range of issues including: the psychological and therapeutic functions of multi/bilingualism; practice in making formulations in different languages; the creative therapeutic potential of the language gap. 


Altarriba, J., & Santiago-Rivera, A. L. (1994). Current perspectives on using linguistic and cultural factors in counseling the Hispanic client. Professional Psychology: Research and Practice, 25, 388-397.

Amati-Mehler, J. Argentieri, S., & Canestri, J. (1993). The babel of the unconscious: Mother tongue and foreign tradition. Madison, CT: International Universities Press.

Bhaskar, R. (1979). The possibility of naturalism: A philosophical critique of the contemporary human sciences. Brighton, UK: Harvester.

Bowker, P., & Richards, B. (2004). Speaking the same language? Psychodynamic Practice, 10(4), 459-478.

Burck, C. (2004). Living in several languages: implications for therapy. Journal of Family Therapy, 26, 314-339.

Caldwell-Harris, C. L., Tong, J., Lung, W., & Poo, S. (2011). Physiological reactivity to emotional phrases in Mandarin–English bilinguals. International Journal of Bilingualism 15(3), 329–352.

Costa, B. (2010). Mother tongue or non-native language? Learning from conversations with bilingual/multilingual therapists about working with clients who do not share their native language. Journal of Ethnicity and Inequalities in Health and Social Care, 3(1), 15-24.

De Maesschalck, S. (2012) Linguistic and cultural diversity in the consulting room: A tango between physicians and their ethnic minority patients. Unpublished Doctoral Dissertation, Ghent University.

Dewaele, J.-M. (2010). Emotions in multiple languages. Basingstoke, UK: Palgrave Macmillan.

Dewaele, J.-M., & Nakano, S. (2012). Multilinguals’ perceptions of feeling different when switching languages. Journal of Multilingual and Multicultural Development DOI: 10.1080/01434632.2012.712133

Harris, C. L. (2006) When is a first language more emotional? In A. Pavlenko (Ed.), Bilingual Minds: Emotional experience, expression, and representation (pp. 257- 283). Clevedon, UK: Multilingual Matters.

Imberti, P. (2007). Exploring and understanding the language experience of the non- English-speaking immigrant. Families in Society: The Journal of Contemporary Social Services, 88, 67-73.

Kaiser, H. F. (1970). A second generation Little Jiffy. Psychometrika, 35, 401-415.

Li, W. (2000). The bilingualism reader. London, UK: Routledge.

Moreno, J. L. (1953). Who shall survive? Beacon, NY: Beacon House Inc.

Nguyen, B. (2012). Working with monolingual and bilingual clients in the UK when English is not your first language. Unpublished MA Dissertation, Reading University, UK.

Ożańska-Ponikwia, K. (2011). What has personality and emotional intelligence to do with ‘feeling different’ while using a foreign language? International Journal of Bilingual Education and Bilingualism DOI:10.1080/13670050.2011.616185.

Pavlenko, A. (2005). Emotions and multilingualism. New York, NY: Cambridge University Press.

Pavlenko, A. (2006). Bilingual selves. In A. Pavlenko (Ed) Bilingual minds: Emotional experience, expression, and representation (pp. 1-33). Clevedon, UK: Multilingual Matters.

Perez Foster, R. (1996). The bilingual self: duet in two voices. Psychoanalytic Dialogues, 3, 69-121.

Perez Foster, R. (1998). The Power of language in the clinical process: Assessing and treating the bilingual person. Northvale, NJ: Aronson.

Santiago-Rivera, A. L., & Altarriba, J. (2002). The role of language in therapy with the Spanish-English bilingual client. Professional Psychology: Research and Practice, 33, 30-38.

Schrauf, R. W. (2000). Bilingual autobiographical memory: Experimental studies and clinical cases. Culture and Psychology, 6, 387-417.

Stern, D. (1998). The interpersonal world of the infant. London, UK: Karnac.

Stevens, S., & Holland, P. (2008). Counselling across a language gap: the therapist’s experience. Counselling Psychology Review, 23(3), 15-23.
Tehrani, N., & Vaughan, S. (2009). Lost in translation -using bilingual differences to increase emotional mastery following bullying. Counselling and Psychotherapy Research, 9(1), 11-17.

Winnicott, D. W. (1963). The Maturational process and the facilitating environment. London, UK: Karnac (reprinted 1996).

Winnicott, D. W (1971). Playing and reality. London, England: Routledge.

Wilson, R. J. (2008). ‘Another language is another soul’: Individual differences in the presentation of self in a foreign language. Unpublished doctoral dissertation. Birkbeck College, University of London.
How to Cite
Costa, B., & Dewaele, J.-M. (2012). Psychotherapy across Languages: beliefs, attitudes and practices of monolingual and multilingual therapists with their multilingual patients. Language and Psychoanalysis, 1(1), 19-41.
Original Articles