Bilingualism as a Necessary Clinical Competence By Jason Linder, LMFT on 2/21/19 - 2:42 PM

The majority of people in the world speak more than one language, but in the United States people have primarily been monolingual. This may not be sustainable. Technology, mobile dominance, the internet, economic growth, and globalization have reconstructed our social sphere, exponentially amplifying social interaction between continental and national borders. In unprecedented ways, our world has transformed into a diverse multicultural and multinational global hub that is increasingly interconnected. An essential aspect of this global diversity includes an estimated 7,105 living languages¹. Of the more than 7 billion people on our planet, the largest portion, approximately 1.2 billion people, are first-language Chinese speakers, followed by Spanish, English, and Hindi. Countless interactions between speakers of these and many other languages happen daily, and predictably, this has steadily increased demand for bilingual psychotherapists.

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Despite the anti-immigration rhetoric prevalent in Washington, many non-English speakers continue to enter the country. In our age of technological boom and globalization, it is increasingly vital for psychotherapists to not only learn a second language but also to consider the unique and subtle implications of language differences and how an individual’s linguistic roots transect with their geographic location.

Psychotherapy, as taught in graduate programs nationwide, has recognized the need for therapists to address spirituality, religion, race, gender, ethnicity, class, gender, and sexual orientation. However, our field has only recently begun to widen its lens to address language in more depth. Language training will increasingly be not only relevant but also central in psychotherapy training curriculums as globalization, diversity, and intersections across national borders accelerate.

Psychotherapists are frequently in contact with clients whose first language is not English. The profound need for therapists to be able to communicate with non-English speaking clients already exists and is poised to expand exponentially. The most prominent language spoken in the United States after English is Spanish. Although a few graduate programs have integrated Spanish language training into their curriculum, not many recognize that this is a growing need². Currently, language training is considered supplemental, but now more than ever it must become more fundamental to training to keep up with where the world is heading.

One specific population I am passionate about working with is Spanish-speaking immigrants. They are the largest and most rapidly growing ethnic group in the United States. Not only do they underutilize mental health services, but they also tend to have high rates of mental health problems like trauma, domestic violence, depression, substance abuse, and family separations due to immigration restrictions. Research also suggests they tend to seek psychotherapy less frequently and tend not to view talk-therapy as a viable way of meeting their mental health needs, despite its demonstrated effectiveness across multiple studies, including meta-analyses.

Between 2011 to 2013, I completed my Master’s in International Counseling Psychology at the Mexico Campus of Alliant International University. I learned Spanish as I was completing my practicum in Mexico City, practicing solely with Spanish-speaking clients as well as speaking Spanish during class and supervision. We often discussed the nuances of the language differences and how they affected our work with clients, for better or worse. Toward the end of the degree, I completed a research project that covered this topic in greater depth³.

To briefly summarize, we found that in many instances participant clients described language differences as a non-issue, which should be encouraging to you, reading this, if you are considering strengthening your bilingual skills; you do not need to master a second language to make a difference.

Clients who are dominant in any other language than English are often honored by sincere and diligent attempts on the part of the clinician to learn their language. And, according to clients’ self-report (which may have been contaminated by wanting to please us, referred to broadly as research demand characteristics), language differences had unexpected clinical benefits, such as equalizing inherent power dynamics in therapy and strengthening rapport and collaboration as therapists and clients work to understand each other despite significant language differences. Predictably, in some ways, the language limitations of the therapists were also challenging and were related to clinical difficulties that we needed to creatively address with clients, such as not feeling understood by their therapists who were learning Spanish and psychotherapy simultaneously. Fast forward to today, my training has paid off; I work part-time at a non-profit called Palomar Family Counseling Service located in Escondido, California, with Spanish-speaking families.

Aside from broadening your opportunities as a psychotherapist and our field keeping up with our changing times, learning Spanish is a profound act of social justice: you can be the one decreasing the dire paucity of effective bilingual services as we take on the increasingly diverse mental health needs and challenges of clients whose languages and world views are different from ours.  

(1)  Paul, Simons & Fennig, 2013, Ethnologue: Languages of the world. Dallas, TX: SIL International.

(2) Platt, 2012, A Mexico City based immersion education program: Training mental health workers for practice with Latino communities. Journal of Marital and Family Therapy

(3) Linder, Platt, & Young, 2018¿Me explico?: Mexican client perspectives on therapy with Spanish as second language (SSL) Clinicians. Sage Research Methods.

File under: The Art of Psychotherapy, Musings and Reflections