Psychotherapy Bulletin

Psychotherapy Bulletin

Bilingualism as a Tool in Psychotherapy

…the one point that the emigrant feels so particularly painfully is—one can only say—the loss of the language in which one had lived and thought and which one will never be able to replace with another for all one’s efforts at empathy. (Freud, as cited in Urdang, 2016, p. 156)

Psychotherapists live and work in an increasingly globalized world in which people move between countries for a variety of reasons and bring with them their native cultures and languages. The makeup of the United States (U.S.) is becoming more diverse, with 60.6 million of 291.5 million people aged 5 and over (21% of this population) speaking a language other than English at home, according to U.S. Census data (Ryan, 2013).

Thus, psychotherapists are not only likely to encounter bilingual clients in their practices, but may in fact be bilingual or immigrants themselves. It is this interplay between native and adopted cultures and languages in the therapy room that is gaining more interest in the field of multicultural psychology.

However, it is still largely missing from the training of psychotherapists, given that most theories and therapies covertly assume that both parties come from the same linguistic standpoint. Language is a particularly important aspect of therapy as it is one of the main means of communication. It seems important for psychotherapists, therefore, to consider what role language plays in the therapeutic dynamic for bilingual people, as well as to understand how to use it as a tool in therapy.

I am one such psychotherapist, both a bilingual immigrant myself and someone who works with clients who speak a native language other than English. Sometimes our common language, the one we use in therapy, is English. Other times it is Russian.

I often find myself reflecting on the role that language plays in my work. I know first-hand that some words cannot be translated or have a different affective salience depending on the language in which they are spoken.

For example, words like pain, grief, anger, when uttered in Russian (боль, печаль, злость) touch me much more deeply; in English they feel like mere translations of the feelings at a superficial level. Other words have no equivalent in English at all, and may require multiple terms to approximate; for example, тоска is some combination of melancholy, longing, and heartache, with a possible connection to homesickness or nostalgia.

Furthermore, as I shift between languages, I also notice changes in my sense of self, with each language bringing a certain set of historical and cultural experiences. Because I moved to the U.S. as a pre-adolescent, for example, my maturing through adolescence and into adulthood happened largely in English, the language I spoke at school, with my peers and significant others, and in society at large. Russian was the language I used with my family, and thus I remained a child within that system of familiar relationships when speaking my native language. As I progressed through my psychology training, therefore, I began to wonder: How do these two cultural identities play out in psychotherapy through the use of two languages?

The following is not meant to be an exhaustive review, as the study of psycholinguistics is an already extensive subfield, and bilingualism has gained more attention in multicultural literature in recent years. Since the formulation of the Sapir-Whorf hypothesis (Sapir, 1929; Carroll, 1956)—that language influences one’s worldview—psychologists have recognized that languages affect our cognitive processes, organization of the world, and sense of self. Researchers have studied such phenomena as assimilation and integration of identity through the use of language, the brain structures involved in storing and processing linguistic material, and memory and language (Clauss-Ehlers, 2006). Nonetheless, I hope that the following overview will help summarize some of contemporary thinking around the role of bilingualism in therapy and provide some ideas of how to use it as a therapeutic tool.

Mechanisms of Bilingualism

Bilingualism is one’s ability to be fluent in two languages (Clauss-Ehlers, 2006). Although we cannot actually see where language is stored in the brain, neuroimaging techniques have helped us construct a pattern for the storage and retrieval of linguistic material as it pertains to our understanding of concepts (Santiago-Rivera & Altarriba, 2002). One language acquisition model by Kroll and Stewart (1994) suggests that bilingual individuals have a large word store for their first language and a smaller one for the acquired second language.

A third store is conceptual and is linked to the first language. As one learns a second language, words in the new language are connected through lexical links to words in the first language store. This leads to the formation of direct conceptual links from the second language store to conceptual memory. Thus, this model suggests that as individuals become more proficient in a second language, they are able to directly access conceptual memory from a word in the second language. Conceptual storage then expands as one learns more words and creates new links between languages.

According to Santiago-Rivera and Altarriba (2002), although little is known regarding the encoding and storage of emotion words (e.g., love, hate, fear) in bilingual memory, researchers have identified differential patterns of usage as a function of language proficiency. It has been suggested that when individuals learn emotion words in their first language, those words are stored at a deeper level of representation than their second language synonyms. Because emotion words in the first language are usually experienced in many more contexts and have been applied in varying ways, encountering an emotion word in the second language is not likely to activate as many different associations.

Psychologists have also posited that learning a second language is a process of not only acquiring the knowledge of new words, but also developing the ability to think and feel using new words and concepts (Leavitt, 2010). This may then lead to a change in one’s worldview and identity. These mechanisms of bilingualism may be at play for both the client and the therapist, creating a certain dynamic in the therapy room. The next sections discuss the influence of bilingualism on the therapeutic process, as well as possible techniques to address it.

The Bilingual Client

The phenomenon of the bilingual client has been discussed from the start by early psychoanalysts, as Freud was a native speaker of German and later used his second language, English, in his work with patients. In one case (as described in Clauss-Ehlers, 2006), early psychoanalysts discussed working with a woman whose native language was German but who fled to the U.S. during World War II as an adolescent and acquired English as a second language. In therapy she spoke only English and refused to speak German.

It was later discovered that when she was finally able to speak German, she was able to access many more feelings of childhood anxiety and the trauma of experiencing the war. This showed that different self-experiences are organized by language and pointed to the idea that it may be useful for bilingual individuals to switch between languages in order to access those different experiences and feelings.

This process of changing between languages is called code switching. Any switch away from one language to another may hold therapeutic significance, especially if it follows a consistent pattern for the bilingual client. As described in the case example above, the switching can have a distancing or defensive function, as the client attempts to veer away from the deeper emotions one experiences when using the native language.

Studies have also found that talking about taboo or embarrassing topics is easier in one’s second language, further suggesting that code switching to one’s second language can serve as a defense (Santiago-Rivera & Altarriba, 2002). It is important then to pay attention to the pattern of language switching in therapy, and discuss the meaning it might have for a particular client depending on context, topic of discourse, and conceptual and emotional relevance.

The Bilingual Therapist

A significant aspect for the bilingual therapist is the development of an integrated professional and cultural identity as it may pertain to working in two languages with bilingual clients. The therapist’s experience of oneself as a bilingual individual follows a developmental trajectory, the successful completion of which enables the development of a more complex, integrated, and professional identity (Burck, 2004).

Additionally, in a study of bilingual psychotherapy, Kokaliari and Catanzarite (2011) reported that language was found to be a factor that influenced the therapeutic alliance, as it triggered clients’ issues of trust, idealization, and hostility towards the psychotherapist.

Furthermore, the same study reported two major themes of countertransference: White monocultural bilingual therapists tended to engage intellectually and were more concerned with boundaries, whereas bicultural bilingual therapists tended to engage relationally and were more concerned with self-awareness. Therefore, the therapist’s cultural awareness plays an essential in the therapeutic dynamic.

Bilingualism as a Tool in Therapy

In summary, it is important to consider the function that the first and second languages play for bilingual clients in communicating and understanding their emotions and experiences. It is also essential for bilingual therapists to reflect on their own cultural identities and assess their level of comfort with using both languages in therapy.

Bilingualism can be a powerful psychotherapeutic tool. When working with bilingual clients, the clinician should pay attention to language-related phenomena and bring attention to them. For a language-matched dyad (when the therapist and client speak the same two languages), the clinician may acknowledge and analyze the client’s pattern of code switching and further discuss whether there is a consistent switch to the second language for emotionally salient material or taboo topics, for example. The clinician may encourage the use of both languages in therapy in order to assist the client with achieving integration.

For a non-matched dyad, the therapist, recognizing the benefits of using a dual language system to process feelings and experiences, can encourage clients to express themselves in their native language first, then translate what had been said; subsequently, the dyad can explore the meaning of uttering emotional material in the first language. Another important factor when dealing with the issue of bilingualism in therapy is sensitivity to and clarification of the client’s identification with the native culture and language, including asking about the preferred language.

Overall, the increasing number of bilingual people in the U.S. calls for an increase in bilingual psychotherapists who are able to speak and understand the language through which the client experiences the world. This, in turn, calls for more research and training, through formal means and supervision or consultation, by which clinicians can learn techniques for utilizing their bilingualism as the powerful psychotherapeutic tool that it can be.

Dr. Daria Diakonova-Curtis received her PhD degree in Clinical Psychology from the California School of Professional Psychology at Alliant International University, San Francisco. Currently, Dr. Diakonova-Curtis is completing her clinical postdoc year with CHE Behavioral Health Services in New York City and is looking forward to being licensed as clinical psychologist in the state of NY soon. Dr. Diakonova-Curtis is also a member of a UN-affiliated non-profit organization, Association for Trauma Outreach and Prevention, Meaningfulworld, where members respond to disasters around the world by leading workshops and healing groups to reduce the effects of traumatic events and increase resilience. Dr. Diakonova-Curtis is originally from St. Petersburg, Russia, and spent the last three years as a postdoctoral fellow at St. Petersburg State University, investigating factors that put Russian women at risk for HIV. Dr. Diakonova-Curtis is a member of the Diversity Committee of Division 29, and is passionate about bringing issues of diversity, international issues, and social justice into the realm of psychotherapy.

Cite This Article

Diakonova-Curtis, D. (2016). Bilingualism as a tool in psychotherapy. Psychotherapy Bulletin, 51(4), 38-42.


Burck, C. (2004). Living in several languages: Implications for therapy. Journal of Family Therapy, 26(4), 314-339. doi:10.1111/j.1467-6427.2004.00287.x

Carroll, J. B. (Ed.). (1956). Language, thought, and reality: Selected writings of Benjamin Lee Whorf. Cambridge, MA: MIT Press.

Clauss-Ehlers, C. (2006). Bilingualism. In Y. Jackson (Ed.), Encyclopedia of multicultural psychology (pp. 70-71). Thousand Oaks, CA: Sage.

Kokaliari, E., & Catanzarite, G. (2011). Understanding the role of language in bilingual psychotherapy: Clinical implications. Psychiatrische Praxis, 38(S 01), OP18_TP. doi: 10.1055/s-0031-1277822

Kroll, J. F., & Stewart, E. (1994). Category interference in translation and picture naming: Evidence for asymmetric connections between bilingual memory representations. Journal of Memory and Language, 33(2), 149-174. doi:10.1006/jmla.1994.1008

Leavitt, J. (2010). Linguistic relativities: Language diversity and modern thought. Cambridge, UK: Cambridge University Press.

Ryan, C. (2013). Language use in the United States: 2011. Retrieved from

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(1), 30-38. doi:10.1037//0735-7028.33.1.30

Sapir, E. (1929). The status of linguistics as a science. Language, 5, 207-214. doi: 10.2307/409588

Urdang, E. (2016). Human Behavior in the social environment: Interweaving the inner and outer worlds. New York, NY: Routledge.


  1. Patrizia I Spiga

    Bilingualism as a Tool in Psychotherapy by Dr. Diakonova-Curtis was a pleasure for a bilingual therapist like myself to read. It reflects exactly my language experience as an Italian immigrant and as a bilingual therapist.
    Dr. Diakonova-Curtis writing on this subject is clear, insightful, truthful, and well reasearched, in short a validating pleasure to read. I will share it with my bilingual clients, friends, and American family members who believe that I tend to exaggerated statements when I am explaining significant events.
    Thank you Dr. Diaknova-Curtis!
    Best Regards,
    Patrizia I Spiga, LMFT

  2. Sara

    I was wondering whether or not you are aware of any groups that are currently advocating for more bilingual therapists?


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