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Why should I do therapy in my native language?

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Johanne is a Danish psychologist trained in behavioral methods and the co-founder of It's Complicated. She completed her education as a psychologist at the University of Copenhagen in 2013, with a master's degree and experience within the fields of narrative therapy, cognitive-behavioral therapy and acceptance and commitment therapy (ACT).

Last Updated on December 28, 2023 by It’s Complicated

There are varied opinions on the topic of how language affects therapy. Some claim that non-native therapy is less effective than therapy in your mother tongue, and some say that non-native therapy is more analytical than native therapy.

Living in Berlin does not equate to living your life in German. Most people moving to Berlin never become fluent in German. In my case as a Dane, I reached a basic small-talk Späti level, and then I couldn’t be bothered delving deeper into the intricacies of German grammar.

However, to compensate, I became much better at English, so much so that I think my English skills might have exceeded my Danish skills at this point.

In relation to my profession as a therapist, this means I do around 80% therapy in English and 20% in Danish. There are simply many more English-speakers seeking therapy than there are Danish. And of the English-speaking clients I have, more than half of them have English as a second language. So, this means that most of my sessions are done in my second language with people who are also speaking in their second language. What does this mean for my work and my clients?

The opinions on the topic language and therapy are varied, but roughly speaking, the theories can be split into two categories: Those that claim nonnative therapy to be less effective and less emotional than therapy in your mother tongue, and those which say nonnative therapy might be more analytical than native therapy.

Native therapy can be more effective and emotional

Studies have been made which show that doing therapy in your mother tongue is more effective than doing nonnative therapy. The reason for this is that the client’s cultural values are integrated better into the treatment when therapy is happening in the client’s native language.

There are also studies demonstrating that clients speaking their non-native language in therapy express less intuitions and are more emotionally detached. Furthermore, it has been found that clients’ narratives are expressed incompletely in a second language.

At least in the US, psychologists are increasingly advising foreigners to seek psychotherapy with a bilingual counsellor to minimize missing nuances or emotional implications. But isn’t it also possible that doing non-native therapy comes with benefits?

Is therapy in your second language more rational?

While studies show that there is more direct access to painful memories and past hurt with your mother tongue and that native therapy therefore is more emotional, the other side implies that therapy in your second language is more rational and analytical.

It has been shown that we reason in a more logical way when using a foreign language. Using a non-native language reduces decision-making biases, because it provides greater cognitive and emotional distance than a native tongue does. So does this mean that foreign language therapy actually makes us better adept at analysing and making rational decisions than if we did therapy in our mother tongue?

If the main distinction is native emotionality versus foreign rationality, the question becomes what we want out of therapy. But certainly non-native therapy shouldn’t be seen as inferior to mother tongue therapy, rather different — a type of therapy which might allow us to comprehend and analyse situations from a bit of a distance.

What to consider in regards to language when choosing a therapist

Based on the above-mentioned findings, the most important consideration when looking for a therapist, is what you need from therapy. For instance, if you need some behavioural and cognitive tools to sort out specific current difficulties in your life, and your second language is English, there is reason to believe that English therapy would be helpful in teaching you logical, reason-based methods of dealing with your problems — even more so than native therapy.

However, if you need a therapist who can join you on an emotional journey to where your problems and your pain started, and if you know of professional counsellors doing therapy in your native language, opting for someone who speaks your language, both culturally and semantically, seems to be the way to go.

But like with so many other criteria when looking for a therapist, it’s good to ask yourself if you need someone who resembles you or if it’s enough to find someone who simply shares aspects of your cultural experience. In the end, more than anything else, it’s the therapeutic relationship and rapport that makes for successful therapy.

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