Why Can Therapy in a Foreign Language Be So Difficult?

Why is therapy in a foreign language sometimes hard? A guide to the language of emotion, translation fatigue, cultural context and mother-tongue therapy.

You may have lived abroad for years, run your working life in German, English or French, and speak comfortably in meetings. But one day you find yourself sitting in front of a therapist, trying to describe your childhood, your relationship with your mother or a deep hurt inside you, and you may notice that the words suddenly fall short. Therapy in a foreign language is an option that works for many people, but for some it can be unexpectedly difficult. In this article we look at why this can happen, which signs may point to a language-related difficulty, and what you can do about it.

What Is Therapy in a Foreign Language, and Why Is It Worth Talking About?

Therapy in a foreign language means receiving psychological support in a language other than your mother tongue. For many Turkish people living abroad, this means working with a therapist in the language of the country where they live. This is often a practical necessity: because of the local health system, insurance coverage or proximity, it may be easier to receive a service in that country's language.

Therapy in a foreign language is not "bad" or "inadequate" in itself. Many people benefit from therapy in their second language. For some people, the second language can even offer a kind of safe distance when talking about difficult subjects. For example, it may be easier to say something in another language that would feel far too embarrassing to say in your mother tongue.

For others, however, the opposite is true: speaking in a foreign language can make it harder to reach your feelings, slow down the therapeutic relationship or increase the sense of "I haven't been understood". This difference can vary depending on when and in what context a person learned the language, in which language their emotional experiences took place, and how much the cultural context needs explaining.

Imagine a woman who has lived in the Netherlands for ten years and runs her work in Dutch, and who starts working with a local therapist because of anxiety. In sessions she can comfortably describe work stress, sleep problems and everyday worries. But when the subject turns to the distance she felt from her father in childhood, her sentences get shorter, her voice flattens and she quickly changes the subject. At home, when she thinks of the same memory in Turkish, her eyes fill with tears. This example shows that the same person can have different levels of emotional access to different subjects in different languages. In other words, the issue is not "knowing" the language but being able to "feel" in it.

For this reason, there is no single right answer when it comes to therapy in a foreign language. For some people, therapy in the local language is effective enough; for others, support in the mother tongue may be more suitable; and some may use both options at different times or for different subjects. What matters is observing your own experience and recognising your needs.

Signs That Therapy in a Foreign Language Is Proving Difficult

If you experience some of the following, you may consider that language is affecting your therapy:

• Being able to describe events in sessions but struggling to express your feelings
• Feeling distant while speaking, as if you were "giving a report"
• A feeling after the session that "I didn't say what I really wanted to say"
• Losing the flow of your thoughts while searching for a word
• Constantly translating in your head during sessions and getting tired from it
• Feeling that meaning is lost when explaining some Turkish concepts (such as gurbet, hasret, ayıp, kırgınlık and vefa; roughly, life in exile, longing, shame or impropriety, hurt feelings and loyalty)
• Thinking that the therapist misreads some family dynamics or cultural values
• Having to stop speaking at moments when you cry or become angry
• Speaking less, or keeping what you say superficial, out of fear of making a language mistake

Sometimes these signs do not appear in the first sessions but emerge as therapy deepens. At first it may be easy to talk about current problems, but as you go back into the past and into family relationships, language can feel like a more obvious barrier. These signs do not mean that therapy in a foreign language is not working for you. But it is important to notice them and, if necessary, share them with your therapist.

Why Does It Happen? The Language of Emotion and Cultural Context

Emotions are often encoded in the language in which they were first learned. Experiences in childhood, lullabies, scoldings, words of affection and fears are usually learned in the mother tongue. For this reason, memories and feelings from those years can be recalled more vividly when spoken about in the mother tongue. A language learned in adulthood, on the other hand, may be more closely tied to work, school and formal relationships. As a result, some people feel a distance between themselves and their emotions when speaking in their second language.

Translation fatigue. When speaking in a second language, the mind has to think both about what to say and about how to say it. This extra mental load can become more noticeable in emotionally intense conversations. A person can become tired as they try at once to feel their emotion and to find the right word.

The meaning that words carry. Some words have no exact equivalent in another language, or their equivalent does not carry the same emotional weight. Conveying the cultural and emotional meaning of expressions such as ayıp (shame, impropriety), elâlem (what people will say), hakkını helal et (forgive what is owed) or kırgınım ama küs değilim (I'm hurt but I'm not cross with you) can require lengthy explanations. During those explanations, the feeling itself may fade into the background.

Having to explain the cultural context. In the Turkish family structure, subjects such as responsibility towards parents, respect for elders, kinship relations, the culture of hospitality and holiday traditions may be things that need explaining to a therapist from a different culture. Some therapists are very curious and sensitive about these matters; even so, explaining constantly can wear the client out and lead to a feeling of "I'm not being understood". We discuss this topic in more detail in the article on culturally sensitive therapy.

Feeling inadequate. Being afraid of making language mistakes can make a person feel less intelligent, less competent or less like "themselves". This feeling can make it harder to open up in therapy. For more on the effects of the language barrier on self-confidence, you can read the article on the language barrier and self-confidence.

The Effect on Family, Relationships and Children

The language question shows itself not only in the therapy room but in family life too. In mixed marriages, partners may speak a shared language that is often not the mother tongue of either. In this situation, one person's being unable to express themselves fully during arguments can lead to misunderstandings and hurt.

Language matters for children, too. Imagine a twelve-year-old growing up abroad who wants to tell their parents about a problem at school; but their Turkish is not enough to explain it, and their parents' command of the local language is limited. The child may then feel alone and give up sharing their problems. Creating a shared emotional language in the family, in other words supporting the naming and discussion of feelings in both languages, can help prevent this kind of disconnection.

Language is also an important matter in couples therapy. If one partner speaks the same language as the therapist and the other does not, the balance of power can be upset without anyone noticing. For this reason, when choosing couples therapy, it helps to look for a language and setting in which both partners can express themselves comfortably.

What You Can Do on Your Own

If you are having, or are thinking of having, therapy in a foreign language, the following steps can make the process easier:

1. Talk openly with your therapist about language. Saying "I find it hard to describe some feelings in English" helps your therapist support you better. Many therapists are understanding about this.
2. Do not hesitate to use Turkish words. When you cannot find the equivalent of a concept, you can say it in Turkish and briefly explain what it means. This gives your therapist valuable information about your cultural world.
3. Take notes before the session. Write down in advance the subjects you want to talk about, your feelings and any important sentences that come to mind. You can write them in Turkish and convey them in your own sentences during the session.
4. Expand your emotional vocabulary. Make a list of words that express feelings in the language of the country where you live: disappointment, shame, longing, guilt, hurt and so on. This list can support you in sessions.
5. Keep a journal and let the language be free. Write your feelings journal in whichever language feels more natural. Some days it may be Turkish, some days another language; both are acceptable.
6. Be patient with yourself. Making a language mistake is not a barrier to therapy. A therapist is trying to understand your inner world, not assess your language skills.
7. Describe emotional moments in short sentences. When you feel an intense emotion, instead of trying to build long, flawless sentences, use short phrases such as "I'm very sad right now" or "This is hard to say". Short sentences make it easier to stay focused on the feeling.
8. Explore your options. Find out whether there are options in the city where you live, such as Turkish-speaking therapists or online therapy in your mother tongue. Some people continue with local therapy while choosing to receive mother-tongue support for particular subjects.

Whichever language you speak, what matters is that your feelings are heard and understood.

When Should You Seek Professional Support?

Regardless of the language question, you may consider seeking support from a mental health professional in the following situations:

• Sadness, lack of motivation, anxiety or restlessness that has lasted a long time
• Marked changes in sleep and appetite
• Panic attacks, intense fears or constant worry
• Recurring conflicts and disconnection in relationships
• Loneliness in gurbet (life far from home), identity confusion or difficulty adjusting
• Difficult past experiences affecting your present

If you are having therapy in a foreign language and feel you are not getting much out of it, rather than giving up on therapy, it is advisable to talk to your therapist about this first. Sometimes small adjustments can make a big difference.

If you have thoughts of harming yourself or ending your life, do not wait. Call the emergency number for the country you are in: 112 in EU countries, 911 in the USA and Canada, 999 or 112 in the United Kingdom, and 000 in Australia. Online therapy is not an emergency intervention service; in situations of serious risk, local emergency services and psychiatric services are necessary.

How Does Mother-Tongue Online Therapy Work?

For some people, therapy in the mother tongue can make it possible to reach feelings more directly and to be understood without having to explain the cultural context. The meaning of a sentence such as "My mother never said 'I love you' to me, but she prepared my breakfast every morning" within Turkish family culture can be understood without explanation. This can help the therapeutic relationship to form more quickly. However, this is not true for everyone and is not a guarantee; what matters is that you find the setting in which you feel most comfortable. For more on this, you can read the article on why mother-tongue therapy matters.

Work in mother-tongue online therapy generally proceeds as follows:

• Introduction and assessment: The difficulties you are experiencing, your migration story, your experience of language and your goals are discussed.
• Work based on Cognitive Behavioural Therapy (CBT): The relationship between automatic thoughts, emotions and behaviours is examined. For example, we work on how a thought such as "I will never be fully understood here" affects you and what a more balanced view might look like.
• Flexibility to work bilingually: Some clients occasionally use words from the language of their country of residence in sessions. This is natural and can be part of the work.
• Addressing the cultural context directly: Subjects such as family expectations, shame, guilt, gurbet and belonging can be discussed without the burden of explaining.
• Cooperation with local support: If necessary, the work can be carried out alongside local therapy or psychiatric services; in this case it is recommended that both sides are informed.

For online sessions, a quiet and private room, headphones and a secure internet connection are enough. A time that suits both sides is planned, taking the time difference into account. Payment is made online; pricing is in TL and payment with an international card is possible. You will need to check the insurance terms in your country of residence regarding insurance reimbursement. For detailed information, you can visit the page for Turks living abroad.

Frequently Asked Questions

Doesn't therapy in a foreign language work?

No, therapy in a foreign language works for many people. Some people find it easier to express their feelings in their mother tongue. You can assess which language is more suitable for you according to your experiences and your level of comfort.

Should I leave my local therapist and switch to therapy in Turkish?

It is important not to rush this decision. You can first talk to your current therapist about your difficulty with language. Some people prefer to continue with both kinds of support, while others choose to move to one option after a while.

If my Turkish is weak, will mother-tongue therapy still be helpful?

For second- or third-generation people who speak Turkish mostly within the family, therapy in the mother tongue can sometimes feel emotionally familiar. It is possible to use words from another language in sessions when needed. What matters is that you feel comfortable.

If I make language mistakes in therapy, will I be misunderstood?

In a good therapeutic relationship, language mistakes are not a major barrier to being understood. The therapist can ask questions to clarify what you say. Saying so when you feel you are not being understood is also part of the process.

• #therapy in a foreign language
• #mother tongue
• #emotions
• #bilingualism
• #online therapy

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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