Between two languages: Bilingual therapy as a matter of equity, not convenience
With thanks to our member, Beata Tyka, for this article.
Living between languages
When I arrived in the UK over twenty years ago, my level of English was zero.
Not “basic.” Not “communicative.” Zero.
I remember the shame of not being able to express even simple needs. The frustration of knowing who I was inside, yet being unable to show it through words. The painful feeling of being perceived as less capable simply because I could not speak fluently. At times, what hurt most was not the broken language itself, but the sense that the other person did not want to understand it.
Language is not only a tool of communication. It is dignity. It is identity. It is belonging.
More than half of my time in the UK I have worked as a counsellor and hypnotherapist. From the very beginning, my bilingualism was part of my practice. Today, I work with people who speak only English, only Polish, both languages fluently, or whose first language is neither Polish nor English. Language choice in therapy is rarely neutral. It carries meaning, safety, and sometimes power.
In discussions around Diversity, Equity and Inclusion (DEI), language is often mentioned, but not always explored in depth. In therapeutic practice, however, language is not an accessory. It can be the difference between access and exclusion.
Access to therapy and the illusion of availability
In theory, psychological services in the UK are widely available. In practice, access is uneven.
For many Polish migrants (and migrants from other communities) language remains a significant barrier. Public services are predominantly delivered in English. Even when interpreters are available, many people report that therapy through an interpreter does not feel the same.
Having worked as an interpreter in psychotherapy sessions myself, I understand why. The emotional flow is interrupted. Nuances are lost. Confidentiality may feel diluted. The therapeutic relationship becomes triangular rather than dyadic.
Private bilingual therapy exists, yet it requires financial investment. For some, paying for mental health support feels uncomfortable or unjustified. In certain cultural contexts, seeking therapy is still associated with weakness, stigma, or failure. Many individuals believe they should cope alone. Others expect that one or two conversations will solve long-standing difficulties, and when change requires effort, they conclude that counselling “does not work.”
Another barrier is simple misinformation. Many people do not distinguish between a psychiatrist, a psychologist, and a counsellor. Without clarity, fear grows.
Despite living in the same city for over a decade as a practising therapist, I still hear: “I didn’t know you could have therapy in Polish.” This statement reflects not only a gap in awareness but also a deeper invisibility of linguistic needs within mainstream mental health conversations.
Equity in therapy means more than offering services. It means ensuring those services are accessible in a way that respects identity.
Does trauma live in a language?
In academic discussions, the idea of “emotional distance” in a second language is often explored. In my practice, I have not observed trauma residing more strongly in one language than another. What I have observed, however, is the difference between having , and not having, the vocabulary to express experience.
When clients switch languages during a session, something shifts. Sometimes the change is subtle. Sometimes it is profound. Certain words in Polish carry a directness that English softens. Certain English expressions allow a gentler entry into painful material. National sayings, cultural idioms, humour, and metaphors often lose their emotional weight when translated.
The issue is not where trauma sits. The issue is whether the client can name it.
When language becomes limited, self-expression narrows. When vocabulary expands, experience becomes accessible.
Bilingual therapy is therefore not about preference. It is about precision. It allows people to choose the language that holds their meaning most accurately in that moment.
The therapist’s responsibility in bilingual practice
Working bilingually is not simply a practical skill. It requires sustained cognitive and cultural awareness.
For the therapist, there is dual attention - to process and to language. Subtle differences in phrasing can alter meaning. Cultural references must be understood in context. Assumptions must be continually examined.
For the client, cultural differences may also shape expectations of therapy. Concepts such as boundaries, self-disclosure, authority, or emotional expression are interpreted through cultural lenses. A therapist working across languages must therefore hold not only linguistic fluency but also cultural humility.
My own experience of seeking therapeutic support in the UK added another layer to my professional understanding. Sitting in the client’s chair as a migrant who had once struggled to speak reinforced how vulnerable it can feel to express complex emotions in a non-native language. That perspective remains with me in every session.
Bilingual practice should not be seen as a niche or novelty. It is a professional competence requiring training, reflection, and ethical awareness.
When a second language helps
While I believe therapy in one’s first language should be a standard option rather than a premium service, there are situations in which working in a second language is beneficial.
Some people feel freer speaking about family or culturally sensitive topics in English, creating a helpful psychological distance. Others are confident in their second language and feel comfortable with a therapist from a different cultural background. In areas where no therapist shares the client’s first language, working in English may be the only viable path to support.
The key principle is choice.
Choice restores agency. Agency strengthens therapeutic alliance.
Migrants as contributors, not exceptions
Migrants do not come to a country only to receive. They come to work, to contribute, to build families, to serve communities. Many are highly skilled professionals who operate daily in a second language. Yet when it comes to mental health, they may still need support in their mother tongue.
Acknowledging this need is not special treatment. It is recognition of human complexity.
In DEI conversations, linguistic diversity deserves greater visibility. Inclusion is not achieved by inviting everyone into the same room if some cannot fully participate once inside.
Language matters because identity matters. And identity shapes how we heal.
Bilingual therapeutic practice is not an optional addition to inclusive care. It is an essential component of equitable mental health provision in multicultural societies.
