Therapy for immigrants: does language, culture and place matter?
Moving to another country changes more than your address. It can change your routines, your relationships, your sense of humour and sometimes your sense of who you are. So when you think about starting therapy, a few questions come up that other people never have to ask. Should I find a therapist where I live now, or someone from back home? Should I speak in my first language or my second?
There isn’t one right answer. Here is what the research says, and what I think from my own experience as a therapist, and as an immigrant myself.
Language: where feelings live
Researchers who study multilingual people often find that languages learned early in life tend to carry more emotional weight. A review by Izsóf Jurásová and Kissová found that the mother tongue usually has a stronger emotional charge, and that bilingual people may switch languages in therapy to turn the intensity of an emotion up or down.
But it doesn’t work the same way for everyone. In a study called “My recovery is in English”, researchers interviewed 30 multilingual people about therapy in a later language. For some, the second language gave them the emotional distance they needed to talk about past trauma, while for others it felt inadequate for expressing themselves fully.
In my view, this fits what many of us feel. Some parts of us were formed in a particular language, such as the child who was scolded, comforted or teased at home. Those parts may only fully speak that language. Others find it easier to approach painful memories in a language that doesn’t carry the same charge. Neither is better. What matters is having a therapist who is curious about this, and who lets you move between languages if you want to.
Culture: being understood, not just heard
Therapists don’t all share the same cultural assumptions, and those assumptions can show up in subtle ways. Ideas about how close families should be, how directly to speak, or what counts as “healthy independence” vary a lot between cultures. Some therapists in your new country may not be familiar with how you were brought up, and may read your way of communicating or relating to your family through their own lens.
Research suggests this matters. A 2016 meta-analysis by Hall and colleagues pooled 78 studies with nearly 14,000 participants, and found that therapy adapted to a client’s culture did better than the unadapted version, with a medium-sized advantage. The evidence isn’t unanimous, though. One systematic review of CBT for Latin American patients found no difference in effectiveness between adapted and conventional versions. It’s also worth saying that these studies look at ethnic minority groups in general, not only people who have moved country.
There is also evidence about the therapist’s attitude. Hook and colleagues found that when clients saw their therapist as culturally humble (respectful and open rather than superior), they built a stronger working relationship and reported more improvement.
Place: the therapist back home
Working with someone from your home country can feel like a relief. They may share your culture, your language and your sense of humour, and you won’t have to explain where you come from.
In my opinion, though, there can be a gap on the other side. A therapist back home may understand where you come from, but not where you live now. They may not grasp the loneliness, the missing family, the paperwork, or the feeling of belonging fully in either place. From what people who are in therapy back home have told me, some therapists also have mistaken ideas about what life in the UK is like. That’s only a handful of experiences, not a rule. But it’s a reminder that someone can know your culture well and still not know the life you live now. Neither choice is perfect. Each one covers some parts of your experience better than others.
Questions to ask yourself
If you’re deciding, it may help to sit with a few questions. There are no right answers, only what’s right for you.
Which language do my feelings live in? Do I speak about painful things more easily in my first language, or does a second language give me useful distance?
What do I most need my therapist to understand? My culture and family background, my life in the UK now, or both?
How much explaining am I willing to do? Would I feel relieved or tired if I had to teach my therapist about my culture?
How will I know if something isn’t working? Do I feel able to raise a problem or make a complaint, and do I know which professional body the therapist belongs to and where they are based?
What can I realistically afford? Fees can vary by country, but it’s worth considering the whole picture and what I need from the work.
Can I try it out? Many therapists offer an initial conversation. How do I feel with this person, and do I feel understood?
Which one is right for you?
Choosing a therapist as an immigrant means weighing language, culture, place and cost, and different people will weigh them differently. The research doesn’t point to a single winner. What it suggests is that feeling understood and being able to express yourself fully matter a great deal.
If you’re unsure where to start, an initial conversation with a therapist can help you figure out what you need. I offer therapy in both English and Spanish, so if you’d like to talk, you’re welcome to get in touch and choose the language that feels right for you.