Your therapist is a non-native speaker and recent immigrant. Will you see her?
By Min Cheng, Ph.D.
During my dissertation defense at Columbia University, a committee member posed a poignant question: “Min, my father is an elderly man. He would probably refuse to see you, a young woman from China, for psychotherapy. How would you handle a situation like that?”
How would I handle a situation like that? Run away, hide, and never come back? While this hypothetical flight response conjures up comic relief, I was aware that the professor posed an unjust yet justifiable question, one that I’m not unfamiliar with: Can a non-native speaker, someone born and raised in a strikingly different culture, provide competent psychotherapy to Americans? Why would an elderly American man consult me for his problems? Hell, why would any American consult me, a non-native speaker who recently immigrated to the country, with their problems?
While it is not at all uncommon for immigrants to become excellent engineers, mathematicians, or accountants, providing psychotherapy in a language that one did not grow up with is a different business. For better or for worse, the only tool a therapist has is herself: her ability to understand the client’s story with all its cultural contexts and emotional nuances; her ability to connect with the client on an emotional level, as quickly as she can; her ability to empathize with the client’s unique human dilemma and provide assurance, care, and guidance through her carefully selected clinical interventions. All of these abilities substantially rely on mastery of language, in this case, English.
From this challenge arises the fundamental existential anxiety of a non-native speaker therapist: Why me? What am I here for? What do I have to offer?
One challenge inherent in being a non-native speaker therapist is the constant role reversal between being a person who really needs help herself and being a professional helper who makes a living taking care of others. As a recent immigrant, I struggled intensely during the first few years of my life in this country–learning the language, surviving graduate school, sorting out my personal life, all the while pulling myself together from the mess of my own envy, resentment, self-pity, and misery so that I could focus on my clients’ issues and problems during my much saner working hours. Talk about “imposter syndrome.”
Another struggle involves the constant adaptation to various “versions” of the English language. Interning at a hospital on the Manhattan lower east side, I went through three training “rotations”: four months in a child/adolescent outpatient clinic, four months in a HIV clinic, and four months in a psychiatric inpatient ward. I quickly realized that my whole life, I had been taught only one variety of English: “proper,” White, middle-class, academic-friendly English. This “standard” dialect was utterly inadequate for my work at the hospital. The vast majority of my clients at the hospital came from working-class or poor backgrounds. I had clients who were homeless, ex-prisoners, and ex-sex workers. My clients also came from a myriad of ethnic backgrounds and countries of origin: Black, Hispanic, Asian, White, biracial, multiracial, recent immigrant, second generation…. I had the most diverse clientele a therapist could ever ask for, and they all spoke different “languages.”
For instance, some of my clients in the substance recovery group referred to various jails and state prisons by their locations, and they seemed to have no trouble understanding each other. In one way, I looked like a total idiot co-leading these groups. Never in my life did I feel so dumb, naïve, and sheltered as when I was working amongst these street-savvy clients, most of whom were twice my age. Half the time, I was simply sitting there, getting an education about life experiences, struggles, and suffering beyond my wildest imagination.
Intimidating as these experiences were, it was uncommon for my clients to dismiss me simply because I did not speak in grammatically correct and beautifully pronounced sentences. On the contrary, my clients were most generous and patient with me.
Once, a 40-year old Latino dad told me, “Min, I am glad that I get to work with you. Even though you’re new at this, you are curious, enthusiastic, and most earnest.” Another time, a White woman thanked me profusely after our year-long work together, telling me that I was a talented therapist. And there’s that time when I helped a Chinese mother-daughter duo navigate bullying and school refusal. To this day, I still remember how the mother’s face lit up when she realized that I could speak her mother tongue. Even my clients who were recovering from substance abuse, the ones whom I felt intimidated by, warmly invited me to join them in their serenity prayer, as they could probably tell that I was inexperienced and nervous. Truly, my clients already trusted me before I trusted myself. My clients saw me as a real therapist before I saw myself as a real therapist.
As time went by, I slowly caught up with what my clients intuitively knew about my strengths and talents as a therapist. I realized that some of my “disadvantages” as a non-native speaker were also, paradoxically, my best gifts, if I looked at them from a slightly different angle.
While I did not always get my clients’ jokes or cultural references immediately, I was always humble, authentic, and curious. One time, a Black male client told me that he grew up watching “The Cosby Show.” He told me that he had always wanted a family like the Cosbys. Not knowing either the content or the iconic nature of the show at the time, I could not really capture what he meant by wanting a family like that. I made a point to ask him about the show, even though it highlighted my foreigner status and possibly made me look uninformed. As he explained the show and its personal relevance to him, we both gained new insights into his experiences and desires. When you are a therapist from a different culture, you are learning through your clients on a daily basis. In a simple exchange, the client immediately becomes the teacher, and this changes the dynamics in the room.
Similarly, as a recent immigrant who personally grappled with the challenging process of migration, I am particularly sensitive to anyone who struggles with isolation, marginalization, or life transitions. I understand, viscerally, what it means to struggle, even when someone is doing the absolute best they can with all the resources and tools they have. This genuine compassion soothes my clients and fulfills me.
Last but by no means least, my Chinese upbringing and American education taught me that there are often multiple realities, multiple perspectives, and multiple solutions to the same issues in life. An “enmeshed” family might be seen negatively in the West, but it is the norm in Eastern collectivist cultures. The world is complex, paradoxical, and dialectical, and, yes, two opposing things can be true at the same time (e.g. “I’m weak and I’m strong.” “I’m the helper and I’m the seeker.”). This cognitive flexibility helps me navigate life dilemmas that often don’t have a unified solution.
As I’m writing these words, I realize that I’m extremely fortunate to work in the field of psychotherapy, which values cultural perspectives and life experiences; where you can take your personal struggles, failures, and triumphs, and put them as treasures into your chest of clinical wisdom; where there is much support for beginner therapists and ample room for imperfection. Not all fields are like this. Not every non-native speaker graduate student has these privileges and opportunities.
Despite the advantage of being in the generous business of psychotherapy, a non-native speaker therapist still has many barriers to conquer, real and imagined: cultural, linguistic, and systemic. At times, these barriers prove oppressive and detrimental to the novice therapist. In extreme cases, I witnessed fellow trainees having to go through extra language courses or being forced out of a program, partly due to the program’s insensitivity to international students’ needs. Even when a therapist receives their degree, their professional prospects remain limited by their immigration status.
In the end, there exists a delicate balance between the sobering reality and my innate optimism. What I learned from my decade of training and practice is that the cultural and linguistic barriers are not insurmountable, as long as the therapist keeps an open attitude to their “disadvantages” and lets their clients and teachers educate them along the way. In the end, some of your supposed weaknesses may become your greatest strengths.