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Exploring The Impact Of Bilingualism On Therapy Sessions: A Qualitative CaseStudy

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Introduction: Exploring The Impact Of Bilingualism On Therapy Sessions: A Qualitative Case Study

Proposal summary

The purpose of this proposal is to explore the term "bilingualism" and explain its impact on counselling or therapy sessions. Bilingualism can be defined as the co-existence of two language systems within an individual, as contrasted to monolingualism. In the therapy session, one of the important questions that may arise is how two languages can interact at behavioural and cognitive levels and bilingualism has a long-standing interest to psycholinguists, neurologists, educators, and clinicians. When it comes to the use of two different languages in therapy, it can be evident that with the change of or switching languages, multilingual people often try to change their identity, and even can adopt different tones of voice, and gestures (Heracleous & Yoneyama, 2019). Therefore, it can be stated that in psychotherapy, language or bilingualism is used to contribute hugely when it comes to forming therapeutic alliances, understanding, and trustworthiness between patients and therapists.

The aim of this research proposal is to explore the impact of “bilingualism” on a therapy session. More specifically this research proposal will be based on exploring the efficacy of understanding the client’s bilingualism on therapy being offered by the therapist. This research proposal will include a precise discussion of the research background. In this research proposal, research questions will also be included based on which further work can be carried out. Lastly, this proposal will include methodology and expected result/outcome.

So, the aim of the proposed research is to explain the term “bilingualism” in reference to clinical therapy and explore the impact of bilingualism on therapy sessions. Therefore, the main objectives of this research proposal will be:

  1. To identify the difference between mother tongue and bilingualism
  2. To explore the correlation between Bilingual individuals and psychotherapy along with its use in therapy sessions
  3. To identify and explore the experiences that therapists used to face while giving counselling or therapy to patient, who is bilingual

Research Questions

Considering the aim and purpose of the research proposal, the research questions will be as follows:

Main question: What is the level of understanding and lack of understanding about the impact of bilingualism on clinical therapy given by the therapist?


  1. How and to what extent mother tongue can be differentiated from Bilingualism?
  2. What are the experiences that the therapists used to face while dealing with patients and bilingualism during a therapy session?
  3. How Bilingualism can be correlated with psychotherapy, therapy session, and treatment process?

Background Literature

Language is used to play an important role in a person’s identity formation- as it can construct reality and the self. In another way, language is considered as the core factor of therapeutic work, because it is the language that therapists rely on to develop alliances, understand the inner worlds of clients and establish rapport. As per many researchers, language can create principles and schemes, which can be circulated and converse the subjective experiences.

Multilingualism and self-expression

Bilingualism and emotion

According to research carried out by Han, (2019), based on the ‘Bilingualism and Emotions Questionnaire BEQ’ in psychotherapy sessions or during any counselling session, the participants used to prefer the language that they acquired in early life. The age of onset of acquisition can also be considered as an important fact that people used to choose foreign languages to express emotion, while the context of acquisition is a significant factor in bilingualism. The psycholinguistic exploration and the psychoanalytic studies refer that an individual used to start learning a second language after puberty and the two languages used differ from each other when it comes to expressing emotion.

According to Heracleous & Yoneyama, (2019), the first language is always used to express personal involvement or emotional feelings, whereas the second language is used for expressing inner speech – distance, and detachment, and holds less emotional outbound. In the counterargument, Bromberek-Dyzman et al. (2021) mentioned that many patients used to prefer to talk in a second language. Seto & Forth, (2020) has mentioned that there is always a distance between the first and second language and that can be the key reason why the patients or therapists used to prefer the "stepmother tongue" during therapy or session to suppress the emotional overcharge.

Mother Tongue

When speaking about bilingualism, it is important to discuss the role of the mother tongue. Mother tongue refers to the language that a child first acquires or learns when he starts speaking or thinking. The people associated with psychodynamics and psychoanalysis used to focus on one language and highlight the different and difficult relationship the individuals used to hold with their mother language. According to Szoke et al. (2020), the mother tongue can be defined as the “intrapsychic registry” as the mother tongue can be used for encoding and triggering the memories, inner feelings, and fantasies from early livelihoods.

Contemporary Concept

Lopez & Torres-Fernandez(2019) has denoted different ideas about the different representations of the self and dual sense of self among bilingual patients. According to them, based on the language spoken by an individual, that individual should sound or/and act in different ways and will also interpret and understand things in different ways. In the case of bilingualism, not only there will be a sense of duality, but also the individuals will showcase split personalities which can lead to over-intellectualized emotional content. This is because the language that is being used during therapy sessions is not their native language or mother tongue and thus it cannot correspond to their emotional senses. Afterwards, this phenomenon is become popularized as the “detachment effect”.

On the counterargument, Grasso et al. (2019) have mentioned that "linguistic detachment" can provide a scope of safe linguistic space to the patient in therapy and it can make the patient comfortable for discussing the intense material by protecting their second language. KK Nair et al. (2023) have mentioned, bilingualism can act as a framework through which therapists can understand the past events related to the patient and the new way to conceptualize the experiences.

Language Dynamics in Treatment

Language switching

According to Trevino, Tao & Van Epps. (2021), in linguistics, code-switching or language alteration occurs when the speaker alternates between two languages to continue a single conversation in a specific situation. A survey on Japanese immigrant women who migrated to the United States from Japan showcased that when those women were forced to speak in English, they found it difficult to express their emotions, instead of while discussing on Japanese topics. The alteration in the topic, of the speaker has had a discernible impact on the formal characteristics of speech (Skokna & Gorman, 2020). Many surveys indicate that language switching is used as a useful therapeutic strategy for bilingual therapy when the therapist works with bilingual clients.

According to Carl Rogers's humanistic approach to psychology, bilingualism can create restrictions in client-centred therapy, as bilingualism can create restrictions to understanding the use of active listening tool summarizing and paraphrasing approach in person-centred therapy (Zhang & Cheng, 2021).

Justification of Proposed Research

With the change of time, the world is now more inclined to multiculturalism, and thus the demand for bilingual therapy is increasing. Additionally, there are very few researches that have shed light on exploring the impact of bilingualism on therapy sessions. In fact, there are no or limited studies that have relied on qualitative data collection from therapists or clinicians to highlight their experiences as bilingual therapists when it comes to working with bilingual clients.

Methodology and Epistemology


In this part, the theory of knowledge will be discussed regarding the method, validity, and scope of the research proposal. The aim or purpose of the proposal is to explore the impact of bilingualism on therapy. Based on the purpose of the work, qualitative study will be best fitted. This exploratory study is aiming to investigate the insight and experiences of bilingual therapists while providing therapy or session to bilingual clients. The focus will be given more on the issues being faced by the therapists regarding the language and dynamicity of the language within the therapeutic frame. Additionally, in this proposed work, the focus will be given to exploring the use of language and language switching for both the patients and therapist in the therapy program (Newman & Gough, D. (2020). Therefore, a qualitative study will be preferable to collect knowledge related to the subject matter. According to (), the grounded theory relies on the identification of the pattern, observation and themes in information or data rather than approaching the information with expectations based on existing theory. Therefore, by using the exploratory research design, the researcher can lead to a deeper understanding and exploration of the topic rather than connecting the subject with pre-established theories.


Considering the purpose and aim of the proposed work, it has already been mentioned that qualitative and exploratory research studies will be the best fit to explore the impact of bilingualism on therapy. Therefore, an inductive research approach will be preferable for this proposed work. The justification for using the inductive approach is, it is a systematic process of analysing the qualitative data and information through which the researcher can lead the work to the specific evaluation of the objective. More specifically, by using the inductive approach, the researcher can develop a theory from the pattern, observation and generalized ideas about the impact of bilingualism on therapy. On the other hand, exploratory research design will be conducted here. The justification for using the exploratory research design is, firstly, this design is used by researchers when there is no past data or only a few articles are available for reference (Pandey & Pandey, 2021)e. With the exploratory research design, the researcher can develop a theoretical idea about how and to what extent bilingualism is important and influences therapy.

Based on the research objectives, and subject matter, Interpretivism can be a suitable choice as a research philosophy. Interpretivism research philosophy involves where the researcher can interpret the element of study, based on human observation or interest. Interpretivism research philosophy is associated with the philosophical position of idealism and it is used to explore the diverse approach related to any research topic or phenomenology (Newman, & Gough, 2020). With the interpretivism philosophy, for this proposed work, the researcher can identify the difference between the thought and insight related to bilingualism in therapy between therapists and clients or patients.

Phase 2 -Data collection

Considering the epistemology and proposed research methodological approach, the Primary Qualitative method will be considered as the data collection method. By using the qualitative exploratory research design, the researcher can examine the underrepresented topic by conducting an exploration of the subject matter on a greater emotional basis and with more flexibility to investigate the unexpected responses.

Therefore, for this proposed work, a semi-structured and open-ended questionnaire will be set up. The justification for using semi-structured open-ended questions is to gather rich and narrative information from the participants (Mukherjee, 2019).

More specifically, an interview will be conducted in the form of a pilot study, through which the insight of therapists can be collected regarding the impact of bilingualism on therapy from the therapists and patients. The purpose of this study is to understand the experiences of the individual therapist related to the impact of bilingualism on therapy or session- therefore the narrative analysis of the responses will be the best approach to capture and analyse the participants’ insight about the subject matter and it can offer a diversified understanding about the bilingual experiences in therapy (Pandey & Pandey, 2021).


For the interview, five to six bilingual mental health providers who are licensed clinical and social care workers or psychologists will be selected as the sample. while choosing a sample, the focus will also be given to checking that the chosen respondents must offer counselling services or therapy to the patients. The selection criteria of the respondents for the interview will be:

  1. The sample will be bilingual
  2. The respondents must have experience working with bilingual patients

Expected Result

After the interview, an open coding system using grounded theory will be used to break down the information collected from the transcript into smaller and analyzable forms. The expected result or outcome of this work will be based on the natural occurrence of language switching in therapy. More specifically, the interview and narrative analysis will reflect that bilingualism can provide countertransference experiences, feelings of closeness as well as distance during therapy which in turn can impact the session both positively and negatively. During the interview, it can also be expected that the participants will reflect on the language-related self-experiences as they shed light on how the approached language can impact the outcome of therapy and how the integrated language can be used by the therapist to provide better outcomes sin therapeutic intervention,


Bromberek-Dyzman, K., Jo?czyk, R., Vasileanu, M., Niculescu-Gorpin, A. G., & B?k, H. (2021). Cross-linguistic differences affect emotion and emotion-laden word processing: Evidence from Polish-English and Romanian-English bilinguals.International Journal of Bilingualism,25(5), 1161-1182.https://journals.sagepub.com/doi/pdf/10.1177/1367006920987306

Grasso, S. M., Cruz, D. F., Benavidez, R., Peña, E. D., & Henry, M. L. (2019). Video-implemented script training in a bilingual Spanish–English speaker with aphasia.Journal of Speech, Language, and Hearing Research,62(7), 2295-2316.https://pubs.asha.org/doi/abs/10.1044/2018_JSLHR-L-18-0048

Han, M. (2019). Exploring the Nexus Between Bilingual Learning, Emotions, and Creativity: A Case Study of a Former Korean Bilingual Student’s Creative Artifact (Book).https://opencommons.uconn.edu/dissertations/2352/

Heracleous, P., & Yoneyama, A. (2019). A comprehensive study on bilingual and multilingual speech emotion recognition using a two-pass classification scheme.PloS one,14(8), e0220386.https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0220386

KK Nair, V., Clark, G. T., Siyambalapitiya, S., & Reuterskiöld, C. (2023). Language intervention in bilingual children with developmental language disorder: A systematic review.International Journal of Language & Communication Disorders,58(2), 576-600.https://onlinelibrary.wiley.com/doi/abs/10.1111/1460-6984.12803

Lopez, A., & Torres-Fernandez, I. (2019). Exploring the Experiences of Supervisors and Supervisees who engaged in Bilingual Supervision.Journal of Counselor Preparation and Supervision,12(1), 10.https://digitalcommons.sacredheart.edu/jcps/vol12/iss1/10/

Mukherjee, S. P. (2019). A guide to research methodology: An overview of research problems, tasks and methods.https://books.google.com/books?hl=en&lr=&id=RbOtDwAAQBAJ&oi=fnd&pg=PP1&dq=research+methodology&ots=FHA9VE1jrn&sig=20BkvqPUAIoNBiCAOcI0EW2hl4M

Newman, M., & Gough, D. (2020). Systematic reviews in educational research: Methodology, perspectives and application. Systematic reviews in educational research: Methodology, perspectives and application, 3-22.https://library.oapen.org/bitstream/handle/20.500.12657/23142/1007012.pdf - page=22

Pandey, P., & Pandey, M. M. (2021). Research methodology tools and techniques. Bridge Center.http://dspace.vnbrims.org:13000/jspui/bitstream/123456789/4666/1/RESEARCH METHODOLOGY TOOLS AND TECHNIQUES.pdf

Seto, A., & Forth, N. L. (2020). What Is Known About Bilingual Counseling? A Systematic Review of the Literature.Professional Counselor,10(3), 393-405.https://eric.ed.gov/?id=EJ1272212

Skokna, G., & Gorman, B. (2020). Cognate Therapy Using Academic Vocabulary Words for Bilingual Students.Unpublished master’s report, Elmhurst College, Elmhurst, IL.https://www.elmhurst.edu/wp-content/uploads/2020/05/elmhurst-college-research-performance-showcase-2020-skokna-cognate.pdf

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Trevino, A. Y., Tao, K. W., & Van Epps, J. J. (2021). Windows of cultural opportunity: A thematic analysis of how cultural conversations occur in psychotherapy.Psychotherapy,58(2), 263.https://psycnet.apa.org/record/2021-27025-001

Zhang, L. J., & Cheng, X. (2021). Examining the effects of comprehensive written corrective feedback on L2 EAP students’ linguistic performance: A mixed-methods study.Journal of English for Academic Purposes,54, 101043.https://www.sciencedirect.com/science/article/pii/S1475158521000874

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