Research & Evidence Health and Social Care

Introduction

Justification of the title and its relevance to health and social care

This research article aims to explore the term ‘bilingualism’ and explain its impact on the counselling or therapy sessions. According to Costa and Sebastián-Gallés (2014), bilingualism is the co-existence of two language systems within an individual as contrasted to the monolingualism. In any therapy or counselling session, one of the most common questions that arises is how two languages can interact and impact the cognitive and behavioural approach of an individual. Therefore, bilingualism in therapy sessions always holds an important approach for the psycholinguists, neurologists, clinicians, and educators. In health and social care, exploring the impact of bilingualism on therapy sessions is highly relevant as it focuses on growing needs of culturally and linguistically inclusive healthcare services (Heracleous & Yoneyama, 2019). In multicultural societies, bilingualism is becoming common among the individuals who seek therapy. On the other hand, understanding the influence of bilingualism on therapy or mental health related counselling sessions is important to evaluate its impact on effective communication, accurate diagnosis, and culturally competent care for both healthcare professionals and service seekers.

Therefore, the key reason to explore this topic is to evaluate the impact of language on emotional expression and cognitive process of an individual. There are many studies which indicate that individuals express their mind and needs along with emotions differently by using their first and second languages. This can affect the depth and accuracy of the communication therapy. From the social care perspective, bilingual clients or service seekers often experience difficulties like language-related obstacles, stigma, and cultural boundaries while communicating with people or expressing their thoughts with the surroundings (Gerchow et al., 2021). Therefore, exploring the bilingualism in counseling sessions can help the healthcare professionals to develop a tailored or patient-centric approach, which can enhance the patient outcomes. For example, the bilingual therapists or the trained interpreters can bridge the communication gaps for the clients who have bilingualism challenges and can ensure that clients feel understood and valued during a therapy session (Gartner et al., 2024). This is specifically important for the vulnerable populations like refugees, immigrants. And ethnic minorities who used to face language barriers to access the healthcare services.

Furthermore, this topic aligns with the contemporary healthcare principles, such as person-centered care and health equality. It can encourage the healthcare professionals to recognize the linguistic diversity as a key factor in providing holistic and inclusive care. By studying the impact of bilingualism on counselling sessions, or therapy sessions, practitioners can develop the best practices which can support linguistic and cultural competency, ultimately improving the patient satisfaction and patient outcomes.

Struggling to meet tight deadlines or understand difficult topics? Native Assignment Help offers expert guidance and support, while Assignment Help UK ensures your assignments are well-researched, structured, and tailored to achieve academic success. Get help today and master your subjects with confidence.

Background of Research

The aim of the topic or research is to explore the impact of ‘bilingualism’ on a therapy or counseling session. Language plays an important role in people’s identity formation. It can construct the reality and the self. In other word, it can be stated that language is considered as the core factor of any therapeutic work, because it is the language on which therapists can rely on to develop an alliance with the patient, and can understand the actual needs and inner world of the clients and establish trustworthiness. According to Han, (2019), in any psychotherapy session, or any counselling session, participants are used to prefer the language that they use in their early life. The age of onset of acquisition can be considered as an important factor that a person can use to choose the foreign languages to express their emotion, while the context of acquisition is an important factor in bilingualism. When we speak about bilingualism, it is important to focus on discussing the role of the mother tongue. According to the mother tongue refers to the language that a child first acquires or learns when they start speaking or thinking. The people associated with the psychodynamics and psychoanalysis used to focus on one language and highlighted the different and difficult relation the individuals used to hold with their mother language. Bromberek-Dyzman et al. (2021) have mentioned that there is always a difference between the first and second language, and that can be the key reason why patients or therapists prefer the ‘stepmother tongue’ during therapy or session to suppress the emotional overcharge during mental health counselling. Therefore, bilingualism has a significant impact in the health and social care aspect, specifically when it comes to the focus on therapy sessions.

Search Strategy

a. Database searched

To ensure the comprehensive literature review on the impact of bilingualism on therapy sessions, the following academic databases have been used for searching purposes:

1. PubMed- it is used for searching the healthcare and psychological studies
2. CINAHL or Cumulative Index to Nursing and Allied Health Literature
3. PsycINFO- it is used for psychological and mental-health related research
4. Scopus- it is used for multidisciplinary studies.

b. Keyword and Boolean operators

To improve the accuracy and reliability of the search, for this proposed research, Boolean operators have to be used as a search strategy. Based on the objectives of the research topic, the following keywords and boolean operators have been used to refine the search:

Objectives	Keywords	Boolean operators
To identify the difference between bilingualism and the mother tongue	Bilingualism, Mother Tongue	(Mother tongue OR First Language OR Native language) AND (Bilingualism OR Multilingualism)
To explore the correlation between bilingual individuals and psychotherapy, along with its use in a therapy session	Bilingualism, Multilingualism, psychotherapy, therapy session	(Bilingualism OR Multilingualism) AND (Psychotherapy OR Counseling OR Mental Health treatment) ; (Bilingual client OR Multilingual Patient) AND (Therapist communication OR Language Barrier OR Therapeutic outcomes)
To identify and explore the experience that therapists face while giving counseling or therapy to bilingual patients	Counseling, Bilingual therapy, patient	(Therapist experience OR Counselor challenges) AND (Bilingual patient OR Multilingual clients); (Language barriers OR Interpreter use) AND Therapy sessions OR Psychotherapy) AND (Therapist-client relationship) AND (bilingualism OR cultural competence)

c. Inclusion and exclusion criteria

To improve the credibility and accuracy of the search of secondary resources from online databases, inclusion and exclusion criteria have been followed. To identify the impact of bilingualism on therapy sessions, the following inclusion and exclusion criteria have been followed to identify the best-fit peer-reviewed journals:

Inclusion criteria:

1. Peer-reviewed articles and journals that include bilingualism, and multilingualism and its impact on therapy session
2. Studies that focus on bilingual individuals in psychotherapy, speech therapy and counselling sessions

The research and articles that discuss the impact of language on emotional expression, diagnosis and therapy outcomes.

Exclusion criteria:

1. Studies and journals that are unrelated to the bilingualism in health and social care settings
2. The journals and articles that are published on or before 2010
3. The journals that focused only on language acquisition without therapeutic context.

Study types considered

For this proposed research, a secondary qualitative research design has been chosen. The justification of choosing qualitative design for this proposed study is that it can allow for in-depth exploration of the existing literatures to evaluate the impact of bilingualism on the therapy session. This approach can enable the analysis of previously conducted interviews, case studies, and thematic research in therapists-client interaction, language barriers and cultural competencies. Additionally, qualitative findings can also provide a rich insight about the therapeutic challenges without the need for primary data collection (Mukherjee, 2019).

Challenges faced in the search process, and they were resolved

During the search process, the foremost challenges that have arisen are difficulty in identifying the relevant studies, specifically which are focused on bilingualism in therapy. This was resolved by refining search terms using Boolean operators (eg ‘bilingual’ AND psychotherapy or ‘language matching’ AND mental health).

Another challenge that has been faced was to access full-text articles, which was overcome by using online and credible database sources. Additionally, filtering the studies based on inclusion criteria helped me to focus on high-quality, peer-reviewed sources.

Annotated Bibliography

Citation	Summary	Evaluation	Reflection
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	This research is based on a comprehensive study on speech emotion recognition (SER) in bilingual and multilingual speakers, where two-pass classification schemes have been used. This research addressed the challenge of identifying the emotional states in speech when the individuals switch between languages, a critical factor in bilingual communication and therapy settings. This research paper stated that the emotion recognition plays an important role in human-computer interaction. The result indicates that bilingual individuals exhibit different emotional intensities depending on the language spoken, with certain emotions being more effectively conveyed in a speaker’s first language. This study also highlighted the need for language-aware emotion recognition system to improve cross-cultural communication in healthcare settings.	This study used a two-pass classification scheme, which increases the accuracy of detecting emotional states in different languages. The study is data driven employing machine learning technique to analyse speech, which strengthens the reliability and applicability. Limitation of this study includes the focus on technological aspect rather than on psychological or social implications, which limits the direct application of the therapy session.	The findings of this study reinforce the complexity of bilingual emotional expression, which significantly inform my research on bilingualism in therapy sessions. This study also highlights the need for therapists to be aware of how language choice can affect the emotional depths, which further can influence client-therapist communication.
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	This article uses a systematic review on bilingual counseling, analyzing the challenges, benefits, and effectiveness of therapy sessions conducted in multiple languages. The finding of this study emphasises that bilingual counselling enhances the rapport-building client comfort, and cultural sensitivity.	The key strength of this study is: use of a comprehensive and structured approach to synthesizing evidence from multiple sources. This study provides an in-depth understanding of the bilingual counseling in the therapy session.	This study has deepened my understanding of how language choice can influence the therapy session and the importance of bilingual competence in counseling sessions.
Szoke, D., Cummings, C., & Benuto, L. T. (2020). Exposure in an increasingly bilingual world: Native language exposure therapy with a non-language matched therapist. Clinical Case Studies, 19(1), 51-61.https://journals.sagepub.com/doi/pdf/10.1177/1534650119886349	This study explores the ET for trauma in bilingual clients when the therapist does not share the client’s native language. This study also argues that language mismatch does not inherently reduce therapeutic efficiency if clinicians employ culturally competent practice. This study includes an example which shows that bilingualism can reduce the PTSD symptoms in a Spanish-speaking client treated by an English-speaking therapist.	Strength: a. It showcases the importance of language-matching as a necessity in therapy. b. This study highlights the practical strategies for culturally responsive care (bilingual materials). c. Advocates for flexibilities in multilingual settings Limitation a. Small sample size (single case study). b. Limited generalizability to other languages/ culture c. Lack of long-term outcome data.	The findings suggest that language barriers need not preclude the effective therapy if clinicians prioritise the cultural humility, client collaboration, and adaptive tools like bilingual resources. This shift focuses from rigid language-matching requirements to a culturally informed framework.

Literature Review Summary

Key themes

The role of language in emotional expression

According to Heracleous & Yoneyama, (2019), bilingual individuals display different emotional intensities based on the language they used for speaking. This study focuses on the SER or Speech emotion recognition to highlight the gap between first language and second language, where it is stated that bilinguals often feel more emotionally detached when people speak in their second language. 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. On the other hand, the article by 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 prefer the "stepmother tongue" during therapy or sessions to suppress the emotional overcharge. Szoke et al. (2020) further illustrate that it is often seen that any clients use or switch languages during therapy to match the intensity of their emotion. More specifically, individuals in any mental health related counseling session use their native language rather than a second language to express their mental health status and trauma, as it feels more authentic. Szoke et al. (2020) also stated that therapist often uses exposure therapy in a language different from the client’s native language, which demonstrates the complexities of emotional expression when the therapist and client do not share a common first language.

The impact of therapist-client language matching on treatment outcomes

According to Szoke et al.(2020) therapists tend to use native language exposure therapy as the therapist does not share the client’s native language. This study suggests that therapy can be effective even without full language alignment, with which the therapist can employ cultural competencies, visual cues, and adaptive communication strategies. However, Seto et al.(2020) argues that therapy is most effective when the therapist switches the language to accommodate the client’s comfort level, reinforcing the importance of bilingual training for mental health professionals. Therapist-client language matching plays an important role in shaping the effectiveness of therapy in bilingual settings. According to Heracleous & Yoneyama, (2019), the ability of the therapist to communicate in the client’s preferred language can influence the client’s emotional expression, help in developing therapeutic trustworthiness between clients and professionals, and improve overall treatment outcomes. The key findings of Heracleous & Yoneyama, (2019) stated that bilingual individuals display variation in emotional intensity depending on the language used, which can further impact how the therapist interprets the client’s distress. This study stated that clients may unconsciously distance themselves from trauma when speaking in a second language, reducing emotional engagement in therapy, whereas in contrast speaking in one’s native language tends to produce a stronger emotional response, which can make the therapy more effective.

The article by Seto & Forth (2020) reinforces this statement by emphasizing that bilingual clients often code-switch during therapy, using their first language to express deep emotions and switching to a second language when discussing sensitive issues objectively. The absence of therapist-client language alignment can further arise many challenges in a therapy session. Szoke et al. (2020) examine the case study where a non-language-matched therapist conducted exposure therapy with a bilingual client. Despite the language barrier, alternative communication strategies like visual aids, slower speech, and cultural sensitivity helped in facilitating the effective therapy. However, this study also highlights that clients may struggle to engage themselves fully in therapy when forced to use a second language or non-native language, which potentially leads to incompetent emotional processing in the therapy session.

Compare and contrast the methodologies, findings and conclusions.

Upon comparison of three studies, it can be stated that the research carried out by Heracleous & Yoneyama, (2019) has used an experimental study by using the speech emotion recognition technologies to explore how bilingual and multilingual individuals express emotions. This quantitative study implemented a two-pass classification scheme to analyze speech patterns in various languages. On the other hand, the study by Seto & Forth (2020) used a systematic literature review to focus on the importance of therapist-client language matching, code switching, and bilingualism in therapy sessions. Unlike the other two articles, Szoke et al. (2020) used case study method, where a non-language-matched therapist provided exposure therapy. This qualitative method offered valuable insights into the practical challenges and adaptive strategies employed in therapy.

Findings Heracleous and Yoneyama (2019) discovered that emotional expression differs across languages, which affects speech recognition accuracy and may influence how therapists perceive emotions in bilingual clients. Seto and Forth (2020) concluded that bilingual therapy strengthens therapeutic rapport, with language-matched therapists being more adept at grasping emotional subtleties, thereby enhancing client outcomes. Szoke et al. (2020) showed that therapy can still be effective even when the therapist and client do not share a language, provided that therapists use strategies such as visual aids and cultural sensitivity, although language barriers can complicate emotional processing. Conclusions: All three studies emphasize the importance of language in emotional expression and the effectiveness of therapy. However, Heracleous and Yoneyama (2019) concentrate on technological solutions, while Seto and Forth (2020) call for increased bilingual training. Szoke et al. (2020) underscore the need for adaptive strategies for therapists who are not bilingual.

Evaluation of the quality of the evidence and its implication for practice

The quality of evidence across the three studies varies based on methodology, sample size, and applicability to real-world therapy settings. The quality of evidence in the three studies differs based on their methodologies, sample sizes, and relevance to real-world therapy contexts. Heracleous & Yoneyama (2019) deliver robust quantitative evidence through a well-structured experimental design and data-driven results. However, their emphasis on speech emotion recognition might not fully encompass the intricacies of therapeutic interactions. Seto & Forth (2020) conduct a systematic literature review, enhancing the reliability of their conclusions by integrating findings from various studies. Nonetheless, the differences in methodologies among the studies they reviewed could impact the overall consistency of their results. Szoke et al. (2020) provide an in-depth case study that offers useful practical insights, but its focus on a single case limits its generalizability. These findings highlight the importance of bilingual training for therapists, cultural awareness, and alternative approaches for therapy when language does not match. Future research should aim for large-scale studies to confirm these findings across a range of therapy environments.

Gaps in the research and an area for future study

Upon analysing the three studies, it can be stated that Heracleous & Yoneyama, (2019) emphasises speech emotion recognition but lacks clinical applicability of bilingualism in therapy sessions, whereas the study carried out by Seto (2020) highlights the empirical evidence on effective bilingual counselling frameworks and patient outcomes. The study carried out by Szoke et al. (2020) provides a case study but the findings are not generalizable to a larger population. Therefore, the future study must explore the longitudinal effects of bilingual therapy, the role of cultural competencies in treatment success and effective strategies for non-language matched therapy across diverse mental health conditions.

Gaps in the literature

Cultural Nuance in Emotion Recognition: While Heracleous & Yoneyama (2019) explore the technological aspects of speech emotion recognition (SER), they fail to consider the cultural differences in emotional expression that exist across various languages. Future studies should incorporate cultural contexts into emotion recognition models to enhance accuracy for diverse bilingual speakers.

Empirical Frameworks for Counseling: Seto & Forth (2020) highlight the absence of robust empirical evidence supporting effective bilingual counseling frameworks, particularly for non-Western populations. Future research should focus on creating standardized bilingual counseling protocols through longitudinal, cross-cultural studies.

Language-Mismatched Therapy: Szoke et al. (2020)'s single-case study design uncovers a lack of data regarding the long-term outcomes and wider applicability of therapy when the therapist and client do not share a native language. A promising direction for future research is to examine the differences in emotional processing, such as how trauma narratives vary between languages in therapeutic settings.

Conclusion

This research delves into how bilingualism affects therapy sessions. It emphasizes the ways in which language shapes emotional expression, cognitive processes, and the interactions between therapists and clients. The study addresses the significance of bilingualism in healthcare, especially for vulnerable groups who encounter language barriers. It looks into how language contributes to identity formation and underscores the necessity of recognizing a patient's preferred language to foster trust and effective communication. The literature review draws from various academic databases and aims to pinpoint studies related to bilingualism in psychotherapy, counseling, and mental health treatment. The goal is to uncover the challenges and opportunities in delivering culturally and linguistically inclusive care to bilingual individuals.

References

Bromberek-Dyzman, K., Jończyk, R., Vasileanu, M., Niculescu-Gorpin, A. G., & Bąk, 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

Costa, A., & Sebastián-Gallés, N. (2014). How does the bilingual experience sculpt the brain? Nature Reviews Neuroscience, 15(5), 336–345. https://doi.org/10.1038/nrn3709

Gartner, K., Mösko, M., Becker, J. C., & Hanft-Robert, S. (2024). Barriers to use of interpreters in outpatient mental health care: Exploring the attitudes of psychotherapists. Transcultural Psychiatry, 61(2). https://doi.org/10.1177/13634615241227337

Gerchow, L., Burka, L. R., Miner, S., & Squires, A. (2021). Language barriers between nurses and patients: A scoping review. Patient Education and Counseling, 104(3), 534–553. https://doi.org/10.1016/j.pec.2020.09.017

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

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

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

Szoke, D., Cummings, C., & Benuto, L. T. (2020). Exposure in an increasingly bilingual world: Native language exposure therapy with a non-language matched therapist. Clinical Case Studies, 19(1), 51-61.https://journals.sagepub.com/doi/pdf/10.1177/1534650119886349