A Multilingual Outlook: Can Awareness-Raising about
Multilingualism Affect Therapists’ Practice? A MixedMethod Evaluation
Sofie Bager-Charleson1
Metanoia Institute London
Jean-Marc Dewaele and Beverley Costa
Birkbeck University of London
Zeynep Kasap
Metanoia Institute London
Abstract
Therapists are often unprepared to deal with their clients’ use of other languages. This
study focuses on therapists’ experiences of having undertaken awareness-raising
training about multilingualism. Did the training impact their practice? If so, in what
areas? Adopting a mixed-method approach, quantitative data were initially collected
via an online questionnaire with 88 therapy trainees and qualified therapists who
underwent training in multilingualism, combined with interview data from 7
volunteers. Having identified the issues on which the training had had most and least
impact in survey responses, the interviews were guided by our emergent interest into
the impact of the training with potential relational complexities and unique, personal
experiences in mind. A narrative-thematic analysis uncovered interrelated themes,
relation to changes, or impact of the training, with regard to Identity and Therapeutic
Theory Therapists referred to considerable transformative learning on both a personal
and professional level, for instance in terms of how multilingual clients might bring
different and sometimes conflicting ways of organizing events and experiences into
meaningful wholes through their narratives during the session. Language switching
seemed less significant in the survey, but emerged as a central theme in the interviews,
especially with regard to the possibility of addressing, challenging and sometimes
combining different emotional memories, cultural and existential concerns. Working
across these areas triggered some therapists to consider the need for expanding their
theory.
Introduction: Multilingualism in Psychotherapy
Awareness of multilingualism in therapy is a relatively new field of inquiry.2 Many
practitioners do not consider their language(s) to play any significant part of their
1
Correspondence concerning this article should be addressed to Dr. Sofie Bager‐
Charleson, Metanoia Institute London. Email:
sofie.bager.charleson@metanoia.ac.uk
2 We do not make a distinction between bi‐ and multilinguals, so all speakers with
at least some basic knowledge of more than one language will be included in the
category of the multilinguals.
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modality or therapeutic work. As Barden &Williams (2007, p. 8) suggest, it is
“common to be fluent in a language without having to consider how it is put together
or what stops it falling apart. It just is.” We will consider the impact of multilingual
training on therapists, using a mixed-methods approach. The training, which is
evaluated in this paper has been delivered since 2010 to a variety of therapy trainees
and qualified therapists. The study is situated within a new wave of research on
multilingualism and psychotherapy whose main aim is to gain a better understanding
of the roles of clients’ languages in therapy and ways for therapists to handle and
interpret code-switching appropriately and accurately.
Literature Review
Training Therapists to Consider the Impact of Multilingualism
in Therapy
This research project builds on the findings and recommendations of researchers such
as Costa & Dewaele (2012), Dewaele &Costa (2013), Georgiadou (2015), Kokaliari
(2013) and Verdinelli & Biever (2009), for psychotherapy trainings to address the
issue of multilingualism. A training programme for therapists who are both
multilingual and monolingual, structured around the findings emerging from research
studies: Costa (2010), Costa & Dewaele (2012), Dewaele & Costa (2013), Pavlenko
(2005), Santiago-Rivera & Altarriba (2002), Tehrani &Vaughan (2009) and Verdinelli
& Biever (2009) has been developed, delivered and revised as new research findings
emerged. This study aims to evaluate the impact this training has had on the
participating therapists and on their practice.
Georgiadou’s (2014) research focused on international counselling trainees’
experiences. She included a recommendation that counselling courses pay more
attention to languages and difference. She builds on McKenzie-Mavinga’s (2011)
suggestion that students who face difficulties regarding acculturation and
discrimination need opportunities for discussion. Georgiadou (2015) recommends
“counsellor education programmes acknowledge the additional challenges that
international trainees may encounter in practice in relation to linguistic competence
and provide sufficient space and possibilities for relevant discussion with peers, tutors
and supervisors” (p. 9). Skulic’s (2007) research led him to conclude that a therapist’s
bilingualism can both promote and/or adversely affect the therapeutic process. He
recommends that therapists need to be helped via training or supervision with others to
be aware of their own cultural positioning, stereotypes and language related issues.
More recent research conducted by Georgiadou (2015) - an exploration of
international counselling trainees' training experience - discovered that trainees
identified benefits in practising across languages and cultures during placement.
Research on monolingual therapists’ experiences of working with multilingual clients
(Bowker & Richards, 2004; Stevens & Holland, 2008) demonstrated that therapists
were pushed outside of their comfort zone. Costa and Dewaele (2012, 2013) research
suggested that multilingual clients may benefit from a therapeutic environment where
they can use their first language, but it is the therapist’s ability to grasp personal
meanings of language usage (for instance switching, avoidance etc.), which is of
therapeutic value. A mixed-method study, combining a survey of 101 monolingual and
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multilingual therapists and interviews with three psychotherapists showed that
multilingual therapists tended to view their ability to share a language, or to have a
facility for languages or thinking about languages with a patient as positive with
respect to their capacity for attunement with the client. They felt better equipped to
help patients to feel more connected and less isolated but also pointed to the potential
problem linked to increased empathy and intimacy, namely possible collusion – an
issue monolingual therapists were less likely to encounter. They insisted that it was
crucial to pay proper attention to the appropriate setting and maintenance of
boundaries and not to overlook the issue of disclosure. The therapists agreed that
having been in contact with other languages had stimulated their thinking about
language use with their clients checking understanding and sometimes simplifying
their language. Although they had not invited other languages into the therapy, they
agreed that this had potential. The survey and the interviews seemed to have acted as a
trigger for reflection. In other research studies therapists reported a distinct lack of
training for multilingual work (Gonzalez et al., 2015; Trepal et al., 2014; Verdinelli,
2009) — they often felt isolated and disconnected while learning how to use the two
or more languages in their personal and professional lives.
Underpinned by the findings from the research conducted by Jean-Marc Dewaele and
Beverley Costa (2012, 2013) the curriculum of the training programme was
developed. Although much of the research makes recommendations for specific
training for multilingual therapists or monolingual therapists, this training is aimed at
mixed groups of monolingual and multilingual therapists, with a view to
mainstreaming rather than marginalising the subject. Dewaele and Costa’s (2013)
research: “Psychotherapy across Languages: Beliefs, Attitudes and Practices of
Monolingual and multilingual Therapists with their Multilingual Patients”, is one of
the few pieces of research which has targeted monolingual and multilingual therapists
simultaneously.
The curriculum of the training included the following topics identified as significant in
the research: the impact of multilingualism on identity, transference and projections,
emotional expression, early memories, emotions and relationships, language-switching
in therapy and counselling. Pavlenko (2004, 2005, 2006) argues that multilinguals can
frequently feel different, behave differently and express themselves differently in their
different languages. They can express different emotions in their distinct languages
and this can of course impact on their sense of self and their relationships (Dewaele,
2013, 2016). The curriculum also includes: multilingual defense and protective
structures, trauma and shame, treatment and repair referring to Tehrani & Vaughan’s
(2009) demonstration of how a multilingual client can harness their multilingualism
for repair after a traumatic incident. The danger of making assumptions is also
included in the curriculum as one of the topics. Antinucci (2004) identifies a common
position taken by multilingual therapists with their multilingual clients of over
identification or over joining with the client. These nine curriculum topics were the
items chosen to be included in the questionnaire.
The training was a brief intervention comprising between 7 and 14 hours of teaching,
and some or all the topics were covered depending on timing and participants’ needs.
It was delivered between 2010 and 2015 to a wide range of trainee and qualified
monolingual and multilingual mental health clinicians in the statutory and voluntary
sectors in the UK.
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The Context of the Training
The Mothertongue multi-ethnic Counselling Service was a culturally and linguistically
sensitive counselling service (2000-2018), which provided professional counselling to
people from black and ethnic minority backgrounds in their preferred language.
Mothertongue developed, revised and delivered two training initiatives and one
clinical supervision initiative based on findings from research, as referenced above.
Only the evaluation of the brief training intervention on multilingualism is included in
this paper.
The training has been delivered to a variety of therapy trainees and qualified
therapists, including IAPT trainees, CAMHs teams, trainee and trained clinical
psychologists, trainees on psychotherapy training programmes, voluntary sector
organisations offering psychotherapy and counselling to victims of domestic violence,
asylum seekers and refugees, and parents of children in hospices. This training
explores the impact of multilingualism on clients’ and professionals’ development
including their identity, emotional expression, trauma, memory and defenses. The
training considers how language issues and acculturation stress impact on people who
have recently migrated as well as British born 2nd and 3rd generation migrants and
refugees. The training also explores how multilingualism impacts on the therapeutic
relationship.
The following topics, which incorporate the main findings from the research, are
included:
•
•
•
•
How language shapes our identity and sense of self.
How to work safely with a client’s language in the room when we do not
understand it.
How to engage with language switching to help clients with emotional
expression, management of traumatic symptoms, self-soothing and repair.
How others’ or our own multilingualism impacts on us and how this shapes our
reactions to our multilingual clients.
The training methodology includes a selection of the following, depending on timing
and participants’ needs: discussion, role play, demonstrations, hot seating, action
methods - for participants to take different perspectives, DVDs, creative literature –
novels, plays, poetry. Personal experiential exercises – creative writing, guided
visualisations, journal writing, art exercises, autobiographical writing and reflective
discussions are also used. The therapists attending the training were contacted in 2015
with an invitation to participate in the study. 88 therapists responded, covering a broad
range of therapeutic approaches.
This study is an evaluation of the impact the multilingual training has had on the
therapists and their practice. The research design and questionnaire obtained approval
from the Ethics Committee of the School of Social Sciences, History and Philosophy
at Birkbeck, University of London.
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Methodological Considerations for a Mixed Methods
Approach
Critical Realism with a Transcultural Interest in Narrative
Truths
This study adopts a critical realist stance to knowledge, suggesting that there may be a
pre-existing, mind-independent reality, but that this reality is ‘mediated through and
by individual experiences and representation, and is socially situated’ (Finlay &
Ballinger, 2006, p. 258). We view critical realism from a transcultural lens; whilst
inter- and cross-cultural theories typically highlight the significance of improved
understandings and dialogues between cultures, transculturalism suggests that
“cultures are as much internally differentiated as they are different from other
cultures” (Freudenberger, 2004, p. 39). We are interested in shared themes among
therapists with regard to their experiences of multilingual training, but we are also
hoping to contribute with research about unique, personal experiences in the field.
Like Wittgenstein, we suggest that “the limits of my language means the limits of my
world” (Wittgenstein, 1922/1960, p. 62). Whilst doing so we adhere for instance to a
realist stance to language as human, physical and mental capacity which differ from
animals and have evolved for at least 3000 years, possibly since the origins of homo
sapiens 200,000 years ago.
We also position our research in the context of a reality where geographical, socioeconomic and political factors impact directly and indirectly on reasons for migration
and multilingualism. But our critical realism also includes the, for critical researchers
underpinning “challenge of the taken for granted” (Finlay and Ballinger, 2006, p. 258).
The earlier mentioned idea that the “limits of my language means the limits of my
world” also involves an understanding of language as “subjective, judgement laden
and culturally embedded” (Williams, 2007, p. 84). This assumption underpins our
research. We aim to contribute with knowledge into what Polkinghorne (1991) refers
to as ‘narrative truths’. Seeking to “conceptualize the self as a narrative or story, rather
than as a substance, brings to light the temporal and developmental dimension of
human existence”, asserts Polkinghorne (1991, p. 141). We are bringing this ‘lens’ on
the individual’s way of organising events; our own included, into the research into
therapists’ accounts of their experiences from training.
The study into the impact of training in multilingual therapy straddles two stages.
With Critical Realism as an “umbrella foundation” (Creswell et al., 2011, p. 100) it
has been conducted as a multiphase mixed method study with both fixed and emergent
(Creswell et al., 2011, p. 54) aspects to its design to gain what Bryman (2001) and
Brannen (2005, p. 12) refer to as “complementarity”. This involves approaching
therapists’ experiences from two angles, expecting the two methods will help us to
“generate complementary insights that together create a bigger picture” (Brannen
(2005, p. 12).
Fixed methods designs involve “studies where the use of quantitative and qualitative
methods is predetermined and planned at the start of the research process, and the
procedures are implemented as planned” (Creswell et al., 2011, p. 54). Emergent
design reflects the decision to involve “a process that is ongoing, changeable and
iterative in nature” as part of a “purposeful and carefully considered’ aspect, ‘prior to,
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during, and after, implementation”, as Wright (2009, p. 63) puts it. Allowing new and
emerging research questions to guide the study is not uncommon in mixed method
research. Combining quantitative approaches to the data with qualitative is often
legitimised because they can each answer different research questions (Creswell et al.,
2011, p. 62). In this study, an example of an emergent theme is the carrying over of
questions arising in the quantitative study into the qualitative inquiry. Another
significant indicator of the ‘ongoing, changeable and iterative’ (Wright, 2009) nature
of the study is the way in which the qualitative phase has developed with the
subjectivity of the researchers in mind. The qualitative research phase is guided by a
constructionist framework with ‘relational interviewing’ (Josselson, 2013) and a
narrative variation of our thematic analysis (Bamberg, 2003; Braun & Clarke, 2006;
Chase, 2005), which developed during our data analysis.
Quantitative and Qualitative research
Questionnaires and surveys involving Likert scales are, as Saldana (2012) concludes;
“designed to collect and measure a participant's values, attitudes, and beliefs about
selected subjects” (p. 93). Quantitative data transform meaning into numbers for
statistical analysis into a fixed, linear string of response; from less to more as
illustrated in the statistical presentation of the mean or average score determined by
summing all the scores and dividing by the number of survey participants.
Qualitative inquiry aims, on the other hand, for a “three-dimensional” (Saldana, 2012,
p. 93) focus; it displays varying levels of depth “with opportunities for gathering and
assessing, in language-based meanings, what the participant values, believes, thinks,
and feels about social life”. We are interested in shared experiences among therapists
regarding their multilingual training, but we are also hoping to contribute with
research about unique, personal experiences in the field.
Quantitative Study
Participants in the Quantitative Study
Over 15 organisations which had commissioned the training for their therapists were
asked to pass the invitation on to their therapists, (approximately 200 in total), who
had undergone the training. The therapists were sent an invitation to complete the
survey relating to specified therapeutic aspects which could/could not have been
impacted by the training.
A total of 88 participants (70 females, 16 males) completed the survey. Eighty-seven
participants took part in the training between 2013 and 2015 and 1 took part in
2012. Participants’ ages ranged from 22 to 68 (Mean = 42.2, SD = 13.4). They
included a majority of psychotherapists, counselors and psychological wellbeing
practitioners - some of whom were still in training. Seventy-six participants reported
having English as a first language, other first languages included British Sign
Language, French, German, Greek, Gujarati, Hindi, Italian, Polish, Portuguese,
Punjabi, Russian, Spanish and Swahili. A majority (n = 64, 72.7%) reported using
English exclusively in therapy, the remaining participants reported using other
languages at their disposal. Seventy-nine participants (90%) reported having been
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trained in English, with the remaining participants having been trained in British Sign
Language, Gujarati or Spanish.
Instruments
The main questionnaire was exploratory in nature. It contained 18 items in the form of
statements with 5-point Likert scales (ranging from “strongly disagree” to “strongly
agree”) and six open-ended text box questions. Not all the items were applicable to all
the participants. The items covered the training in: therapy with multilingual clients;
interpreter-mediated therapy and participants’ experiences of supervision for
multilingual therapists. Only the evaluation of the training in therapy with multilingual
clients is considered in this paper. The questionnaire was pilot-tested with 3 therapists.
This led to the deletion of some items and the reformulation of others. The final
version of the questionnaire was put on-line on Google forms. Organisations which
had participated in the training were enlisted to recruit participants. The questionnaire
was anonymous but the last item allowed participants to leave an email address if they
agreed to be interviewed on the issues covered in the questionnaire.
First question
The first question invited participants to pick a value reflecting their agreement to the
following question: “Has the training to work with multilingualism in therapy
impacted on the way you work therapeutically with the multilingualism in the room
with reference to…?”:
-
Identity including transference and projections
Emotional expression
Defense
Trauma
Repair
Code-switching
Shame
Early memories, emotions and relationships
The danger of making assumptions
The nine categories represented a mixture of epistemic approaches to multilingualism,
ranging from linguistic (code-switching) to psychoanalytic (defense, trauma, early
memories, countertransference) and systemic (assumptions) which reflected the
pluralist training structure. These closed questions were followed by an open question,
allowing participants to add a comment in an open-ended text box.
Results of Quantitative Data
Descriptive Statistics
1. Impact of training on therapeutic work
Mean scores were calculated for every item. Items were then sorted according to the
amount of impact reported on participants’ therapeutic work (see Figure 1).
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Figure 1
Impact of training on therapeutic work
The participants rated the impact of the training highest with regard to the danger of
making assumptions, with a mean value situated between “quite a lot” and “very
much”. The items “emotional expression” and “identity” had a mean score situated
half-way between “so-so” and “quite a lot”. The items “defense”, “early memories,
emotions and relationships”, “shame” and “trauma” were closer towards the “so-so”
value. The training seemed to have had least impact on code-switching, with a mean
score hovering between “not especially” and “so-so”. In other words, the training had
not had much impact on therapists’ interest in or ability to engage with code-switching
in therapy.
2. New Emergent Questions
The analysis of the quantitative data provided some insights into how the participants
related to the nine different key components of their training. This revealed, as
mentioned, for instance that the training was reported to have had least impact on code
switching, and the highest score for impact was the danger of making assumptions.
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Qualitative Study
Qualitative Data Questions
Our next aim was to move deeply into each category addressed in the quantitative
study. Our focus shifted from what was being shared to participants’ unique,
individual ways of organizing events and experiences from their training.
Participants in the Qualitative Study
The overarching emerging question into the next stage was what – if at all, the
different training components had meant to the individual therapist and his/her clients.
7 participants who had previously completed the online survey offered to meet for an
hour long in-depth interview. We followed up all 7 offers. Participants’ ages ranged
from 30 to 59 (Mean = 47.8, SD = 9.6). They worked across a variety of modalities,
including psychodynamic, person-centred, transactional analytical and cognitive
behavioural therapy. The majority selected English as their primary language, even
though all but one participant was multilingual. They were all trained in English and
used English as the main language in their psychotherapy practice.
Relational Interviews
The interviews were structured with Josselson’s (2013) relational model in mind. The
aim was to “to understand how people construct or interpret their experiences, rather
than piecing together views of an external event” (2013, p. 7). Although we were
curious to learn more about how individual therapists may relate to the nine categories
from the survey, we did not want to assume that the topics raised in the survey were at
the forefront of the therapists’ lasting experiences from their training. We agreed to
approach the participants in as open way as possible, with some space towards the end
of the interview to tentatively explore the categories from the survey. Our earlier
mentioned epistemological positioning for the project in terms of critical realism was
extended into this second stage. In our interviews, we pursued a philosophical position
which acknowledged a pre-existing reality, but also assumed that this reality was
mediated “through and by experience and representation, and is socially situated”
(Finlay & Ballinger 2006, p. 258). Relational interviews assume in accordance that
“we do not have the direct access to another’s experience; we deal with ambiguous
representations of it – talk, text, interaction and interpretation”, as Hollway and
Jefferson (2001, p. 3) put it. It also meant that we understood the interviews as
attempts to “elicit narratives of lived experience in a two-person setting” (Josselson,
2013, p. 12) with the interviewer and participant dynamics as part of the data.
Analysis of the Qualitative Data
Reflexive Pair-Reading
Having agreed on the relational approach to the interviews, which were conducted by
Zeynep, the interviews were interpreted by two researchers with different
backgrounds. Sofie is originally trained as a psychodynamic couple therapist and has
remained working within an integrative framework. As a researcher, she is anchored
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within qualitative research with a special focus on reflexivity (Bager-Charleson, 2014,
2016). Zeynep is originally trained within neurobiology, and arrived at research from
another angle but with an interest in deepening her phenomenological thinking as part
of her MSc studies in Person-Centred psychotherapy.
Thematic Analysis
Thematic analysis is a “method for identifying, analysing, and reporting patterns
(themes)” (Braun & Clarke, 2006, p. 7). It is not wedded to any specific theory and
can be “applied across a range of theoretical and epistemological approaches” (p. 5).
Our first stage of the process involved reading through the transcripts several times,
whilst “jotting down ideas and potential coding schemes” (p. 86) based on what ‘stood
out’ to us. This ‘coding’ stage involved identifying freestanding textual units of the
content in ways, which Braun and Clarke (2006) compare with looking for ‘individual
bricks and tiles’. A ‘theme’ is compared to the ‘load baring walls’ and represents
rather “any level of patterned response or meaning within the data set” (Braun &
Clarke, 2006, p. 82). Qualitative researchers ‘only gain control of their projects by first
allowing themselves to lose it’ suggest Kleinman et al. (1993, p. 3). This was certainly
the case for us. Our analysis seemed to generate endless threads, each fitting into
different code clusters and themes. Our aim was to highlight references to the earlier
mentioned categories - anything and everything which might be deemed of relevance
to the enquiry. Reading the transcripts as a pair facilitated a discussion about hoping
to register ‘anything and everything’ in a reflexive (Alvesson & Skoldberg, 2000)
context. This process is elaborated upon in other contexts, focusing on research
reflexivity (Bager-Charleson & Kasap, 2017).
The transcripts were not easy to access, and we spent considerable time exploring
what prevented us from connecting with some of the participants’ voices and accounts.
There was both a practical and a personal aspect to our initial level of “not hearing”.
Several participants struggled to find the words: “And I spoke with her and about the
research that she’s doing and, ummm, one of my interests is also trying which I
haven’t finalised but it’s trying to to do research also on my own to try to put my two
fields of interest together (Z: Uh huh) so I spoke with her also in this (Z: Ok) respect”
(Therapists No 3:2).
Both of us experienced strong emotions during our readings. We both initially tapped
into a keen desire to create order – and experienced a sense of personal, deep seated
culturally tinted failure over being unable to ‘find’ that order. Sofie registered
enactments in terms of irritation and explored these in her clinical supervision as
potential embodied responses to the research. Supervision facilitated space to explore
emotional responses. Sofie also used creative writing (Richardson & St Pierre, 2005)
to explore embodied responses ranging from excitement to despair.
Narrative-Thematic Analysis
The interviews were analysed for codes and themes in both what Braun and Clarke
(2006, p. 84) refer to as ‘latent’ and ‘explicit’ or ‘semantic’ level’ of reading. Typical
for the semantic/explicit approach is the focus on themes linked to direct or indirect
responses to our research question. We were also interested in what Braun and Clarke
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refer to as a ‘latent’ focus on new, different and maybe ‘conflicting’ themes. Our
thematic analysis gravitated towards an interest into ‘latent themes’ linked to the
participants’ ‘narrative knowing’. ‘Narrative knowing’ (Polkinghorne, 1991; Ricoeur,
1981) focuses on narratives as means for people to “conceptualize the self by linking
diverse events of their lives into unified and understandable wholes” (Polkinghorne,
1991, p. 136).
Narrative approaches differ (see for instance see Pavlenko, 2007) but share an interest
in how participants impose or express order on the flow of experience through their
narratives about experiences and events in their lives. Riessman (2008) proposes a
typology of the four main types of analysis, namely thematic, structural, dialogic and
visual. The thematic narrative analysis moves, as Chase (2005, p. 662) suggests ’away
from traditional theme-orientated methods in qualitative research’. It ’extends the
narrator-listener relationship’ into an interpretive process (Chase, 2005, p. 662) which
approaches narratives as told in a context. What Chase refers to as an attempt to elicit
the ‘complexity and multiplicity within narrators’ voices’ (2005, p. 663) felt like a
valuable and realistic target for our reading. It made sense to us both as
psychotherapists to listen to the narrators’ voices ‘with an interest in the subject’s
positions, interpret practices, ambiguities, and complexities – within each narrator’s
story’ Chase (2005, p. 663). Chase’s reference to Bamberg (1997) was helpful; he
proposes three levels of narrative positioning, namely:
•
•
•
how narrators position themselves in relation to others in their narratives
how the narrators position self in relation to an audience
how the narrators position ‘themselves to themselves’ (Bamberg in Chase,
2005, p. 663)
Ethical Implications
The qualitative section has been guided by ethical considerations to honor the research
relationship within which certain personal disclosures have been encouraged and
made. To protect the anonymity of the participants and their clients we have changed
details tracing to specific persons in terms of language, modality and in some cases
gender.
Results of the qualitative data
The participants referred to some considerable transformative learning. We interpreted
two main areas in which the participants (addressed as therapists in this section) were
referring to being affected by their training, namely:
1. Identity
1.1. Working with clients’ different sets of narrative knowing
1.2. Changes of the therapists’ own narratives selves
2. Therapeutic Theory
2.1. A Need to Expand theory
2.2. A Growing Sense of Clinical Authority
2.3. Work in progress
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1. Identity
One therapist addressed how the training had resulted in her viewing language as a
path into “a whole world of understanding and experiences” (4:4). Another therapist
referred to being profoundly affected by the training in terms of: “I felt it [the
training] changed me as a person, it changed my attitude to people” (5:4).
In this section we will refer to different angles of this level of transformative learning.
The client’s different sets of narrative knowing
Many therapists reflected on talking therapy from new angles after their training in
multilingualism. For psychotherapy, the underpinning principles of free association
and narrative knowing (e.g. the way the client organize events and experiences into
meaningful wholes through their narratives during the session) seemed to have been
challenged for some therapists in different ways. One therapist said: “There was a
whole world of understanding and experience that we … actually mainly
unconsciously couldn’t go to because his [the client] experience wasn’t translated”
(4:1).
We interpreted the therapist’s use of ‘translating’ as something, which had more to do
with the client’s narrative knowing than it having an actual linguistic or semantic
meaning. The same therapist referred to language as a whole way of thinking and
shaping the world and seeing the world. We understood this to mean that therapy can
approach languages to explore different sets of personal as well as cultural values,
beliefs and ways of relating to the world – and how these are impacting the client’s
sense of self: “If you learn...in two languages you are exposed to two way of thinking
[…] language isn’t just language but a whole way of thinking and shaping the world
and seeing the world. So, you can’t just translate things from one language into
another […] language can help us to express a … different part of our personality”
(4:7).
Therapist 3 spoke about languages as different sets of arranging events and
experiences in terms of ‘paradigmas’: “Expressing yourself in different languages
helps also… about considering where your ideas about things kind of originates ... it’s
complex, working with different languages is looking at different paradigmas about
the world” (3:3).
We interpreted this again as reflecting how the training had triggered the therapists to
consider how multilingual clients might bring different and sometimes conflicting sets
of narrative knowing about the Self. For the therapist to actually speak different
languages or to try to help the clients to translate different sentences literally, seemed
less significant than to facilitate explorations around underpinning personal and
cultural values and beliefs about Self and Others in their narratives. One therapist
spoke in terms of reconciling different sides of self. Therapist 3 described some posttraining work with a client whose native language was German. The therapist did not
speak German herself, but felt that her client had benefitted from language switching:
“She [the client] was keeping her two selves separate. She has a cut off German side
and her English self … for her it was difficult to reconnect that German side … [so it
was] good when she started to bring German words” (3:3).
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The emotional meaning of language is stressed as important. Therapist 3 referred to
her German client’s seemingly emotionally barren mother tongue, and to how English
had provided emotionally richer narratives to organise her experiences and
understanding about the self within. Language switching facilitated, in turn, an
opportunity for the client to understand more about this contrast, including as the
therapist said; to ‘connect with her German cut off side’. The same therapist
continued: “I think about the broader implications of language on people’s
understanding of different emotional meaning, that’s so important (3:2).
The therapist’s own narrative knowing
Some therapists had begun to explore their own selves in different languages after the
training. Therapist 5 was surprised that she ‘had not considered language so much
earlier’. She continued “I’m not a monolingual person ... I’m thinking, my brain
doesn’t work in one language exclusively” (5:6).
Another therapist said: “And now you know, above all, again after the weekend with
Beverley, it’s not about being me better understood but maybe some stuff would come
up in French that doesn’t come up in English” (4:7).
This therapist had reviewed her own use of language in personal therapy:“I don’t
know why I had this kind of strong thing that oh no it wasn’t a good idea ... I just
never considered the impact of language [and]I thought my English was good enough
to do [personal] therapy, I never thought I would be better understood in [my native
language] it didn’t cross my mind” (4:3).
The training had illuminated some of the therapists’ own troubled identities, and some
of the seemingly powerful learning was still being either processed during the actual
interview, by for instance adding midsentence (when talking about her client):
“…saying that … when I was a baby my mum used to talk to me in German [second
language]” (6.3).
Language awareness was reflected upon, as mentioned, as a path into early
relationships and therapist 4 expressed in this sense the impact of the training as
having begun to consider what being an infant to a mother who changed language after
her birth might have meant. What happened to the mother after her narrative
configuration or ways of arranging diverse events into meaningful wholes in her
narratives changed; and how night that have impact her (the therapist) as a baby?
Another therapist said “... and now I am wondering, thinking about how French is my
mother tongue, my dad is from Belgium [and] my mum’s from Switzerland from the
German-speaking part, but I was never fluent in German” (6:7).
2. Therapeutic Theory
Another impact of the training seemed to be reflected in the way in which some
therapists referred to their original therapeutic modality being expanded. Another
therapist said: “I never considered the impact of language […] I started thinking
about, you know, do I do my reactions in terms of countertransference, could it
actually be culturally influenced?” (5:3).
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The above participant had begun to explore the psychoanalytic concept
countertransference in a social constructionist perspective, e.g. as a collectively
represented, social phenomena.
Another CBT trained therapist evidenced a newly developed interest in existential
perspectives with an openness for the unknown’: “I do [normally] work very, ummm,
in a CBT way – always have an agenda…[But] I kept thinking, I don’t have an
answer, I just know it’s going to be painful whatever you do it’s going to be very tough
... it’s difficult being in-between” (2:4).
A further CBT therapist referred to psychoanalytic thinking and the importance of
using language with a ‘timeline’ in mind ‘to help the client access his early, emotional
memories’. The therapist said: “What surprises me as a CBT therapist is I wouldn’t
really think much about defense … but the greatest importance [is] the time lines and
the early memories” (5:7).
One therapist said: “it changed how I work with people from ethnic minorities […]
feeling displaced, we are all from different backgrounds” (2:8). Another therapist said
“I always considered therapy as middleclass … on a personal level I feel a bit
ashamed of myself” (7:11).
The training had triggered the earlier mentioned psychoanalytically anchored therapist
to consider concepts like defence, transference and identification in terms of culturally
introjected values and potential blind spots. She considered biases both in terms of
avoiding and being overly drawn to certain cultures. Working with a person from the
same culture in a new country for both created a setting ripe for fantasies about the
other. Therapist 5 commented upon the value of challenging perceived similarities in
such relationships: “Being more finely attuned to the differences but also the
similarities, [the training] brought that home. That the perceived similarities can also
be differences … Languages is a whole reference system … childhood, culture, class
and different understandings. Having an awareness of different languages [is] also
about considering where your thinking comes from…for us as therapists too” (5:12).
Budding clinical authority
The therapists spoke tentatively of a new confidence in their multilingual work. The
references to the importance of drawing from different languages were not put into
action during the interviews by any of the therapists, and we have interpreted this
partly as an omission from our part; language switching is something, which we could
have encouraged and learnt more about through the interviews. We also consider it as
a potential indication that the learning about multilingualism is relatively new and
maybe still taking shape. There is an indication of not knowing where to turn to
consolidate the learning. One therapist refers to having become interested in the theme
of multilingualism, but feeling uncertain of how to pursue the training: “At first you
know when I first got into the weekend I thought, arghhh a whole day of working with
[this]… hmmm not interested thank you very much. And I, but I did change my mind
completely … But if we had more time you know, maybe we could have two events to
think about your own language and how it affects you, and then the second [part]
could be related to your clients” (4:9).
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Discussion
Our aim with this mixed-method study has been to explore the impact of the training
as described by therapists. The first stage involved a survey which addressed nine key
components of the training. This survey was completed by 88 therapy trainees and the
key findings from this part of the research were revealed in the scores given by the
participants to each of the nine components. The highest score was attributed to raising
their awareness about the danger of making assumptions. The lowest score was
attributed to increased awareness about the importance of code-switching in therapy.
The attention to language switching stood out more in the interviews than it had in the
survey results; it was a theme in most of the narratives, although not always using the
actual terms of ‘code-switching’. Languages were described as reference systems,
emotionally, socially and cognitively; and language awareness was referred to as a
means of integrating and engaging dialectically with the two ‘systems’ or aspects of
the self.
Transformative Learning in Progress
Assumptions were indeed a dominating theme; it seeped into most areas of life. As
one therapist said: “I felt it changed me as a person, it changed my attitude to
people”. The therapists expressed overall a considerable degree of transformative
learning as a result of their training. Much attention was paid to the therapists’ client
work, focusing on the clients’ ability to free-associate, narrative knowing and selfdiscovery. As therapist 5 said; “Languages is a whole reference system … childhood,
culture, class and different understandings”. The therapists reflected also, in the
interviews, about how the training had affected their thinking around how using
different languages might have impacted their own sense of self. One reflected over
her own mother having stopped using her native language. Another therapist became
curious about what she could explore about her sense of self in personal therapy
drawing more from her native language. Interestingly, none of the therapists used
language-switching in the interviews. The therapists spoke about having had to revise
and expand their original theoretical frameworks. One psychoanalytic therapist
incorporated a new systemic thinking in her practice, one family therapist spoke about
incorporating psychoanalytic attachment theory and neuroscience, one CBT therapists
spoke about an interest in existentialism and another CBT therapist incorporated
psychoanalytic perspectives into his practice after the multilingual training. Social
constructionist, Psychoanalytic, Existential and CBT frameworks were considered
from different angles with new questions in mind, largely integrated around a social
constructionist approach to language with an interest in a client’s developing and
sometimes conflicting narrative knowing. From having been considered a problem,
multilingualism is being referred to as a potential therapeutic asset by the interviewed
therapists. The learning feels new and exciting and enriching in most therapists’ cases.
The interviews suggest, however, that therapists would have benefitted from further
training, maybe a two-staged training with; as one therapist suggested - one event “to
think about your own language and how it affects you” and a “second part, related to
your clients” (4:9).
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Limitations of the Research
With hindsight we think that the interviews would have been a valuable opportunity to
explore the potential impact that language switching may have had on the therapists.
We approached the interviews with the low scoring from the survey for codeswitching in mind, and had – as outsiders- paid little attention to the area of study
ourselves beforehand. We noticed from the way the therapists talked about language
switching that it had been a significant part of their learning, but wonder what
encouraging the therapists to draw from different languages during the interviews
might have evidenced.
Another limitation in our study, is that one of the authors was directly involved with
the training. A decision was taken to include this author as she was the access point for
the training participants. She was also one of the authors of the original research,
which informed the training curriculum. This author was involved at the access stage,
original questionnaire design and the description of the training and was not involved
at any stage in analysing the quantitative data, in interviewing participants or listening
to the transcripts. With the inclusion of the other researchers and authors, it was
decided that there was some useful learning that had emerged from the research which
validated its dissemination more widely.
Further Research
Although the sample size of 88 therapists in the survey and 7 therapists in the
interviews was a reasonable size, only one set of training was evaluated. It would be
useful to evaluate other trainings from different organisers and to include therapy for
couples, families and groups. It would also be useful to research the experiences of
clients who have received therapy from multilingually trained therapists to consider
other angles to the impact of the training on the ultimate beneficiaries. The therapists
in this study refer to language awareness as a therapeutic tool to explore multilingual
clients’ opportunities to free associative explorations of their different sets of narrative
knowing. We would like to see more research into the lived experience of language
switching to understand multilingual clients’ understanding, challenging and potential
reconstruction of their narrative selves.
Conclusion
In psychotherapy, the therapist is typically expected to facilitate the client to freely
associate around events and experiences, and rely on language as a means to organize
events and experiences into meaningful wholes through narratives, which can be
explored, challenged and potentially restricted during the therapeutic relationship and
session. The therapists in our survey (n = 88) suggested that their training in
multilingualism had challenged their assumptions to a high degree. Our interview
participants (n = 7) evidenced transformative learning on a professional as well as
personal level. Based on the findings of the present study, we suggest that training
about multilingualism as a means of understanding multilingual clients’ different and
sometimes conflicting ‘narrative knowing’ and sense of self, be integrated in core
psychotherapy courses. Based on the interviews in particular such training should
include more space to include both personal and professional development
components to allow trainees to consider the impact of multilingualism on their lives
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and on the lives of their clients.
Acknowledgments
We are very grateful to all the people who took the time to participate in the research
and for the very helpful comments offered by the reviewers.
Authors’ Biographical Note
Dr. Sofie Bager-Charleson is the Director of Studies on the MPhil/PhD at Metanoia.
She also teaches and supervises research students on the Professional Doctorate
programme, DPsych and on the TA MSc at Metanoia/Middlesex University. She has
published widely in the field of research reflexivity, including the text book Practicebased Research in Therapy: A Reflexive Approach (Sage, 2014) and acting as guest
editor in the UKCP journal the Psychotherapist (2016) about Creative Use of Self in
Research. She researches into Psychotherapy research (Bager-Charleson, du Plock &
McBeath 2018 in press) and is the co-founder of IMPACT, a research network headed
by Professor du Plock at the Metanoia Institute, aimed to encourage the generation and
exchange of ideas and knowledge within and beyond the Institute. Sofie is a UKCP
and BACP registered psychotherapist and supervisor. She holds a PhD from Lund
University in Sweden, specialising in attachment issues within families and reflective
practice amongst teachers.
Dr. Jean-Marc Dewaele is Professor of Applied Linguistics and Multilingualism at
Birkbeck, University of London. He does research on individual differences in
Second Language Acquisition and Multilingualism. He has published over 210 papers
and chapters, co-edited five books and six special issues. He is the author of a
monograph Emotions in Multiple Languages in 2010 (2nd edition in 2013) and coauthor of Raising Multilingual Children (2017). He is president of the International
Association of Multilingualism, Convenor of the AILA Research Network
Multilingualism, and former president of the European Second Language Association.
He is General Editor of the International Journal of Bilingual Education and
Bilingualism. He won the Equality and Diversity Research Award with Beverley
Costa from the British Association for Counselling and Psychotherapy (2013) and the
Robert C. Gardner Award for Excellence in Second Language and Bilingualism
Research (2016) from the International Association of Language and Social
Psychology.
Dr. Beverley Costa, a psychotherapist, set up Mothertongue multi-ethnic counselling
service in 2000. Mothertongue also runs a dedicated Mental Health Interpreting
Service. In 2009 Mothertongue won The Queen’s Award for Volunteering. Beverley
is an Honorary Research Fellow at Birkbeck, University of London and has written a
number of papers and chapters on therapy across languages. Together with Jean-Marc
Dewaele, their paper: Psychotherapy across Languages: beliefs, attitudes and
practices of monolingual and multilingual therapists with their multilingual patients,
won the 2013 BACP Equality and Diversity Research Award. She established
Colleagues Across Borders in 2013, which offers pro bono peer support and training
to refugee psychosocial workers based in the Middle East. She set up the Bilingual
Therapist and Mental Health Interpreter Forum in 2010. This meets twice a year in
Language and Psychoanalysis, 2017, 6 (2), 56-75
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London. She produced the world premiere of the play about a cross language couple
The Session in 2015 at The Soho Theatre, London. She is currently producing an Arts
Council England funded play about interpreters.
Dr. Zeynep Kasap, graduated with a BSc in Biological Sciences and Bioengineering
from Sabanci University in Istanbul, Turkey in 2005. Following a one-year MSc in
Cell Biology in Bordeaux, France, she moved to Italy to pursue a PhD in
Neurobiology. Zeynep obtained her PhD in Neurobiology from SISSA institute in
Trieste, Italy in 2010. She had a brief post-doctoral research experience in
neurobiology at University College London, and became interested in psychotherapy.
She is now on her second year at Metanoia Institute, pursuing an MSc in
Contemporary Person-Centred psychotherapy.
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