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Multilingual Awareness in Psychotherapy (MAP)

Multilingual Awareness in Psychotherapy (MAP)

Co-chairs: Dr Sofie Bager-Charleson & Dr Beverley Costa

Dr Zeynep Kasap



Multilingual awareness in therapy is a new field of inquiry. The research group MAP approaches multilingual awareness as an undervalued therapeutic intervention with opportunities for self-discovery on a personal, relational as well as socio-cultural level. MAP is an offspring to the Therapists and Research Practitioner (TRP) group research group which aims to progress knowledge and enhance research supported practice for counsellors, psychotherapists, and counselling psychologists. MAP supports effective and sustainable training for multilingual therapeutic practice. It explores four main aspects of multilingual awareness, namely:

· Language and therapy training

· Language in the world

· Language and self

· Language and the therapeutic relationship


Recent and previous research output

Multilingualism and therapy training

Underpinned by findings from research (Dewaele and Costa 2012, 2013) a curriculum of training programme was developed and 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. The training was evaluated (Bager-Charleson, Dewaele, Costa and Kasap 2017, Costa and Dewaele 2018) through a mixed methods study; the findings form a significant basis for further MAP research.

Language in the world

Multilingual awareness offers opportunities to explore personal as well as cultural meanings behind the language use(s) for both clients and therapists. It is a route into socio-political and cultural constructs and experiences. Finding someone in a new culture who speaks their language involves typically a sense of gain and relief, however multilingual awareness also explores risks for joint idealisation of a lost cultures and language (Costa and Dewaele 2013, Bager-Charleson, Dewaele, Costa and Kasap 2017)

Language and self

Multilingual awareness reaches in this sense beyond a practical level of basic understanding and simply sharing someone’s language to considering the therapeutic value of understanding personal and cultural meanings of language use and choice. What happens for instance to a person’s whole sense of self in another language? Is it transformed in some

way? Research (Dewaele and Costa 2013) into the experiences of 182 multilingual clients who have experienced therapeutic approaches in different countries highlighted how language can provide opportunities avoid and address pivotal memories. It can, for instance, be used to create ‘proxy’ selves as a means of hiding difficult or unsafe feelings, but also to help the client approach particularly emotionally charged areas in a ‘protected’ way. Operating in the learnt language can in this sense provide a sense of freedom to speak and behave in ways that were different from their usual modes.

· Language in the therapeutic relationship

Our research suggests a lack of training for multilingual work, leaving many therapists (Bager-Charleson, Dewale, Costa and Kasap 2027) isolated and disconnected when drawing from two or more languages in their personal and professional lives. Multilingual awareness offers, as suggested, opportunities to consider power dynamics and opportunities for growth on many levels. What happens to the therapeutic relationship when it is conducted in English as the bridge language or common language (lingua franca) between the native English-speaking therapist and the English-as-an-additional language-speaking patient? And what happens when the bridge language turns multilingual? The efficacy of support/supervision interventions for spoken language interpreters is another area. It was examined via a pilot research project (Costa, Lazaro, Rausch, 2019) for volunteer interpreters in an immigration detention support NGO. Analysis of pre- and post-intervention focus groups and questionnaires indicated an improvement in self-care, resilience, confidence, and effectiveness after three support sessions, suggesting that a remote yet personal support program can mitigate the effects of vicarious trauma and burnout for non-professional and professional interpreters working in ethically challenging refugee contexts.

· Language and Power, Agency

It is understandable, whether you are monolingual or multilingual, for you to feel excluded when people around you speak languages that you do not share. Where therapists and clients cannot be linguistically matched and there is no lingua franca, they will need to incorporate an interpreter into their therapeutic relationship. if they are going to be able to work together and if clients are truly going to experience equity of access to mental health services. But therapists can feel anxious about inviting a third person into the intimacy of the therapeutic dyad. They can feel disempowered and pushed into passivity by being excluded from the languages shared by the client and the interpreter. Research (Costa and Briggs, 2014) explored some of the challenges and the assets of working with interpreters in therapy and counselling. They considered issues such: as triadic relationships; anxiety and power; communicating about working methods; collaborative rather than competitive relationships; clinical safety.


· Linguistic Privilege, Linguistic Empathy and the Multilingual Therapeutic Frame

If we aim to live our lives in as egalitarian and non-oppressive way as possible, it can be painful to acknowledge that English L1 speakers are privileged. We may not be aware of our linguistic privilege, having as our first language one of the highest prestige world languages. The lack of status of some languages, compared with English, intersects with the legacy of

colonisation. Understanding our relationship with our own languages and linguistic histories can help therapists to develop their linguistic and multilingual empathy. Even highly experienced clinical supervisors have almost certainly not received any training in multilingualism in psychological therapies. Many supervisors can therefore feel at a loss to support their supervisees with linguistic issues. Some supervisors may not even be aware of the need to address the multilingualism of supervisees and supervisees’ clients, and how to operate through a multilingual therapeutic frame. A specialist training programme for supervisors has been developed that aims to help supervisors to build the confidence of their supervisees to apply the multilingual therapeutic frame and to work with cultural and linguistic sensitivity. A research project to evaluate the efficacy and impact of the training programme is proposed.


Ongoing and scheduled projects

· E-learning therapists: The Paul Hamlyn Foundation Ideas and Pioneers stream has recently awarded Dr Costa of Pasalo CIC funding to create an e-learning resource on multilingualism and mental health, based on earlier research. The e-learning resource will be created with consultation from the Open University and will be hosted on the OpenLearn Website as a free learning module for CPD. This e-learning project will be explored and developed within Metanoia, with collaboration with OU and with an accredited structure in mind.


· Creative writing between sessions. A mixed method inquiry into the experience of using creative writing between sessions in therapy with English as second language


· Impact on practice for therapists trained to work with multilingualism. Research project developed from Wellcome/ISSF funded project on multilingual couples, with Professor Jean-Marc Dewaele, to measure the impact of training into working with multilingualism for therapists. Project will collect participants’ (who are ex-trainees) responses to a recorded therapy dialogue with a multilingual client, in which they have to choose, justify and develop their interventions.



Conference presentations

13 June 2016. Birkbeck University of London. Research Presentation: ‘Can Awareness-raising About Multilingualism Affect Therapists’ Practice? A Mixed-method Evaluation’, by Bager-Charleson & Costa.


14 June 2016. Birkbeck University of London. ‘Reflexivity in Research’, by Bager-Charleson. Bloomsbury round table on communication. Cognition and culture; multilingualism, multiculturalism and emotion.


May 17 2019. BACP Research Conference Shaping counselling practice and policy: the next 25 years. The talking cure – building clinicians’ confidence to work therapeutically with multilingual patients, by Costa

and for

13th - 15th September 2018 University of Lisbon (Portugal). XIth International Conference on Third Language Acquisition and Multilingualism, by Costa

21-22 November 2019. InDialog3 Interpreter Practice, Research and Training: the Impact of Context. Colleagues across Borders and Professions: mitigating the effects of burnout and stress for interpreters, through mentorship, by Costa

14 March 2020. Sherwood Psychotherapy Training Institute Research Conference Turning Learning into Practice. Other Tongues Researching multilingualism and psychological therapies, by Costa



Bager-Charleson, S., Dewaele, J.-M., Costa, B., & Kasap, Z. (2017a). A Multilingual Outlook: Can Awareness-Raising about Multilingualism Affect Therapists’ Practice? A Mixed-Method Evaluation. Language and Psychoanalysis, 6(2), 56-75. https://doi.org/https://doi.org/10.7565/landp.v6i2.1572

Bager-Charleson & Kasap, Z. (2017b) Embodied Situatedness and Emotional Entanglement in Research. Counselling and Psychotherapy Research, 17 (3) 190–200, http://onlinelibrary.wiley.com/doi/10.1002/capr.12122/full

Costa, B. (2020). Other Tongues ─ psychological therapies in a multilingual word. A guide for qualified practitioners, trainers and supervisors. PCCS Books.

Costa, B. (2018) Why do their languages matter? BACP Children, Young People & Families, June 2018. Lutterworth: BACP

Costa, B. & Dewaele, J-M. (2018) The talking cure – building the core skills and the confidence of counsellors and psychotherapists to work effectively with multilingual patients through training and supervision. Counselling and Psychotherapy Research. 2018;00:1–10. https://doi.org/10.1002/capr.12187

Costa, B. (2017) Team Effort – training therapists to work with interpreters as a collaborative team International. Journal for Counselling Development. 39(1): 56-70

Costa, B. (2017) The strength and the stress of triangles: support and supervision for interpreters and therapists. Chapter in J. Boyles (ed.): Psychological therapy with torture survivors in exile; a human rights approach. London: PCCS Books.

Rolland, L., Dewaele, J.-M. & Costa, B. (2017) Multilingualism and psychotherapy: Exploring multilingual clients' experiences of language practices in psychotherapy. International Journal of Multilingualism. 14 (1), 69-85.

Blog published on the EU Parliament Terminology coordination website, July 2017 about mental health interpreting and supervision. http://termcoord.eu/2017/07/the-challenges-of-interpreting-in-mental-health-settings/

Costa, B., Dioum, M., Yorath, S. (2015) My languages matter: the multilingual outlook for children in care – a White Paper

Dewaele, J.M & Costa, B. (2014) A cross-disciplinary and multi-method approach to research on multilingualism in psychotherapy p30-38 in Bager-Charleson, S (2014) Doing Practice-based Research: A Reflexive Approach for Therapists. London: Sage

Costa, B. & Briggs, S. (2014) Service-users’ experiences of interpreters in psychological therapy: a pilot study International Journal of Migration, Health and Social Care, 10:4 , 231-244 DOI 10.1108/IJMHSC-12-2013-0044. –

Costa, B. (2014) Counselling in many tongues. Therapy Today Vol. 25/4, 20 -23

Costa, B. (2014) You can call me Betty. Healthcare Counselling and Psychotherapy Journal Vol. 14/4

Costa, B. & Dewaele, J.M. (2012) Psychotherapy across Languages: beliefs, attitudes and practices of monolingual and multilingual therapists with their multilingual patients, Language and Psychoanalysis: http://www.language-and-psychoanalysis.com/ -winner of the 2013 BACP Equality and Diversity Research Award

Dewaele, J-M., Costa, B. (2013) Multilingual Clients’ Experience of Psychotherapy Language and Psychoanalysis, 2013, 2 (2), 31-50 http://dx.doi.org/10.7565/landp.2013.0005



Open University

Birkbeck University