Exposure in an Increasingly Bilingual World: Native Language Exposure Therapy With a Non-Language Matched Therapist

Abstract

Language is an essential part of psychotherapy and experts in cultural competence encourage the consideration of language as an element in cultural adaptation to therapy. Providing clients with services in their native language is associated with lower dropout and better outcomes. Therapies such as prolonged exposure therapy (PET) for posttraumatic stress disorder (PTSD) require clients to recount trauma memories to activate and correct overreactive fear networks in the brain. Research shows that the most genuine and detailed recall of these autobiographical memories occurs when people recollect in the same language in which the memory was encoded. Clients are less likely to drop out, tend to see better outcomes, and most closely follow the treatment protocol for PET when speaking in their native language. In an increasingly bilingual world, therapists may share a common language with a client but may be unable to speak the client’s native language. A novel solution for PET involves starting therapy in the therapist/client dyad’s shared language and then eventually conducting imaginal exposures in the client’s native language. The following case provides a successful example for how and why such therapy can be conducted.