In a multicultural society, it’s inevitable that counsellors, like everyone else, will come across people whose first or even second language is not English. But if therapist and client are — quite literally — speaking different languages, how can therapeutic work even begin to take place? The answer lies in the gift of empathy.
A colleague of mine was working some time ago with a client whose first language was not English. Nor was her second language. English was in fact her third language, and not one that she felt very competent in at that point. The only reason I know this is because I spoke to her when she first enquired about counselling at the centre where I work. She was understandably nervous — for several reasons no doubt — and I didn’t feel I’d been able to reach her on even a superficial level to pass on information. How much more difficult then for my colleague when he and his new client sat down together and tried to establish a therapeutic understanding between them?
One answer would of course be to have an interpreter in the room, but that brings its own challenges — not least that it introduces an additional ‘unknown quantity’ into the room, someone else that the client may have anxieties about trusting with her personal ‘stuff’. It may also be inappropriate or ethically unsound: will the interpreter be bound by the same or similar rules on confidentiality? Who will be responsible for sourcing someone suitable and qualified? Who will be responsible for paying their fee? Leaving aside the client’s concerns about having an interpreter in the room, how might the therapist feel to have their ‘performance’ witnessed by someone other than their client? How much confidence might the therapist have that their words and intentions are communicated accurately to their client, and vice versa?
So given a situation where counsellor and client are — quite literally, as well as metaphorically — speaking a different language to each other, how can they be sure that their relationship will be as therapeutically solid and effective as possible? How can the therapist be sure that he or she is truly ‘hearing’ the client, and how can the client be sure that he or she has been understood by the therapist?
There is the potential in every relationship (therapeutic or otherwise) for a gap to exist between what has been said (and intended) and what has been heard (and understood), even when the speakers are using the same language. But in the therapeutic relationship, where a much greater depth of understanding is required, that gap could so easily become an unbridgeable gulf, leaving the client feeling ‘unheard’ and frustrated, and the counsellor feeling deskilled or inadequate.
So what was my colleague and his new client to do? Interestingly, such were the limitations of the client’s vocabulary when it came to describing her feelings, that my colleague was thrown back (for want of a better phrase) onto relying on his other senses in order to understand what his client was struggling to find words for.
It’s a commonly-stated ‘fact’ that the majority of the meaning in communication is transmitted non-verbally — through tone of voice, facial expression and body language — rather than through the content of the words themselves. This concept, which you might argue has achieved the status of ‘generally accepted truth’, emerged from some research done in the late 1960s by a psychologist, Albert Mehrabian, and his colleagues at the University of California in Los Angeles. Mehrabian’s famous formula suggests that 7% of the message a speaker is conveying comes through the content of the words spoken, 38% of the message is conveyed by tone of voice, and 55% by the body language of the speaker. This concept — the significance of the non-verbal aspects of communication — has long been seized upon by public speaking and communication trainers to emphasise the importance of having congruence between what you say, how you say it, and how you feel (as expressed in your facial expression and body language) about what you’re saying.
Take this example: a man and a woman are on a date, and the man asks the woman if she’s having a good time; the woman says yes, she is, but her tone of voice is strained and her body language is quite closed (arms folded, avoiding eye contact, etc.). According to Mehrabian, this might suggest that the woman is not telling the whole truth about her feelings. On the other hand, you might argue that perhaps she’s just cold and avoiding eye contact because of glare from the lights. In fact, critics of Mehrabian’s research, and there are many, argue that his approach was too simplistic and not really applicable to the way people communicate in the real world.
(You can find a summary of Mehrabian’s work on his own website: Biographical Sketch of Albert Mehrabian. If you’re looking for a critique of his work, one site with an introduction and links to more detailed reviews is Speaking About Presenting.)
Criticisms aside, it’s nevertheless true that meaningful communication is about much more than just the words that we use, however carefully chosen and nuanced they may be. A great deal of understanding can be gained from a kind of ‘enhanced listening’ — becoming aware of facial expression, patterns of breathing, points of tension or otherwise in the body, posture, tone of voice and so on. How else would we be able to follow a story told only in gesture and expression by mime artists?
But how do we actually understand the meaning of what someone is trying to tell us when they don’t have the words to express how they feel? The ability to tune into, or share, the emotional and sometimes physical feelings of another person, and to understand on a cognitive or mental level the reasons for those feelings is known as empathy — identified by the psychotherapist Carl Rogers as one of the core elements of what he called his “person-centred” approach to therapy.
Interestingly, there has been some research into the neurological processes involved in empathy. Magnetic resonance imaging scans (MRIs) have demonstrated that when a person is shown an image of pain being inflicted on someone else, the same area of the brain ‘lights up’ as when the observer him or herself experiences pain directly. (See the 2005 article by P.L. Jackson, A.N. Meltzoff, and J. Decety called How do we perceive the pain of others: A window into the neural processes involved in empathy, in NeuroImage, vol. 24, pp. 771-779.) The same phenomenon applies to other emotional or physical responses as well. So if you’ve ever watched a documentary about a painful surgical operation and found yourself rubbing the same part of your own body as if it hurt too, or listened to a friend talking about an embarrassing incident and felt your own cheeks going red, then you’ve experienced a bodily empathic sense of someone’s else’s emotional or physical state.
Part of my training as a counsellor involved becoming aware of the feelings and sensations in my body as I sat with my clients, and tuning into the implicit information that they might be giving me about what is going on inside my client’s emotional world. By tuning into what is not being said out loud by a client, but which may be clear from his or her body language and tone of voice, a therapist can provide a feeling for the client of being understood at a very deep level indeed. And that can be immensely healing.
And so even though my colleague could only share a few words of English with his new client, he was able nonetheless to express to her a sense of being understood: that her emotional pain had been ‘felt’ by him. And that in itself was the beginning of a therapeutic conversation.
All clinical material on this site is peer reviewed by one or more clinical psychologists or other qualified mental health professionals. This specific article was originally published by Dr Greg Mulhauser, Managing Editor on .on and was last reviewed or updated by