Language Use as Both Bridge and Barrier in Bilingual Therapy: A Single Case Study Analysis of the Chinese International College Student, “Mary”

Abstract

Psychologists often encounter clients from varied language and cultural backgrounds, which can pose challenges to the process of helping. The case of "Mary," an unmarried, 24-year-old Chinese international student in the U.S., embodies these dynamics and offers insights into how culture and language shape, and are shaped by, the therapy alliance, process, and outcome in bilingual therapy. Mary was seen in individual therapy that combined a multicultural, relational psychodynamic, humanistic, client-centered, and solution-focused approach by one of the authors  (Y.X.) for 10 sessions (over a 14-week period, with four cancellations); and the therapy was supervised by the other author (J.N.F.). Mary’s presenting problems included challenges in adjusting to her new environment, including a decline in self-confidence and difficulties in her social life, which led to significant anxiety in her daily life.

To enhance understanding of the course of therapy, we employed an adapted version of the Critical Incidents Technique (CIT) to analyze significant moments in Mary’s 10 sessions. We focus on the role of language use in bilingual therapy, exploring its functionality as both (a) a buffer against the intense impact of emotional and traumatic experiences, and (b) as a bridge that can foster deeper psychological engagement. We highlight the mechanisms by which the therapist, with supervision, attempted to provide Mary with a meaningful and helpful psychotherapeutic experience. The core theme in our analysis of the case includes the ways that Mary uses her primary (Mandarin) and secondary (English) languages to avoid, and then access, hurtful and traumatic experiences.