Reflections on Bilingual Therapy, Defense, and Emotional Access in the Case of “Mary”

Abstract

Fuertes and Xu (2026) present a case study examining the psychological roles of language in bilingual psychotherapy through their work with “Mary,” a Chinese international graduate student navigating anxiety, shame, and acculturative strain. In this commentary, I focus on two main areas: (1) clinical decision-making and mechanisms of change through treatment, and (2) the broader theoretical, training, and service delivery implications that arise from the work. In both areas, language is emphasized as a tool for affective regulation and psychological defense. I also highlight the timing of linguistic challenges in building the therapeutic relationship and the role of the supervisor in providing a supportive and reflective holding environment, and  examine the complexities in interpreting outcome data, particularly when changes in symptoms do not clearly match signs of psychological growth.  Institutional factors, such as the limitations of short-term university counseling and the need for supervision that responds to cultural and language differences, are also discussed.  Overall, the case serves as an insightful way to understand  bilingual psychotherapy not merely as treatment across two languages, but as a process that takes place through multiple emotional, relational, and language domains.