A Response to “Reflections on Bilingual Therapy, Defense, and Emotional Access in the Case of ‘Mary’”

Abstract

This article responds to Dr. Marcela Almeida’s (2026) commentary regarding our case study of the bilingual psychodynamic treatment of "Mary," a Chinese international student (Fuertes & Xu 2026). This response addresses key clinical and systemic themes, beginning with an elaboration on context-dependent and language-dependent memory literature to support the integration of native language (L1) in bilingual therapy. Re-examining the relational dynamics of the therapeutic dyad, this response clarifies that the therapist's approach was a deliberate clinical stance rooted in shared demographic empathy and maternal/big-sister countertransference, rather than a defensive peer performance. Furthermore, Mary’s consecutive session cancellations are conceptualized as active, existential communications regarding her readiness to cross linguistic and emotional thresholds, rather than standard therapeutic ruptures. This response also discusses how the subsequent shift from English to Mandarin was facilitated through deliberate, supervised "planted" interventions that tested the elasticity of the client’s defenses to allow an organic affective awakening. Finally, the response highlights the limitations of standard English-normed symptom scales within university counseling center models and echoes the call to formalize bilingual psychotherapy as a distinct, rigorous specialty competency supported by linguistically matched, culturally responsive supervision.