The First Session in a Second Language

Guest posts occasionally bring perspectives and expertise that differ from my own work as a psychotherapist and expat therapist. I believe there is value in exploring different lenses on expat life – including financial, practical, and logistical realities that can shape a family’s experience abroad. 

Guest contributor Peter Klein from Seek a Psych wrote the article below, shared here in its original form. The views, guidelines, and recommendations expressed are entirely those of the author and do not constitute advice from me or my practice.

As always, readers are encouraged to seek appropriately qualified professional advice regarding their own circumstances.

Guest posts occasionally bring perspectives and expertise that differ from my own work as a psychotherapist and expat therapist. I believe there is value in exploring different lenses on expat life – including financial, practical, and logistical realities that can shape a family’s experience abroad. 

Guest contributor Peter Klein from Seek a Psych wrote the article below, shared here in its original form. The views, guidelines, and recommendations expressed are entirely those of the author and do not constitute advice from me or my practice.

As always, readers are encouraged to seek appropriately qualified professional advice regarding their own circumstances.

What I personally found particularly interesting in Peter's piece is that, at Middlesex University, I undertook research into how therapists experience conducting therapy in a language different from their mother tongue. In this article, Peter approaches the subject from the other side: the perspective of the client seeking therapy in a language other than their first.

My own experience of having therapy in English, which is my second language, has been somewhat different from some of the experiences Peter describes. English was, in many ways, the language in which I first learned to express myself emotionally, to connect more fully with my inner world, and to explore some of my earlier experiences. It became a language through which I could access parts of myself that I had not previously found the words for.

Reading Peter’s article has made me reflect further on how personal our relationship with language can be. For some, their first language may hold the strongest emotional associations, while for others, another language may offer a different kind of freedom, distance, or possibility for expression. Perhaps what matters is not simply which language we speak, but what that language has come to mean in our lives, and what becomes possible when we feel safe enough to express ourselves in it.

Peter explores some of these nuances in the thoughtful article below.

Thank you to Peter for his contribution - if you would like to contribute an article about expat life to my blog, please feel free to contact me at henriette@thegoodexpatlife.com.

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I was born in Germany and have lived in England for most of my adult life, so my clinical work happens in English. That is my second language. People hear it and assume something must be lost on the way across.

Now and then something is. A word turns up in German first and I have to reach past it. What the arrangement has taught me is that fluency and accuracy are separate skills. Therapy leans very hard on the second.

The version of you that arrives in English Expats usually arrive at a first appointment with a rehearsed account of why they have come. Often that account is already in English, because the decision was made in English, in a search box, at 11pm. It tends to be a good account. It has been tested on friends. Sometimes that is the problem. The rehearsed account is tidier than the one that comes out once they stop performing it, so I ask what was happening on the day they decided to look for help.

Something shifts when a client tells the same story in the language it happened in. English gives distance. A man can describe a scene from childhood in flat, factual sentences that would be impossible for him in Polish, and the flatness tells me more than the story does. He is still holding it away from himself. Switch him back and the scene takes longer to say, the detail thickens, and his breathing changes before his words do. That is where I stop taking notes.

None of that makes the distance a trick, and it does not stay kind. Shame attaches to particular words, and those words are usually the ones the people who raised you used. Some clients can only say them after switching.

Words that exist in one language only

A client stops mid-sentence and says English has no word for it. Then they produce one, and the room changes. I listen for that. It might be a single term carrying a whole family arrangement, or the particular way a parent said their name when something had gone wrong.

Newer arrivals have the reverse problem. They have plenty of vocabulary for daily life in the new country and almost none for what happened before they moved. Registering with a doctor and describing how you felt at the age of 12 need different words, and only one set has been practised lately.

What has no words at all

Not everything arrives in a sentence. Some of what clients bring was laid down before they had much language, and it surfaces as an image, a smell, or the arrangement of a room. Words become a poor tool at that point, and an unnecessary one.

I have sat with people who could describe nothing except a pressure in the chest and the colour of a hallway. We worked with what was there, in the order it arrived, and the words came later, badly at first and then well enough to use.

Plenty of people worry in advance that their English will not stretch to therapy. It does not need to. The work does not turn on your vocabulary, and it never has. It turns on staying with something difficult while another person is in the room, which most people can manage in whatever language they can produce three honest sentences in.

Switching in the middle of a session

Some clients use both languages in a single hour, sometimes inside one sentence, without any chaos. That is normal. Decide together at the start which language the sessions will run in, and say plainly that a switch is allowed at any point.

One arrangement I have used ran the first 10 minutes in German and the rest in English. The 10 minutes were where the week's real material surfaced, and after a while we both expected it there.

An interpreter in the room changes the work

A relative interpreting changes things well beyond accuracy. An adult will not say some things in front of a parent, and a parent will not always interpret faithfully either. A trained interpreter is the better answer, though still a third person present and still a filter.

The pace shifts. Everything arrives one beat later, and a client has time to hear themselves, which some people find unbearable and others find useful. Idiom is where it shows most. A good interpreter will stop and say they cannot carry a word across, and that pause is often the most honest moment in the hour.

Choosing a therapist, and checking their background

Two questions about the therapist matter more than most of what their website says. Do they work in your language because it is their first, or because they learned it well later? And where did they train, in that language or another one? Clinical vocabulary learned as a student sits differently in the mind from a language picked up later at a desk.

Then the background. In the UK, counsellor and psychotherapist are not protected titles, so anyone may use them. Clinical psychologist and counselling psychologist are protected, and both sit on a statutory register you can check. The professional bodies for the talking therapies, among them BACP, UKCP and NCS, hold voluntary registers, which is a different thing from a licence. Accreditation from one of them means training, supervision and practice have been checked and that the accreditation can be withdrawn. It is worth knowing which of the two you are looking at.

Germany runs a different system and repays a little reading before you book. Psychotherapeut is a protected title with one defined training and licensing route. The Heilpraktiker für Psychotherapie is a separate legal category with a narrower scope and a shorter training behind it, and both can appear on one website with no explanation. Denmark brought psychologists into its general healthcare authorisation system on 1 January 2026, administered by Styrelsen for Patientsikkerhed, with a transitional arrangement that allows people who were entitled to use the title psychologist under the previous rules at the end of 2025 to continue doing so until 31 December 2028.

. The Netherlands keeps a register for healthcare psychologists. Ireland registers psychologists through CORU, while counsellors and psychotherapists sit on voluntary association lists. In each case, ask anyway.

Four questions get most of the way, and a practitioner who has been asked them before will answer them in about a minute.

• Which register are you on, and what is the number?

• Where did you train, and what qualification did that give you?

• Who would I complain to if something went wrong?

• Are you supervised, and by whom?

A registration number tells you that someone has been checked at least once, that a training of several years sits behind the name on the door, and that a body exists which can consider a complaint. None of it shows up on a website that advertises fluency and kindness and nothing else.

Because so much of this work now happens online, a therapist in Copenhagen can take a client in Manchester. Requirements differ by country, and some regulators restrict work with clients based in their jurisdiction, so ask where the therapist is physically sitting when they see you, and which body would handle a complaint about them. A careful practitioner will know. If they cannot answer, treat that as your answer.

The first hour, practically

A first appointment is usually somewhere between 45 and 60 minutes, though the shape of it varies with the country and with the therapist. Some use a longer assessment, and some go straight into the work. Part of the hour goes on why you came, and part on whether the two of you are a workable pair. If the whole appointment goes on paperwork, ask when there will be time to talk about what brought you. What you are trying to gauge is whether this person can hold something difficult without flinching or filling the silence.

Bring the thing you would rather not bring. If saying it is too much, write it down and hand it over, or read it aloud. Several clients have done that with me, and it changed nothing about the treatment except that we could begin.

At the end, ask whether they would work differently if you switched language. The reply tells you whether language is part of their thinking or just something the website advertises. Most therapist websites go quiet on this. A short, specific answer is a good sign.

When your therapist is more fluent in the shared language than you are

This is the common situation for an expat. The sessions run in English, and the therapist has more of it than the client does. Raise it early. It feels awkward for about ten seconds, and it saves a year of sessions in which you softened every sentence. Say plainly that you will be more precise in your own language, and ask them to slow down rather than finish your sentences for you. I would rather be told that at the start, so we can decide together what to do with it.

The reverse happens too, and it is worth naming. A client can be the more fluent one, when the therapist trained in another country or learned the language as an adult. Then the work can quietly run on the client's English, and the client ends up looking after the therapist's comprehension. If you notice yourself doing that, say so. Aim for accuracy. Eloquence is not the point of the hour. Say it in whichever language holds it. If the exact word for the thing turns up in the language you left behind, say it there and let the therapist catch up.

Peter Klein is a BABCP-accredited cognitive behavioural psychotherapist working in Richmond, London, in German and English, in person and online. He runs Seek A Psych, a multilingual directory where you can find a therapist who works in your own language, in the UK or online.

My own experience of having therapy in English, which is my second language, has been somewhat different from some of the experiences Peter describes. English was, in many ways, the language in which I first learned to express myself emotionally, to connect more fully with my inner world, and to explore some of my earlier experiences. It became a language through which I could access parts of myself that I had not previously found the words for.

Reading Peter’s article has made me reflect further on how personal our relationship with language can be. For some, their first language may hold the strongest emotional associations, while for others, another language may offer a different kind of freedom, distance, or possibility for expression. Perhaps what matters is not simply which language we speak, but what that language has come to mean in our lives, and what becomes possible when we feel safe enough to express ourselves in it.

Peter explores some of these nuances in the thoughtful article below.

Thank you to Peter for his contribution - if you would like to contribute an article about expat life to my blog, please feel free to contact me at henriette@thegoodexpatlife.com.

---

I was born in Germany and have lived in England for most of my adult life, so my clinical work happens in English. That is my second language. People hear it and assume something must be lost on the way across.

Now and then something is. A word turns up in German first and I have to reach past it. What the arrangement has taught me is that fluency and accuracy are separate skills. Therapy leans very hard on the second.

The version of you that arrives in English Expats usually arrive at a first appointment with a rehearsed account of why they have come. Often that account is already in English, because the decision was made in English, in a search box, at 11pm. It tends to be a good account. It has been tested on friends. Sometimes that is the problem. The rehearsed account is tidier than the one that comes out once they stop performing it, so I ask what was happening on the day they decided to look for help.

Something shifts when a client tells the same story in the language it happened in. English gives distance. A man can describe a scene from childhood in flat, factual sentences that would be impossible for him in Polish, and the flatness tells me more than the story does. He is still holding it away from himself. Switch him back and the scene takes longer to say, the detail thickens, and his breathing changes before his words do. That is where I stop taking notes.

None of that makes the distance a trick, and it does not stay kind. Shame attaches to particular words, and those words are usually the ones the people who raised you used. Some clients can only say them after switching.

Words that exist in one language only

A client stops mid-sentence and says English has no word for it. Then they produce one, and the room changes. I listen for that. It might be a single term carrying a whole family arrangement, or the particular way a parent said their name when something had gone wrong.

Newer arrivals have the reverse problem. They have plenty of vocabulary for daily life in the new country and almost none for what happened before they moved. Registering with a doctor and describing how you felt at the age of 12 need different words, and only one set has been practised lately.

What has no words at all

Not everything arrives in a sentence. Some of what clients bring was laid down before they had much language, and it surfaces as an image, a smell, or the arrangement of a room. Words become a poor tool at that point, and an unnecessary one.

I have sat with people who could describe nothing except a pressure in the chest and the colour of a hallway. We worked with what was there, in the order it arrived, and the words came later, badly at first and then well enough to use.

Plenty of people worry in advance that their English will not stretch to therapy. It does not need to. The work does not turn on your vocabulary, and it never has. It turns on staying with something difficult while another person is in the room, which most people can manage in whatever language they can produce three honest sentences in.

Switching in the middle of a session

Some clients use both languages in a single hour, sometimes inside one sentence, without any chaos. That is normal. Decide together at the start which language the sessions will run in, and say plainly that a switch is allowed at any point.

One arrangement I have used ran the first 10 minutes in German and the rest in English. The 10 minutes were where the week's real material surfaced, and after a while we both expected it there.

An interpreter in the room changes the work

A relative interpreting changes things well beyond accuracy. An adult will not say some things in front of a parent, and a parent will not always interpret faithfully either. A trained interpreter is the better answer, though still a third person present and still a filter.

The pace shifts. Everything arrives one beat later, and a client has time to hear themselves, which some people find unbearable and others find useful. Idiom is where it shows most. A good interpreter will stop and say they cannot carry a word across, and that pause is often the most honest moment in the hour.

Choosing a therapist, and checking their background

Two questions about the therapist matter more than most of what their website says. Do they work in your language because it is their first, or because they learned it well later? And where did they train, in that language or another one? Clinical vocabulary learned as a student sits differently in the mind from a language picked up later at a desk.

Then the background. In the UK, counsellor and psychotherapist are not protected titles, so anyone may use them. Clinical psychologist and counselling psychologist are protected, and both sit on a statutory register you can check. The professional bodies for the talking therapies, among them BACP, UKCP and NCS, hold voluntary registers, which is a different thing from a licence. Accreditation from one of them means training, supervision and practice have been checked and that the accreditation can be withdrawn. It is worth knowing which of the two you are looking at.

Germany runs a different system and repays a little reading before you book. Psychotherapeut is a protected title with one defined training and licensing route. The Heilpraktiker für Psychotherapie is a separate legal category with a narrower scope and a shorter training behind it, and both can appear on one website with no explanation. Denmark brought psychologists into its general healthcare authorisation system on 1 January 2026, administered by Styrelsen for Patientsikkerhed, with a transitional arrangement that allows people who were entitled to use the title psychologist under the previous rules at the end of 2025 to continue doing so until 31 December 2028. The Netherlands keeps a register for healthcare psychologists. Ireland registers psychologists through CORU, while counsellors and psychotherapists sit on voluntary association lists. In each case, ask anyway.

Four questions get most of the way, and a practitioner who has been asked them before will answer them in about a minute.

• Which register are you on, and what is the number?

• Where did you train, and what qualification did that give you?

• Who would I complain to if something went wrong?

• Are you supervised, and by whom?

A registration number tells you that someone has been checked at least once, that a training of several years sits behind the name on the door, and that a body exists which can consider a complaint. None of it shows up on a website that advertises fluency and kindness and nothing else.

Because so much of this work now happens online, a therapist in Copenhagen can take a client in Manchester. Requirements differ by country, and some regulators restrict work with clients based in their jurisdiction, so ask where the therapist is physically sitting when they see you, and which body would handle a complaint about them. A careful practitioner will know. If they cannot answer, treat that as your answer.

The first hour, practically

A first appointment is usually somewhere between 45 and 60 minutes, though the shape of it varies with the country and with the therapist. Some use a longer assessment, and some go straight into the work. Part of the hour goes on why you came, and part on whether the two of you are a workable pair. If the whole appointment goes on paperwork, ask when there will be time to talk about what brought you. What you are trying to gauge is whether this person can hold something difficult without flinching or filling the silence.

Bring the thing you would rather not bring. If saying it is too much, write it down and hand it over, or read it aloud. Several clients have done that with me, and it changed nothing about the treatment except that we could begin.

At the end, ask whether they would work differently if you switched language. The reply tells you whether language is part of their thinking or just something the website advertises. Most therapist websites go quiet on this. A short, specific answer is a good sign.

When your therapist is more fluent in the shared language than you are

This is the common situation for an expat. The sessions run in English, and the therapist has more of it than the client does. Raise it early. It feels awkward for about ten seconds, and it saves a year of sessions in which you softened every sentence. Say plainly that you will be more precise in your own language, and ask them to slow down rather than finish your sentences for you. I would rather be told that at the start, so we can decide together what to do with it.

The reverse happens too, and it is worth naming. A client can be the more fluent one, when the therapist trained in another country or learned the language as an adult. Then the work can quietly run on the client's English, and the client ends up looking after the therapist's comprehension. If you notice yourself doing that, say so. Aim for accuracy. Eloquence is not the point of the hour. Say it in whichever language holds it. If the exact word for the thing turns up in the language you left behind, say it there and let the therapist catch up.

Peter Klein is a BABCP-accredited cognitive behavioural psychotherapist working in Richmond, London, in German and English, in person and online. He runs Seek A Psych, a multilingual directory where you can find a therapist who works in your own language, in the UK or online.