Psychotherapy in a Foreign Language

This text is the result of the reflections I gradually matured during my life, in particular during my years abroad: since most of my patients spoke a different language from mine, the analytical work was conducted in their native language, english or french.
Working with a mother tongue which was not mine, it has stirred in me a lot of questions in those years: how could I understand my future foreign patients since I  learned english and french at school and then I have broadened my knowledge but I am not  native speakers in any of them?   Would I be able to communicate, understand and  make me understand? Would  the relationship between us be shallower, less personal,  less authentic because of this? Would I be able to understand the cultural differences  they proposed  me  beyond those languages? and  which implications it would have on transference (analyst projection of emotions and dynamics from the patient’s internal world)?
What emerged in the evolution of the work with my foreign patients was that the understanding of their lived didn’t  make its way into me  with  translation and/or understanding of each word  they said,  but thanks to the way  I felt  myself in the relationship with them.
For example, Tom, an English child of six, dwelt for entire sessions describing the green monsters that  attacked and  frightened him so much. The theme of aggression    materialized immediately in a  talk with his parents,  when emerged  their high level of mutual   anger that came  with screams and bluster even before children . Yet even if I have been working a long with Tom on the aggressiveness issue of his family, he carried on  dwelling in the description of these monsters. The more Tom dwelt on  their details,  the more I tried to  decode  all terms,  the more I felt  unable  to understand who they were, what did they mean to him .  At one point it broke inside me a strong feeling of loneliness, which accompanied me during our meetings  and  made me realize that it had nothing to do with our language difference. Rather it had to do with a  foreigner in the relationship, loneliness, that needed to be translated into a language understandable for both.  I told Tom I felt very  alone during our sessions despite my being  there with him, and asked him if he felt the same in his life too.  My words attracted his attention, leading him away from the story of the monsters and Tom replied affirmative.   I told him that maybe he sought refuge in his own world  with his monsters because he was very angry.  Tom looked at me and  told me I had it all figured out.
In working with my foreigner patients I understood I had to take into account  cultural differences conveyed by language differences.
I have had some Irish patients   leading  me to reread  things that, in my culture, were considered alcohol abuse in a different social way, not only related to  addiction problems. In Irish culture the  ”  heavy drinking  ”  is part of being together, of having fun.  It is a tradition passed on from their families.
My patients, living abroad, find themselves among countrymen, even with family and children    and got drunk to have fun together, to feel part of their world  of origin   .
With these patients I realized how much I had to be different and delicate in dealing with the  “alcohol “issue. All issues related to addiction and substance abuses were present in them, but there was also another “new”, cultural element, that as a therapist I had to learn to modulate my thoughts.
The harmful effects of the substance on the body, could not enter the mind of my patients, they did not exist.
The mere thinking of a funny alternative was a thought very hard to be taken into my patients’ consideration because it meant betraying their culture and their country and therefore being excluded from the community.
It meant becoming stranger to themselves, living in a grey non-membership area.
In the context of a  multilingual  analytical work, the analyst is also  more  sensitive to non-verbal  aspects of communication.
The patient’s story is  heard  not only from the point of view of the meaning. It is heard also from the point of view of the  sound and poetic : thus it is more easily to catch those emotional and bodily dissonances expressing unconscious patient voices.
Language may be considered a shared experience, a relational one: it allows us to transmit   each other what we feel, what we think  , and vice versa.  And it helps us to understand if one understands us or what one thinks.
The linguistic aspect is an aspect of the relationship, but not the most important.
There are also other channels of communication.
Let’s consider for example the relationship Newborn-Mother.
It is now known that the interactions between a mother and her baby, in  the first days, months of life, are  possible because, immediately after birth, it is already present in the baby a capacity/need to be in relation: it precedes  his possibility to express verbally.
Essentially it is a very efficient system of non-verbal emotional, but facial, vocal and gestural, a system which remains active for the rest of his   existence.
Day by day the newborn, who  expresses himself through his crying and body, and the mother try to  create  a common language among themselves which will allow both to feel recognized, understood and  loved.
I guess with my foreign patients, but not only with foreign ones, it is set in motion this kind of  ”  emotional  adjustment” which is not related to verbal but to what comes before   and   traces its  origins  from the mother-newborn  dyad.
I meet with   them in a “transitional space” similar in its construction to the dynamics  occurring between a child, who is learning to speak and his mother. Mother says a word, the child repeats it in his way and his babbling is the interpretation of  the way the mother has shown the world. At that point the mother integrates into her way of speaking the babble of the child.
Language becomes maternal as it contains and outlines the feelings and experiences both of the mother and of the child.
In the studio the analyst interprets, the patient babbles in response to interpretation, the therapist reinterprets, transforming what the patient said: in this way  a new meaning is produced .
So therapist and patient come to speak the same language.
The analyst acts as a mother who teaches a new language to the patient, the language to decipher his inner world.
Not to mention that even the silent presence of the mother tongue and the culture of the therapist, as otherness, may affect the meeting.
Foreign is not at least the language that the patient speaks, but the part that everyone has inside, which requires a space and an interpreter in order to accommodate, mean and transform it.