Seeing Therapy Clients in English? Five Things to Know First

Here are five things to know if you want to expand your practice to English-speaking patients without feeling overwhelmed.

When I tell my therapist friends I teach clinical psychologists English, they often have similar reactions:

“Wow- that sounds great, but I wouldn’t even know where to start. There’s so much to learn, and I only have a C1 level,”  

And I totally understand; sometimes it feels like, in therapy sessions, we need to have absolute control over every single word. Many therapists would love to perfectly understand each single word their clients use and never make any mistakes. So of course, it feels impossible to work in English, if we expect no less than perfection!

It sometimes frustrates me to think about all those experienced, and capable therapists who aren’t helping English-speaking patients because they are too scared of pronouncing the word “beach” like “bitch” (How often do you talk about beaches in your sessions anyway?!)  

So, here’s a way to get around that. Working with English-speaking clients could be easier than you think if you bear these five tips in mind:  

1.     To begin, you need an advanced (C1) spoken level of English, but not necessarily a proficient/bilingual (C2) level. To work as a therapist in English, you need great fluency, accuracy, and a lot of specialized vocabulary in the field of psychology. However, there is no need to start with a proficient, or C2 level. Why not? Firstly, the way you speak is focused on specific objectives. It’s not really useful to be able to talk about other highly specialized things like spark plugs or a windshield washer (parts of a car). Even if your client starts talking about their car in a lot of detail, you’re trying to understand the underlying meaning and emotion behind what they are talking about, not the car itself. Secondly, your level of English will improve as you work with English-speaking clients (see the last point).

What if you’re not sure what your level is? Just book a free consultation with me! In 60 minutes, we will discuss your level, needs and objectives.

2.     You will need a proficient level of listening comprehension (C1+ or C2). Yep, this point is really what you really want to focus a lot of your energy on. Of course, speaking skills are crucial, but the most important thing is to understand your clients so you can respond to them accurately in the first place. When working with English-speaking patients, you’ll likely be exposed to all sorts of accents from people around the world. Many of your clients will use different varieties of English (American English versus British English, slang versus more formal English…) Besides, you’ll often be in situations where people don’t speak very clearly (they’ll cry, mumble, whisper, or if you’re working online, there might be technical issues). Finally, you might decide to work with children or the elderly, who are more difficult to understand. In conclusion, it’s important to train your ear as much as possible before working with English-speaking clients.

3.     It’s generally not very useful to focus on developing your reading and writing skills. Finally, some good news, right? Don’t get me wrong, both skills are important. Reading does improve your vocabulary, but it’s very time-consuming. And time is not something most therapists have a lot of. As for writing, you will likely need to write emails or maybe even simple reports, but these are usually quite formulaic or methodical. From a therapeutic perspective, it’s usually considered better for important conversations to take place in sessions, rather than via emails. What’s more, these days, there are tech tools that can help you write more accurately, like Grammarly or Chat GPT.

4.     Therapists already have many paralinguistic skills they can use to express nuances in meaning. Of course, the choice of words you use is very important, and that’s what I help my clients with. I teach them how to grow their vocabulary and improve their grammar in ways that are appropriate to their use in clinical sessions. If that’s what you’re interested in, I’m happy to help.

However, therapists sometimes forget that they convey a lot of meaning simply through body language, facial expressions, tone of voice, use of silence, gestures, etc. For example, when my students aren’t sure how to formulate an intervention in a more polite way, I notice they soften their tone of voice and speak in a slower, more tentative way. This is another way of transmitting the same message.

 5.     Clients/patients are often the best teachers. As you continue to work with English-speaking clients, you will constantly be exposed to new vocabulary, idioms, and ways of expressing thoughts and feelings. You cannot completely prevent minor mistakes and small misunderstandings from happening. In fact, they will allow you to become a better English-speaking therapist. Unfortunately, if you wait for your English to be 100% perfect before you start working with clients, you’ll never feel ready enough. You might have to accept that your patients will help you to grow too. 

In conclusion? Working with English-speaking clients might be a little easier than it sounds. 

Yes, it does require a minimum level, some preparation, and a lot of controlled practice. However, therapists are constantly learning how to perfectly attune to their patients in their own language, and this very powerful skill you have will help you learn the English you need.

If you want more specialized tips on how to provide therapy in English, feel free to download my free guide and join my email list here.