How to Handle 5 Language Issues with Native English Therapy Clients

Spoken by a quarter of the world’s population, English is currently the world’s lingua franca.

This seems like an advantage for native English speakers, right?

They rarely need to learn a second language. They can attend therapy sessions in English almost everywhere around the world. But if therapists who speak English as a second language struggle to understand, does it simply mean their English isn’t good enough?

Not so fast.

Effective interpersonal communication is a two-way street, and both speakers share responsibility.

Many of the native English speakers who do not have to or want to learn another language fluently often lack awareness of what it’s like to communicate in a second language. They don’t always adjust their speech for non-native speakers, which can make them less effective communicators in multilingual settings.

Here are five language difficulties when working with native English speakers, and strategies to address them.

1.        Fast-paced speech

While intermediate English language learners say 150 words per minute, native speakers on average speak 250 words per minute. - nearly double!

This can make comprehension harder, especially when a native speaker client isupset. They might be speaking quickly and crying, mumbling, stammering or whispering.

But what should you do? Can you ask a client to slow down?

It depends on the context- use your clinical judgement here.

For instance, you can make it mindfully model slow, reflexive and deliberative speech, using appropriate pauses, which can implicitly encourage your client to mirror this.

For emotionally dysregulated or distressed clients, a softer, slower and soothing tone of voice can help. You can suggest taking a deep breath. (For instance like this therapist who gently says “Why don’t we take a few breaths together?”)

Some other phrases you could use:

• "Let’s pause for a second and take a big, deep breath”

• “Try taking a long breath … in…. and exhale out. That’s right.”

Breathing techniques can help very angry clients too, but adapt your tone of voice so it’s not overly soft and gentle.

If you’re struggling to understand what they’re saying, try tuning into their body langugage and non-verbal cues. Reflect the emotions they are expressing, rather than the content:

• This has really hit a nerve for you”

• “I can see how (upset/angry/frustrated/ furious) this is making you.”

You could help them defuse from this emotion by describing its intensity:

• “On a scale of 1 to 10, how angry would you say you are right now?”

If you have a strong alliance with a client who is speaking quickly but aren’t emotional, you could use playful humor. Make sure you smile and use a light-hearted tone.

• “Hang on a second- my poor old brain isn’t going as fast as yours. Let’s pause for a second so it can catch up”

• (Using a metaphor of a slow and fast road) "Whoa, we’re speeding right up on the highway now! I’m barely keeping up! Can we take the scenic route for a bit?"

Of course, listening to fast-paced speech becomes easier with practice (see tip 2 for connected speech below).

2.        Connected Speech

Native speakers don’t pronounce each word distinctly; they link words together in a natural flow. This can make it difficult for learners to distinguish where one word ends and another begins.

Ten years ago, I lived in Melbourne, Australia with my Spanish ex-boyfriend. He had an upper intermediate level of English and wasn’t very familiar with the Australian accent (there aren’t a whole lot of Australians in Seville!).

One day, he asked “What does arecón mean? I hear it all the time!” Confused,  I said I had no idea, and that it sounded like a Spanish word.  A few nights later, we were having dinner with friends when someone said “Oh, I reckon it’s closed on Sundays”. My ex elbowed me, excitedly. “That’s it! Arecón!!”. It made perfect sense that he'd heard I reckon as one word. It’s a colloquial way of saying “I think” that is more commonly used in specific parts of the US and Australia.

Understanding connected speech takes time, but shadowing (imitating native speakers) is a useful technique for improving comprehension and pronunciation. 

Listening to mental health professionals from different English-speaking countries is one of the most helpful things you can do.  These podcasts are in American English, these are great Australian, Canadian and British YouTube channels/playlists, and the therapist in this movie has an Indian accent.

3.        Phrasal verbs

If you’ve been learning English for a while, you might shudder or feel sick at the thought of studying phrasal verbs. They are so notoriously difficult that native speakers make funny videos about them. Break up (a relationship ending), break in (a robber entering your home), break out (getting pimples) and break through (making progress) mean completely different things. This means that if you use the wrong preposition, you can make a mistake that causes a big misunderstanding.

So, what should you do? Focus on the most common ones. Only try to learn one at a time, including practising it in conversations. And if in doubt, try to use another verb instead, or ask your client to explain what they mean (see tip 4 below)

4.        Lesser-known vocabulary and expressions

English is full of weird, colourful vocabulary and expressions. There are reduplicates like wishy-washy and airy-fairy, constantly evolving slang like “stan” and “salty” and regional idioms or expressions. This often confuses native speakers too!

Before trying to memorise every new word, consider how useful it will be in sessions. Should this word be a part of your active or passive vocabulary?

If you can’t deduce the meaning of the word from the context, there is no shame in asking the client to clarify what they mean:

•  “What do you mean by (new word)?”

• “I’m not sure I follow. Does that mean (use a synonym)?”

• “It sounds like (rephrase what they said). Is that right?”

• “So you’re saying you (rephrase what they said). Is that so?”

5.        Polite language

Finally, clients from English-speaking countries may use subtle, indirect ways of expressing politeness, especially in the UK and Canada.

For instance, the British tend to use understatements to make a situation sound less important than it is. For instance, they might say “it’s not ideal” instead of saying “this is a massive problem”. They often do this to avoid causing a scene or disturbing others. They can also do this as a joke. When my husband sees Roman ruins, he says that it’s a “bit of a fixer-upper"  (which is an expression people use when a house needs a renovation).

It can be difficult for people from other countries to understand this irony, because British people keep a straight face when making jokes. You can get the hang of this quite quickly by watching TV shows like Downton Abbey (pay close attention to Maggie Smith’s character), Black Adder or Fawlty Towers.

If you notice it during a session and want to try it out yourself, you could try to respond to it by saying something like:

• “Bit of an understatement?” (making an understatement yourself to double-check how upset they are about something)

• “Understatement of the century!” (when you’re sure they made an exaggerated understatement as a joke).

Another confusing aspect of polite language is the use of indirect language. “I’m afraid I don’t think I’ll be able to make it to our next session after all” is trickier than “Sorry, I can’t come to our next session”. Questions like “do you know if there is a public parking around here?” are more confusing than “Is there a public parking around here?” Make sure you understand indirect questions by reading this explanation. I recommend doing the exercises provided.

Question tags are complicated too. It’s much easier to understand when someone asks “Did you go to the meeting?” than “you didn’t go to the meeting, did you?”. However, it’s important to understand them as they can imply judgement. “You didn’t go to the meeting, did you?”, implies that the speaker doesn’t think the person should have gone to the meeting or they don’t think it’s likely. On the other hand, “you went to the meeting, didn’t you?”, suggests that the speaker thinks the person should have gone to the meeting or that it’s likely.

Working with native English speakers can be challenging. But instead of discouraging  you, I hope this blog post will help you better anticipate those challenges, prepare for your sessions and navigate them more confidently.

With plenty of practice and patience, you can provide the support native speakers need. If you want to work towards this objective, book a free consultation here. We’ll discuss your specific needs and objectives.

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