The Hidden Cost of Doing Therapy in Your Second Language
Updated: Oct 15
Dubai is home to over 200 nationalities, and a striking number of my clients are Arabic speakers: not just Emirati, but Lebanese, Syrian, Egyptian, Jordanian, Palestinian, Iraqi and North African. They grew up with different dialects, different family structures and different relationships to religion, gender and duty. And yet, in my office, they reach for the same instinct: to speak about what hurts in Arabic, even when they're fluent in English.
I understand why. I was born and raised in Lebanon, studied in North America, and have been in private practice in Dubai for fifteen years. I work with clients in Arabic, English, and French, and I've noticed the same pattern across languages, again and again: people don't just prefer their first language in therapy. They process differently in it.
Why Language Isn't Neutral
When a client switches from English into Arabic mid-session, often without noticing, something shifts. The sentences get longer. The pauses change. Sometimes the tears arrive that weren't there a moment before.
This isn't sentimentality. It's well documented. Bilingual people recall more memories from a period of their life when they are asked in the language they spoke at the time (Marian & Neisser, 2000). A language learned later can also carry less emotional charge: bilingual speakers often report, and studies have found, that painful material can feel less intense in a second language, particularly for people who learned it later in life (Pavlenko, 2012; Caldwell-Harris, 2014). It's one reason some people can discuss trauma fluently in English and feel almost nothing, then switch to Arabic and feel everything at once. The English isn't dishonest. It's further from the source.
That emotional distance isn't always a problem. Sometimes it's useful, giving clients room to approach something too raw to face head-on. But when someone switches languages in the middle of an emotional moment, the switch itself often means something. Research with bilingual families has found that switching tends to follow a rise in emotion, especially negative emotion (Williams et al., 2020; Dewaele, 2010). Missing that shift means missing the moment.
Dialect Isn't a Detail
In practice, Arabic isn't one language. It's many dialects, each with its own weight. A Lebanese client's Arabic carries different emotional weight, humor, and directness than a Gulf client's, or an Egyptian client's. A word for shame, for pride, for family obligation doesn't translate cleanly even between Arabic dialects, let alone into English.
Speaking Arabic is not the same as understanding where someone is from. Understanding that a client's relationship to their father means something different in a Levantine household than a Gulf one, or that religious language carries different weight depending on where someone grew up, isn't a nice-to-have. It changes what actually gets said in the room, and what doesn't.
What This Looks Like in Practice
In sessions, I move between English, Arabic, and French depending on where a client naturally lands — sometimes within the same sentence. I don't correct the code-switching. I follow it, because it's usually telling me something: which language a topic is safe in, and which one it isn't yet.
For clients elsewhere in the UAE, or who prefer not to come in person, this works the same way online. The language flexibility doesn't disappear over video.
The Real Question to Ask
If you're looking for an Arabic-speaking psychologist, "Do they speak Arabic?" is the wrong first question. The better one is: will they understand not just your words, but where you're from within the Arab world, and what that shapes in how you talk about pain?
That's the standard I hold myself to with every Arabic-speaking client I work with, regardless of which country, dialect, or generation they come from.
References
Caldwell-Harris, C. L. (2014). Emotionality differences between a native and foreign language: Theoretical implications. Frontiers in Psychology, 5, 1055. https://doi.org/10.3389/fpsyg.2014.01055
Dewaele, J.-M. (2010). Emotions in Multiple Languages. Palgrave Macmillan. https://doi.org/10.1057/9780230289505
Marian, V., & Neisser, U. (2000). Language-dependent recall of autobiographical memories. Journal of Experimental Psychology: General, 129(3), 361–368. https://doi.org/10.1037/0096-3445.129.3.361
Pavlenko, A. (2012). Affective processing in bilingual speakers: Disembodied cognition? International Journal of Psychology, 47(6), 405–428. https://doi.org/10.1080/00207594.2012.743665
Williams, A., Srinivasan, M., Liu, C., Lee, P., & Zhou, Q. (2020). Why do bilinguals code-switch when emotional? Insights from immigrant parent–child interactions. Emotion, 20(5), 830–841. https://doi.org/10.1037/emo0000568
About the Author: Sarah El Nabulsi, M.Sc., M.A., M.A. is a DHA Licensed Clinical Psychologist based in Dubai, working with adults and couples in Arabic, English and French.
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