Working with interpreters in therapy can be deeply rewarding — but it’s also complex and emotionally demanding. This research explored how trainee and recently qualified therapists navigate interpreter-mediated therapy (IMT), with a focus on the therapeutic relationship, communication strategies, and adequacy of training.  

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Reviewing the literature 

Interpreter-mediated therapy is crucial in providing equitable access to mental health care for refugees and migrants (Geiling et al., 2021; Tribe & Keefe, 2009). Yet most research in this area focuses on clinical settings with consistent interpreter support — not the reality for community-based therapists (Mahdavi et al., 2023; Gartley & Due, 2015). In these under-resourced contexts, therapists frequently lack adequate training and opportunities to build relationship with interpreters (Hanft-Robert et al., 2023). 

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Existing literature also tends to focus on the challenges — miscommunication, boundary issues, and power dynamics — without offering practical strategies for navigating the relationship or recognising the growth potential of this work (Costa, 2017; Müller et al., 2023; Chang et al., 2020). This research contributes to closing that gap by exploring the lived experiences of therapists and highlighting their strategies for navigating interpreter-mediated therapy in real-world, often unpredictable, settings. 

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Methodology 

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Six therapists were interviewed using semi-structured, one-to-one interviews. Interviews focused on capturing each therapist’s personal experience of IMT. Interpretative Phenomenological Analysis (IPA) was chosen for its focus on lived experience and meaning-making — a strong fit for the study’s aim of understanding how practitioners make sense of the relational and practical challenges of this work.

 

A reflexive journal was kept throughout the research process, supporting researcher self-awareness and rigour. As a researcher with experience of IMT, I was particularly mindful of the influence my own perspectives could have on data collection and analysis. Reflexive notes, alongside careful clarification in interviews, helped minimise assumptions and deepened the interpretive process. 

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The study received ethical approval from the University of South Wales Ethics Committee (Feb 2024). 

 

Key findings 

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Therapists described IMT as initially daunting, with no formal training and feelings of unpreparedness. Over time, they adapted by slowing down and becoming more intentional and emotionally attuned. IMT altered session pacing and emotional dynamics, often making distress harder to manage. Interpreter styles varied widely, shaping the therapeutic atmosphere. Despite early challenges, therapists found IMT to be a source of professional growth, deepening their reflective practice and communication skills across all client work. The findings highlight both the need for better training and the transformative potential of IMT when adequate support is provided. 

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Therapists described interpreter-mediated therapy (IMT) as a profoundly different way of working — one that initially brought anxiety, uncertainty, and emotional challenge. None of the participants had received formal training, and many reported feeling unprepared when first faced with this work. 

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“I did feel in brand new territory and completely ill-equipped.” 

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As they adapted, therapists found themselves slowing down, choosing their words more intentionally, and developing new sensitivities. Working through an interpreter changed the emotional pacing of sessions, sometimes making moments of distress harder to hold. 

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“You want to help the client in that moment but you have to sit with that emotion a little bit longer.” 

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Participants also described navigating the variability in interpreter style — from warm and collaborative to emotionally distant or overly directive. These differences significantly shaped the feel and flow of sessions. 

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Over time, however, IMT was described not just as challenging, but as a source of meaningful growth. Therapists became more reflective, more aware of language, and more emotionally attuned — not just in interpreter-mediated work, but across their practice. 

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“The skills I gained through this really helped me even when I went back to working with English-speaking clients.” 

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Overall, the study highlights a clear need for improved training and reflective support — and the rich developmental potential of this work when that support is available. 

 

Implications 

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This study highlights the need for practical, flexible, and reflective support for therapists working with interpreters — especially in under-resourced settings. 

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1. Experiential Training  
Training that reflects the reality of IMT and helps therapists manage unpredictability. Role-plays, real-life scenarios, and space for reflection to build confidence and adaptability.  

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2. Supervision and Peer Reflection 
Peer group supervision and reflective spaces offer a low-cost, high-impact way for therapists to share experiences and reduce isolation. 

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3. Realistic Guidance, Not Rigid Protocols 
IMT is relational, fluid, and full of variables. Practitioners need tools to work flexibly — not prescriptive rules. Guidelines should support adaptability and mutual understanding, not perfection. 

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Selected references 

A full reference list is available by downloading the dissertation. 

 

Chang, D. F., Hsieh, E., Somerville, W. B., Dimond, J., Thomas, M., Nicasio, A., Boiler, M., and Lewis-Fernández, R. (2020) ‘Rethinking Interpreter Functions in Mental Health Services’, Psychiatric Services, 72(3), pp. 353-357. Available at: doi: 10.1176/appi.ps.202000085 (Accessed: 5 May 2024).  

 

Costa, B. (2017) ‘Team Effort – Training Therapists to Work with Interpreters as a Collaborative Team’, International Journal for the Advancement of Counselling, 39(1), pp. 56-69. Available at: doi:10.1007/s10447-016-9282-7 (Accessed: 10 June 2024).  

 

Costa, B. (2022) ‘Interpreter-mediated CBT – a practical implementation guide for working with spoken language interpreters’, The Cognitive Behaviour Therapist, 15(8), pp. 1-17.  

 

Gartley, T. and Due, C. (2015) ‘The Interpreter is Not an Invisible Being: A Thematic Analysis of the Impact of Interpreters in Mental Health Service Provision with Refugee Clients’, Australian Psychologist, 52(1), pp. 1-28. Available at: DOI:10.1111/ap.12181 (Accessed: 5 May 2024).     

 

Geiling, A., Knaevelsrud, C., Bottche, M., and Stammel, N. (2021) ‘Mental Health and Work Experiences of Interpreters in the Mental Health Care of Refugees: A Systemic Review’, Frontiers in Psychiatry, 12(1), pp. 1-18.   

 

Gryesten, J. R., Brodersen, K. J., Lindberg, L. G., Carlsson, J. and Poulsen, S. (2023) ‘Interpreter-mediated psychotherapy – a qualitative analysis of the interprofessional collaboration between psychologists and interpreters’, Current Psychology, 43(2), pp. 1420-1433.    

 

Hanft-Robert, S., Lindberg, L. G., Mosko, M. and Carlsson, J. (2023) ‘A balancing act: how interpreters affect the therapeutic alliance in psychotherapy with trauma-affected refugees – a qualitative study with therapists’, Frontiers in Psychology, 14(1), pp. 1-13. Available at: https://doi.org/10.3389/fpsyg.2023.1175597 (Accessed: 12 May 2024).  

  

Mahdavi, E. G., Due, C., Walsh, M. and Ziersch, A. (2023) ‘Service Providers’ Experiences of Interpreter-Assisted Mental Health Care for People with Refugee Backgrounds’, Professional Psychology, Research and Practice, 54(3), pp. 203-212. Available at: https://doi.org/10.1037/pro0000505 (Accessed: 14 May 2024).  

  

Müller, L. R. F., Herold, M. L., Unterhitzenberger, J. and Rosner, R. (2023) ‘Development and evaluation of a training program for interpreters in the field of trauma-focused cognitive behavioural therapy’, Frontiers in Psychology, 14(1), pp. 1-12. Available at: https://doi.org/10.3389/fpsyg.2023.1148690 (Accessed: 12 May 2024).   

    

Searight, H. R. (2021) ‘Conducting Psychotherapy through a Foreign Language Interpreter: Ethical Dilemmas’, in Gaab, J., Biller-Andorno, N., Trachsel, M., Sadler, J. Z. and Tekin, S. (eds.) Oxford Handbook of Psychotherapy Ethics. Oxford: Oxford University Press, pp. 818-834.  

 

Tribe, R. and Keefe, A. (2009) ‘Issues in using interpreters in therapeutic work with refugees. What is not being expressed?’, European Journal of Psychotherapy and Counselling, 11(4), pp. 409-424. Available at: https://doi.org/10.1080/13642530903444795 (Accessed: 5 May 2024).   

 

Tribe, R. and Thompson, K. (2009) ‘Exploring the Three-Way Relationship in Therapeutic Work with Interpreters’, International Journal of Migration, Health and Social Care, 5(2), pp. 13-21. Available at: https://doi.org/10.1108/17479894200900009 (Accessed 10 March 2024).