The Hidden Cost of Doing Therapy in Your Second Language

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, North African. People who grew up in different dialects, different family structures, different relationships to religion and gender and duty — and who nonetheless, in my office, 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 practiced across the Gulf since 2009. 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 — and many do, 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. Emotional vocabulary learned early in life is stored more deeply and connects more directly to memory than vocabulary learned later, in classrooms or offices (Marian & Neisser, 2000). Languages acquired later in life tend to create genuine emotional distance — bilingual speakers often report, and studies confirm, that painful material feels less intense when discussed in a second language (Pavlenko, 2012; Caldwell-Harris, 2014). It's why 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 unconsciously switches languages mid-sentence during an emotional moment, that shift itself is often meaningful — a signal of deeper engagement with what's being said (Zhou et al., 2020; Dewaele, 2010). Missing that shift means missing the moment.

Dialect Isn't a Detail

Arabic isn't one language in practice — it's dozens of them. 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.

This is where a lot of "Arabic-speaking" therapy falls short — technically bilingual, but culturally flattening. 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 based outside Dubai, 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), 405–419. https://doi.org/10.1080/00207594.2012.743665

Zhou, Q., Tao, A., Main, A., & Lee, C. (2020). Why do bilinguals code-switch when emotional? Insights from parent–child interactions. Emotion, 20(7), 1201–1213. https://doi.org/10.1037/emo0000625

About the Author: Ms. Sarah El Nabulsi, M.Sc., M.A., M.A. is a DHA Licensed Clinical Psychologist based in Dubai, working with clients across the Arab world in Arabic, English, and French.

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