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3.1 million New York City residents are foreign-born. I am one of them, complete with accented English and a flutter of nervousness at JFK Airport passport control. Some of the patients I see for psychotherapy also belong to this huge and diverse group of immigrants/expatriates/relocating professionals. So, when therapy is “Made in the USA,” but both the participants are not, does it make any difference? Well, the work may be done in another language, so to speak.
Foreign-born patients don’t necessarily seek out foreign-born therapists, though a foreign born patient might appreciate the fact that the therapist is familiar with the challenge of reorganizing identity—it might feel good to imagine one’s therapist has also once found it confusing to use an American debit card for the first time, or needed some time to get accustomed to the richness of cupcakes.
Plenty of these transplants have relocated voluntarily and, in general, the acute stressors faced by many other immigrants do not strain them. But despite their privileged circumstances, their worldly air, these expats are still defined and shaped by their nomadic experience. Multiple hyphens in one’s identity—as in Israeli-born-Germany-raised-New York-resident—has significance. Each piece is an essential aspect of the individual and will be part of the therapeutic encounter.
More often than not, therapy is conducted in the one shared language, English. When both patient and therapist are foreign born, English is not, for either person, what Julia Kristeva, the philosopher and psychoanalyst, calls “the language of once upon a time,” the one that narrated infancy, the prosody of words that lulled us to sleep as babies.
If language is the thread of the therapeutic process, then a foreign born therapist and a foreign born patient are weaving together a different kind of fabric, as compared to their native English-speaking counterparts.
Janet, a college student of an Asian origin, illustrated this well when she complained her English, although fluent and lively, “sat heavier” on her tongue--that the words felt like “things” rolling in her mouth, a little bit like a loose tooth, maybe. Janet was not only describing difficulties articulating words in English, but also commenting on the wider emotional gap between a word and the feeling with which it’s associated when speaking in a second language.
It is common to feel grief about being “lost in translation” and this should not be minimized. But maybe the pain of not being understood in familiar ways is an opportunity to discover other experiences of being known and recognized. In therapy, a silent and empathic gaze can sometimes feel more transformative than the most eloquent statement.
Adrian, a young man born in Sweden to Croatian parents, who also lived in Germany and Argentina before coming to New York, was scanning his mind for the right word, in the right language, to convey his sense of disorientation when he wakes up in the morning, sometimes not even certain on which continent he is located. He grew frustrated with his inability to come up with a “good English word” until we realized that his sudden loss for words, his frantic inward search, spoke louder than any sound. It served as an unexpected compass in our conversation. Adrian embodied, rather than articulated, his disequilibrium. As Adrian and I exchanged gazes it was clear that he was understood and recognized in a deep way. He may have failed to tell me what he felt, but he showed me through his linguistic collapse what he felt like.
There are particular instances in which both therapist and patient have emigrated from the same country. In this case, they probably share an affinity, a comforting familiarity that can quickly cut through many layers of later adaptation. It feels good, for sure, to see someone who shares cultural references and the social, political and physical landscape of one’s childhood.
However, there are potential pitfalls for this dyad. Patient and therapist might be tempted to create a cultural island, thinking in terms of “us” vs. “them,” creating what Salman Akhtar, a South Asian born psychoanalyst, calls a “nostalgic collusion,” of idealizing the country of origin and together vilifying their new home. They might make assumptions about sameness that blur important individual experiences and differences.
Living away from one’s homeland is becoming increasingly common, a striking social trend of the 21st century. The soaring numbers don’t mean that this is a simple experience. In therapy we are working to tap into the home within, a place of security and warmth, as well as build a physical and emotional home through our relationships with others, from all over the world.
Dana Goren, Ph.D., is a Clinical Psychology Fellow at William Alanson White Institute. She is the recipient of the 2014 award for best early career professional paper, American Psychological Association, Division 39 (a panel award). Her interests are immigration, emerging adulthood and child development. She is a licensed psychologist in private practice in Manhattan, working with adults, adolescents and children. She conducts therapy in English and Hebrew. Email: danagorenphd@gmail.com.
