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Recently, the implications for psychotherapy of a number of factors which affect the communications of subordinate bilinguals have been explored. (1-4) These are individuals who speak their second language less well than their mother tongue. In these patients, the added encoding demands may produce a blocking of emotional expressiveness, speech disturbances such as those found in anxiety, and even a failure to integrate affects and experiences. The use of the second language may reinforce intellectual defenses, and emotional associations available in the context of the mother tongue may be inaccessible. Conversely, however, some bilingual patients may be able to approach material in the second language which would be too threatening or emotionally charged in the primary language. When the patient and the therapist are matched bilinguals, language choice can be strategically used as a unique therapeutic technique. (5) Thus, it may be advisable to encourage an obsessive patient who uses intellectualization and avoidance to verbalize in his more emotionally charged mother tongue. A hysterical patient, however, may benefit from verbalizing experience in his second learned, less emotional language, moderating the emotional tone and the impulse to flee from charged areas and making this material more accessible to rational consideration.
The purpose of this paper is to report a pilot study of the use of language-switching in the psychotherapy of a subordinate bilingual patient. The treatment was to be a combined dynamic-behavioral approach, (6) designed to both develop intellectual coping mechanisms and behavioral skills. It is important to bear in mind that the therapist (P.P.) is primarily English-speaking with just a basic conversational proficiency in Spanish, the dominant language of the patient.
Patient is a 28-year-old, single, Spanish-speaking woman who was admitted to Bellevue Psychiatric Hospital because of depression with suicidal ideation, severe anxiety, and ag