What Is Known About Bilingual Counseling? A Systematic Review of the Literature

Aug 18, 2020 | Volume 10 - Issue 3

Atsuko Seto, Nancy L. A. Forth

Results from a systematic review of the empirical literature on bilingual counseling published between 2000 and 2019 are presented. The findings from 15 articles are divided into three areas: counselor perspectives, client perspectives, and training and supervision. The review revealed that the studies published within the past two decades have focused on examining counselors’ perspectives on bilingual counseling. Studies that seek to understand clients’ perspectives as well as training and supervision of bilingual counselors seemed to be scarce. Recommendations drawn from the existing literature are provided for future research, counselor preparation, and the practice of counseling with linguistically diverse clients.  

Keywords: bilingual counseling, counselor perspectives, client perspectives, training and supervision, linguistically diverse

The bilingual population in the United States is diverse (Pérez Rojas et al., 2014). According to the American Community Survey from the U.S. Census Bureau (2015), over 350 languages, including 150 native North American languages, are spoken in the United States. This data, collected from 2009 to 2013, reflects the total U.S. population older than five years of age. In 2018, over 41 million people in the United States spoke Spanish at home, followed by approximately 3.47 million Chinese-speaking and 1.76 million Tagalog-speaking individuals (U.S. Census Bureau, 2018). Furthermore, the total number of bilingual populations in the country has nearly doubled since 1980, with one in five individuals speaking a language other than English at home (Grosjean, 2018). In considering this staggering data, counselors in both community and school settings are encouraged to increase competencies necessary for work with linguistically diverse clients.

Several scholars in the mental health professions have discussed the significance of bilingualism within counseling practices, specifically with the Latinx population. First, both the English and Spanish language are essential to a Latinx person’s day-to-day living and interactions with the mainstream society and the ethnic community (Cofresi & Gorman, 2004). Second, an individual’s language proficiency is instrumental in gaining access to mental health services and is a critical component of counseling (Delgado-Romero et al., 2018). When clients have considerably limited English proficiency, they are less likely to seek counseling services that require comprehension of the language. Third, to develop appropriate treatment plans, counselors are encouraged to consider clients’ language background (Santiago-Rivera & Altarriba, 2002). Finally, because of potential language barriers and cultural mismatch, a shortage of Spanish–English-speaking mental health providers may discourage individuals of Latinx descent from seeking professional help (Delgado-Romero et al., 2018). It is also important to acknowledge the considerable diversity that exists within the Latinx population, and other terms, such as Hispanic/Latino (Santiago-Rivera & Altarriba, 2002; Smith-Adcock et al., 2006), Latino (Cofresi & Gorman, 2004), and Latino/a that (Pérez Rojas et al., 2014) appear in the existing literature on counseling with Spanish–English-speaking clients. Although these aforementioned points specifically refer to the Latinx client population, they speak to the need for increased efforts to understand counseling services for linguistically diverse clients.

Despite the growing number of individuals who speak more than one language, the use of bilingual counseling and its effectiveness are underrepresented in the current literature (Ali, 2004; Ivers & Villalba, 2015; Santiago-Rivera & Altarriba, 2002; Softas-Nall et al., 2015). Gallardo-Cooper (2008) defined bilingual counseling as “therapeutic discourse that accommodates the client’s linguistic characteristics and incorporates bilingual or multilingual factors as vital components of psychological and contextual functioning” (p. 1022). In 2004, Fuertes published a review of the existing literature on this topic and conceptualized bilingual counseling as “a special form of counseling” (p. 85). Fuertes’ review underscored the need for more studies in this area, stating that “there has been a dearth of conceptual and empirical literature on the topic of bilingual counseling and virtually no conceptual or empirical research on the topic of bilingual supervision” (p. 84). Moreover, coming to a consensus on what is bilingual can be difficult because different dimensions (e.g., reading, writing, speaking) need to be assessed to determine a person’s language proficiency (Santiago-Rivera & Altarriba, 2002). To gain a more accurate understanding of the current practice of bilingual counseling, its effectiveness, and related training and supervision, a systematic review of the literature published in the past two decades was conducted in this study.

Method

Two counselor educators formed a research team for this study. The team used the work of Edwards and Pedrotti (2008) as a guide for developing the steps to conduct a comprehensive search of relevant articles. First, several keywords were identified with the intent to identify journal articles that paid particular attention to bilingual counseling. The keywords included counseling, counselling, therapy, and psychotherapy combined with the words bilingual, multilingual, bi-lingual, and multi-lingual (e.g., bilingual counseling, multilingual counselling, bilingual therapy, multilingual psychotherapy). Additionally, the keywords bilingual client, bi-lingual client, multilingual client, and multi-lingual client were included to conduct searches as thoroughly as possible. Each team member independently ran multiple searches on major online databases (e.g., PsycINFO, ERIC, PsycARTICLES) by using the keywords to locate as many peer-reviewed journal articles published between 2000 and 2019 as possible. Collectively, the searches generated over 750 hits. Second, the abstracts of the articles from our respective searches were reviewed to determine whether they specifically focused on bilingual counseling. Third, the results from the two independent reviews were compiled into a list of potential articles for a final review. Forty articles were selected for this final review process. Upon the review of all 40 abstracts and discussion on the applicability of each article for this study, it was determined that 22 articles addressed the practice of bilingual counseling as the primary content. Of these articles, seven of them were removed from the list because they did not offer findings from an original study. Hence, the remaining 15 articles were included in this systematic review (see Table 1).

Results

The selected articles provided insights into the experiences of clients and/or counselors in bilingual counseling settings, including interpreter-mediated sessions. Additionally, a few articles (Ivers & Villalba, 2015; Mirza et al., 2017; Trepal et al., 2014) discussed experiences of graduate counseling and psychology students and their perceived cultural competency. The present review is organized into three areas: client perspectives, counselor perspectives, and training and supervision. Some of the articles are included in two sections (e.g., counselor perspectives and training and supervision) because the study findings covered more than one aspect of bilingual counseling.

Table 1

Articles About Bilingual Counseling (N = 15)

Note. Cl = Client; Co = Counselor; T/S = Training and Supervision

Client Perspectives
     Four of the 15 studies (Pérez Rojas et al., 2014; Ramos-Sánchez, 2007, 2009; Rolland et al., 2017) addressed the perspectives of clients as part of the investigation. Of those studies, the participants in only one (Rolland et al., 2017) consisted of actual clients. In this study, Rolland et al. (2017) conducted an online survey with over 100 participants. Collectively, these participants represented 42 nationalities and had experienced counseling as a client in 19 different countries. The participants reported that they switched languages or used words in another language (code-switching) to express certain emotions, recall particular memories, or translate words and phrases into another language. For expression of emotions or recalling specific memories, some participants used a second language to distance themselves from painful experiences, whereas others used their primary language to express their feelings more accurately. Participants reported that they were more likely to engage in code-switching or language switching when they knew that their counselor was also bilingual. Although the participants generally appreciated their counselors’ efforts to switch languages and felt connected with their counselors in doing so, a few stated that they felt disconnected from their counselor when they were asked to switch languages. Rolland et al. offered insight into the intricacy of bilingualism in counseling and noted that

language has the power to transport the speaker to a different place, and depending on how this is handled the client may be able to share a different part of themselves with the therapist, or may find themselves disconnected, alone with the memories and inner self. (p. 81)

Another noteworthy point from this study was that the client’s language background was often unaddressed in sessions. Over half of the study participants stated that they never discussed their linguistic background with their counselors, and roughly 89% did not recall discussing with their counselors which language(s) could be utilized in sessions.

Three articles (Pérez Rojas et al., 2014; Ramos-Sánchez, 2007, 2009) discussed the effects of the language-switching technique on counseling relationships and clients’ perceptions of counselors, particularly in Spanish–English simulated counseling settings. Participants in these studies were college students as opposed to actual clients. In the study by Pérez Rojas et al. (2014), 51 Latina and 12 Latino students were asked to review one of two 15-minute recorded counseling sessions. In one session, a bilingual counselor invited a client to switch from English to Spanish in order to express the client’s feelings and thoughts, whereas in another session, a bilingual counselor did not invite a client to switch languages. Results in this study did not support the authors’ main hypothesis that a counselor’s invitation to switch to Spanish would foster a therapeutic bond with a client. Furthermore, the participants did not perceive the bilingual counselor as more culturally competent and credible than the counselor who only spoke English with the client. The authors speculated that bilingual clients may have varying reactions to counselors when being prompted to switch languages in sessions and that evaluation criteria for bilingual counselors may differ from that of non–mental health bilingual individuals.

In the area of perceived counselor credibility, past studies have typically focused on counselor ethnicity (Atkinson et al., 1989; Coleman et al., 1995). In 1999, Ramos-Sánchez et al. explored perceived counselor credibility by Mexican Americans regarding language. Because of the lack of findings, Ramos-Sánchez suggested further exploration in language switching and conducted another study. The findings from this subsequent study, using the same sample of 65 Mexican American college students, were presented in two articles (Ramos-Sánchez, 2007, 2009). Each participant played the role of a client in one of four experimental groups: a session led by a Mexican American counselor who only spoke English, a European American counselor who only spoke English, a Mexican American bilingual counselor, or a European American bilingual counselor. In addition to exploring the participants’ perspectives as a client in an interview, four observers rated clients’ emotional expressions in these four different conditions (Ramos-Sánchez, 2007). Results revealed that participants were more likely to engage in emotional disclosures in the language-switching conditions than the participants in the English-only settings (Ramos-Sánchez, 2007). The findings also suggested that ethnic and language differences or similarities between clients and counselors did not have a significant impact on the participants’ perceptions of counselor credibility and multicultural competency (Ramos-Sánchez, 2009). It is notable to mention that the Mexican American English-only speaking counselors were rated the highest among all counselors. Moreover, the European American bilingual counselors were rated higher than the Mexican American bilingual counselors. The findings support the idea that strong counseling relationships can be established despite ethnic differences between counselors and clients. Additionally, the findings may speak to the importance of training both Latinx and non-Latinx counselors on bilingual counseling in order to support Spanish–English-speaking clients (Ramos-Sánchez, 2007, 2009).

The primary limitations among the aforementioned studies (Pérez Rojas et al., 2014; Ramos-Sánchez, 2007, 2009) include having a small sample size and using volunteer college students in a controlled laboratory setting as opposed to actual clients. Although the participant group in Rolland et al.’s (2017) study consisted of actual clients, the study relied on the participants’ recollections of their counseling experiences and did not include the perspectives of counselors.

Counselor Perspectives
     Nine articles (Costa & Dewaele, 2014; Johal, 2017; Kokaliari et al., 2013; Mirza et al., 2017; Nguyen, 2014; Santiago-Rivera et al., 2009; Trepal et al., 2014; Vaquero & Williams, 2019; Verdinelli & Biever, 2009) offered counselors’ perspectives on bilingualism in the counseling process and its impact on therapeutic relationships. Of those articles, six studies (Kokaliari et al., 2013; Mirza et al., 2017; Santiago-Rivera et al., 2009; Trepal et al., 2014;  Vaquero & Williams, 2019; Verdinelli & Biever, 2009) were conducted in the United States. In terms of counselor theoretical orientations, this present review found two articles (Kokaliari et al., 2013; Nguyen, 2014) with psychoanalytic/psychodynamic framework, whereas some studies included counselors from a wide range of theoretical orientations. For example, the participants in Costa and Dewaele’s study (2014) employed integrative approaches, cognitive behavior therapy, systemic approaches, and psychodynamic therapy. A qualitative study (Santiago-Rivera et al., 2009) with nine Spanish–English-speaking counselors reported using cognitive behavior, person-centered, family systems, psychodynamic, and/or psychoanalytic theory in their practice.

Of these nine articles, six articles (Kokaliari et al., 2013; Mirza et al., 2017; Santiago-Rivera et al., 2009; Trepal et al., 2014; Vaquero & Williams, 2019; Verdinelli & Biever, 2009) explored bilingual counselors’ insights into working with linguistically diverse clients. Three articles in particular (Santiago-Rivera et al., 2009; Vaquero & Williams, 2019; Verdinelli & Biever, 2009) involved Spanish–English-speaking bilingual counselors, and four articles included bilingual and multilingual counselors with various language combinations. One article (Costa & Dewaele, 2014) included both monolingual and bilingual counselors, and one article (Mirza et al., 2017) focused on a monolingual counselor’s experience working with bilingual mediators to support clients whose primary language was not English.

Perceived Challenges
     The existing studies suggested that utilization of more than one language within therapeutic relationships could become a source of anxiety for some counselors. The factors associated with their anxiety included speaking a different dominant language than clients, counseling clients in languages other than English despite receiving their training only in English, having an accent that is not familiar to clients, and being an entry-level counselor. Verdinelli and Biever (2009) indicated that some of the native Spanish-speaking bilingual counselors in their study perceived potential difficulty communicating with native English-speaking clients and were concerned about how their clients perceived their accents. Non-Latinx bilingual counselors in Vaquero and Williams’ (2019) study shared their concerns about their limited vocabulary in Spanish and their ability to facilitate clients’ emotional expressions effectively. Similarly, bilingual counselors in Johal’s (2017) study expressed their discomfort in using languages other than English in their practice and did not believe bilingual counseling strengthened a counseling relationship. Johal further explained that these participants received their formal training in English only, which may partially explain the findings. Master’s-level interns who participated in the study by Trepal et al. (2014) also stated that anxiety related to providing counseling services in languages other than English was exacerbated by their novice status as a counselor and a lack of training they received in bilingual counseling.

Participants in Verdinelli and Biever’s (2009) study spoke about the complexity of the bilingual counseling process. Specifically, some of the heritage Spanish speakers, who acquired a second language later on in their lives, discussed the challenges of conducting counseling sessions in Spanish because of language variations that exist within Spanish-speaking communities. Although the participants in Vaquero and Williams (2019) were seasoned professionals who had worked with bilingual families for an average of 15 years, they recognized the challenge of switching languages without excluding a particular family member. Specifically, speaking Spanish to connect with a parent or an adult caregiver whose primary language is Spanish might have excluded a child client whose primary language is English.

Contexts within which clients live may also influence therapeutic relationships. Nguyen (2014) interviewed bilingual counselors from seven different countries. Together, the participants spoke 14 languages in addition to English. Some of the participants believed that the shared identity of being bilingual fostered therapeutic relationships with clients. However, a few participants recounted situations in which a client became concerned about a possible breach of confidentiality because the counselor not only spoke the client’s language but also shared the same cultural background with the client, resulting in being a member of the same local ethnic community. Kokaliari et al. (2013) had similar findings in their study, in which a few participants described how the sameness between clients and counselors could blur therapeutic boundaries when counselors are unaware of potential transference or countertransference in sessions. Although having the same language background may foster counseling relationships, it could also present concerns for clients depending on the social contexts in which this similarity occurs.

Time was another challenging factor in findings by Trepal et al. (2014) and Johal (2017). In Johal’s study, some of the participants who provided bilingual counseling (in their second language) were often challenged by the amount of time it took to translate what they would say in their primary language to the language spoken by their clients. Similarly, participants in the study by Trepal et al. found that they often rehearsed speaking their second language (e.g., role-playing with a bilingual family member) as a means to feel better prepared for their sessions.

Perceived Benefits
     These challenges notwithstanding, participants from five studies (Costa & Dewaele, 2014; Kokaliari et al., 2013; Trepal et al., 2014; Vaquero & Williams, 2019; Verdinelli & Biever, 2009) stated that the shared language and ethnic background with clients nurtured therapeutic bonds. For example, Latinx bilingual counselors reported switching languages—in this case, English to Spanish or vice versa—effortlessly to build rapport with clients (Vaquero & Williams, 2019). Participants in three studies (Costa & Dewaele, 2014; Kokaliari et al., 2013; Nguyen, 2014) reported that they became more mindful of the danger of overidentifying with clients who shared the same linguistic and cultural background. Both monolingual and bilingual counselors in Costa and Dewaele’s study (2014) agreed that they were more attentive to the client’s statements and nonverbal communication in bilingual counseling settings than in working with native English-speaking clients.

Several scholars explored counselors’ understanding of clients’ intention behind switching languages in counseling sessions. These included clients’ attempts and desires to: (a) express emotions more accurately and comprehensively (Kokaliari et al., 2013; Verdinelli & Biever, 2009); (b) enhance communication with a counselor (Kokaliari et al., 2013; Verdinelli & Biever, 2009); (c) recall specific memories such as traumatic events and dreams (Kokaliari et al., 2013); or (d) emphasize their point of view to a counselor (Kokaliari et al., 2013). As discussed earlier, these findings significantly overlapped with the clients’ perceptions of the roles of language in counseling (Rolland et al., 2017). In the study by Vaquero and Williams (2019), the counselors worked with bilingual families—young children and their parents/caregivers. These counselors noted that caregivers spoke with their children in Spanish to communicate their affection, whereas English was often used to discipline children.

The participants in Verdinelli and Biever’s study (2009) noticed that clients tended to discuss particular events in the language in which those experiences occurred. According to Kokaliari et al. (2013), the participants explained how some clients used their non-native language to discuss topics that are considered culturally taboo (e.g., sexual abuse, sexual orientation) or not consistent with their cultural framework. According to Verdinelli and Biever (2009), some participants believed that clients switched languages to avoid engaging in a deeper level of self-exploration. A similar observation was made by the participants in Kokaliari et al.’s (2013) study, in that clients seemed to use a second language when they needed to process highly emotional events such as trauma. In this case, participants perceived the client’s decision to switch languages as a form of self-protection.

With regard to a counselor’s intention to switch languages, Santiago-Rivera et al. (2009) indicated that Spanish–English-speaking bilingual counselors in their study switched from English to Spanish in order to establish a strong rapport with clients, engage or redirect clients in session, facilitate a client’s self-reflection and emotional expression, or foster self-awareness. According to Vaquero and Williams (2019), the Spanish–English bilingual counselors stated that they often deliberately switched to Spanish to connect with parents/caregivers in a counseling session, whereas they switched to English to build rapport with child clients. These counselors also switched languages to strengthen caregiver–child relationships.

Collaboration With Interpreters
     To meet the needs of linguistically diverse clients, counselors, when possible and appropriate, may work with an interpreter. Mirza et al. (2017) examined potential challenges and benefits of collaboration with interpreters in counseling sessions. In this study, a doctoral-level psychology student served as the counselor and conducted interpreter-mediated counseling sessions with six clients whose primary language was not English. This counselor encountered a few challenges, including feeling excluded from side talks between the interpreter and the client, difficulty ensuring the accuracy and thoroughness of interpretations, and redirecting the interpreter to facilitate a session. The counselor perceived that using simple words and concise statements, checking in with clients periodically for clarification, and consecutive interpretations (translation following a statement by a counselor or a client) as opposed to simultaneous interpretations were helpful to a therapeutic relationship. To make an interpreter-mediated session beneficial to clients, the counselor in this study found it critical that both the interpreter and the counselor make the necessary adjustments to the counseling or interpretation approach as well as clearly defining each other’s roles in a session. In other words, when there is a synergy between a counselor and an interpreter, the interpreter’s involvement is likely to foster a counselor–client relationship and offer additional support to a client.

Several scholars (Johal, 2017; Kokaliari et al., 2013; Mirza et al., 2017; Nguyen, 2014; Vaquero & Williams, 2019) mentioned a small sample size as a common limitation of their studies. Focusing only on one set of a bilingual combination (Santiago-Rivera et al., 2009) or a particular ethnic group (Verdinelli & Biever, 2009) also made it challenging to generalize study findings to larger populations. Nguyen (2014) and Santiago-Rivera et al. (2009) cautioned that study findings were based only on counselors’ perceptions, which may differ from that of clients. In addition to Nguyen and Santiago-Rivera et al., Johal (2017) and Trepal et al. (2014) also noted the importance of acknowledging the potential effects of researcher bias on data collection and analysis of qualitative research studies.

Training and Supervision
     In reviewing the 15 selected articles for this present study, five of them (Ivers & Villalba, 2015; Johal, 2017; Smith-Adcock et al., 2006; Trepal et al., 2014; Vaquero & Williams, 2019) focused on implications and recommendations for training and supervision in counseling practice. Two groups of scholars (Ivers & Villalba, 2015; Trepal et al., 2014) conducted their studies examining the effects of bilingualism with counseling students at a university in the southwest region of the United States. One common theme regarding the connection between counselors-in-training and their clients emerged in the two studies—when counselors-in-training shared the same language as the client during sessions, they felt more connected with their clients and more confident, as they perceived a higher level of multicultural counseling skills and awareness.

Supervision was specifically addressed in three of the 15 selected articles. Both Trepal et al. (2014) and Johal (2017) shared challenges experienced by supervisees who provided bilingual counseling with clients. Vaquero and Williams (2019) explored counselors’ perceptions of bilingual supervision as part of their study. The participants in Johal’s study stated that the practice of bilingual counseling was minimally addressed in their training, and they received little support from their employers and supervisors in this area. Several participants in the study by Trepal et al. (2014) stated that they needed to translate client session tapes for their supervisors—who were not bilingual—before receiving supervision, which added more involved time on their part. Participants in all three studies (Johal, 2017; Trepal et al., 2014; Vaquero & Williams, 2019) believed supervision was more effective when their supervisors spoke the same language that they used with their clients. For example, some bilingual supervisors were able to help the participants learn different terms and provide a clear example of a counseling process in Spanish (Vaquero & Williams, 2019).

Smith-Adcock et al. (2006) conducted a survey study with district-level directors of student services in Florida. They sent questionnaires to assess the needs of bilingual school counselors of Hispanic/Latinx children and families in their school districts. Specifically, the majority of the participants in this study reported that their school district needed more bilingual counselors, and 82% stated that students and families would benefit from receiving educational materials in Spanish. In addition, the participants believed that school counselors should be equipped to educate school communities on Hispanic/Latinx cultures, be aware of community resources, and engage in outreach efforts to involve parents in their children’s school experiences. These results suggest that bilingual counselors may be expected to fulfill various needs of linguistically diverse students and clients in addition to providing counseling services. Although this study did not specifically address training and supervision in bilingual counseling, the findings underscore the importance of developing training programs that are responsive to the specific needs of bilingual and multilingual communities.

Of the five articles that addressed training and supervision, four of them (Ivers & Villalba, 2015; Johal, 2017; Trepal et al., 2014; Vaquero & Williams, 2019) shared a common limitation to their studies that is typically found in research. These authors believed their results might not be generalized to all populations and settings because a small number of participants were used in their respective studies. As mentioned previously, Trepal et al. (2014) and Johal (2017) suggested that personal bias might have occurred, affecting their results. Finally, Ivers and Villalba (2015) cautioned that their use of a self-report instrument might have resulted in skewed findings.

Discussion

     The purpose of this study was to gain a greater understanding of the topics that have been addressed in the existing literature regarding bilingual counseling, training, and supervision. Fifteen empirical articles were included in this study. Results reveal that more studies have explored perspectives of counselors on bilingual counseling than that of clients. Only one study involved current or former clients of counseling services. This may be due to the fact that recruitment of actual clients is more difficult than relying on convenience samples.

The results also suggest that more studies are needed for reaching consensus among scholars on what makes bilingual counseling therapeutic and effective. For example, participants in several qualitative studies (e.g., Kokaliari et al., 2013; Trepal et al., 2014; Vaquero & Williams, 2019; Verdinelli & Biever, 2009) perceived that speaking in the client’s primary language positively contributed to counseling relationships. Rolland et al. (2017) postulated that language switching, when used appropriately, is beneficial to clients because it can facilitate a deeper level of self-reflection and exploration. On the contrary, no statistical significance was found on the effects of the language switch on therapeutic bonds in two quantitative studies (Pérez Rojas et al., 2014; Ramos-Sánchez, 2007, 2009). These quantitative studies were conducted in a lab setting with college students, which the authors mention as a potential limitation of their studies. These findings may suggest that switching languages is an art of counseling; it is multifaceted, and its effectiveness may be contextually based. Additionally, more studies that explore the perspectives of both clients and counselors as well as examine variables that impact bilingual counseling relationships are needed. Pérez Rojas et al. (2014) helps to explain these inconclusive findings by stating that “the role that language switching plays in psychotherapy may be more complex than what has been theorized so far” (p. 71).

In terms of the specific language combinations that have been included in the previous studies, the Spanish–English-speaking population seems to be the group that has been most represented in the literature. This finding may not be surprising given the fact that Spanish is the second most spoken language in addition to English in the United States. Strong advocacy to support Spanish-speaking populations may also explain why this specific language combination has received the most attention in the profession. It is important to acknowledge that some scholars (e.g., Kakaliari et al., 2013; Rolland et al., 2017) in more recent years have conducted studies that involved multiple languages. Equally encouraging is an increased attention to the training and supervision of bilingual counselors. Although the existing literature in this area is considerably limited, several scholars (e.g., Ivers & Villalba, 2015; Johal, 2017; Trepal et al., 2014) have shed some light on the experiences of bilingual counselors and graduate counseling students and have offered some helpful recommendations for the training and supervision of counselors.

Implications

Counseling Practice
     Findings from the present study suggest that switching languages, when done appropriately, may bolster therapeutic relationships with clients and facilitate clients’ self-exploration and expression. However, a few studies included in the present analysis also revealed that in some cases, the language match between the counselor and client may not strengthen therapeutic relationships. Determining when to switch languages may depend on a client’s preference, presenting concerns, history of language acquisition (e.g., growing up bilingual or acquiring another language as an adult), and level of language proficiency with each language spoken. Consequently, meeting the needs of bilingual clients requires counselors to know how to assess a client’s language background accurately. Only one study (Rolland et al., 2017) in the present analysis addressed clients’ perceptions of the assessment of their language background by counselors. As discussed previously, many participants reported counselors neither asked about their language backgrounds nor discussed which language(s) could be used in session. Cofresi and Gorman (2004) recommend that counselors assess the client’s language background (e.g., how they acquired a second language) and proficiency, dominant language, preferred language, and level of acculturation. They also suggest that, where possible and feasible, assessments should be conducted in the language “most compatible with the bilingual client’s language proficiency and dominance” (p. 104).

Bilingual clients have the ability to choose which language better offers a vehicle for the expression of ideas. Therefore, framing bilingualism as a client’s strength rather than deficiency or barrier (Santiago-Rivera & Altarriba, 2002) is crucial in fostering a genuine rapport with the client. The acquisition of an additional language has been associated with advanced cognitive abilities, including in the areas of problem-solving, reading, spelling, and memory recall (Ivers et al., 2013). Instead of assuming language barriers with a bilingual client, counselors are highly encouraged to communicate their genuine curiosity to learn about the client’s experience as a bilingual individual, explore benefits of bilingualism, and work to create a therapeutic environment that appreciates linguistic diversity.

Findings from the present study suggest that clients may switch languages for several different reasons. These include but may not be limited to expressing emotions more fully, recalling and discussing particular memories or events, and improving communication with others. In some cases, clients preferred to use a second language to process traumatic events and intense emotions or discuss topics that are considered culturally taboo or sensitive (Kokaliari et al., 2013; Verdinelli & Biever, 2009). In addition to asking clients about their preferences for using a particular language in session, discussing potential benefits and limitations of bilingual counseling may be helpful during the initial phase of counseling. Doing so may encourage clients and counselors to engage in ongoing and open discussions about the impact of languages on the client’s progress and counseling relationships.

Counselor Preparation
     There is a significant shortage of training programs that equip counselors-in-training to provide bilingual counseling. Delgado-Romero et al. (2018) explained: “While professional mental health organizations recognize the need to provide linguistically and culturally appropriate services, there are limited opportunities to learn or use a second language in graduate mental health counseling programs” (pp. 341–342). This point was reflected in Trepal et al.’s (2014) study, in which the counseling interns expressed their concerns about engaging in bilingual counseling because they had not received any training on bilingual counseling. Trepal et al. also noted that some counseling interns in their study might have experienced increased anxiety for not only practicing counseling for the first time but having to do so in a bilingual setting. As counselor programs work to prepare more students for working with linguistically diverse clients, it seems imperative to provide appropriate supervision and additional support to those who are expected to provide bilingual counseling services during their clinical experiences. For example, the participants in Trepal et al.’s study recommended that programs assist bilingual students in forming a peer support group that allows exchange of information on bilingual counseling and promotes bilingualism.

The participants in Johal’s study (2017) made an essential point; that is, it should not be assumed that bilingual counselors know how to provide counseling in more than one language simply because they speak the language. Developing training programs that prepare students to work with bilingual clients (Costa & Dewaele, 2014; Santiago-Rivera & Altarriba, 2002) as well as increasing the number of bilingual counselors (Ivers & Villalba, 2015) are therefore critical steps to serving linguistically diverse client populations. Four of the 15 articles reviewed for this study (Ivers & Villalba, 2015; Johal, 2017; Trepal et al., 2014; Vaquero & Williams, 2019) offered one common suggestion for counseling training programs. All spoke of the importance of providing additional training that increases awareness in culture and language. Several scholars whose studies focused on supporting the Latinx population offered helpful recommendations for graduate counselor education and training programs, including: (a) integrating a community-engagement and collaboration component into the training curriculum (Smith-Adcock et al., 2006); (b) creating opportunities for cultural immersion experiences (Ivers & Villalba, 2015); (c) offering courses in both English and Spanish (Ramos-Sánchez, 2007); (d) delivering some content (e.g., diagnostic terms) in Spanish (Vaquero & Williams, 2019); and (e) developing standards for evaluating counselor competency in providing bilingual counseling (Verdinelli & Biever, 2009). Additionally, training programs should emphasize the significance of understanding history, nationality, culture, community, and geographic settings (e.g., living in an urban vs. rural community) of linguistically diverse clients (Vaquero & Williams, 2019). These recommendations may be applicable and helpful to counselor education programs that are committed to preparing students for providing bilingual counseling services to meet the needs of their local communities. Furthermore, some counselors may have an opportunity to offer counseling services to clients in collaboration with an interpreter. It is essential that specialized training is available to counselors and interpreters who are interested in joining forces to serve clients within the context of mental health service delivery. Such training curricula should address the effectiveness of evidence-based approaches to providing interpreter-mediated counseling services (Mirza et al., 2017).

Conclusion and Future Research

Scholars who have written about the current practice of bilingual counseling encourage researchers to explore the following areas in future studies: (a) associations between counselor language proficiency and clients’ perceptions of counselors and counseling relationships (Ramos-Sánchez, 2009; Trepal et al., 2014; Verdinelli & Biever, 2009); (b) actual clients’ experiences of mental health services (Johal, 2017; Ramos-Sánchez, 2009); (c) effectiveness, roles, and use of language switching in counseling (Costa & Dewaele, 2014; Pérez Rojas et al., 2014; Ramos-Sánchez, 2007, 2009; Santiago-Rivera & Altarriba, 2002; Vaquero & Williams, 2019); (d) relationships between counselors’ bilingualism and their multicultural counseling competency by combining self-reports and external observations (Ivers & Villalba, 2015); and (e) efficacy of bilingual supervision and training models on bilingual counseling (Trepal et al., 2014).

The purpose of this study was to gain a more accurate understanding of the practice of bilingual counseling, its effectiveness, and related training and supervision by conducting a systematic review of the literature published over the past two decades. It is important to note that the search results for this present review were limited by the selected keywords and available databases. In addition, some of the dissertation studies might have not been included unless they were published in peer-reviewed journals. With this in mind, this systematic analysis of existing literature on bilingual counseling suggests that very few studies have examined the experiences of linguistically diverse clients in counseling settings.

Similarly, there is a lack of literature that discusses how graduate-level counseling programs are addressing bilingual counseling and supervision as part of their curriculum. However, it is encouraging to see that more recently conducted studies have collectively begun to examine the complexity of bilingual counseling in both clinical settings and training programs. Given the Latinx population being by far the largest bilingual group within the United States, this group seems to have received the most attention among linguistically diverse groups. While continuing to undertake studies with this particular population, conducting more studies that involve clients, counselors, and graduate students of other bilingual backgrounds may contribute to the existing body of the literature.

Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.

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Atsuko Seto, PhD, NCC, ACS, LPC, is an associate professor at The College of New Jersey. Nancy L. A. Forth, PhD, NCC, LPC, is a professor and program coordinator at the University of Central Missouri. Correspondence may be addressed to Atsuko Seto, 2000 Pennington Road, Ewing, NJ 08628, seto@tcnj.edu.