Why do I talk to my therapist in English?

When talking about my therapy journey, I get uncomfortable when I speak in Arabic.

I prefer English when talking about my diagnoses, symptoms, and therapist’s recommendations. Therapy jargon, such as “future-tripping,” “listening to my body,” “coping mechanisms,” and “seeking help,” simply sound awkward when translated into Arabic. Even though Arabic is our first language, my therapist and I almost exclusively speak in English.

Many young Lebanese share this urge—a need to express themselves and discuss their pain in English. In the process, they delegate Arabic to the background. 

Many young Lebanese share this urge—a need to express themselves and discuss their pain in English. In the process, they delegate Arabic to the background. Why? And for those who don’t speak English, do they still seek therapy?

Why young Lebanese are moving to speak English in therapy 

Lebanese society is colorful, diverse, and multilingual. Many Lebanese speak Arabic, English, and French, reserving certain languages for certain settings.

In Lebanon, approximately 9 percent of Lebanon’s population suffers from moderate to severe mental health disorders. However, just 9.8 percent of those suffering from long-term mental health disorders seek help, and around 19.7 percent of Lebanese with mental health disorders get treatment, such as therapy. For those who are in therapy, they often choose to speak English. 

Class, Education, and Environment

Education and class can play a key role in determining this language preference. “Patients who usually seek psychotherapy are well-educated people with a certain level of income,” psychotherapist Maureen Mahfouz Bejjani says. “They come with an understanding of what therapy is.” Bejjani, who has worked at multiple NGOs like Handicap International, connects the access upper-class Lebanese have to learning English as their reason for speaking it in therapy. She argues class and the access to education it provides are what determine whether a person has access to learn English.

“Patients who usually seek psychotherapy are well-educated people with a certain level of income,” psychotherapist Maureen Mahfouz Bejjani says. “They come with an understanding of what therapy is.” Bejjani connects the access upper-class Lebanese have to learning English as their reason for speaking it in therapy. She argues class and the access to education it provides are what determine whether a person has access to learn English.

Three additional therapists Raseef22 interviewed stress that therapy has become mainstream for all social classes in Lebanon. Counter to Bejjani’s point, one’s participation in therapy may have more to do with their open-mindedness and willingness to try therapy in the first place. “Therapy is a mindset that you have to embrace, despite your education, income or environment,” family consultant and mental health counselor Rania Hashem says. “Many well-to-do patients reject the idea of therapy and many less well-off accept it.”

Several native Arabic speakers in therapy Raseef22 interviewed prefer speaking English because of the environment they grew up within. “My parents spoke to my siblings and me in English a lot of the time, and we learned to speak English with our friends at school at the age of three or four,” Mahmoud Ayash, who lives in the affluent area of Ramlet al-Baida, says. “Of course we would choose therapy in English.”

English as lingua franca 

The increasingly hegemonic role English plays in business, culture, education, and social media pushes some patients to speak English simply because of personal preference. For example, Raseef22 spoke to a patient whose parents only speak Arabic, so he taught himself English. He noted he chooses to speak English with his therapist because “that’s the language I think in.” Why? “It’s the American influence.”

Although French has historically been viewed as the language of sophistication in Lebanon, English is gradually replacing it. While a notable minority choose to speak French in therapy, such patients appear to be dwindling. Solange, an assistant working at a psychiatric clinic in Achrafieh and Dbayeh, highlights that: “English is the new business language, which means that those who speak French [with their therapist] constitute a small number. They barely make up 20 percent of our patients.” Solange adds that, in return, the number of psychotherapists fluent in French has also dropped because a lot of them are graduates from English-language universities. Across Lebanon, more French-educated Lebanese students are choosing to go to college in English, and English has usurped French as the predominant language in Lebanese universities.

Although French has historically been viewed as the language of sophistication in Lebanon, English is gradually replacing it. Solange, an assistant working at a psychiatric clinic in Achrafieh and Dbayeh, highlights that: “English is the new business language, which means that those who speak French [with their therapist] constitute a small number. They barely make up 20 percent of our patients.” In turn, the number of psychotherapists fluent in French has also dropped because a lot of them are graduates from English-language universities. 

Raja Sabra, a 36-year-old economics instructor at the American University in Beirut (AUB) who spent several years in therapy for obsessive compulsive disorder, represents Bejjani’s target patient. He is increasingly comfortable with the dominance of English in Lebanon. Sabra speaks mostly English, in and out of therapy. “English is the language of my education. It’s the language of my work, the language I learned to express myself in.”

The role of stigma

Despite progress made in recent years, stigma against mental illness and those who seek psychological help in Lebanon continues to contribute to language choice in therapy. “Many of my patients or their families completely refuse when I refer them to a psychiatrist,” Hashem expresses. A 2019 study grounded this observation, finding that two-thirds of 2,800 surveyed Lebanese held stigma toward mental illness.

Stigma about Arabic being a less prestigious language than English also impacts what language Lebanese feel comfortable speaking in therapy. “When patients enter my clinic, they immediately start talking to me in English,” says Hashem. “They avoid talking in Arabic, even though they perfectly understand it. I think it is partly habit, partly prestige.” 

“When patients enter my clinic, they immediately start talking to me in English,” says Hashem. “They avoid talking in Arabic, even though they perfectly understand it. I think it is partly habit, partly prestige.” 

Arabic and bridging the linguistic gap

But what about Arabic?

“Translating therapy [to Arabic] word by word to patients is difficult, because a lot of people find it easier to express themselves in English or French,” Bejjani said. “Take for example, the word ‘stressed.’ It’s much easier to say it in English or French, because all of our education has been in these two languages.”

However, not every mental health professional shares Bejjani’s viewpoint. A lifeline operator at Embrace, an NGO that operates Lebanon’s first and only national suicide hotline, told Raseef22 that because she received her training in Arabic and is required to answer the phone in Arabic, she finds performing her duties easy. “Arabic is the language I use daily,” she says. That being said, Embrace still caters to callers who prefer to not speak Arabic. “Training at Embrace is also given in English and French when applicable.”

Despite progress made in recent years, stigma against mental illness and those who seek psychological help in Lebanon continues to contribute to language choice in therapy. "Many of my patients or their families completely refuse when I refer them to a psychiatrist," family consultant and mental health counselor Rania Hashem expresses. 

Despite many young Lebanese's preference for speaking English, more opportunities are being created for those who prefer speaking Arabic and see a need for it in the healthcare sector.

Sukeina Ali Ibrahim is one example of the small but growing number of professionals working to incorporate Arabic into therapeutic practice. Ibrahim is a psychotherapist by training who offers Arabic-language therapy. She has helped translate three psychology books from English to Arabic and is currently working with a sworn translator on translating the WISC-IV test, a test that measures intellectual performance in children and teenagers.

“It’s a huge responsibility, translating all these terms and concepts,” she says. “You have to take into account the differences in traditions, values, family dynamics, and other factors. What might be acceptable in one culture might be taboo in another culture, so a knowledge of both cultures is necessary.”

“It’s a huge responsibility, translating all these terms and concepts,” psychotherapist Sukeina Ali Ibrahim says. “You have to take into account the differences in traditions, values, family dynamics, and other factors. What might be acceptable in one culture might be taboo in another culture, so a knowledge of both cultures is necessary.”

In addition to translating, Ibrahim also works to integrate translations of foundational Western psychotherapy literature into educational settings. Ibrahim notes research on psychotherapy lags in non-Western languages. She argues this is mostly because modern therapy is a mostly Western approach and major pioneers of the field laid its foundations in European languages such as English and German. “We have a bulk of psychology literature translated to Arabic and taught in Arab universities, especially in Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT). And we are trying our best today to bridge the gap in Arabic literature on psychotherapy.”

English-educated psychotherapists with a working knowledge of Arabic, such as AUB graduate Dania Dbaibo Darwish, are also trying to bridge the linguistic gap.

“Psychological concepts are easier said in English, but I try to think in English and talk in Arabic in such cases, especially if I’m on national television,” Darwish explains. “I have to do my research and come prepared.”

Why do I talk to my therapist in English?  

One thing all interviewees had in common was the notion that psychotherapy, regardless of the language it is conducted in, aims to alleviate human suffering.

Serene, a 37-year-old makeup artist and one of Hashem’s patients, concluded her interview by putting it this way: “I advise anybody who is against seeking therapy to try it, because it changed my life completely. It made me a new person.”

Gradually, English became the lens through which I viewed the world. Somewhere along the way, I lost touch with my Arabic. I might live in an Arab country and embrace its quasi-Arab culture, but English reigned supreme when it came to communicating my state of mind.

Therapy also made me a new person. When I look back, I chose to speak English in school with my friends because it was cool and hip. It was the glorious age of the nineties, and we were obsessed with RnB artists like Usher and Sade. The internet had just launched, which meant I suddenly had access to the whole world in English. Gradually, English became the lens through which I viewed the world.

Somewhere along the way, I lost touch with my Arabic. I might live in an Arab country and embrace its quasi-Arab culture, but English reigned supreme when it came to communicating my state of mind.

Then again, I wouldn’t mind speaking Arabic with my therapist. English might have a hegemonic role in therapy, but there is a surprising amount of room for other languages in a country as beautifully diverse as Lebanon. I think it might even be fun to try therapy in Arabic.  

*This article was edited and proofread with the assistance of Zoe Wolfsen.