Sixteen percent of Philadelphians are immigrants. How easy is it to get mental health care in their native languages?

When it comes to accessing adequate mental health care, immigrants and refugees face a plethora of barriers. But for those who speak little to no English, one of their biggest obstacles is language.

According to data from Psychology Today, a website where many mental health providers list their practices, of the 1,258 therapists and therapeutic clinics listed in Philly, only 171 (or 13.6%) speak a language other than English. Of those 213, Spanish was the most represented with 71 Spanish-speaking providers. The next most-spoken languages amongst Philly therapists are Russian, at 17; French, at 16; and Mandarin, at 11.

These numbers are in stark comparison to the languages that Philadelphians speak. According to census data, 24% of Philadelphians speak a language other than English at home, and 11% don’t speak English very well.

“This issue is very much on our mind, because we have found it almost impossible to provide therapy services for our clients outside [our organization] except for a few small exceptions,” said Gwen Soffer, associate director of wellness and trauma-informed practice at the Philly-based Nationalities Service Center, which offers resettlement and support services to refugees and immigrants.

The mental health field was a mystery to Hider Shaaban when he first immigrated to the United States.

Shaaban and his family fled the Iraq War in 2007 before making their way to the U.S. under refugee status two years later. That was when he discovered the mental health field — something he didn’t hear about much when he was growing up in Iraq — and later decided to become a therapist.

“It was a revelation to me, in a way,” said Shaaban, now a clinical psychologist and the executive director of the Philadelphia Center for Psychotherapy. He went on to specialize in trauma, a nod to the trauma that he and his community experience, and that he often sees swept under the rug.

“They don’t necessarily have the language to describe [the trauma] … which can feel isolating on top of the existing pain of that trauma,” he continued.

Today, Shaaban is one of four Arabic-speaking therapists in Philadelphia, according to Psychology Today. Meanwhile, roughly 3,700 Arabic-speaking Philly residents are not fluent in English, according to census data — demonstrating the disproportionate representation many locally spoken languages may have in the city’s mental health field.

“If you’re offering therapy and you don’t have their mother tongue, they really aren’t accessing everything that they could be accessing in a therapy session.”

Mental health professionals are largely in agreement that sharing a language, particularly the patient’s native language, can deeply impact the therapeutic experience for the client and the client’s relationship with the provider. Sharing a native language not only provides more room for connection between the patient and provider, but also allows for the patient to better articulate emotions.

“If you’re offering therapy and you don’t have their mother tongue, they really aren’t accessing everything that they could be accessing in a therapy session,” Soffer said. “And it could go in the other direction for the therapist — what are they missing from what the client is saying, and what are they missing in their own expression?”

This is particularly true when there aren’t direct translations of English wellness terminology to other languages.

“When you talk about language, it’s not just ‘do we have people that speak the language of the community members with whom we work’ but also, ‘do we have the same vocabulary of expressing their needs and their hope for outcomes?’” said Cathi Tillman, executive director of La Puerta Abierta in Norris Square, which focuses on providing mental health care to immigrants and refugees.

When someone indicates being depressed, or anxious, or isolated, Tillman said, that could mean something very different not only in the client’s language, but also within the context of the person’s cultural and life experiences.

On the other hand, focusing the conversation on how clients feel in their bodies, whether they have trouble sleeping at night, or what thoughts are running through their head are ways to approach mental wellness conversations with people hailing from cultures that may not put mental health care as front-and-center it is in American culture.

When a therapist and patient don’t share a spoken language, an interpreter can be brought in to sessions. But, sometimes, bringing an interpreter into a therapeutic session can be disruptive, both to the flow of the session and to the provider-patient relationship.

But when it’s done right, Soffer says, it can be a “magical triad.”

Oftentimes, the interpreter can even serve as a cultural broker, suggesting the therapist rephrase or rethink questions or comments to the patient.

Soffer’s favorite success story is of a Spanish-speaking, Puerto Rican female therapist treating a Sudanese, Arabic-speaking man using a Syrian, Arabic-speaking interpreter.

“Normally, you might look at those three people and go, ‘why?’” Soffer said. “But they have this magical triad going on where the client actually trusts both of them so much.”

It’s a trusting relationship that wouldn’t exist if his therapist was using a translation service hotline, bringing in a different interpreter for each session. But according to Soffer, the consistency of working with these two women for three years has led the man on an incredible healing journey with a strong support system.

Lamya Broussard, a resident therapist for the nonprofit Caribbean Community in Philadelphia, has had similar success when using interpreters for her sessions with predominantly Haitian-Creole or French-speaking patients.

“We speak the language of love, of humanity, of dignity, of respect, that opens up our communities, even when you have a translator,” she said. “It takes a little patience … but in terms of the healing I’ve seen, it’s very much the same as when I’m speaking to someone who is English-speaking.”

» READ MORE: Mental health care for refugees is tricky. These three Philly providers found an answer in group settings.

But that doesn’t mean that utilizing interpreter services does not come without some difficulties.

La Puerta Abierta also utilize interpreters for patients who speak Indigenous Latin American languages, such as Kaqchikel. But finding interpreters who speak such lesser-known languages can be extremely challenging. Some providers have even heard stories of therapists allowing patients to bring in family members as interpreters or using Google Translate, avenues that they strongly discourage.

To steer therapists away from those discouraged practices, some providers are taking matters into their own hands.

The Nationalities Service Center, for example, has recently launched a mental health interpreter training program to create a pipeline for people with immigrant lived experiences and language expertise to be able to access such careers. Creating such a program, Soffer said, is a way to try to remove barriers such as cultural stigma and the expense of pursuing interpreter degrees.

The program both trains interpreters to use their skills specifically in mental health settings and provides supportive supervision for them because of the trauma they may be exposed to in sessions — sessions that could invoke their own shared traumas. The program also provides scholarships for people interested in pursuing mental health or social service careers.

“It’s important to address the systemic issues,” Soffer said. “We’re creating the model, and hopefully we can do something that will bring more people in.”