Module 6: Multilingual Considerations


Module Created by Pamela Santiago Tamariz, M.Ed., Israel Arevalo, M.A., LSSP, and Anita Sohn McCormick, Ph.D., LSSP, Licensed Psychologist




Intake Process

Identifying the language needs of the client and the client’s caregivers

  • This may include documentation (i.e., intake form, informed consent, activities, etc.) and preferred language for the provision of services

Explicit use of clear and concise communication in the preferred language


Informed Consent

  • Informed consent should be provided to the parent/client by an adequately fluent practitioner and/or interpreter.
    • Provide all written documentation in the preferred language of the client, or, if they are a minor, in the guardian’s language. 
    • When using the services of an interpreter, practitioners should strongly consider coordinating with interpreters and clients in anticipation of services (setting expectations on how the collaboration should proceed).

Technology Literacy

  • Practitioners should be mindful of a client’s technological literacy as limitations their knowledge and understanding of software, processes and programs may result in clients having difficulty accessing, navigating, and participating within a telehealth session (Triana et al., 2020).


Access to Technology

  • Consider your client’s access to technological resources (e.g., stable Wi-Fi, computer, webcam, microphone, etc.) to participate in telehealth sessions (Triana et al., 2020).
  • Consider holding a problem solving meeting to explore these limitations and come up with possible solutions or alternatives.


Practitioner-Interpreter collaboration

  • Strive for synergy between the interpreter and the practitioner to effectively establish a relationship with the client while providing language support.
    • Using clear and simple statements
    • Frequently checking in with the client for clarification
    • Interpreting statements sequentially over simultaneous interpreting
    • Pacing the session to allow for best communication between client and practitioner through an interpreter


Equal Access

  • Addressing potential structural barriers to telehealth services 
    • Practitioners should consider providing resources for clients to learn to use technology relevant to the provision of services (e.g. Youtube videos, case management sessions)
    • Practitioners should ensure access for individuals with limited English proficiency (LEP)
      • Use of telehealth platforms that are available in other languages (e.g. Spanish) and/or offer multilingual language support
      • Use of telehealth platforms that support both video and audio modalities for clients with limited access to computers, or high resolution video.


Counseling Services

Self-assessment of cultural and linguistic competence as it relates to the provision of therapeutic services

  • Aim to understand the culture-specific assets (personal, social, familial, etc.) and limitations (economic, social, etc.) of bilingual (and likely bicultural) populations and how to assist in managing and addressing these areas (Villalba, 2007).

Validating bilingualism during therapy

  • Clients may sometimes not find the ‘right word’ to express their thoughts or emotions in English – encouraging the use of native language to find the right word or phrase may allow them to best express their thoughts or emotions.
  • Reframing bilingual skills as an asset in order to help clients explore the positive factors of bilingualism while also developing strategies to cope with negative factors (Villalba, 2007)
  • Validating clients use of bilingualism during therapy may also strengthen the therapeutic relationship (Perez-Rojas et al., 2019).
  • Language-matching during therapy allows for a deeper relationship building experience in therapy.

Assessment Services

  • Selecting standardized tests normed on culturally and linguistically diverse populations is essential.
  • Ensure that the sample population of the selected tests is representative of the client’s linguistic and cultural background.
  • Consider utilizing tests that have shown to have validity even while used through virtual means such as zoom or other telehealth platforms (eg. nonverbal measures).
  • Telehealth naturally creates a barrier between practitioners and clients – especially amongst clients of cultures or groups that emphasize interpersonal connectedness or that rely heavily on nonverbal interactions- therefore, spending more time building a relationship and obtaining relevant information to the assessment is critical.
  • When language matching is not possible, practitioners should make use of whatever nonverbal communication is available.
  • Considering the impact of language diversity or bilingualism during the assessment and as part of the results 
  • Consider the possibility of hybrid assessment strategies where standardized measures are administered in person but questionnaires or other information gathering methods are completed in a virtual environment. 
  • Integration of results should include a section on bilingual/language impact on the assessment results and conclusions drawn.


Conducting Language Assessments

  • In children with autism, practitioners should be able to adapt and respond with flexibility to individual differences and needs of the children and parents, considering the standardization criteria and noting any variations in administration (Sutherland et al., 2019).

Cultural Considerations

  • Ethnic match is not enough for cultural responsiveness (Arcia, LaCay & Fernandez, 2002), nor is common language. Providers should be sensitive to intragroup differences/when engaging in counseling and assessment of multilingual populations. 
  • The acceptability of therapeutic techniques or interventions should be considered within a cultural framework.

Supervising Bilingual Services

  • Self-assessment of cultural and linguistic competence prior to the delivery of supervision to bilingual counselors and/or bilingual clients
    • Supervisors should be fluent in both languages to provide optimal supervision of both process and content of sessions for both therapy and assessment.
    • Supervisors should include discussions on the impact that client’s bilingual/multilingual skills have on the relationship and interaction with the practitioner.
    • Supervisor should include a discussion on how cultural/linguistic differences/similarities with the practitioner are impacting the therapeutic content.

    Considering social and emotional needs of bilingual practitioners (Trepal et al., 2014; Perry & Sias, 2018; Set & Forth, 2020)

    • Peer-support groups
    • Reduction of caseloads if bilingual practitioners are experiencing additional demands related to providing services (e.g., translation of sessions for supervision purposes, documentation, bilingual assessment)

    Other Considerations

    • Advocating for the recruitment of bilingual supervisors and practitioners
    • Advocating for multicultural competence training for supervisees


APA training module lists

Handbook development

Learning communities

Distinction between assessment and therapy

Diversity considerations

Cultural competence self-assessment checklists/questionnaires

Cultural and Linguistic Competence Module


The following presentation will illustrate an initial session with a bilingual parent seeking services for their child.  The intent of this video is to demonstrate how cultural constructs are inseparable from linguistic ones.Therefore, awareness of cultural concepts such as collectivistic vs. individualistic world views, power differentials and perceptions as well as cultural competence and self-awareness are critical.  Specifically to language related issues, awareness of dialectical differences, code switching behaviors and linguistic humility are important for the counselor/examiner to consider.


Anaya, Y. B. M., Hernandez, G. D., Hernandez, S. A., & Hayes-Bautista, D. E. (2021). Meeting them where they are on the web: addressing structural barriers for Latinos in telehealth care. Journal of the American Medical Informatics Association, 28(10), 2301-2305.

Arcia, E., Sanchez-LaCay, A., &  Fernandez, M.C. (2002). When Worlds Collide: Dominican Mothers and Their Latina Clinicians. Transcultural Psychiatry, Vol 39(1): 74–96.

Arias, F., Safi, D. E., Miranda, M., Carrión, C. I., Diaz Santos, A. L., Armendariz, V., … & STAR Consortium. (2020). Teleneuropsychology for monolingual and bilingual Spanish-speaking adults in the time of COVID-19: Rationale, professional considerations, and resources. Archives of Clinical Neuropsychology, 35(8), 1249-1265.

Costa, B., & Dewaele, J. M. (2012). Psychotherapy across languages: beliefs, attitudes and practices of monolingual and multilingual therapists with their multilingual patients. Language and Psychoanalysis, (1), 18-40.

Farmer, R. L., McGill, R. J., Dombrowski, S. C., McClain, M. B., Harris, B., Lockwood, A. B., … & Stinnett, T. A. (2020). Teleassessment with children and adolescents during the coronavirus (COVID-19) pandemic and beyond: Practice and policy implications. Professional Psychology: Research and Practice.

Fleming, D. A., Edison, K. E., & Pak, H. (2009). Telehealth ethics. Telemedicine and e-Health, 15(8), 797-803.

Henry, B. W., Block, D. E., Ciesla, J. R., McGowan, B. A., & Vozenilek, J. A. (2017). Clinician behaviors in telehealth care delivery: a systematic review. Advances in Health Sciences Education, 22(4), 869-888.

Hsieh, E. (2010). Provider–interpreter collaboration in bilingual health care: Competitions of control over interpreter-mediated interactions. Patient education and counseling, 78(2), 154-159.

Linardi, N., Herrera, C., & Cacace, C. (2021). A Nonprofit’s Transition to Teletherapy Due to the COVID-19 Crisis: Learning How to Adapt. Journal of Systemic Therapies, 40(1), 52-58.

Luxton, D. D., Pruitt, L. D., & Osenbach, J. E. (2014). Best practices for remote psychological assessment via telehealth technologies. Professional Psychology: Research and Practice, 45(1), 27.

Martyr, M. A., Kivlighan III, D. M., & Ali, S. R. (2019). The role of telepsychology training clinics in addressing health disparities with rural Latinx immigrant communities. Translational Issues in Psychological Science, 5(4), 346.

Pérez-Rojas, A. E., Brown, R., Cervantes, A., Valente, T., & Pereira, S. R. (2019). ” Alguien abrió la puerta:” The phenomenology of bilingual Latinx clients’ use of Spanish and English in psychotherapy. Psychotherapy, 56(2), 241.

Perry, V. M., & Sias, S. M. (2018). Ethical concerns when supervising Spanish-English bilingual counselors: Suggestions for practice. The Journal of Counselor Preparation and Supervision, 11(1), 10.

Seto, A., & Forth, N. L. (2020). What Is Known about Bilingual Counseling? A Systematic Review of the Literature. Professional Counselor, 10(3), 393-405.

Sutherland, R., Trembath, D., Hodge, M. A., Rose, V., & Roberts, J. (2019). Telehealth and autism: Are telehealth language assessments reliable and feasible for children with autism?. International Journal of Language & Communication Disorders, 54(2), 281-291.

Triana, A. J., Gusdorf, R. E., Shah, K. P., & Horst, S. N. (2020). Technology literacy as a barrier to telehealth during COVID-19. Telemedicine and e-Health, 26(9), 1118-1119.

Villalba Jr, J. A. (2007). Culture‐specific assets to consider when counseling Latina/o children and adolescents. Journal of Multicultural Counseling and Development, 35(1), 15-25.

Vázquez, A. L., Navarro Flores, C. M., Alvarez, M. D. L. C., & Domenech Rodríguez, M. M. (2021). Latinx caregivers’ perceived need for and utilization of youth telepsychology services during the coronavirus pandemic. Journal of Latinx Psychology.