Building Trust and Relationship across Language Barriers: A qualitative study of Interpreter- Mediated Psychotherapy with therapists, interpreters and patients

Background Among a variety of barriers to accessing and providing mental health care for migrant and refugee populations, language barriers play a crucial role. Interpreter-mediated psychotherapy (IMP) has emerged as an effective approach to overcoming these challenges and promoting equitable access to mental health care. However, IMP also introduces a more complex relationship structure: the classical therapist–patient dyad evolves into a triad. Despite the utilisation of interpreters, little research has examined the specific dynamics and quality of relationships within this triad. Relational qualities such as trust, empathy, and mutual understanding are known to be key indicators of a positive therapeutic relationship. This study explores these qualities in IMP, focusing on trust-building, the role of nonverbal communication, and relationship development among all parties involved, in order to inform practices that foster equity in mental health care for patients facing language barriers. Methods To address this, 21 semi-structured interviews were conducted with mental health care providers (n = 6), interpreters (n = 6), Turkish- and Arabic-speaking patients (n = 6), and three experts in migration and mental health, relationship building in psychotherapy, and translation studies. The interviews were audio-recorded, transcribed verbatim, and analysed using qualitative content analysis. Results 13 relational qualities emerged from analyses of the triadic relationship. Across all relationships, trust emerged as a central theme for all participants. Within the patient-therapist dyad, clear information about confidentiality fosters patient openness, while patients particularly value nonverbal communication alongside the therapist’s emotional presence and responsiveness. In the interpreters’ relationship with both therapist and patient, the importance of accurate translations and adherence to confidentiality appeared to be the most influential factor in building trust among the involved parties. Conclusion This study offers insights into the lived experiences of linguistically diverse service users. It highlights the role of IMP in advancing equitable mental health care and shows that, despite potential uncertainties, therapeutic relationships and trust can be effectively established when language barriers exist. These insights offer concrete starting points for developing guidelines and trainings both for practitioners and interpreters, aimed at fostering inclusion, mutual understanding, and improving the overall quality of mental health service delivery in settings with language barriers.