Access to Psychotherapy for Minority-Language Speakers: A Scoping Review to Build Recommendations for English-Speaking Communities in Québec

Many people from minority language communities in Québec face barriers to accessing mental health services because of systemic, linguistic, and cultural challenges. For English-speaking communities, accessing psychotherapy in their first language can be especially difficult, even though research shows that therapy is generally more effective when delivered in the patient’s primary language.

This project will review research published over the past two decades on psychotherapy in linguistic minority settings. The study will examine how language affects the quality and effectiveness of mental health care, as well as existing clinical guidelines and policy recommendations related to language-concordant services.

The findings will help identify ways to improve access to effective mental health care for English-speaking communities in Québec. The project will also bring together researchers, practitioners, and community partners to develop practical recommendations for strengthening mental health services in patients’ first language.

Outputs:

Coming soon…

Improving Mental Health Care for Migrant and Minority Patients for English-Speaking Communities in Québec

Quebec’s English-speaking communities include people from migrant and minority backgrounds who differ in their cultural background and first language (while preferring English as first official language). Access to mental health care for these communities benefits from training and retaining clinicians from a wide range of cultural and linguistic backgrounds. Unfortunately, these clinicians often leave Québec due to limited French-language support and lack of training in multicultural practice. The loss has direct implications for quality of care: psychological interventions are most effective when delivered in a culturally-sensitive way, in the patient’s first language. We propose a bilingual mini-conference and training workshop to help tackle this challenge.

The event will bring together clinicians, students, educators, and policy stakeholders from those disciplines granting the right to (a) practice psychotherapy in Quebec, or (b) pursue a psychotherapy license: clinical psychology, psychiatry, nursing, social work, and occupational therapy. Through interactive workshops, applied training sessions (e.g., the Cultural Formulation Interview), and collaborative discussions, participants will explore how we can better support the training and retention of multilingual and multicultural mental health professionals. Speakers will also present findings from recent studies, including those funded by Dialogue McGill, investigating clinician retention and language-related barriers to care. The goal is to share knowledge, co-develop solutions, and foster a province-wide dialogue on inclusive training.

The event will be hybrid and fully bilingual: speakers will have the option to present in French or English. Concordia University will host the event, supported by research assistants, a keynote speaker, and trained facilitators. The results will be translated where necessary and shared widely across Québec’s mental health networks. By focusing on both language and culture, this initiative aims to help build a more sustainable, accessible, and culturally safe mental health care system for English-speaking Quebecers, especially those from migrant and minority backgrounds.

Outputs:

March 2026 - Hosted a conference on Language, Culture, and Mental Health.

Integrating French second-language experiences into clinical psychology training to enhance retention of English-speaking trainees

This project addresses the need for culturally and linguistically sensitive mental health services, with a focus on supporting English-speaking clinical psychology trainees in Québec. Many trainees leave the province after graduation due to challenges related to French-language requirements and the difficulty of building a sustainable practice that includes Francophone clients, which contributes to a shortage of English-speaking mental health professionals.

The study examines a new initiative at Concordia University that integrates French-language training into clinical psychology education for English-speaking trainees. It aims to understand how this approach may improve training experiences and support long-term retention in the province.

The project combines a systematic review of international best practices in second-language training for mental health professionals with qualitative interviews. We will speak with 30 clinical psychology trainees, clinical supervisors, and community-based clinicians to better understand their experiences using French in clinical settings.

The findings will be used to produce a report outlining best practices for French-language training and assessment in clinical psychology, with implications for improving trainee retention and strengthening access to bilingual mental health services in Québec.

Outputs:

• Evidence synthesis: Following interviews with trainees and supervisors, the team conducted a global systematic review to identify best practices for second-language training of mental health clinicians, aligned with the study’s qualitative analysis.

• Final report (forthcoming): Will present theory- and evidence-based guidelines for integrating French second-language training into clinical psychology programs.

• Expected impact: Improved retention of English-speaking trainees in Québec and enhanced access to mental health services for English-speaking communities.

• Knowledge sharing: The final report will be disseminated to higher education institutions and Centres intégrés universitaires de santé et de services sociaux to support collaboration and strengthen health and social services for English-speaking populations.

Linguistically- and Culturally-Sensitive Psychotherapy: Improving Communications to Improve Outcomes

This project examines how language and cultural differences can affect the quality and effectiveness of psychotherapy, particularly for people experiencing anxiety or depression. When clients and therapists do not share the same linguistic or cultural background, misunderstandings can arise that may interfere with treatment.

Building on previous research supported by Dialogue McGill, the study aims to test strategies that help therapists better address these communication challenges. It will combine a review of existing research, an analysis of real therapeutic interactions, and an evaluation of interventions designed to improve communication and outcomes over time.

The study includes 12 participants from migrant or minority backgrounds who speak English as a second language and prefer another official language. Some will receive therapy in a matching language context, while others will experience a language mismatch, allowing for comparison of experiences and outcomes.

Using both qualitative and quantitative methods, the project will explore how misunderstandings arise in therapy and how they can be reduced. The results are expected to improve mental health care for linguistically diverse populations in Quebec and inform training for therapists working in multicultural settings more broadly.

Outputs:

• Publications in progress: A peer-reviewed article is in preparation examining how linguistic and cultural barriers affect psychotherapy, how they can be addressed, and their impact on treatment outcomes (quantitative analysis completed).

• Knowledge tools: Development of the Acculturation Toolkit, an online resource to support second-language training for clinicians, building on tools refined through this project.

• Published outputs: Four encyclopedia entries on cultural-clinical psychology published in the SAGE Encyclopedia of Depression and Anxiety, incorporating findings from the team’s systematic review.

• Knowledge mobilization:

  • Participation in an expert workshop (June 2024) featuring research funded by Dialogue McGill.

  • Keynote presentation (September 2024) highlighting this project and related funded research.

• Next steps: A training and dissemination workshop, integrating materials from this and previous funded projects, is planned for Fall 2025.

Linguistically- and Culturally-Sensitive Psychotherapy: Training and Retaining Migrant & Minority Therapists

Mental health care in multicultural communities is enhanced when local therapists represent the population and when these therapists are trained in linguistically- and culturally-sensitive psychotherapy. Unfortunately, many trainees do not feel well-prepared for diversity and migrants/minorities face barriers to building a career in Québec.

We will: (1) use qualitative inquiry to study perceived training deficits and career barriers in psychologists trained at anglophone institutions; (2) use quantitative techniques to establish a consensus model of the changes needed to retain multicultural expertise in Québec. 

Participants will be 40 clinical psychology trainees and 40 licensed clinical psychologists. This project will use a cultural consensus design, a mixed methods approach with four sequential steps: (1) qualitative interviews (in this case, analysis of previously collected interviews); (2) free listing responses to open-ended questions; (3) sorting the most common responses while thinking aloud; and (4) survey design based on the consensual sorts.

The qualitative interview and think-aloud transcripts will be studied using qualitative inquiry, specifically thematic analysis. The free listing, sorting, and survey components will be studied using quantitative analysis; frequency analysis, multidimensional scaling, and cultural-consensus analysis, respectively.

We anticipate this project will improve training of mental health professionals and will yield steps to boost retention of migrant/minority psychologists in Québec. We will develop recommendations for the two anglophone training programs, and for the professional order. Our results will be relevant to other cultural settings characterized by linguistic and cultural complexity.

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Outputs:

• Zhao, Y., Segalowitz, N., Voloshyn, A., Chamoux, E., & Ryder, A. G. (2021). Language Barriers to Healthcare for Linguistic Minorities: The Case of Second Language-specific Health Communication Anxiety. Health communication, 36(3), 334–346. https://doi.org/10.1080/10410236.2019.1692488

• Ryder, A. G., Doucerain, M. M., Dere, J., Jurick, T., Zhou, B., & Zhou, X. (2021). On dynamic contexts and unstable categories: Steps towards a cultural-clinical psychology. In M. Gelfand, C.-Y. Chiu, & Y.-Y. Hong (Eds), Advances in culture and psychology, volume 8 (pp. 195-245). OUP.

• Voloshyn, A., Dussault, È., Segalowitz, N., Ryder, A. G. (2022, September). A qualitative study of clinical psychologists’ reflections on their work with linguistically- and culturally-diverse clients [Paper session]. Presentation at the 6th World Congress of the World Association of Cultural Psychiatry, Rotterdam, Netherlands.

CKOL: Documentation on Health and Social Services in English-Speaking Quebec

The Community Knowledge Open Library (CKOL), created by the Quebec English-Speaking Communities Research Network (QUESCREN), Concordia University, is a growing online repository of documents from groups and stakeholders serving and working with English-speaking communities in Quebec. The objective of the current project for which we are seeking funding is to add material related to health and social services in English-speaking Quebec to the existing CKOL database.

This material will be gathered from existing project partners, and we will establish new partnerships with members of the Community Health and Social Services Network (CHSSN), from whom we will also start obtaining CKOL material. Integrating new documents into this user-friendly one-stop database will increase access to knowledge through an enriched CKOL database. This will make it easier for stakeholders to meet the health care and social service needs of English speakers in Quebec.

Linguistically- and Culturally-Sensitive Psychotherapy: Evaluating an Approach to Assessment and Treatment

The Centre for Clinical Research in Health (CCRH) successfully established a university- funded state-of-the-art research clinic at Concordia University (of which the principal investigator is co-founding member). The clinic is launching an evidence-based, culturally-sensitive psychotherapy program for migrants with anxiety and/or depression. This larger project provides investigators with a valuable opportunity to evaluate the effectiveness of language-sensitive mental health interventions in a real-life clinical setting.

It is therefore proposed to: (1) Integrate research tools (developed with previous Dialogue McGill funding) into the assessment battery completed by all clients completing the treatment protocol used with migrant clients at CCRH. (2) Use qualitative techniques to study video-recordings and transcripts of actual clinical sessions to study the consequences of language discordance on effective communication and treatment. (3) Use quantitative analysis techniques to test whether potential problems identified by the assessment battery are linked to problematic features of actual clinical interactions. Hypotheses are: H1: Indices related to better functioning in a given language will predict fewer in-session communication difficulties when the treatment is conducted in that language. H2: Fewer in-session communication difficulties will predict more rapid symptom improvement.

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Outputs:

1. Unknown. (2020, May). Cultural scripts for normalcy and deviancy: A mixed-methods approach to understanding mental illness in new contexts [Presentation]. Interacting Minds Center, Aarhus, Denmark

2. Unknown. (2019, November). Linguistically- and Culturally-Sensitive Psychotherapy: A Proposal [Presentation]. Centre for Clinical Research in Health, Montreal, Quebec.

Communication Networks of Linguistic Minorities: Who Talks to Whom About Health?

There is a considerable literature documenting the help-seeking pathways of patients. The early stages usually involve considerable negotiation within a person’s existing social network before outside help is sought. The team has previously developed a social network measure designed to assess linguistic characteristics of social networks (Ryder & Segalowitz, funded by Dialogue McGill) as well as a measure of second language health communication anxiety (Segalowitz & Ryder, funded by Dialogue McGill). The overarching goal of this project is to finalize the adaptation of these measures to Multilanguage settings, establish their psychometric properties, and explore the interrelations of these instruments in Francophone and Anglophone community samples. To this end the project has proposes the following objectives: (1) Adapt the acculturation battery for use in multilingual settings. (2) Translate the adapted acculturation battery into French (the other measures have already been translated). (3) Implement an online system to deliver the entire set of measures in either language. (4) Evaluate the overall set of measures in Francophone and Anglophone community samples.

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Outputs:

1. Zhao, Y., Segalowitz, N., Voloshyn, A., Chamoux, E., & Ryder, A. G. (2021). Language Barriers to Healthcare for Linguistic Minorities: The Case of Second Language-specific Health Communication Anxiety. Health communication, 36(3), 334–346. https://doi.org/10.1080/10410236.2019.1692488

2. Ryder, A. G., Doucerain, M. M., Dere, J., Jurick, T., Zhou, B., & Zhou, X. (in press). From acculturation and psychopathology to cultural-clinical psychology. For M. Gelfand, C.-Y. Chiu, & Y.-Y. Hong (Eds), Advances in culture and psychology (vol. 8). Oxford, U.K.: Oxford University Press.

3. Chang, J., Pak, S., Doucerain, M. M., & Ryder, A. G. (2019, January). Validation of the AIM as a well-being and acculturation measurement tool [Poster presentation]. Sixth Annual Conference of the Centre for Clinical Research in Health, Montreal, QC, Canada

4. Tao, D., Doucerain, M. M., Segalowitz N., & Ryder, A. G. (2018, October). Social network and mental health help-seeking attitudes: The case of Chinese migrants in Montreal [Poster presentation]. 5th International Convention of the World Association of Cultural Psychiatry, New York, NY, USA

5. Tao, D., Doucerain, M. M., Segalowtiz N., & Ryder, A.G. (2018, July). What’s the relationship between one’s social network and mental health help-seeking attitudes? The case of Chinese migrants in Montreal. Paper presented at the 24th International Congress of International Association of Cross-Cultural Psychology, Guelph, ON, Canada

Still birth among Arabic speakers: Comparison with Francophones and Anglophones in Quebec

Language status is slowly emerging as a source of inequality in perinatal health for minorities in Quebec. Minority groups in Quebec are primarily defined by language, where Arabic, the most important immigrant language, accounts for 18% of foreign languages. In Quebec, language reflects ethnicity and social status, and is associated with cultural norms and access to health care. Previous research demonstrated that compared with Francophones, the Anglophone minority has a higher risk of numerous adverse birth outcomes, including stillbirth, preterm birth, fetal growth restriction, and infant mortality. Inequality in perinatal health for other minority groups, including Arabic speakers, has however not been studied. In the context of increasing immigration, the research will study inequality in stillbirth between Arabic speakers and Francophones and Anglophones in Quebec. The researcher hypothesize that Arabic speakers have a higher risk of stillbirth compared with Francophones, due to limited health care access, communication barriers, cultural or socioeconomic differences, or behavioral factors.

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Outputs:

1. Auger, N., Racape, J., Raynault, M. F., Bilodeau-Bertrand, M., Lee, G. E., & Janevic, T. (2020). Stillbirth among Arab women in Canada, 1981-2015. Public health reports, 135(2), 245–252. https://doi.org/10.1177/0033354919900894