Interview with Andrea Carta, psychologist and systemic psychotherapist at MindSwiss and Clinica Psiche. A graduate in Clinical Psychology from the Catholic University of Milan, he holds a double specialisation in psychotherapy (clinical hypnosis and the Selvini Palazzoli systemic approach), a research doctorate in Criminology and advanced training in EMDR and integrated psychodiagnostics. In his clinical work he deals in particular with couples, families and personality disorders.
In couples therapy, communication is central. How much does the possibility of expressing oneself in one's mother tongue matter when working on conflicts, misunderstandings and complex relational dynamics?
It matters profoundly, more than one might imagine from the outside. When a couple arrives in therapy, they often bring conflicts that have layered over time: misunderstandings, repeated wounds, words said badly or not said at all. In these cases, language is not just a vehicle: it is the ground on which everything plays out. In your mother tongue you have direct access to emotions, to idioms that carry a world of meanings, to the tones with which we were loved, scolded, consoled as children. In a second language, however well you master it, you often remain on the surface. It is like trying to describe a dream while translating it in real time: something is always lost. In couples therapy this is even more delicate, because you do not work only on the content of what is said, but on the how it is said, and the “how” lives in the language of the heart.
From the systemic point of view, the couple is a system of shared meanings. How does the mother tongue contribute to building or rebuilding these meanings within the therapeutic journey?
This is a question that touches the heart of the systemic approach. Every couple builds over time its own affective vocabulary: words that have a specific weight only for those two partners, expressions that condense experiences lived together, inside jokes, ways of naming each other. This shared emotional lexicon is almost always rooted in the mother tongue. When I work with a couple in Italian, I can access that level of meaning with a precision that would be impossible in another language. Think of expressions like “mi hai fatto sentire piccolo” (you made me feel small) or “non mi vedi più” (you no longer see me): these are phrases that in Italian carry a universe of nuances, linked to our relational culture, to our way of understanding closeness and distance. In systemic therapy, the work consists precisely in making these meanings visible, in deconstructing them together and building new ones. If the language is the right one, the process is more authentic and deeper.
When a couple lives in Switzerland but comes from another cultural context, what critical issues emerge if the therapy does not take place in the language of the heart?
Switzerland is a plurilingual country, and it is an extraordinary richness. But precisely this plurality can become a trap when it comes to intimacy and suffering. Many Italian-speaking couples living in Zurich, Geneva or Basel find themselves having to choose between doing therapy in German or French, languages they perhaps use at work every day, or not doing it at all. The problem is that the language of work is not the language of emotions. In a second language you tend to intellectualise, to simplify, to stay in the cognitive comfort zone. Couple conflicts, however, do not live there: they live in the gut, in childhood memories, in patterns learned in the family. If I cannot say “I feel abandoned” with the same intensity with which I feel it, the therapy risks remaining on the surface. According to FOPH data, over the course of a year up to a third of the Swiss population may be affected by a mental disorder, yet only half of these people access treatment. For the Italian-speaking community outside Ticino, the language barrier is often the first concrete obstacle.
Does online couples therapy change relational dynamics compared to the in-person setting? What advantages and limits do you find in clinical practice?
Yes, it changes them, but not necessarily for the worse. Let us start with the concrete advantages: the online setting allows both partners to be in their own environment, and this sometimes lowers defences. I have seen couples who in the office would have been rigid and formal, and who from home managed to show themselves more vulnerable. Then there is a practical aspect that should not be underestimated: online therapy eliminates the problem of travel, incompatible schedules, the babysitter to find. For many couples, these logistical barriers were the reason they never started a journey. As for the limits, the most relevant concerns non-verbal communication: online I catch less of the body's micro-movements, postural tensions, the gestures one partner makes towards the other. However, with experience and the right attention, you learn to read through the screen too. The tone of voice, the pauses, the glances: all this comes through online as well, if you know where to look.
Working online, how do you preserve the quality of the therapeutic alliance and the depth of listening, elements that MindSwiss considers central?
The therapeutic alliance does not depend on physical distance, but on the quality of presence. This is a conviction we share across the whole MindSwiss team. In practice, it means that the first thing I do in a session, online or in person, is to create a space in which both partners feel listened to without judgement. Online this requires a different kind of attention: I have to be more explicit in giving back what I perceive, more attentive to silences, more precise in giving the floor. But it is a technical adaptation, not a compromise on quality. The most recent research, moreover, shows that the effectiveness of online psychotherapy is comparable to in-person therapy for most clinical profiles. What really counts is that the therapist is trained, that the setting is well cared for, and that there is an authentic relationship. We work a lot on this, also through the initial orientation interview, which serves precisely to understand together whether the conditions for a good journey are there.
In situations of high conflict, can the physical distance of the online setting facilitate a more authentic expression, or does it risk amplifying tensions?
It is a question I am often asked, and the honest answer is: it depends. In some high-conflict situations, physical distance is an advantage. When the partners connect from different rooms, something I sometimes actively suggest, a space of safety is created that allows each one to express themselves without feeling physically threatened by the gaze or closeness of the other. This can foster an openness that in the office, sitting one metre apart, would be more difficult. On the other hand, there are couples for whom distance amplifies the feeling of disconnection, and in those cases in-person work may be more indicated, at least in an initial phase. As a systemic therapist, my task is to read the specificity of each couple and adapt the setting to their needs, not the other way round. There is no universal format: there is the right one for that couple, at that moment.
Many couples postpone asking for help. Can online accessibility reduce the stigma and lower the entry threshold to therapy?
Decidedly yes, and I see it in daily practice. The stigma around couples therapy is still strong, especially in Italian culture: asking for help is often read as an admission of failure, and many couples arrive when the situation is already seriously compromised. The online format changes this dynamic significantly. Connecting from home, without having to physically enter an office, lowers the emotional threshold. There is no waiting room, no risk of running into someone. For Italian-speaking couples living in Switzerland there is also a double advantage: they can access a journey in their mother tongue, wherever they are on Swiss territory, without having to search, often in vain, for an Italian psychotherapist in their city. This is a concrete, structural change that digital makes possible today.
In your systemic work, how important is it to grasp the linguistic nuances, the unsaid and the metaphors used by the partners? What do you risk losing if you do not work in the mother tongue?
It is fundamental. An essential part of my work consists in listening not only to what the partners say, but to how they say it. The metaphors a person uses to describe their relationship are windows onto their inner world: “I feel caged”, “it is like talking to a wall”, “we are two strangers under the same roof”. Each of these images tells a precise story, and in systemic therapy those stories are the material we work on. In Italian, moreover, we have an enormous expressive richness when it comes to relationships, nuances that in other languages simply do not exist or do not carry the same weight. If a patient tells me “mi manca il fiato” (I cannot breathe), I know they are not describing a physical symptom: they are talking about relational suffocation. If they tell me “non mi sento a casa” (I do not feel at home), they are talking about belonging. Grasping these nuances requires a deep linguistic and cultural common ground. If therapy takes place in a language that is not the language of the heart, the risk is that the unsaid remains unsaid, and in couples therapy, that is exactly where the most important work hides.
For those living in Switzerland who wish to explore a couples therapy journey in Italian, MindSwiss offers an orientation interview: a space to understand together if and how a therapeutic journey can be useful. Contact MindSwiss. With a medical prescription, sessions can be reimbursed by LAMal, subject to deductible and co-payment.
