Ever more American mental health professionals rely on interpreters to bridge language and cultural gaps between themselves and clients who do not speak English. This study analyzes in-depth ethnographic interviews with 10 mental health professionals involved in a torture treatment and assessment center to examine how the use of interpreters affects mental health service delivery. The findings highlight the following factors that affect the clinical process: challenges to communication, accuracy of communication (both linguistic content and cultural context), changes in therapy dynamics, and the emotional reactions of interpreters to the stories told by clients. This study discusses the need to properly train interpreters and to safeguard against their exposure to vicarious trauma.