I recently had one of the most humorous, awkward, uncomfortable, and revealing experiences I have encountered in international healthcare marketing.
I work with U.S. and international healthcare-adjacent businesses, including international clinicians developing educational, wellness, and other nonclinical offers to provide these virtually across borders. Much of my work involves helping professionals understand how people search for services across cultures and languages. One of the most common mistakes that Spanish-speaking owners of international businesses make is imagining the United States as neatly divided into two groups: English-speaking Americans who speak only English, and U.S. Latinos who are native Spanish speakers.
The actual market is considerably more interesting. Not all U.S. Latinos speak Spanish natively, or even speak it at all. At the same time, Latinos are not the only people in the United States who speak Spanish. Spanish is the country's most widely studied language, and the United States has millions of people who learned it as a second language in school, at university, through family relationships, through living abroad, or independently. Instituto Cervantes has described Spanish as the most studied language in the United States across educational levels and estimates that the country has millions of Spanish learners. The United States also contains one of the largest Spanish-speaking populations in the world.
Some of these second-language speakers become advanced or highly proficient. They form relationships in Spanish, work in Spanish, consume media in Spanish, and sometimes seek wellness education or professional services in Spanish. Although, naturally, they may search for those Spanish-language resources in English. This seems to astonish people, but multilingual search behavior is not a standardized language examination. A person can be perfectly capable of receiving a service in Spanish and still type "Spanish-speaking psychologist online" rather than "psicóloga de orientación psicoanalítica que trabaja por videollamada con pacientes internacionales."
Why? Because English may remain the person's dominant language for researching, comparing, and purchasing services in the United States. English-language search terms may also produce more results aimed at international consumers. The person may know exactly how to discuss her childhood in Spanish but have no idea what Colombians call a discovery call, an online booking page, or a cancellation policy. Language proficiency is domain-specific. Someone can discuss attachment, grief, politics, and family dynamics in Spanish, and then search Google in English because she cannot remember whether the thing she wants is called a taller, curso, programa, consulta, or acompañamiento. Advanced Spanish speakers are still allowed to want efficient search results.
I recently wrote an article explaining that some people intentionally receive therapy or wellness education in their second language. I do this myself, and I am not unique. A second language can provide emotional distance from a difficult subject. It can allow someone to explore a different part of her identity. It may provide access to an approach, cultural perspective, or professional who is unavailable locally. Sometimes the person simply enjoys using the language and values the relationship she has developed with a particular clinician.
A Colombian psychologist found the article and sent me a screenshot of my own writing. Then came a stream of very sweet messages. "Dear Marion." What a beautiful article. What an interesting idea. She complimented my work and told me she had never considered this population before. She had assumed that Spanish speakers in the United States were U.S. Latinos, and that U.S. Latinos were necessarily native speakers of Spanish. Neither assumption is correct.
I was pleased that the article had expanded her understanding of the market. That is what educational content is supposed to do. I explained that Americans who speak Spanish as a second language may actively search for Spanish-language therapy, wellness education, courses, and other services. In English, of course. We are bilingual, not committed to making every Google search a cultural immersion exercise.
Then I casually mentioned that I had just had a good session that morning with my own Colombian psychologist, with whom I meet weekly in Spanish. The new psychologist complimented my Spanish. And then, in real time, a realization appeared to dawn on her: wait, this is one of them. She had just learned that bilingual Americans who receive services in Spanish exist, and suddenly one had appeared directly in her messages. Not merely a theoretical bilingual American. A live one. Already acclimated to Colombian psychology. Already receiving therapy in Spanish. Already capable of understanding sweet messages addressed to "dear Marion." There was only one complication: I already had a Colombian psychologist.
Fortunately, the new psychologist was prepared to acknowledge this obstacle with the phrase "all due respect to your current psychologist" before attempting to persuade me to experience her focus instead. All due respect to my current psychologist, whose patient she was now trying to poach.
I had given her a marketing insight. She had mistaken the marketing strategist for the first available lead. Her market-development process appeared to be:
The United States has millions of Spanish learners, bosteut apparently it was important to secure the first one she found.
The interaction was somewhat humorous because it compressed an entire market-expansion strategy into one opportunistic moment. She had encountered an unfamiliar obstacle: how does a Colombian psychologist reach Americans who learned Spanish as a second language and might want services in Spanish? That question requires reflection. Who are these people? Why do they use Spanish? Which services do they seek in Spanish, and which do they still seek in English? What makes them trust a professional in another country? How do they evaluate credentials? What payment and scheduling systems do they expect? Which therapeutic approaches appeal to them? What concerns might they have about cultural differences? Most importantly, what does this particular psychologist offer that would make an appropriate person independently choose her?
Those questions contain uncertainty. They require research, experimentation, mistakes, and revision. By contrast, messaging the bilingual American who wrote the article offered the path of least resistance. No audience research was required. No positioning had to be developed. No search strategy had to be tested. The potential customer had personally arrived to explain the market, confirm her own participation in it, and provide evidence that she could sustain a therapeutic conversation in Spanish. Why build a bridge to an unfamiliar market when you can try to pick up the market researcher and carry her across? But the shortcut bypassed nearly everything that would create a sustainable business.
A major part of my marketing work involves removing unnecessary friction. If a U.S. buyer must first locate a clinician's WhatsApp number, enter a WhatsApp channel, request a session through a separate calendar, wait for manual confirmation, receive payment instructions, pay through another system, send proof of payment, and then wait for the appointment to be finalized, that is not a meaningful learning experience. That is simply a difficult checkout process.
But not every obstacle is useless friction. Some obstacles are the work. Determining what makes your service distinctive is the work. Learning which markets align with your strengths is the work. Understanding how bilingual consumers actually search is the work. Testing whether your message attracts the people you want to serve is the work. Good marketing removes barriers that prevent an appropriate buyer from acting. It does not remove the business owner's need to understand the buyer.
The deepest irony is that the lesson I applied to this experience came from the very Colombian psychologist the new psychologist wanted me to leave. My psychologist uses a psychoanalytic approach. She once explained that when we encounter an obstacle, psychology does not necessarily regard it as something to evade as quickly as possible. An obstacle can give us an opportunity to examine what we have done in the past, recognize recurring patterns, and grow by working through them differently. Psychoanalysis pays particular attention to the ways earlier experiences and unconscious patterns reappear in present behavior. Working through those repetitions can produce insight and growth. The International Psychoanalytical Association similarly explains that unconscious patterns often have a repetitive quality, and that understanding and working through them can help people connect past experience with present behavior.
Viewed through that framework, immediately attempting to recruit me was the least psychologically interesting response available. The new psychologist had encountered an obstacle of learning. She had discovered that her understanding of the U.S. Spanish-speaking market was incomplete. She could have asked:
Instead, this particular clinician realized that she had discovered one bilingual American and attempted to skip directly to conversion. From the perspective of immediate effort, it was efficient. From the perspective of psychological, educational, and business development, it avoided the most valuable part of the process.
Before becoming a marketing strategist, I taught at the university level and trained in pedagogy, applied linguistics, instructional technology, and educational psychology. That background shapes how I work. Learning is not simply the transfer of an answer from someone who knows to someone who does not. The learner must examine prior knowledge, recognize assumptions, test new interpretations, make mistakes, and integrate what she discovers. An educator can remove irrelevant confusion. She can organize information, model a process, provide feedback, and shorten the learning curve. She cannot perform the learner's growth on the learner's behalf.
The same is true in marketing. I can explain that the Spanish-speaking U.S. market includes more than native Spanish-speaking Latinos. I can show a clinician that someone may search in English and purchase a Spanish-language service. I can help her distinguish consumer groups, evaluate market alignment, clarify her positioning, improve her website, and design a more effective customer journey. But she still has to reflect on what she offers. She still has to decide whom she is equipped to serve. She still has to encounter the market, tolerate uncertainty, and learn from the response. My role is not to provide a clinician with a bilingual American who can be collected immediately upon completion of the lesson.
Identifying a person who fits a demographic description is not the same as understanding a market.
I am an American learning Spanish as a second language. I receive therapy in Spanish from a Colombian psychologist. I therefore embodied the exact consumer behavior my article described. But those facts alone did not make me an appropriate prospect.
The psychologist had not attracted me through a differentiated offer. I had not expressed dissatisfaction with my current care. I had not asked about her therapeutic services or indicated that I was seeking someone new. I had said that I enjoyed the session I had with my current Colombian psychologist that morning.
That was not a buying signal. It was nearly the opposite of a buying signal.
A sustainable marketing strategy would require the new psychologist to determine what she offers that is relevant to bilingual U.S. residents, communicate that value where they are already searching, and allow interested people to choose her.
An important cultural consideration here is the value many U.S. consumers place on autonomy, independence, and privacy when selecting healthcare providers. Personal recommendations certainly influence healthcare decisions, but many healthcare, wellness, and educational content consumers prefer to conduct their own research and choose a provider who is separate from their existing social and professional relationships.
When I was once searching for a new primary care provider, a friend in Atlanta recommended her own physician. I declined because I did not want to share a doctor with my friend. The recommendation was positive, but the social proximity made the arrangement less appealing to me.
Something similar happened several years ago after I posted on LinkedIn about my frustration with finding a qualified U.S. psychotherapist. Someone tagged a Canadian psychologist who offered private-pay services. I considered working with her, but the introduction had occurred publicly through my own professional social media account. That made the prospective therapeutic relationship feel too exposed. I wanted to find and evaluate a therapist privately, through a process I controlled, rather than have my professional identity, personal frustration, and potential therapeutic relationship converge in the same public space.
In both cases, the provider may have been entirely suitable. The issue was the pathway through which the provider entered my awareness.
That distinction matters in marketing. Reaching a qualified person is not enough. The customer journey must also give that person the degree of privacy, agency, and psychological distance necessary to explore the service comfortably. This is particularly important in therapy and other services involving sensitive personal information.
Some bilingual consumers may discover a Colombian psychologist through Spanish-language content. Others may use an English-language search query while deliberately seeking a service delivered in Spanish. This is ordinary multilingual behavior.
People do not stop being U.S. consumers when they become advanced Spanish speakers. They may want the service in Spanish and the purchasing information in English. They may want a Colombian psychological perspective and a Calendly link. They may discuss the unconscious in Spanish and still expect an automated confirmation email.
Cultural and linguistic hybridity is not a temporary error that disappears at an advanced level of proficiency. It is the market.
There was also a relational and reputational dimension to the interaction. After acknowledging my existing therapeutic relationship “with all due respect to my current psychologist,” she invited me to experience her own enfoque instead. I was immediately taken aback by the abrupt shift from an educational, professional exchange to the personal promotion of her therapeutic services. Rather than making me curious about her approach, the pivot made the interaction feel unexpectedly invasive.
I cannot know what she intended. Her praise of my article may have been entirely sincere, and she may have believed that presenting her therapeutic focus as an alternative was a natural continuation of our conversation. I can only describe how the transition affected me. It reduced my sense of trust and made me want to create distance.
I nevertheless offered her a more appropriate pathway to the audience she had just discovered. A friend owns a New York–based nonprofit devoted to cultural and language exchange and hosts virtual educational events. Its weekly group includes U.S.-based Latinos, Latinos living in their countries of origin, and non-native Spanish speakers.
I suggested that the psychologist present an educational segment introducing her enfoque to that community. Instead of privately positioning herself to me as an alternative to my current psychologist, she could speak publicly to a varied and relevant audience, demonstrate her perspective, and allow participants to decide for themselves whether they wanted to learn more, including potentially proceeding to purchasing her services one-on-one.
In other words, I redirected her from pursuing the nearest individual example of the market toward educating an actual community within it.
She did not respond to that offered alternative.
By that point, I recognized how uncomfortable the interaction had made me. I deleted my messages and removed myself from the situation. When I later described the exchange to members of my family, they were similarly taken aback by the apparent boundary crossing.
This response illustrates another reason that indiscriminate outreach can be costly in the health and wellness space. Even when the person making the offer believes she is simply explaining what distinguishes her services, the context in which she presents that offer shapes how it is received.
An attempt to convert someone who has expressed satisfaction with an existing therapeutic relationship may do more than fail to produce a new patient. It may undermine trust in the professional making the approach.
The closest person who resembles your target audience is not necessarily your next customer. Sometimes she is the person teaching you how to understand the audience—and showing you the more appropriate path for reaching it.
The real opportunity was never to persuade one contented patient to leave another psychologist. It was to understand why that patient existed.
Why would a native English speaker from the United States deliberately choose weekly therapy in Spanish? What made a Colombian psychologist appealing? How had that psychologist established enough trust to sustain the relationship? Which parts of the experience mattered most? How might other bilingual Americans have different motivations, expectations, and needs? And what could the new psychologist offer that would make her own approach meaningfully distinctive?
I had even offered her access to a relevant audience in an educational setting where she could begin exploring those questions. Rather than privately positioning herself against an existing therapeutic relationship, she could have introduced her ideas, observed what resonated, listened to the participants, and allowed genuinely interested people to approach her.
That would have involved more uncertainty than attempting to recruit the bilingual American already in her messages. It also would have offered far more opportunity for learning, trust-building, and sustainable growth.
There is risk in asking those questions because the answers may not immediately validate the offer. There is growth in asking them for exactly that reason. A clinician may discover that her preferred market is narrower than she expected. She may need to change her messaging. Her first offer may not work. She may attract interest from an unexpected group. There will be advances and setbacks. That is not an unfortunate detour on the way to marketing. That is marketing.
My approach combines strategy with education because I want clients to develop the capacity to understand their markets, not merely memorize my conclusions. The objective is not one conversion obtained through proximity. It is a repeatable system grounded in genuine alignment.
So the psychologist did teach me something, although probably not what she intended. She demonstrated how quickly someone can move from "I had never considered this market" to "Dear member of this market, all due respect to your current provider, but have you considered me?" Finding me was the path of least resistance. Understanding people like me would have been the growth opportunity.
My articles are available to help clinicians recognize markets they may have overlooked. My consulting is available when they want help understanding and serving those markets. The bilingual American writing the article is not automatically included as a potential patient.
I work with international clinicians who would like to do the work of exploring what value they offer and how this aligns with what the U.S. market values and how segments of U.S. audiences search for use and these offers. If you are an international clinician who would like to put in the work to learn more about your current and future audiences to grow your business through a dynamic and didactic marketing approach, you can contact us for more information.