The authors examined the reactions of Spanish-speaking patients and of therapists to initial therapy interviews conducted with or without an interpreter. Twenty-one patients who used an interpreter, 40 bilingual patients, and the 16 psychiatric residents who conducted the interviews completed questionnaires aimed at evaluating therapy and communication effectiveness. A number of patient and therapist perceptions were significantly different. Patients interviewed with interpreters felt understood and helped and wanted to return, whereas the therapists responded that patients seen with interpreters felt less understood and less helped and did not want to return. The authors recommend more bilingual/bicultural therapists and an effort to help present therapists realize how valuable their efforts with patients who need an interpreter are.