We examine the extent to which psychotherapy can be successfully conducted with the aid of an interpreter. We propose that, even if we assume idealistic levels of training on the part of the interpreter and the therapist, and openness on the part of the client, there are still many challenges inherent in interpreter-assisted therapy. We focus on some of the characteristics common to client experiences of effective psychotherapy, as well as the characteristics and habits of effective therapists, and show how the insertion of an interpreter into the therapeutic relationship could affect both. Where the literature provides, we also note steps which could be taken to minimise the harmful impacts and maximise the positive contributions which the therapist–interpreter–client dynamic could yield. In South Africa, where informal interpreters play the invaluable role of facilitating essential communication between psychotherapists and their clients, it is imperative that informal interpreters, and clinicians working with interpreters, are aware of some of the complex issues at play in interpreted interactions. The issue of interpreting in mental health care is commonly addressed only in regard to the question of the competence of interpreters; we suggest that attitudinal and skill issues are equally important for clinicians. We conclude that successful therapy with an interpreter necessitates a consideration of the dynamic interaction between all parties involved.