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Alexithymia, characterized by deficits in recognition or expression of emotional experiences, has been demonstrated to be associated with depressive symptoms. In psychotherapy, alexithymia can partly manifest as stunted, disfluent speech when an individual attempts to describe his or her subjective experiences. However, similarly stunted, disfluent speech can be observed in individuals with limited English proficiency who are not diagnosed with a depressive disorder. For individuals who present with both symptoms of depression and limited English proficiency, it can be difficult to determine if disfluent speech is a clinical symptom secondary to depression or simply a byproduct of a language barrier. Determining the underlying cause of speech disfluency is necessary to inform case conceptualization and treatment planning. The following case study describes a Spanish-speaking woman who presented for outpatient psychotherapy to treat major depressive disorder and generalized anxiety disorder. Challenges to the therapy are described; recommendations for English-speaking psychotherapists in similar clinical situations are also provided.