Findings are presented from a narrative study that examined the use of interpreters in psychotherapy with refugees. Fifteen therapists and 15 interpreters were interviewed at 14 refugee mental health treatment centers in the United States. Core findings concerned the impact of interpreters on the therapeutic alliance, the complex emotional reactions that may arise within the therapy triad, the effects of interpreting on interpreters' own well-being, the multiple roles that interpreters play in addition to translating language, and the training and supervision needs of interpreters and of therapists who work with them. Implications of these findings for agencies that use interpreters in their clinical work with refugees are considered, and specific recommendations are made concerning the hiring, training, and support of interpreting staff.