Not surprisingly, Italian is the language spoken natively by most Italians.
Every region in Italy has a distinct native Romance language in addition to Italian that may or may not be the native language of the locals depending on the area: in areas like Rome or Milan the spoken language is nowadays mostly Italian with slight local influence, whereas in southern rural areas the local language is more common; though people will usually be bilingual. Even though Italians call the native languages "dialects" they are in practice seperate languages, much like Chinese languages; they have their own way of writing and don't always belong to the same language family as Italian.
A good phrasebook will be very useful if you're going anywhere remote, while in most big cities you will find many people understanding English, Spanish or French. But even in those areas Italians will be happy to hear you trying to speak Italian or the local language, and will try to understand you even if you are making many mistakes. If you want your errors to be corrected to help you better learn the language, don't forget to ask before starting a conversation. Italians will rarely correct you otherwise as they consider it very impolite to do so especially since it's a second language for many of them. They also appreciate your efforts to speak their language, even if you do it badly, and won't make too much fuss about your mistakes.
English is widely spoken at varied levels of proficiency in the well-traveled touristic areas where it may be used by shopkeepers and tourist operators. Outside of that, you will find that most Italians are not conversant in English. While most younger Italians have studied English at school, due to a lack of practice and exposure, proficiency tends to be poor. Nevertheless, the most basic words and phrases usually stick, and there is often at least one person in a group of younger people who knows enough English to help you out. Senior citizens rarely know English, but they'll try to help you anyway with gestures or similar words and they will most surely assume you understand Italian. If you are going to speak in English, it is polite begin the conversation in Italian and ask if the person understands English before proceeding. Speaking in a foreign language while assuming it will be understood might be considered very arrogant and impolite by many Italians.
In South Tyrol the majority of people also speaks Austro-Bavarian, a Germanic language closely related to German, as their native language (except in the region's capital Bolzano), and German (which is spoken by almost all Austro-Bavarian speakers) is an official language of the autonomous province in addition to Italian. That is because those regions used to be part of the Austro-Hungarian Empire until the end of World War I.
The Romance languages Spanish, French and Portuguese, are not as widely spoken but as they are broadly similar to Italian many will recognize some words thus making yourself understood. In the northwesternmost Valle d'Aosta region there is a Franco-Provencal speaking minority.
In the northern part of Italy, there are small pockets of other Romance languages like Ladin, a Rhaeto-Romance language related to Switzerland's Romansh. Friulano, another Rhaeto-Romance language, is still spoken by a small minority in the border province near Slovenia. There are several small pockets of Greek-speaking communities in the southern regions of Calabria and Puglia and there are an estimated 100,000 Albanian speakers in Puglia, Calabria and Sicily—some of which have migrated in Middle Ages and thus speak rather medieval Arberesh language. Italian is the only official language of Italy but some regions have other language which are also official: German in South Tyrol, Slovene in Friuli-Venezia Giulia and French in Vall' Aosta.
Slovene is a native language in parts of Friuli-Venezia Giulia alongside Italian and is widely spoken in villages near the Slovenian border and Trieste. In almost all cases Slovene speakers will also speak Italian and the Slovene minority will often speak better English than those whose native language is Italian.
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