Connecting worlds and finding common ground
- Ng-Kessler Beatrice
- Jul 14
- 9 min read
Updated: 5 days ago
Chinese clinical psychologist Beatrice Ng-Kessler on the importance of cultural differences in schema therapy.
10 July 2025 - published in The British Psychological Society official webpage I was born and grew-up in Hong Kong, and have been practising as a clinical psychologist for over 13 years. I moved to the UK at the tail end of 2022, and last year I started working with a new client, 'May', who came to me confused and upset. May is from Hong Kong and had sent her daughter to study at a university in the UK. Her daughter would return home from her own therapy sessions, blaming May for all her problems.
May felt I might understand her situation better – as someone who is both Chinese and trained in Schema Therapy. It's one of my most-used and favoured models and, as with many modes of modern therapy, it originated in the West (developed by American psychologist Dr Jeffrey Young). Integrating cognitive, experiential, and psychodynamic approaches, at the core of Schema Therapy is the idea that early experiences form deeply embedded schemas – lifelong patterns that influence how we view ourselves, others, and the world. Moving to the UK felt like a crash course in adapting the way I practiced such methods, to accommodate and understand the needs of clients from both individualist cultures like the UK and collectivist cultures like those of Chinese clients (who I still see a lot).
May's daughter's therapist had framed May as pathologically controlling. While this wasn't entirely untrue, the daughter's therapist missed vital cultural and historical context. May herself had experienced neglect, and when she became a mother, she overcompensated to attempt to make up for it. Yes, her daughter's enmeshment and abandonment schemas likely stemmed from this parenting dynamic – but within collectivistic cultures, such behaviour is common and often rationalised. May and I needed to work together to find a way forward where May can learn how to love her daughter differently – an experience that she never had in her own upbringing.
I reframed my work with May as 'loving with flexibility'. Much of our therapy centred around trauma processing – helping her gain deeper self-understanding and develop compassion for her own inner child. As she became more attuned to her own unmet needs and emotional wounds, she began to see her daughter's behaviour through a different lens – one shaped by empathy rather than control.
Hearing what is unsaid
I often find myself navigating tensions between the psychological models I've been trained in and the cultural values I was raised with. There isn't a 'one size fits all' way of working when helping to support a client nurture their 'healthy adult' emotional state, as we often do in Schema Therapy. As with any therapy, attuning to what is unsaid can be as important as what is said, but this is perhaps particularly true with collectivist clients. They often feel pressure to agree with authority figures, including therapists. If we say, "You must feel pretty angry hearing that from your parents," the client may nod, but what they truly feel might be far more complex: "I'm hurt, but it's normal," or "Yes, I'm angry – but also ashamed for being angry."
I came to recognise this pattern in myself, particularly in my relationship with my own parents. I realised that what I feared most wasn't their disappointment – it was my own deep disappointment in having disappointed them. I knew that when they were angry at my mistakes, I became overwhelmed – not just by guilt, but by a profound sense of internal failure.
But what I did not know was what I truly needed: someone to acknowledge my effort, accept my mistakes, and offer encouragement. In our culture, it's easy to silently dismiss our own hurt and needs – to internalise criticism and bypass emotional support. But without naming these needs, we cannot meet them, nor can we help others do the same.
Between two worlds
Another client of mine was 'Mary', a British-born Chinese woman, who identified strongly as a Londoner. She spoke little Chinese and had mostly white, British friends. She still lived with her mother even though she was over 30-years-old. She often put her mother's needs above her own, avoided jobs that could take her away and said she was happy never to marry – unless her partner is willing to live with her mum too.
From a Western schema lens, this might be viewed as enmeshment or self-sacrifice. But culturally, Mary's behaviour aligns with values of filial piety and interdependence. She's not a passive victim – this is a choice rooted in meaning, loyalty, and cultural pride. When she says, "I'll only marry someone who can live with my mum," she is not expressing pathology but a coherent worldview shaped by love and duty.
I respected Mary's bond with her mother, and at the same time, I held space for her to explore what self-care truly looked like for her. We explored some of her self-dismissed needs – particularly autonomy, which had been quietly sacrificed in the way she positioned her relationship with her mum.
Over time, I came to see that Mary longed for deep understanding from her mother – a kind of emotional intimacy she had never dared to seek, out of loyalty and duty. I invited her to consider that honesty and authenticity – even in small, vulnerable ways – might actually bring her closer to her mother, rather than further apart.
This meant taking the risk of upsetting her mum by expressing personal preferences or voicing a yearning for more freedom in decision-making. But it also meant giving her mother the opportunity to truly see her – not just as a dutiful daughter, but as a whole person.
So I wonder—would someone like Mary be seen by a Western therapist not only as co-dependent with her mother, but also as excessively self-sacrificing or even dysfunctional? Might the therapeutic response focus primarily on assertiveness training and boundary-setting, rather than exploring the deeper internal struggles she faces?
Loyalty versus judgement
Confucianism, a foundational influence on East Asian culture, defines relationships through structured hierarchies – parent and child, teacher and student – with clear moral expectations. Filial piety (Xiao) instructs children to honour and obey as an act of love. Even sayings like, "If your father steals and you hide it, there is honesty within" (The Analects of Confucius), illustrate how loyalty can outweigh moral judgment.
Love in Chinese families is often shown through acts of service, not verbal affirmation. It can encourage parents to become overprotective because 'doing something for their children' is their love language, often to the extent of cultivating dependence. It is not uncommon for adult children to still live with their parents and depend on their parents for everyday things.
In such contexts, it's crucial for the therapist to hold both ends of the rope: recognising how certain parenting patterns may inhibit autonomy, while also understanding these patterns as acts of love shaped by the parent's own trauma. From there, navigating the space between these two ends become possible.
Creating safety beyond words
In supervision, I learnt that another thing a western schema therapist may overlook is the authority they represent in the therapy room – especially with clients from hierarchical cultures. Saying 'This is a safe space' will not be enough. Safety needs to be established through constantly conveying nonjudgemental attitude, emotional attunement, and the therapist tactfully withholding his own opinions. Otherwise, the therapist will never hear anything that's inconsistent with his own opinions.
If a client says, "Don't you think that's ridiculous?" – it's vital that a therapist doesn't jump in with a reaction. Their facial expression, tone, or hesitation may signal an unspoken conflict. Ask yourself, "Is the client expressing something indirectly, or seeking reassurance that their feelings are okay?" Therapists should check in gently, moment by moment, asking clarifying questions can help clients build emotional literacy – because they may never have permission to articulate their emotions directly.
Therapeutic safety is not declared – it is demonstrated, as much as 'act of service' is the love language.
Desensitising emotional aversion
Emotional inhibition is deeply reinforced in collectivist cultures. Self-sacrifice is idealised. Many clients struggle to access or express vulnerable emotions as it is equated with weakness or burdensome to others. Clients from collectivist backgrounds may feel fear being seen as ungrateful if they express anger towards their parents. Experiential techniques – such as chairwork or imagery – may feel overwhelming or shame-inducing, ending in premature dropout.
Before clients participate in experiential interventions, we often need to 'desensitise' them. Therapists can help clients build emotional tolerance gradually. Start with softer reflections:
"It must have felt uncomfortable to hear that." (while the client feels shameful)
"That sounds quite unfair." (while the client feels angry)
"If I were in your shoes, I might feel hurt too." (While the client feels humiliated)
Give the client a 'thinner' slice of emotion, gradually building up with the progress of therapy, can desensitise emotional aversion. This is slow, layered work. The therapist acts as a co-regulator of emotion. I often tell my supervisees that offering a cup of tea to a client who is overwhelmed by shame is, in my view, a small act of limited reparenting.
I use Schema Therapy not only with Chinese clients, but also with some clients from the UK. Some UK clients may appear more stoic—that is, they tend to avoid openly showing vulnerable emotions. Or rather, when they do express them in a much more indirect way. As a Chinese therapist, I need to attune to this particular manifestation of emotional inhibition.
Instead of "giving a thinner slice" of emotion as I might with Chinese clients, I often adapt by using indirect expressions and paying close attention to how my words land with UK clients. For example, if I pick up on something emotionally significant that hasn't been explicitly expressed, I might say, "The way you express it sounds interesting to me." Then I observe how they respond—especially their eye contact and any pause that follows. If I notice engagement or subtle emotional cues, I may gently follow up with, "So educate me here…. how do you feel deep inside about this?" or "Your feelings are very important to me, and I don't want to misunderstand them. Would you mind sharing more about how you're feeling regarding this matter?" to check whether there's something deeper that hasn't yet been articulated.
In my experience, UK clients often welcome this kind of gentle invitation to explore and express their emotions more deeply in the therapy room.
In individualistic cultures, emotional inhibition often manifests through indirect expression. In contrast, in collectivist cultures, a great deal often goes unspoken—even among people who are not particularly emotionally inhibited compared to their peers. Verbal affirmations can sometimes intensify shame rather than alleviate it. In these moments, silent presence, gentle pacing in conversation, and simple gestures of care – like serving tea – can speak volumes.
Once emotional tolerance has been established, we can begin to introduce experiential interventions. I often model chairwork by 'acting out' the client's vulnerable child mode myself. This shared participation helps to immediately reduce the shame of expressing vulnerability – because I am doing it with them, not just asking them to do it alone.
Reparenting with cultural grace
Limited reparenting – central to Schema Therapy – needs careful adaptation. Standard techniques often involve the therapist stepping in during imagery rescripting to confront past perpetrators and assert the client's unmet needs. In a collectivist context, such confrontations can provoke deep shame or worsen emotional inhibition.
Instead, therapists may need to symbolically 'reparent' the client's parents first, to protect the vulnerable child's emotional safety.
Take 'Sam', a 8-year old boy who was physically pushed out of his home for failing a test – a symbolic event that triggered an Abandonment Schema. In Western practice, a therapist might intervene forcefully in imagery: "You had no right to do that to him!" But in a collectivist context, this might rupture the client's internal loyalty to their parents.
A culturally sensitive approach might involve first comforting Sam, then knocking gently on the imaginary door:"Sam's parents, I am Sam's future Schema Therapist. I know how much you love him and how much you've sacrificed to provide the best education. I believe this act – though unintentional – caused harm. He is just a child. Failing a test is a small thing."
I always ensure that these messages are delivered privately to the parents in imagery, not in front of little Sam, to preserve the parents' dignity and reduce the client's guilt. Remember, it is common for the collective client to feel guilty if they see their parents were lectured by someone else.
If I need to be more direct, I may add:"Sam's mum, you cannot punish your child like this over a test. It may create an Abandonment Schema that leads to struggles in intimate relationships later. I know you didn't intend to cause harm, and you look exhausted – may I bring in Sam first and take care of him so you can rest? Would you like some help with the dishes too?"
This kind of empathetic confrontation protects dignity while addressing harm – a reparenting stance that heals without shaming.
Honouring complexity
Schema Therapy offers a powerful framework for healing entrenched patterns. But its effectiveness depends on how well it resonates with a client's lived reality. In collectivist cultures, identity is relational, emotional expression is shaped by social expectations, and boundaries are navigated through unspoken norms.
My hope is that psychologists meet these clients not with assumptions, but by attuning to cultural meaning, being creative with technique, and working at the pace that each client's nervous system and narrative allow. It helps them weave both into a coherent and compassionate whole.
Beatrice Ng-Kessler (Shung Yan Ng) is an HCPC-registered Clinical Psychologist currently in private practice in London. She is an Accredited Advanced Schema Therapist,Supervisor/ Trainer with the International Society of Schema Therapy, and the founder of Chinese Schema Therapy Academy.
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