Schema Therapy, an extension of Cognitive Behavioral Therapy (CBT) founded by Dr. Jeffrey Young, incorporates multiple treatment modes and theories including Emotion-focused Therapy, Psychodynamics and Gestalt Therapy. Jeffrey observed clients with personality disorders who were unresponsive to CBT or relapsed after initially successful treatment. To better help these clients, he developed ‘schema’ to represent how our childhood experiences shape how we perceive ourselves, our relationships and the world. In time, Schema Therapy has become known as one of the most effective treatments for Borderline Personality Disorder.
As a Chinese, I felt some tension learning this mode of therapy. I could sense a dissonance between some of the Western perspectives embedded within the therapy and how this contrasted with the references and norms from within my own culture. For example, it is so common for people around my upbringing would want to fulfil our parents’ expectations on us, to an extend that people will feel guilty if they do not because they are pursuing their own dreams. Thanks to my mindfulness training and with the help of great supervisors, I have become more conscious of this dissonance and how Schema Therapy can be adapted for people from collectivistic cultures.
We wish to develop the client’s ‘Healthy Adult Mode’ in Schema Therapy. The Healthy Adult mode is characterized by a realistic appraisals of one’s situation, a good balance between the different domains of one’s life to support one’s mental health, and an ability to make wise though possibly imperfect decisions. In this mode, we’re “supposed” to be clear about our emotions and needs and able to communicate with people we trust like intimate partners and family members.
In theory, this all sounds fine and perfectly reasonable. However, such a ‘Healthy Adult’ can manifest very differently in a different cultural context. Those brought up within individualistic cultures, feel entitled to talk about their individual needs and entitlements. There is a strong emphasis on the “I”. In contrast, within a collectivistic culture, there is an emphasis on the “we” and we are raised to prioritize our responsibilities and obligations to the bigger group we belong to.
This difference stems partly from fundamentally how we define ourselves in individualist and collectivist cultures. In collectivism, we define ourselves by seeing an individual as part of a wider whole. ‘Self’ is defined by our relationship with others, within a family or some wider network or society. ‘You’ are seen and valued more as ‘part of the group.’ With this kind of upbringing, we are immersed in positive reinforcements urging us to sacrifice ourselves for the wider good. One consequence of definition of self is a prioritisation of group harmony over one’s individual needs or desires. It may also lead to Self-sacrifice Schema.
To train a ‘Healthy Adult Mode’ and to find the comfort to express one’s needs is more complicated in this cultural context because the question of one’s own needs is always entangled with the needs of others. In an Asian family, it’s common enough for parents to educate their children to bring honour, and avoid shame, to their family. Children feel obliged to be successful for the benefit of the whole family. As a Chinese, I feel these pressures within my own family, but I also hear about these issues from other Asian colleagues (e.g. those from Vietnam, Singapore and the Philippines).
I am keen to promote more culturally sensitive Schema Therapy and share my knowledge in the adaptation of it to Chinese clients. Schema Therapy is the home inside me. (While Mindfulness is my home to live in this world.). This is basically why CSTA was found.
In my next article, I shall elaborate about 'Enmeshment with Family'.
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Beatrice Ng-Kessler
Registered Clinical Psychologist (HK and UK)
Advance Certified Schema Therapist and Supervisor (ISST)
Certified Mindfulness Trainer from Canada
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