A qualitative inquiry into the acceptability of schema therapy in Hong Kong and Singapore: implications for cultural responsiveness in the practice of schema therapy

ABSTRACT

Objective

Western models of psychology have long been dominant in the discipline. However, the presumed universality of Western psychological treatment models is increasingly coming under scrutiny; there is a clear need for research to evaluate the cross-cultural applicability of these treatment models. Schema therapy (ST) has been widely disseminated in recent years due to its efficacy in treating chronic psychological difficulties. However, the acceptability and efficacy of ST have yet to be examined in non-Western cultural contexts. This study aimed to investigate the suitability of ST in Hong Kong and Singapore.

Method

A thematic analysis of qualitative interviews with clinicians practicing ST in Hong Kong (n = 6) and Singapore (n = 6) was undertaken.

Results

Overall, the ST model was generally acceptable to clinicians in Hong Kong and Singapore. However, therapists reported some cultural challenges in the practice of ST. Four key themes describe these cultural challenges: language differences, difficulties in the expression of affect, issues related to filial piety, and differences in social norms and expectations.

Conclusion

While the ST model appears acceptable to clinicians in Hong Kong and Singapore, there are some important adjustments needed in the practical application of ST to ensure more culturally sensitive treatment.

KEY POINTS

What is already known about this topic:

1. Western models of psychological treatment dominate the field worldwide but are not broadly representative of the range of human experience across cultures.

2. Schema Therapy is increasingly being disseminated worldwide as an evidence-based therapy but has not been studied extensively across cultures.

3. Hofstede’s (2011) model of six cultural dimensions offers some insights into how different cultures can be understood and compared. Western and Asian culture contrast on many of these dimensions, providing a point of comparison in exploring the relevance and appropriateness of Schema Therapy in Asian (cultural) samples.

What this topic adds:

1. The core tenets of the ST Model were found to be generally acceptable among therapists applying the model in Hong Kong and Singapore.

2. However, the following themes were identified as potential cultural challenges in the practical application of the model among clinicians working in this context: (a) language differences, (b) difficulties in the expression of affect, (c) issues related to filial piety and (d) differences in social norms and expectations.

3. ST may require significant adaptation when applied in an Asian cultural context and would likely benefit from significant involvement of local therapists with significant local cultural knowledge and experience. The application of the core schema therapy techniques (e.g., imagery rescripting, limited reparenting), while true to the model, may be modified by clinicians to be more culturally sensitive.

KEYWORDS:

• Asian culture
• cultural adaptation
• Hong Kong
• schema therapy
• Singapore

Data availability statement

The qualitative data that support the findings of this study are available on request from the corresponding author. The data are not publicly available as their containing information could compromise the privacy of research participants.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical statement

Ethics approval was obtained from the University of Technology Sydney Human Research Ethics Committee (ETH19-4332).