Cultural suitability of schema therapy: a qualitative exploration of clinician views

Objective: There is a growing popularity in the worldwide use of schema therapy (ST) to address a variety of psychological disorders. Yet, research into the cultural suitability of ST is scarce. This study aimed to explore ST clinicians’ experiences of the cultural suitability of ST. Method: Eleven clinicians from nine countries were interviewed about their experiences of practising ST. Interviews were analysed using reflexive thematic analysis. Results: Two main themes, each with subthemes, were identified. The first theme was considerations for Cultural Context and Content: (i) Incongruence with Cultural Norms of Emotional Expression, (ii) “Maladaptive” or “Adaptive”, But in What Context?, and (iii) Issues Related to Familism when Addressing Parent/Critic Modes. The second theme focused on clinicians’ Cultural Competence: (i) Perceptions of Reduced Confidence and Competence in Providing Culturally Responsive Practice, and (ii) Clinicians’ Cultural Values Impacting ST Delivery. Participants discussed strategies to improve the cultural-responsiveness of ST, suggesting areas for further development. Conclusion: Present findings suggest that ST is not a one-size-fits-all approach, underscoring the need to improve the cultural responsiveness of ST, while better supporting clinicians to develop their cultural competence. Future research is needed to establish evidence-based cultural adaptations for ST.