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International Society of Schema Therapy
In This Issue
In this April issue - Schema Therapy with Marginalized Populations
Schema Therapy and Latino Patients… A Cultural Approach
A primary challenge in working with patients from different cultural backgrounds is being able to use cultural generalizations appropriately without losing sight of the individual patient. To succeed in this challenge, clinicians must keep in mind that variations occur between cultural subgroups just as individuals subscribe to group norms to varying degrees. Consideration of culture is essential in the process of diagnosis and treatment of culturally diverse patients. In the past decade the consideration of cultural factors has gained recognition in a variety of disciplines. In this article you will find a discussion of Latino cultural factors that are influential in the development of early maladaptive schemas (as defined within the Schema Therapy Model) and the propensity for specific schemas to develop within Latinos as a cultural group.
ST has demonstrated relatively low levels of attrition (e.g. Giesen-Bloo et al., 2006) with populations who may otherwise struggle to engage in therapy, making it a promising approach for Latinos. Because the ST model assumes that all people develop schemas in childhood (Arntz & van Genderen, 2009), an explicit focus is put on schema development, often involving family relationships. Strategies are employed to defuse dysfunctional, self-defeating patterns fueled by early maladaptive schemas that formed due to unmet needs (Young et al., 2003). The ST focus on interpersonal and family relationships makes it particularly relevant to Latinos because of the cultural value of familism, a deep sense of loyalty, solidarity, and reciprocity among Latino family members (Sabogal, Marin, Otero-Sabogal, Marin, & Perez-Stable, 1987). A careful understanding of familism is considered crucial for successfully recruiting and retaining Latinos in psychotherapy research (Miranda et al., 1996) but the topic is complex. Adherence to familism can bring benefits that are protective (Gallo, Penedo, Espinosa de los Monteros, & Arguelles, 2009) such as family cohesion and support (Sabogal et al., 1987), but it can also present challenges. Overt or covert cultural expectations regarding obligations or gender roles in the family starting in childhood can create emotional conflict with potential to influence adult relationships (Gil & Vazquez, 1996). The focus on schemas allows a way to deal with familism within ST.
Young describes the maladaptive schema category of “Impaired Autonomy and Performance” as: The expectation of an individual’s ability to separate, survive, function independently and/or perform successfully away from their environment is impaired. The schema of dependence/incompetence can be found in this category and is characterized by: The expectation that an individual’s ability to separate, survive, function independently and/or perform successfully away from their environment is impaired. People with this schema often rely on others excessively for help in areas such as decision-making and initiating new tasks. Among Latinos this schema is influenced by the concept of familismo which requires individuals to make decisions and behave in ways that please the family rather than address his or her individual needs. The concepts of machismo and marianismo also influence this schema as they require men to focus their attention on the financial and protection needs of the family and women to place a greater enfaces on the physical and developmental needs of the family which often sacrifices their own needs. This approach does not encourage individuals to act independently and develop confidence in their ability to take care of themselves. But rather it sends the individual the message that their individual happiness will come as a result of focusing on the needs and loyalty to the family. Among Latino patients this schema is often characterized by feelings of dependence and impaired autonomy. Patients are often report feelings of enmeshment and often experience some level of impairment in making life through different life stages.
Young describes the maladaptive schema category of “other directedness” as: The individual is overly invested on the desires, feelings, and responses of others at the expense of their own needs; in order to gain love and approval and maintain their sense of connection or avoid retaliation. The schema of self-sacrifice can be found in this category and is characterized by: the excessive sacrifice of one’s own needs in order to help others. Among Latinos this schema is promoted by the concepts of respeto, which expects the individual to often sacrifice their own needs and defer to the needs of those in charge or the needs of family and/or community. The concepts of machismo and marianismo also influence this schema as they require men to focus their attention strength and women to place a greater enfaces on the needs of the family which often sacrifices their own needs. This approach sends the individual the message that their individual happiness will come as a result of placing the needs of others above those of their own. Among Latino patients this schema is often characterized by feelings of guilt and resentment. Patients are often left feeling that their intimate relationships will only work if they are overly invested in the needs of others. That in order to gain love, approval and maintain a sense of connection they need to place the needs of others above their own.
Young describes the maladaptive schema category of ”Overvigilance and Inhibition” as: The individual has an excessive emphasis on suppressing spontaneous feelings, impulses, and choices or meeting rigid, internalized rules and expectations about performance and ethical behavior, often at the expense of happiness, self-expression, close relationships, or health. The schema of Emotional Inhibition can be found in this category and is characterized by: the belief that you must suppress spontaneous emotions and impulses, especially anger, because any expression of feelings would harm others or lead to loss of self-esteem, embarrassment, retaliation or abandonment. Among Latinos this schema is promoted by the concepts of respeto, which expects the individual to defer to individuals in a position of power often sacrificing the needs of the individual for the needs of those in charge. The concepts of machismo and marianismo further influence this schema as they require men to be strong and maintain the integrity of the family and the later concept requires women to place the needs of the family above all else. Among Latino patients this schema is often characterized by feelings disconnection and isolation. Patients are often left feeling that their intimate relationships will not adequately meet their needs for empathy, nurturance or protection.
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