Schema therapy with marginalized populations.

Marginalized populations are those excluded from mainstream social, economic, cultural, or political life.*

More specifically exclusions can apply to educational opportunities, access to health/mental health care, membership in community groups or clubs, employment opportunities, or feelings of comfort, trust, and “fitting in” to the society in which members reside.  This feeling can be described as “Minority Stress”. Groups can experience exclusion and alienation by virtue of their gender, gender identity, race, religion, education level, appearance or social status, and the list goes on.

In this issue of the Schema Therapy Bulletin, contributors will describe the application of the Schema Therapy model with three marginalized populations: Transgender and Gender Diverse Individuals, Latinos living in the United States, and Military Veterans.

After providing an overview of the distinction between anatomy and identity, Cesar Gonzalez outlines the predominate mental health symptoms prevalent in the transgender population, and explores their relationship to unmet core needs and specific schema development. Describing his work with Adam, a young man beginning hormone therapy to continue his transition from female to male, Cesar demonstrates Gender Affirming Schema Therapy in addressing the maladaptive schemas that arose from his gender dysphoria and his parents’ unwillingness to accept his identity as he experienced it.

Megan Fry and Suzy Redston report on the symptoms likely to bring a soldier to a mental health professional, and describe the coping modes associated with military veterans. They note that in some cases individuals with unmet core needs may be drawn to military service. The structure and functioning of the military, the trauma of war, and the struggle to readjust to civilian life after service can all be stimuli for the manifestation and elaboration of unmet core needs, schemas, and maladaptive coping modes. The case of Ryan, a 44 year old army veteran illustrates these struggles.

Carlos Rojas addresses the important balance between understanding and accepting cultural norms and stereotypes, and seeing each member of the culture as a unique person. Specifically he writes about the culture and values of the Latino community; it’s cultural resistance to mental health care, and it’s emphasis on family, respect machismo (a man’s position in the family), and marianismo, the role and function of women in the family). He goes on to propose that Latino culture may be characterized by particular schema profiles. This understanding can help to facilitate treatment.

Our next issue will focus on New Developments in Schema Therapy. If you are interested in submitting an article for this or any future issue, please email us!

Lissa Parsonnet (USA) &

Chris Hayes (Australia)

*(Marginalized Populations by Kay E. Cook In: The SAGE Encyclopedia of Qualitative Research Methods Edited by: Lisa M. Given).

Dresses, Spiderman, and Gender Dysphoria: a Gender-Affirming Schema Therapy Approach by Cesar A. Gonzalez

Anatomy is Not Identity

After weeks 6 to 7 weeks into a fetus’ development, the expression of a gene induces changes that alter the trajectory of the development of a fetus’ sex characteristics and how expectant parents will eventually respond to the socially acceptable question of, “Are you having a boy or a girl?” In other words, “Are you expecting a baby with a penis or a vagina?” The moment this question is answered is when there are social rules put on the expectant parents and the unborn child. 

These sex characteristics guide social expectations of “what boys do” and “what girls do” and impact how individuals view themselves, others, and their futures – as well as which colors or clothing they will use, which recreational activities they will pursue, what occupations they will be encouraged to follow, and even how much emotion is acceptable to express, and let people know where it's available.

Schema Therapy and Latino Patients... A Cultural Approach by Carlos Rojas (USA)

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.

Treat the Soldier and Unlock the Healthy Adult by Megan Fry and Dr. Suzy Redston (Australia)

Generally, when a person with a military background comes for psychological treatment they have been unwell, with clinically significant symptoms for at least 12 months. There is a significantly higher 12-month prevalence of all mental illnesses compared to the general Australian population. For example, the prevalence of major depression (MDD) was 6.4% compared to 3.1% in general population (1).

Generally military personnel will present for treatment with more than one of the following problems; trauma, unstable mood, anxiety, alienation, hyperarousal or substance use including alcohol. When working with people who have been in any kind of military, it can be very difficult to soothe maladapted modes and release the Healthy Adult.

For the purposes of this article we shall discuss people who have been in the Army when they developed their psychological problems, however the general concepts can apply to other arms of a Defence Force. We shall aim to conceptualise the schema presented in terms of what draws people to join a Defence Force which can give clues to early maladapted schemas; how the training to be a soldier causes and strengthens maladapted coping modes and how these coping modes are not conducive with a healthy civilian adult. The final stage shall be a case study by one author (MF) to illustrate some of our ideas.