Working therapeutically with collectivist cultures using Schema Therapy (with Beatrice Ng-Kessler)

[00:00:05] Bronwyn: Hey, mental workers. You're listening to the Mental Work podcast, the podcast about working in mental health for early career mental health workers. As always, I'm your host, Bronwyn Milkins, and today we are talking about working therapeutically with clients from collectivist cultures.

As early career mental health workers, many of us were trained in western psychological models that emphasize individual autonomy. But what happens when our clients value family social harmony, or duty over individual expression? In this episode, we are digging into how collectivist values shape therapy, how it can deliver culturally safe services, and what schema therapy can offer in this context.

Here to help us out with this topic is our special guest, Beatrice Ng-Kesler. Hi Beatrice.

[00:00:49] Beatrice: Hi Bron, thank you for having me here.

[00:00:52] Bronwyn: It's such a pleasure to have you, and you are our first guest from the UK, which is very exciting.

[00:00:57] Beatrice: Yes. Sounds so exciting to me too, uh, the first time I'm on the podcast originally from Australia.

[00:01:04] Bronwyn: Wonderful. I'm so glad that we can have this cross, uh, continental interaction.

[00:01:08] Beatrice: Yeah, yeah, absolutely.

[00:01:11] Bronwyn: Could you please start us off by telling listeners who you are?

[00:01:15] Beatrice: Uh, sure. Uh, I'm Beatrice Ng-Kessler, I'm a clinical psychologist and schema therapy trainer based in London. I'm also a certified mindfulness trainer from Canada. Um, as I'm born and raised in Hong Kong, I've mainly treated significant amount of Chinese clients at work. Um, when I was in Hong Kong, in my private practice, that's in fact like half of my client are Chinese and then half of them are non Chinese.

But since I moved three years ago, so I have, most of my clients are now Chinese because people are self-identified. You know, when they select their therapist, they come to me naturally, and my own background is collectivistic culture. At the same time, I'm working a very westernized society and I married a white guy, and I'm working closely with people from individualistic background, clinically, and professionally.

[00:02:09] Bronwyn: Wonderful. So it sounds like it's quite a natural interest for you, given your background to be working therapeutically with people from collectivist cultures.

[00:02:17] Beatrice: Absolutely.

[00:02:19] Bronwyn: Is there anything else that draws you to working with these clients from collectivist cultures other than your own background?

[00:02:26] Beatrice: Because it's from all my career I'm facing the same issue. You know, all therapy are coming from the West, although they may borrow ideas from the East, like mindfulness and Buddhism. But the psychotherapy itself is a foreign thing for many collectivistic people because it's positioned from a westernized lens, from a more individualistically informed lens, so there's a lot of assumption that's unknown to people who are coming from the individualistic background.

So one of the clash between these two culture, it's like our self identity is a little bit differently how we define ourself. So like the individualists, they see themselves as an individual, they feel more entitled to the individual rights and their opinions because they're born and raised in that way, so they can express themselves very naturally.

Versus from more collectivistic background, their identities very relational. So we are more unconsciously define ourself very much based on our relationship with others. So that make our self identity much more dynamic and also sometimes vulnerable in some way because that's some elements that's out of our control.

[00:03:48] Bronwyn: You wrote an article for the British Psychological Society and it was about connecting worlds and finding common ground, and you did describe therapy is feeling quite foreign to clients from collectivist backgrounds... Something I've noticed about, I guess, just therapists here in Australia is that we might have a very narrow understanding of collectivist cultures.

So you mentioned before that collectivist cultures and people from that might define themselves relationally, and I'm just wondering if there's any other aspects of collectivist cultures that we might not be aware of in our very small understanding, like could you help broaden our view?

[00:04:24] Beatrice: And that's a very good question. At the same time, that's a very big question because...

[00:04:29] Bronwyn: okay.

[00:04:30] Beatrice: um, yeah, yeah. I, I'm, I'm meaning, you know, because sometimes we, when we learn something different from us, we, we trying to learn it like this is the whole thing. Like math, this is math, but this is well defined. Culture is something pervasive, hybrid, dynamic, multidimensional. It's in everything. It's in your food, it's in your, your way to see the world. It's in your rituals, it's in your habit. So it becomes very difficult to like, okay, this is collectivist culture.

But I'm going to give an example because I think example helps, because we learn from the contrast. Like in my personal and professional life, you know, from the contrast, we come to know about others and ourselves much better. So, let me give you an example. So like, people from, uh, individualistic culture, they can speak in a way that's much more direct and clear. They can clarify things, for example, like, um, oh, I, I, I don't mean to criticize my parents, but this is what it is, you know, so they clarify.

But whilst people from collectivistic culture, despite, they can still say those words, but there's a much more complicated process occurred inside them. So as, because the way they grow up with filial piety, which is a concept that doesn't exist in the individualistic culture. So this filial piety has taught them to say, you know, anything negative about their parents is not acceptable.

That one of the examples that, you know, clearly that point out the differences. And you can see filial piety in Confucius Informed society like Japan, Vietnam, Korea... They all share this kind of concept in different degree. And these people, they have more challenge to express their views, for example, about their parents in the therapy room.

And deeper level many of these clients, they do not even know they have unmet childhood needs, because the filial piety keeps us to respect and maintain the hierarchy. So in the family, it means like the parents and the child hierarchy. So the filial piety teaches us to make, let your parents make decision because they authority and childrens are supposed to obey. So people grew up from this background, they're so used to think or feel from their parents' perspective. So they are rarely used to what therapist mean, their own need.

[00:07:09] Bronwyn: That's such a interesting example and I really love how you've explained that, particularly linking it to schema therapy where the whole focus is on unmet needs. So when I do schema therapy with clients, it can be quite confronting even for Western clients to acknowledge that maybe their parents didn't meet some of their unmet needs. But do you feel like with people from collectivist cultures and having that filial piety, it's even more.

[00:07:32] Beatrice: Yeah, yeah. To a different level and more, not just more confronting for them to feel and express and engage in this conversation, but to also, inside them, you know, the internal landscape is very complex. Because they have so many primary, secondary emotions would come up in the process. You know this, the filial piety itself first is contributing to the enmeshment schema if we use the schema therapy model.

But don't take me wrong, I'm not trying to say that, you know, all collectivist people have enmeshment schema! No, no, that's not what I want to say. What I mean is love and intimacy, that shows up differently in this culture.

[00:08:15] Bronwyn: Yeah, and I think that's a really important point because I think one thing, again, like as a western therapist myself, there's why as a white person, um, I might look at a person's relationship with their parent and be like, ah, enmeshment, and they might score really highly on the enmeshment scheme, and I'll be like, the healthy think here would be to separate. But could you just talk to us about how that might not be a culturally safe way of working with people who are Chinese or from other collectivist backgrounds?

[00:08:40] Beatrice: Yeah. Yeah, that, that's a very good point. Like, first, when we see enmeshment schema, we think the purpose, the goal is to separate...

[00:08:50] Bronwyn: Yeah.

[00:08:51] Beatrice: ...because the assumption is you're not individualizing enough.

[00:08:54] Bronwyn: Yeah, that's right.

[00:08:56] Beatrice: Right? Your developmental needs is unmet. The individualization doesn't finish. That's the assumption from the Westernized lens. But if we see it relative more from a collectivistic side, that's partly who they are. You know, the relational nature of the self-identity kicks in here. You, you can't just go like, okay, let's separate. So where is the owner of that culture and the values goes if we just go into absolute direction?

So what we need to think as a therapist is, so there is tension and how I navigate this space. So it's more for us to help the client, how... how to honor this part of your culture, your values, at the same time, you can develop your auto, um, with autonomy and a healthy adult meets your own unmet needs.

[00:09:52] Bronwyn: Yeah, it, I love how you say tension because I'm wondering like, do people from collectivist cultures, would they perceive the therapist... I mean trying, potentially trying to encourage them to individuate, would that be seen as threatening for some people?

[00:10:08] Beatrice: That absolutely would sound threatening because they may feel the, the unsafe, uh... it's ultimately some part of the unsafe feelings coming from, you know, I worry my parents don't love me then.

[00:10:23] Bronwyn: Yeah.

[00:10:24] Beatrice: I would lose them, right? Um, they no way they would validate this kind of. Me, this version of me, this version that have needs, and the needs is largely validated all in my childhood, in my upbringing until now. So, you know, for them, they have to reach that, you know, what if my parents reject me, what if I'm going to lose them? What if that connection... being with my parents is actually in the way for me to become autonomous?

So you, you see the autonomy need and the connection needs is actually contradict. We, we have to find a common ground with our clients together. That's the challenge, and I find it difficult. One of the things to teach, um, because I'm going to give training in this, you know, applying, um, cultural, uh, competence in the therapy for collectivist clients. One of the challenges, we cannot define culture too narrowly to race or ethnicity because there is really research saying it's collectivism that predicts the filial piety, not ethnicity. So it's not about your Chinese or your Japanese because there's so many Chinese and so many different Japanese. So it's about a degree of collectivism.

That makes that training becomes difficult. It's like what now I'm saying, you know, like the words it's, it's very difficult to deliver because that's not so concrete. But the base is the therapists have to be really sensitive and open-minded while curious about your client's world, you know, how do this person becomes who they are right now? How do this person, for example, how do this person would feel like, uh, she must take care of her elderly parents while her siblings doesn't have it. How, how does that happen to her?

So if you have the curiosity... then it means you understand from her- his perspective, that is the key. And sometimes the therapist doesn't, doesn't know, they doesn't know, right? That you, you don't know what you don't know. So it's, I, I don't blame them. You know? Sometimes the supervisee come to me from individuals, they don't know what is missing. So in the conversation, I'm trying to understand what he doesn't say. Even if she doesn't pick it up, it's not her fault. She just doesn't believe her, it's not fair, right?

So I have to ask her to reflect on questions like, tell me the story of your client. What do you think about how it becomes the way this is? So in the process of the reflective session, that's usually the answer that the therapist needs. It comes from their own... you will also need to know the client.

[00:13:22] Bronwyn: I was going to ask you like, how can white Western therapists from individualist cultures become better at working with clients from collectivist cultures. It sounds like curiosity and openness are key things. And I ask that as well, because I think there are some therapists who are white, who have people from collectivist cultures come to them, and they're comfortable seeing them, but then the white therapist is like, oh, I don't know if I can work well. Like, do you think that we can become better at working with clients from collectivist cultures if we are from an individualist culture?

[00:13:55] Beatrice: Absolutely. Absolutely. That is the good side of the distance. You know, the distance can be a good thing because some of the collectivist clients, they feel actually more comfortable working with an individualistic culture therapist because they are more free to express themselves.

[00:14:14] Bronwyn: Oh, interesting.

[00:14:15] Beatrice: Yeah, they will feel the therapist not judging them as the way they used to in their own culture group, right? So they actually feel a little more space to express, so when they identify you, if you are an individualistic background therapist, if they identify you, very likely, that is a reason they choose you as their therapist. So that, that's a good side of it.

And then that's another side is the therapists have to pay attention, um, that involves the concept of cultural safety. Because the cultural differences can be in play in the therapeutic relationship inside the therapy room too. Collectivistic the clients are more commonly would tend to see their therapists as an authority, so the therapist interpretation and judgment carry a heavier weight.

[00:15:09] Bronwyn: I am wondering, um, this is just something I've observed in my own practice, I find coming from an individualist culture, I find it more difficult to pick up when a client from a collectivist culture perhaps disagrees with me, or what I'm saying to them is not resonating well with them. I think just because of cultural distance there as well. Is this something that you can give us some insight into as to when we might not be resonating with clients from collectivist cultures? How would we know?

[00:15:38] Beatrice: That's a very good question. You know, when you are- you yourself in an authority position, you can just ask directly, does it work? What do you think? Because you are authority perceived, right? So the person find it difficult to explain, you know, being very direct, open, clear to you, right? Because they suppose- they inside suppose that they have to be, you know, conforming, submitting... so you can't get it from a direct question, right? Basically you can't get the reassurance for yourself.

[00:16:12] Bronwyn: Yes.

[00:16:13] Beatrice: You know? So, so, but that's a super good question that you ask because then with that question in your mind, then you will start to observe... what is the body gesture? What is those non-verbal things? What is that response when you, for example, when you suggest something... oh, why don't we explore how should we talk to your parents, you know?

And you will have to see the response of your clients, right? Do they, do they say yes but..? Do they, do they show up with, that very uncomfortable, awkward facial expression? Do they feel something that they didn't say? Because once you sense that you can post an inquiry, I sense that is maybe some nervousness or what here, would you mind to tell me, is that something about our conversation? You know, just tell me about it. You know? So if you have the very open mind sentiment that can wait, it can see it in your client and with time they may feel gradually more and more comfortable to really reveal what is deep down right there, that they feel scared, or they may not even know from the beginning.

[00:17:32] Bronwyn: So it is really open-ended, gentle inquiry, noticing body language and shifts in how they respond to things rather than direct questioning. Because for some of my clients from individual cultures, I might say to them like, you are welcome to disagree with me, and directly that can work quite well, but that, but from hearing what you say, that might not work so well for people from collectivist cultures.

[00:17:55] Beatrice: Yes. Yes. Not that you can't say that, you know, feel free to yourself, right? Say that, say that. But at the same time, bear in mind like, that may not be enough, that's something, but don't expect, like, okay, so they would take it as, oh, this is fake. You know, the safety is built up from a lot of things like the non-verbal observations, like taking care of your clients.

So one of the example I can give here, maybe give more concrete ideas to the audience, one of the re-parenting that I do with my collective client is I offer tea when they feel shame. Because when they feel shameful, you know, everyone, I think the tendency is to think is to hide away, I don't want people to see me, right. And at that very moment for people from collectivistic culture, they really suppress their emotion, that's a very difficult time to be with them, because they don't want me there. So how can I minimize my presence at the same time being present?

So, so my way of doing so is I would, I would make them a tea, you know? I usually know what kind of tea they like, because when they come in I have a box of tea to let them choose, so I remember. So I would make that tea and then put them in front of them. You know, I say nothing, I don't even look at them because I want them to have that space. At the same time, I want them to know that I'm here, I'm here. So it, it works in some kind of, you know, subtle way.

So I want the therapist to, you know, that, you know, creating a safe space is not just what you say... it's everything that you do in a therapy room. How you carry yourself, are you pause enough to listen, are you ask questions that very sensitive to the client's present moment... because you observe and you see, oh, she moved away her eye gaze right now, maybe that's something? You know, so because you pay those attention, your clients start to feel more safe.

[00:19:54] Bronwyn: It's really insightful listening to you talk about this, and it sounds like we need to be even more attuned and really noticing of our clients who are from collectivist cultures to be able to help them in culturally safe ways. Is that right?

[00:20:07] Beatrice: Yeah, yeah. Absolutely.

[00:20:09] Bronwyn: So something that you talk about in the article that I read, which you linked me to was the integration of your Chinese identity with Western psychological training. Could you just tell me a bit about how you do that and how that's influenced the way that you practice therapy?

[00:20:24] Beatrice: The integrations, um, I think the best example is one of the examples of how I bring my collectivistic background to the therapy room... there's no, um, therapy books or training will tell you, offer your client tea.

[00:20:43] Bronwyn: Yes.

[00:20:44] Beatrice: No one tell that, right? So this is like, this is one of my integration. Um, and because I have a mindfulness background, I'm from mindfulness trainer myself... I have a lot of those, um, self search, um, self reflective practice myself. So, um, it, it does help me to ground in the present moment and atune the, to the client's moment by moment. So that's where those, um, you know, my background and the therapy would come together.

So getting back to the question, the how, it is a lot more about how, how the therapist trying to attune to the clients as much as possible. So I don't think all therapists should practice mindfulness like me because this is the only way to do it. I, I also don't think, you know, um, offering tea is the absolute best way to do it, you know, so this is just example.

But I wish the therapists, when they hear this example, they can reflect on how you are taking care of that collectivistic clients, uh, how do you have maybe more means than the way you used to? Um, if what you used to is, for example, reflect, reflect, um, back to the clients, oh, I know, that feels really shameful, you know, I don't, you don't need to feel that way. You know, I don't think, uh uh, I would feel that way or I don't think this is your fault, or I don't... you know, that's maybe one way of your way to handle and I think about, is there any other way?

Trying to ask yourself questions like what I am doing right now and is there any more way that I can do? If you have bad questions for yourself, you will start to expand your tools. It's not just very automatic unconscious because I used to, and then I just, I just automatic response in a way, I think that is... because our culture, um, everyone grow from a culture, right? It can be mixed, it can be whatever, but everyone have it. And that inform us to respond the way, some of the way that we respond to people and to be aware of our own culture is the key difficulty... to try to know what we maybe doesn't know about... That may be the key, you know, the challenge, what I don't know. That is the key challenge.

And working with collectivistic clients, you often cannot ask them directly what you don't know. First, they don't know what you don't know too. Second, they may not be very well aware of their unmet childhood needs themselves. First, they may not be very emotionally, you know, aware of their own emotion because of the emotional suppression that their used to in the way they grow up because you have to be o- obedience to the authority, that would train a lot of emotional suppression inside you, or the the culture itself for more stoicism, so you are not encouraged to express vulnerable feeling because it may be seen as weak. So you know, that kind of background train them of being very emotionally suppressed relative to the individualistic culture.

So there is a lot of barrier, and they don't even know, you know? So that's why the therapist found it quite challenging to get reassured, you know, am I doing the right thing? You know, they feel anxious and in the supervision, that's what I see. But I think the anxious thing is a good thing, because you start to think from that perspective, you start to allow yourself feel a little anxious because you want to do well in your job. So I, I actually celebrate, you know, if the therapist start to feel like that. And I want to help them to reflect on, so what is the possibility, and what you can try next time. What is the subtle observation that you bring in, uh, from the last session and explain to me, or showing me the video? That's what would happen in the supervision, you know, in the, all those nuances. But to go back to the question is, you know, um, there is no, uh, concrete rigid 'how', but there is a lot of work that is inside the therapist.

[00:25:15] Bronwyn: That's really insightful, thank you. One question I had as you were talking and you were talking about the emotional suppression, um, back to schema therapy, you know, one of the main vehicles for change in schema therapy is reconnecting with our emotions and we use emotion focused interventions. And I had a schema supervisor tell me once, he was like, you need to get your cry rate up, Bronwyn, um, like you need to have more clients crying in session. And I just wondered how might it work for clients from collectivist cultures who have emotional suppression if we try and force them into these emotional states and how can we do that safely or should we?

[00:25:53] Beatrice: That's a interesting question, because there may be an assumptions here that um, if we are in touch with our emotions, we will cry, right? So if we feel vulnerable, and I'm fully in touch with it, the expression is crying. So there's an assumption there.

[00:26:10] Bronwyn: It is.

[00:26:11] Beatrice: And for the clients, if not just collectivism, but also the gender stereotype, um, also the upbringing, you know, and how they see themselves... It's, it's not necessarily that they in touch with their vulnerable feelings and then they would cry... if they feel that vulnerable feelings, if I'm the therapist, my goal is I want them to be able to stay with it a little longer so I can do the intervention experientially, right, that schema therapy.

So I want them to be able to stay with it longer, and I may also want them to be able to verbalize to some extent because that helped them to contain those emotions, but I may not necessarily make them cry, or see crying as the outcome. Oh, I reached that goal now.

[00:27:09] Bronwyn: Yep. So we can't focus on crying as a goal necessarily. What about, I guess, for clients who may find it difficult to be in touch with emotions at all, um, due to, I guess, the cultural influence there... is it that therapy would be longer for them? Is it, is that it? Or like, as we build trust, then the emotional contact would come?

[00:27:33] Beatrice: Yeah. Yeah, that's a super good question, Bron. That's exactly what it, it normally happen, it takes much longer for some of the clients, we have to be much more patient. Because we need to build that, that stepping stone for them to be able to express themselves more freely in a more westernized definition. So it's that they don't use to it, many of them, they don't use to explain things in so much detail, describe their feelings in such a detailed way because it make them to be feeling those feelings. So they usually, relative to the people from individualist culture, they usually have more than experiential avoidance, switch topic, they touch it and then they go away. So there is maybe multiple layers of feelings and they touch the surface and then they leave. So they touch it and then they leave again.

So, so that's why some of my supervisees find it difficult to do the experiential intervention because they don't want to go there. You know, they, they, they find it very unsafe. They find it odd, awkward. They find it embarrassing. They, they don't feel safe enough and they don't know what safety looks like because the way they grow up, they don't feel it. There's no nonjudgmental space in my life so far. So you tell me that. I can tell you whatever. What does that mean? So for them it's very difficult. It's not just cognitively, I can trust you. It's like emotionally, experientially, what does that mean? I don't even know. I only feel scared. I only feel weird. And when they first in touch with this, um, phase, cause safety the first time, they will still feel awkward and weird, you know, because they never, they don't use to.

So the therapists have to be very sensitive and patient right here, because you are doing a multiple layers job. So first is you contain this space, you convey this sense of sentiment that you are really nonjudgmental, you are well patient, and you are really trying to know. So that's the base. And then second is how to help them to recognize that emotions and then able to conversation with you about it, right?

So there is the layers of how they become aware and then they can translate into work. So in fact, that's a much longer training that I, so, but I'm trying to simplify it here, is, um, we often have to give a thin slice of emotions. For example, you may sense that there's some anger right there, but they may not want to admit that, yes, I'm very angry with my mom. They, they don't want to, to, to, to, you know, admit that, even they know, even they know.

So, so what you would want is maybe, am I right that I hear some frustration there? So that's a low grade anger, right? Frustration. So that becomes much more acceptable that maybe so they can accept that they can make, maybe move forward a little bit to admit that this is how I feel. So you are working with this kind of nuance.

[00:30:43] Bronwyn: That's such a great example, and I really love what you did there because, as therapists, we can jump to anger and be like, you are angry, but you're right, describing different emotions and breaking it down like frustration or annoyance might be a way to get in there.

[00:30:57] Beatrice: Yeah. Yeah. That takes a lot of patience from the therapist, right.

[00:31:00] Bronwyn: Yeah.

[00:31:01] Beatrice: Jump into where you see, but you can't, you have to build that up and, check-in... am I right? Okay. I'm right, okay. So, so you are gradually moving there. Sometimes you get this sense in one session, and you're just planting the seed for the next session. So that's a lot of patience that take from us in order to work.

[00:31:20] Bronwyn: But it's deeply important because I imagine if we don't have that patience and we go in too hard and we're like, no, you are angry, or, or, try and force it in some way, I, I imagine the client just wouldn't come back to therapy. It'd be too much to them.

[00:31:33] Beatrice: Exactly, exactly. The premature drop out.

[00:31:36] Bronwyn: Yes. I wanted to ask you about a different topic, which is stigma. And so something, um, I guess in Australia and in the US and it maybe in the UK as well, I'm not entirely sure, but there's beginning to be less stigma towards therapy. So in the US especially, it's almost like everybody has a therapist and it's seen as quite normal.

Um, but my understanding of collectivist cultures is that there's still a degree of stigma attached to mental health and to therapy. Um, and I just wondered like, is that true and how do we work with that in therapy?

[00:32:07] Beatrice: It is absolutely true and um, a lot of my clients from collectivistic background, they don't let people know that they're coming to therapy. Um, I totally normalize it, like, this is okay because it's, it's a privacy. It's like you, you have, for example, you have diabetes. You don't have to advertise , you have diabetes. You don't have to tell people that, okay, I have needle to do. You don't have to tell people. That's only fine. That's a privacy thing. You don't need to, right. You don't need to feel the pressure of I have to against it or I have to open it up. There's no pressure about it. So first it's okay.

And then the second is, you know, I'm trying to normalize it within the session. For example, especially when the clients have taboos concept that's in the way of the therapy. It's, I mean, it's affecting the therapy to be effective. So if that's the case, then I may put a little more focus on it, then I may normalize it in a way, like, how people coming in to see me, they are successful people, they are, um, educated, they are super clever, you know, you know, they, they won't, oh, no one would see that they are, oh, someone is, uh, um, depressed, anxious, or whatever. You know, no one would, would know at all because this is just the internal things that happen inside them.

So first of all, people may not know because that is the collectivistic culture. People have more space issue, you know, people know that I feel ashamed and I care so much about what people think about me. And there's, with support that collectivism is predicting more the um, um, the conformity to the group and also the social disability.

So, so they care more. So first I will explain about no one know, you know, if you come to my clinic, you see people in and out. Do you feel they, they, they look insane. No. Why? They look like common people, you know? So that's the second layer. That's about what people see.

And then the third one is, it really depends on the client, but sometimes, you know, um, that's part of my reparenting. It's like, you know, I see you as you as a person. And I don't think because you are seeking psychotherapy that you are, you are less, right? If, If, if, I'm sick, um, if I have stomach ache, I go to a doctor. I'm not less, that's just what it is. So it's the same thing here. So we seek help for people cutting our hair, for people doing something, um, because we need one another.

[00:34:42] Bronwyn: Yeah, so it's deeply normalizing and using yourself, I guess, as a person who the client has a trusting relationship with, to use your views to say like, there's nothing wrong with you to reduce that shame that could potentially be there.

[00:34:56] Beatrice: Yeah. Yeah. And the stress of, you know, how people are interconnected and we need one another, is very resonate with collectivism.

[00:35:06] Bronwyn: Oh, that's a really great point. That's a really good way of putting it, that really helps.

One thing you write about is the importance of humility, and I wondered how can we cultivate this as clinicians when working cross-culturally. I think it seems like a very important concept here. So, what I mean when I think about humility is not assuming that my view is the superior view. And I think as western therapists, when psychotherapy can come from people who are western. It can feel, or you can be kind of, yeah, superior and authoritative in that way. And how can we be more, have more humility when working with people cross-culturally.

[00:35:45] Beatrice: And I think you give yourself a very good answer, Bron.

[00:35:48] Bronwyn: Okay.

[00:35:50] Beatrice: Right? I don't see, yeah, that's a perfect answer. I don't see my culture as more superior. Right, I don't see from my perspective and then you are all others, others, others.

[00:36:02] Bronwyn: Yes.

[00:36:03] Beatrice: But like we is we both culture. It's not about I from my culture and it's more superior than yours. It's about us or how I can understand you more. So it's about us. That's already where we attune to collectivism.

[00:36:22] Bronwyn: Because I imagine like for for early career clinicians as well, there's a lot of scrutiny placed on them, um, like, because they have to learn all these skills. So of course you wanna have like an assessment and a treatment plan and a conceptualization, but maybe being- having humility extends to recognizing like there are different ways of working here that the client might guide you towards.

[00:36:44] Beatrice: Yeah, yeah, you can say so, that's, that's going back to, you know, what is culture competency and how we can define it. Because of course, when we learn something, we want to have it. This is it, right? I want to have a concrete thing, right? But the interesting thing about cultural competency is, this is not so concrete. So what you have just give yourself a very perfect answer is I don't see my culture as more superior than others. That's the attitude that we want to cultivate, and sometimes we don't do it purposefully. You know, but the con-, the the, it may convey that dominance or arrogance just because, I don't know, you know, I think it's more like that rather than people are really arrogant.

[00:37:30] Bronwyn: Yeah, I think, yeah, that, that really sums it up nicely, and I think that covers. Yeah, like reducing that arrogance, reducing that superiority because yeah, there are a lot of clients who come to therapy and may share very different views to us, and it's so important to not be superior and not be arrogant.

[00:37:48] Beatrice: But if I want to, you know, if the early, uh, career therapist may want some tools, I would say, like, you can bear in mind some of the questions. For example, the client share something with you, share some challenge with you. You, you may, you may say something like, um, so can you, can you repeat to- educate me about your background a little bit? You know, because I assume that's something I may not entirely... sure. For example, like is there anything you want me to pay attention to after about what you have just said? Is there something cultural that you think I may not know, would you want to tell me about that? You know, is there any, anything that you know in our conversation, if there's something that you don't know how to express in English, you can feel free to teach me the language that you are using and tell me, explain to me a little bit. You know, don't feel like you have to, you know, be entirely fluent in your second language, because I'm sure that's something we can't convey easily.

You know, so you here and there, you have this kind of questions, pull back, post back to your client and they, they may feel, you know, gradually more and more like, oh, oh, maybe I should tell you about this. Oh yes, actually, this is why we do it, because in my family, this is like this, like this. Because they don't know, they don't know, they need to educate you.

[00:39:06] Bronwyn: That's such great points. I love the questions you posed there, particularly the one, is there something that you would like me to pay attention to more in what you just said? Because I can imagine working cross-culturally, it's like they may say a sentence and be like, this was the main point. But then me individualist, I would be like, no, it was definitely that. That was the main thing, and by asking them, we can get on the same page and be more attuned. I can be more attuned.

[00:39:30] Beatrice: Yes. Yes, absolutely. Yes.

[00:39:33] Bronwyn: Wow. Those are such great questions. I loved those, thank you.

Beatrice, what do you hope that listeners will take away from our conversation today most of all?

[00:39:42] Beatrice: I hope the listeners would take away the concept that, you know, um, working with someone with- from another culture is not about black and white, one thing or the other collectivistic, or individualistic. It's, it's more like how we hold both ends together. How we feel the tension inside that client because of where they come from. So our, our process would lean on to how to navigate space for the clients that they can honor their own values, at the same time be a healthier version of themselves.

[00:40:22] Bronwyn: Beautiful. Beatrice, thank you so much for coming on. I found this conversation deeply informative. I've learned so much, and I'm really glad that you could share this with us because I think the listeners will take a lot from it as well. So thank you.

[00:40:35] Beatrice: Thank you too. Thank you for having me.

[00:40:38] Bronwyn: If listeners wanna learn more about you or get in touch with you or take some of your training, where can they find you?

[00:40:43] Beatrice: Yeah. Um, I'm the founder of Chinese Schema Therapy Academy and my website is www.chinese-schema-therapy.com.

[00:40:54] Bronwyn: Lovely. I'll make sure that link is in the show notes so that listeners can reach out to you and you, it sounds like you're available for supervision as well.

[00:41:02] Beatrice: Yeah, yeah, I'm doing supervision. I have free workshop, upcoming training about, um, cultural adaptations in therapy as well.

[00:41:10] Bronwyn: Lovely. Thank you so much, and again, thank you Beatrice.

Listeners, if you found this episode helpful, please make sure to put it into the ears of somebody else. It's the best way to get it out there, and I'd love for this information to be spread.

Thanks for listening to Mental Work. I'm Bronwyn Milkins. Have a good one, and catch you next time. Bye!