Matthew McKay PHD, Avigail Lev PsyD, Michelle Skeen PsyD, Steven C. Hayes PHD - Acceptance and Commitment Therapy For Interpersonal Problems - Using Mindfulness, Acc PDF

“This intensely practical book offers a cutting-edge evidence-based framework for mental health profes-
sionals seeking to more effectively address the myriad interpersonal problems that individuals seeking
psychotherapy face in their daily lives. It is the first book of its type to bridge the more cognitive notions
of schemas with newer mindfulness and acceptance-based behavior therapies such as acceptance and
commitment therapy. The authors know both worlds intimately, and offer a straightforward approach that
gets to the heart of patterns of unhelpful interpersonal behavior that ultimately damage significant social
bonds. The book is full of practical exercises, worksheets, and even a full-length protocol outlining its use
in either an individual or group therapy format. This book is a must-read for any mental health practitio-
ner who takes seriously the significant social and interpersonal problems faced by those they serve.”
—John P. Forsyth, PhD, professor of psychology at University
at Albany, SUNY, and director of its anxiety disorders
research program
“Acceptance and Commitment Therapy for Interpersonal Problems is a user-friendly guide to helping your
clients employ ACT to manage the pain and suffering caused by unhelpful schemas that contribute to the
relationship distress that often accompanies the personal disorders they bring to their sessions with you.
This book will guide you through a step-by-step process for helping your clients accept schema-related pain
in the service of values-based interpersonal behavior. Highly recommended.”
—Richard Blonna, EdD, author of Stress Less, Live More
“Interpersonal difficulties are a common focus of clinical work, either as a primary presenting problem or
one that further complicates other issues that clients bring with them to therapy. This book skillfully
integrates schema theory with acceptance and commitment therapy. Matthew McKay, Avigail Lev, and
Michelle Skeen guide the reader through a systematic program emphasizing mindfulness and compassion-
ate acceptance of thoughts, feelings, and urges that typically result in interpersonal difficulties, along with
the clarification of personal values to inform alternative ways of relating to others. Numerous handouts
and forms throughout, as well as an appendix with a session-by-session protocol, provide an easy-to-follow
set of empirically-supported guidelines. This book should be a welcome addition to the library of all
mental health professionals who struggle in working with clients who find their relationships with loved
ones, friends, and coworkers more often a source of psychological pain than fulfillment.”
—Robert D. Zettle, PhD, professor of psychology at Wichita State University and the author of
ACT for Depression
“Mental health professionals interested in new horizons in evidence-based treatments will find this book to
be a valuable first step in the direction of integrating acceptance and commitment therapy into their work.
This book offers a unique journey through the ACT material by integrating the vernacular of traditional
cognitive behavior therapy. The authors dare ACT therapists to broaden the scope of their conceptualiza-
tions while challenging CBT therapists to apply mindfulness and acceptance to their toolbox of
interventions.”
—D.J. Moran, PhD, BCBA-D, founder of Pickslyde Consulting and the MidAmerican Psychological
Institute
“While chronic interpersonal problems are often the most difficult to address clinically, this book provides
new hope for the clinician. It is simple, practical, sound, and evidence-based.”
—Kirk Strosahl, PhD, co-founder of acceptance and commitment therapy and coauthor of The
Mindfulness and Acceptance Workbook for Depression and Brief Interventions for Radical Change
“Over the years, different therapy approaches have attempted to help clients struggling with interpersonal
problems. Despite showing some benefits, none of these approaches made a significant difference in these
clients’ lives. Finally, ACT for Interpersonal Disorders offers readers an alternative that is not only innova-
tive, but also based in research. This book sets a gold standard for how to integrate ACT and schema
therapy and shows us step by step how to make real changes in the lives of clients struggling with their
relationship to their own pain and relationships with the people they care about.”
—Patricia Zurita Ona, PsyD, clinical supervisor at the Berkeley Cognitive Behavioral Therapy Clinic
and the Wright Institute’s behavioral medicine training program
“McKay, Lev, and Skeen present a successful, innovative combination of ACT and a schema-based
approach to help clients with interpersonal relationship problems gain more behavioral flexibility and move
beyond inflexible patterns of relating. Rather than changing dysfunctional schemas or core beliefs, the
authors teach readers in clear, practical steps how to help clients alter the way they relate to their thoughts
so that they can choose different responses based on their chosen values. The book is based on long-term
clinical and research experience that shows how clients gain greater psychological flexibility through
building acceptance and defusing from unhelpful thoughts, emotions, and beliefs—including schemas. With
its many worksheets and exercises, as well as a session-by-session treatment outline, this book is a great
resource for any therapist who wants to help clients develop less conflict-filled, richer, and more fulfilling
life.”
—Georg Eifert, PhD, professor emeritus of psychology at Chapman University
“Relying on a storytelling clinical voice, the authors articulate an innovative approach to applying ACT
technology to interpersonal problems using the language of schemas (e.g., abandonment, failure) as a
heuristic to identify historic thoughts, feelings, and action urges that are sources of pain and unlikely to go
away. The book describes a step-by-step treatment approach wherein the clients learn to recognize old
moves to avoid the emotional pain associated with these schemas and discover how to stop these behaviors
that create unnecessary interpersonal suffering. It includes clear descriptions of interventions, with samples
of therapist-client dialogue and handouts to use with clients. The book is based on a small randomized
controlled trial in a group setting and indeed, it includes that protocol in one of the appendices; however,
the material presented in this book could easily be utilized in individual and couples therapy, as well.”
—Jacqueline Pistorello, PhD, coauthor of Finding Life Beyond Trauma
acceptance and
commitment therapy
for interpersonal
problems
Using Mindfulness, Acceptance, and Schema Awareness
to Change Interpersonal Behaviors
MATTHEW M CKAY, P h D
AVIGAIL LEV, Psy D
MICHELLE SKEEN, Psy D
New Harbinger Publications, Inc.

Publisher’s Note
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold
with the understanding that the publisher is not engaged in rendering psychological, financial, legal, or other professional
services. If expert assistance or counseling is needed, the services of a competent professional should be sought.
Distributed in Canada by Raincoast Books
Copyright © 2012 by Matthew McKay, Avigail Lev, and Michelle Skeen

New Harbinger Publications, Inc.
5674 Shattuck Avenue
Oakland, CA 94609
www.newharbinger.com
Cover design by Amy Shoup; Text design by Michele Waters-Kermes; Acquired by Catharine Meyers;
Edited by Jasmine Star
All Rights Reserved
_________________________________________________________________________________
Library of Congress Cataloging-in-Publication Data
McKay, Matthew.
Acceptance and commitment therapy for interpersonal problems : using mindfulness, acceptance, and schema
awareness to change interpersonal behaviors / Matthew McKay, Avigail Lev, and Michelle Skeen.
p. cm.
Summary: “Acceptance and Commitment Therapy for Interpersonal Problems offers a complete professional
protocol for treating clients who suffer from a variety of interpersonal issues, including tendencies toward blame,
withdrawal, anger, contempt, defensiveness, and distrust. Based in acceptance and commitment therapy (ACT) and
schema therapy, this approach helps clients understand and move past their interpersonal disruptions and difficul-
ties”-- Provided by publisher.
Includes bibliographical references and index.
ISBN 978-1-60882-289-8 (hardback) -- ISBN 978-1-60882-290-4 (pdf e-book) -- ISBN 978-1-60882-291-1 (epub)
1. Interpersonal psychotherapy. 2. Interpersonal relations. 3. Acceptance and commitment therapy. I. Lev,
Avigail. II. Skeen, Michelle. III. Title.
RC489.I55M35 2012
616.89’14--dc23
2012003631
Printed in the United States of America
14 13 12
10 9 8 7 6 5 4 3 2 1
First printing
Contents
Foreword v
Introduction 1
1 The Challenge of Treating Interpersonal Problems 3
2 Introducing Schemas 9
3 Understanding Schema Coping Behaviors 25
4 Cultivating Creative Hopelessness and Developing Mindfulness Skills 35
5 Clarifying Values and Committing to Values-Based Action 55
6 Defusing from Thoughts and Developing the Observer-Self Perspective 69
7 Conducting Exposure with Defusion 87
8 Working with Six Key Processes 99
Appendices
A Schema Questionnaire 121

B Research Outcomes 129
C Group Protocol 131
(Written with Koke Saavedra)
References 191
Index 197
Foreword
This is the first book of which I’m aware that combines ideas from schema-focused therapy with
methods from acceptance and commitment therapy (ACT). These two treatment approaches come
from different wings of the cognitive behavioral community, which could suggest that they will be
in conflict. In the hands of these authors, that never happens.
This book approaches schemas simply as well-ingrained patterns of thought. There is nothing
in this idea that violates ACT. Schemas imply a kind of functional theme, and the authors focus on
ten patterns of particular importance to interpersonal problems: abandonment, mistrust, depriva-
tion, defectiveness, alienation, incompetence, failure, entitlement, subjugation, and hypercriticalness.
Chunking patterns of thinking into larger units and themes in this way can make it somewhat
easier for the clinician to detect larger patterns and see the possible functions for more fine-grained
thoughts. It can help the client and clinician alike see the forest and not just the individual trees.
Building on the identification of schemas, the tested protocol presented here brings ACT sensi-
bilities to how schemas can be addressed effectively. That is, schemas, once identified, are addressed
largely through ACT methods. The authors make that task easy by thinking about schemas in a
functional sense. Just as in traditional ACT, which holds that fusion with thoughts leads fairly
directly to experiential avoidance, in the schema-focused perspective described in this book, coping
with schemas leads fairly directly to avoidant forms of adjustment. The functions of schema coping
behaviors are to escape from or avoid the emotional pain that is connected to a particular pattern
of thinking. That helps turn schemas into themes to be used to detect unhelpful patterns of avoid-
ance and their history. It’s a useful idea that is put to good use in this book.
One reason to take a more schema-focused approach in the domain of interpersonal problems
is that such problems present themselves in a bewildering variety of forms. It is very easy to get
caught up in content—in the details of the interpersonal stories and difficulties that make up the
psychological aspect of the social world. Everyone has relationship difficulties from time to time, but
this book is focused on recurring difficulties in relationships based on chronically dysfunctional
styles of interacting. When dealing with problems of that kind, the larger patterns are more impor-
tant than the details of a given instance.
Many years ago, language researchers determined that human language has a limited set of
analytic dimensions; you could summarize the myriad evaluative themes into just three polar
Acceptance and Commitment Therapy for Interpersonal Problems
dimensions (good/bad, strong/weak, and fast/slow). Schemas can help in much the same way. If you
can avoid reifying them, or turning them into causes, schemas can help focus clients and clinicians
alike on a small set of themes to apply to the many details. The act of looking for larger patterns
helps clients take a more defused and mindful look at their own behavior, and it can empower the
search for ways to create new forms of adjustment. It helps clients step back and ask “What am I up
to here?” and “What are the larger patterns of relationship that I am building in this moment?”
That step—of backing up and looking for larger patterns—is a powerful ally of change. It is not by
accident that this book uses ACT methods in service of this process, because the process is entirely
ACT consistent.
The protocol in this book constantly directs the clinician’s attention toward the function of
thought and emotion, and the construction of more effective behavioral patterns. It is very much to
the credit of the authors that the protocol itself has been tested so we can say with some confidence
that it can be of help in working with interpersonal problems. Detailed descriptions of interventions
are provided, and scripts help readers envision when they might be used.
There are a limited number of approaches available for interpersonal problems. It is still early,
but I believe this book adds another method to that list of approaches. Given how pervasive and
destructive interpersonal problems can be, it has not arrived a moment too soon.
—Steven C. Hayes
Foundation Professor, University of Nevada
vi
Introduction
C
lients present with interpersonal problems that often occur across multiple relationships
and life domains (friends, work, family, partner, and so on). Pervasive interpersonal prob-
lems can thus reach a level that could be seen as an interpersonal disorder, contributing to
failed relationships, social isolation, depression, and work dysfunction.
Clients struggling with interpersonal problems are frequent visitors to therapists’ offices. At the
Berkeley Cognitive Behavioral Therapy Clinic, for example, more than 50 percent of our intakes
identify significant recurring interpersonal difficulties. The majority of clients presenting with
depression, trauma, anxiety, and Axis II disorders report interpersonal problems in more than one
important relationship. Colleagues across the country report similar data.
Clearly, interpersonal problems are pervasive in the population seeking psychotherapy.
Interpersonal problems destroy relationships and trigger extraordinary suffering, both for those
affected and for those to whom they relate. Yet for all the pain these problems create, few systems of
psychotherapy directly target the interpersonal behavior that drives the problem, and there is little
research addressing what treatments effectively change disordered interpersonal functioning (this is
discussed in chapter 1). Therefore, the purpose of this book is to offer a treatment that targets
relationship-damaging behavior and also has some empirical support (see chapter 1 and appendix
B for information on a randomized controlled trial of this therapy in a group setting).
Given that you are reading this book, you probably have clients who struggle interpersonally
and repeatedly engage in damaging responses to relational stress. You may also have clients whose
primary concern is anxiety, depression, or trauma but who have a history of broken relationships.
Among these clients, you may have found that treatment targeting only the emotional problems
doesn’t help them reach high levels of well-being. The approach outlined in this book—a schema
formulation with mindfulness-and acceptance-based interventions—may provide you new tools to
effectively treat these interpersonal problems.
In chapter 1, we briefly discuss current treatments for interpersonal problems, reviewing their
effectiveness and shortcomings and explaining why we believe the novel combination of ACT and
schema theory is a more advantageous approach. In chapters 2 and 3, we outline how to begin this
approach by introducing clients to the concepts of schemas and schema coping behaviors and help-
ing them identify their schemas, triggers, and problematic coping behaviors. Clients also assess how
these have impacted their lives and relationships. Chapters 4 through 7 focus on ACT processes:
cultivating creative hopelessness, developing mindfulness skills, clarifying values, committing to
values-based behavior, cognitive defusion, developing the observer-self perspective, and emotion
exposure. The processes and approaches in these chapters are employed to help clients identify how
they would rather conduct themselves in relationships and to provide motivation for undertaking
the challenging work of changing long-standing patterns of behavior. In chapter 8, we discuss com-
mon issues that arise when conducting this therapy and provide suggestions on how to deal with
those issues.
The book also contains three appendices. Appendix A is an example of the type of schema
questionnaire you might administer before treatment to help identify clients’ key schemas. (We
recommend the Young Schema Questionnaire, which you can purchase at schematherapy.com).
Note that Appendix B outlines the results of research on the effectiveness of the approach used in
this book. Appendix C provides a detailed, session-by-session protocol for conducting ACT for
interpersonal problems in a group setting. This group protocol is adapted from the protocol used in
the study summarized in appendix B.
You’ll note that there are some differences in the order in which various techniques are pre-
sented in the main text versus the group protocol in appendix C. In appendix C the organization is
strictly chronological, whereas in the main text, topics are organized more thematically. This the-
matic organization allows us to present similar techniques and concepts together for clarity’s sake.
In practice, you might use techniques from several of the chapters in any given session in response
to what’s going on in the room. For this reason, we recommend that you read through the entire
book—or at least through chapter 8—before utilizing this approach with clients.
Note that we’ve designed appendix C to be a stand-alone guide to treatment. In theory, you
could photocopy this section of the book and use it as your sole reference when conducting group
therapy. However, we recommend that you first read chapters 1 through 8 in their entirety so you’ll
have a deeper understanding of the approach and the theory behind it. This will allow you to offer
group therapy more flexibly, tailoring it to the needs of group members or situations that arise in
session.
Feel free to photocopy the handouts and worksheets in this book for use in your practice.
However, do note that these materials are protected by copyright, so please seek permission to use
them in published material. The exception is the questionnaire in appendix A. It is provided solely
as an example. If you wish to use a similar questionnaire in your practice, please visit schemather-
apy.com, where you can purchase the most current version of Jeffrey Young’s questionnaire for
research or clinical use.
2
chapter 1
The Challenge of Treating

Interpersonal Problems
T
he currently available treatments for interpersonal problems are largely inadequate. They
either fail to target and change the maladaptive coping behavior, fail to address the underly-
ing (transdiagnostic) causes of interpersonal problems, or fail to provide techniques for
tolerating interpersonal distress. A more effective treatment is needed. This book offers a new treat-
ment for chronic interpersonal problems, one that both targets key components of the problem and
has research support.
Acceptance and commitment therapy (ACT) has significant empirical support for effectiveness
with emotional disorders (Eifert & Forsyth, 2005; Saavedra, 2008; Zettle, 2007) and multiple psy-
chological and behavioral problems (Hayes & Smith, 2005). Now, for the first time, ACT has been
combined with a schema therapy formulation (Young, Klosko, & Weishaar, 2003) in an approach
that has been successfully applied to interpersonal problems. We will briefly review the research
evidence for its effectiveness later in this chapter and discuss it more fully in appendix B. For now
we’ll simply say that the outcome data is promising.
Defining Interpersonal Problems

The term “interpersonal problems” refers to recurring difficulties that clients have in relationships
due to specific maladaptive responses and coping behaviors that result in a dysfunctional interactive
style. These responses and behaviors, learned in childhood, may include withdrawing, blaming,
clinging, attacking, or surrendering. They may have served an adaptive function at some point in
life, but in adult relationships they tend to be problematic. For example, it may have been adaptive
for a child to avoid an angry parent, surrender to a domineering parent, or withdraw from a detached
parent, but continuing to use these coping behaviors in current relationships leads to further pain
and suffering.
People often learn these coping behaviors by watching their parents and other family members
deal with pain. They may have had role models who got angry and went on the attack when they
were hurt, manipulated others to meet their own needs, or became overly compliant in order to
avoid abandonment.
Not all coping strategies are learned through modeling. When people get triggered in relation-
ships, they may stumble on a response that somehow gives them a little temporary relief and then
stick with that, doing it again and again in similar situations. These coping behaviors produce short-
term relief in the moment, but in the long run they damage relationships. Interactions stop feeling
good, and after a while others tend to harden or withdraw. This process—trading short-term relief
for long-term interpersonal difficulties—is the source of recurring interpersonal problems.
Three Aspects of Maladaptive Coping Behaviors

The patterns of maladaptive coping behavior that arise as a result of efforts to manage interpersonal
needs and stressors typically have three key aspects:
• They are inflexible.
• They are based on pathogenic beliefs (schemas) about self and others in relationships.
• They are driven by experiential avoidance.
Inflexible
Patterns of maladaptive coping behaviors in relationships are inflexible because they were
formed during early childhood experiences and continue to be reinforced in adult life (Levenson,
1995; Sullivan, 1955/2003). They tend to be inflexible and pervasive regardless of negative conse-
quences and also tend to create a self-fulfilling prophecy. They aren’t altered by negative outcomes
because they are effective, temporarily, at allaying anxiety and pain through negative
reinforcement.
Based on Pathogenic Beliefs

Jeffrey Young (1999) defines schemas as deeply held cognitive structures and core beliefs about
oneself and others, including particular themes and expectations about interpersonal relationships.
Schemas are deeply ingrained because they aid in understanding and organizing one’s world and
one’s relationships. They create a sense of predictability and safety. Further, it has been said “early
4
The Challenge of Treating Interpersonal Problems
maladaptive schemas are…at the core of personality pathology and psychological distress, in par-
ticular personality disorders and chronic interpersonal difficulties” (Nordahl, Holthe, & Haugum,
2005, p. 142).
People’s pathogenic beliefs and expectations in relationships compel them to continue to use the
same schema-avoidant strategies (E. Cohen, 2002; Flasher, 2000; Levenson, 2010; Safran & Segal,
1996). For example, people with an abandonment and instability schema have an expectation that
they will ultimately be abandoned in relationships. This bias leads to distortions and selective atten-
tion toward environmental cues of perceived abandonment. When an individual’s schema gets
triggered, it elicits particular thoughts, feelings, sensations, and behaviors that are connected to the
schema. (In this book, we’ll use the term “schema coping behaviors” (SCBs) to refer to problematic
reactions that occur when schemas are activated.) People may defend against abandonment sche-
mas through excessive autonomy, disconnecting, clinging, or withdrawing. These coping behaviors
are attempts to escape from or suppress the emotional pain connected to the schema. Schemas and
attempts to avoid the pain connected to them drive patterns of maladaptive interpersonal
behavior.
Driven by Experiential Avoidance

Experiential avoidance has been defined as attempts to avoid distressing internal experiences,
including thoughts, feelings, memories, sensations, and other private events (Hayes, Strosahl, &
Wilson, 1999). Experiential avoidance occurs when people are unwilling to experience such private
events and therefore attempt to escape or control these experiences, even if doing so creates more
harm in the long run (Hayes & Gifford, 1997). Control strategies may work in the external environ-
ment; for example, if you’re thirsty you can get some water. However, efforts to control internal
experiences are often unsuccessful and can result in maladaptive behavior. A wide range of research
indicates that many forms of psychopathology can be conceptualized as maladaptive strategies
aimed at avoiding or eliminating particular thoughts, memories, emotions, or other distressing
internal experiences (Chawla & Ostafin, 2007; Gamez, 2009; Hayes, Wilson, Gifford, Follette, &
Strosahl, 1996). Therefore, targeting experiential avoidance strategies in relationships should be a
fundamental component in the treatment of interpersonal problems.
Criteria for Treating Interpersonal Problems

Given the understanding of interpersonal problems outlined above, treatment must target and
change maladaptive coping patterns. To do so effectively it must address all three aspects of these
behaviors:
5
• To address and improve behavioral flexibility, it should encourage a broader repertoire

of behavioral responses and help clients develop this repertoire. Such flexibility must be
based on outcomes and consequences and include an assessment of the workability of
new and old behaviors.
• It must address schemas and how they influence clients’ interpersonal behaviors.
• To target avoidance strategies, it should provide motivation and methods for tolerating
the schema-driven emotional pain that spawns avoidant behaviors.
Current Treatments
Currently, several different treatment approaches are commonly used for interpersonal problems:
• Interpersonal psychotherapy: a time-limited form of psychotherapy, originally devel-

oped for the treatment of depression, that focuses on maladaptive relational patterns
• Transference-focused psychotherapy: a form of psychoanalytic psychotherapy, devel-

oped by Otto Kernberg, that treats borderline personality disorder using transference-based
interpretations
• Time-limited dynamic psychotherapy: a short-term treatment for chronic interper-

sonal problems that targets dysfunctional styles of relating
• Dialectical behavior therapy: a behavioral treatment for borderline personality disor-

der with accompanying suicidal and parasuicidal behaviors that teaches four key skills
(emotion regulation, mindfulness, distress tolerance, and interpersonal effectiveness)
• Schema-focused therapy: a cognitive behavioral therapy treatment targeting border-

line and narcissistic personality disorders that identifies core maladaptive schemas and
schema-avoidance behaviors that damage relationships
Unfortunately, all of these approaches have disadvantages. Although they do target maladaptive
relational patterns, there is mixed empirical evidence for their effectiveness in changing interper-
sonal behavior. Research findings regarding the clinical impact on clients’ interpersonal interactions
are ambiguous. Dialectical behavior therapy, for example, has significant research support for reduc-
ing suicidal and parasuicidal behavior, as well as days in the hospital. Oddly, however, the literature
is vague on its ability to change chronically ineffective interpersonal behavior. And while several of
the current treatments use inventories that assess borderline personality traits, interpersonal func-
tioning is only a subscale of these measures.
Although there is ample evidence that all of these treatments are effective in reducing hospital-
izations, reducing frequency of parasuicidal behaviors, and decreasing symptoms related to borderline
6
The Challenge of Treating Interpersonal Problems
personality disorder, it is difficult to parse their impact on changes in interpersonal behaviors spe-
cifically. In addition, the field suffers from a paucity of objective measures and inventories for
assessing interpersonal functioning and behaviors in relationships.
Moreover, each of the above therapies fails to meet one or more of the criteria for treating inter-
personal problems outlined above. Transference-focused psychotherapy meets none of them, as it
doesn’t target behavioral flexibility, pathogenic beliefs, or experiential avoidance—and also doesn’t
target behavioral change, which is necessary for developing new responses to replace maladaptive
coping patterns. Interpersonal psychotherapy fails to address pathogenic beliefs and also doesn’t
provide methodologies aimed at experiential avoidance or tolerating emotional pain. Dialectical
behavior therapy doesn’t address pathogenic beliefs, and schema-focused therapy doesn’t provide
techniques aimed at curtailing avoidance or tolerating emotional pain. Time-limited dynamic psy-
chotherapy is arguably the most effective and best-targeted approach among current treatments, yet
it too doesn’t address experiential avoidance or provide clients with methods for tolerating the
emotional pain that drives maladaptive interpersonal responses.
In summary, something new is needed that more effectively targets the underlying factors driv-
ing chronic interpersonal problems. We believe that the combination of ACT with a schema-based
formulation is that new approach.
An Alternative Treatment Approach

This book presents a new, acceptance-based treatment approach to interpersonal problems that
targets behavioral change (and maladaptive coping strategies in particular) and addresses all of the
criteria outlined above:
• It is designed to enhance behavioral flexibility in interpersonal settings and is focused

on workability of behavior.
• It addresses the role of pathogenic beliefs, or schemas.
• It specifically targets experiential avoidance by providing specific methods for tolerating

emotional pain (such as mindfulness, self-as-context, and cognitive defusion) and, through
values clarification, provides motivation for changing avoidant behaviors.
People with interpersonal problems are characterized by inflexible patterns of relating and are a
difficult population to treat. Given the rigidity of these patterns, ACT appears to be a beneficial
treatment approach because it promotes psychological flexibility through building acceptance and
defusing from thoughts, emotions, and beliefs, including schemas. ACT doesn’t attempt to change
schemas and core beliefs; rather, it alters the way people relate to them so that they can choose dif-
ferent responses to schema-related pain and take steps in valued directions.
7
This book is based on long-term clinical and research experience that has been gained working
with clients who struggle with interpersonal problems. The ten-week group therapy ACT protocol
provided in appendix C is supported by research conducted by Avigail Lev (2011) testing the effec-
tiveness of a very similar protocol used for the treatment of interpersonal problems. The study was
a randomized controlled trial that was conducted at a community-based clinic for recovery from
substance abuse. The study’s sample consisted of forty-four male clients who were randomly assigned
to control (treatment as usual) or experimental (ACT plus treatment as usual) conditions.
(Treatment as usual was a day-treatment recovery program that included 12-step study, relaxation
training, anger management, relapse prevention, and a host of other services.) The major finding of
the study was that the ACT group experienced significant decreases in problematic interpersonal
behaviors, as measured by the Inventory of Interpersonal Problems (IIP). Results showed large
improvements in pre-to post-treatment measures of interpersonal problems in both the mixed fac-
torial ANOVA and the Cohen’s d (d = –1.23). These findings provide strong support for the
potential effectiveness of this protocol and its ability to improve interpersonal functioning. (See
appendix B for further details about and results of this research.)
Summary
In short, none of the current treatment approaches for interpersonal problems adequately target all
aspects driving maladaptive coping behaviors. The innovative combination of ACT with a schema-
based approach allows for a well-rounded treatment protocol that addresses all of the essential
criteria. To be clear, this is an ACT treatment. It doesn’t use any schema therapy techniques; sche-
mas are utilized solely for the purpose of identifying clients’ primary pain. The goal of this approach
is not to change clients’ schemas or core beliefs; rather, the goal is to help them accept the primary
pain associated with their schemas and assist them in improving behavioral flexibility in order to
enhance values-based living.
8
chapter 2
Introducing Schemas
T
he treatment of interpersonal problems begins with defining early maladaptive schemas and
helping clients identify which schemas are relevant to them and contribute to their problem-
atic relationships. Because this material may be unfamiliar (not to mention challenging),
take your time with it—perhaps two sessions. Then you can move on to helping clients identify
common schema triggers so they can begin to bring more mindful awareness to these situations as
they occur. Once clients are aware of how schema-driven thoughts, emotions, and behaviors are
impacting their interpersonal interactions, they have more opportunity—and more motivation—to
change their behavior.
Understanding Schemas
A schema is a core belief that’s generated in early childhood as a result of an individual’s experi-
ences with parents, caregivers, siblings, and peers. Schemas are deeply rooted cognitive structures
and beliefs that help define a person’s identity in relationship to others. As such, schemas exert a
huge influence over interpersonal behavior and are the driving force behind interpersonal prob-
lems. Early maladaptive schemas are very powerful for a number of reasons (Young and Klosko,
1993):
• They include unconditional beliefs about who we are and what we can expect in rela-
tionship to others and the world. They are experienced as a priori truths and are taken
for granted.
• They are self-perpetuating and resistant to change because they develop in early child-
hood and adolescence. They can be experienced in the first few years of life and can
therefore be preverbal.
• They are derived from early trauma, neglect, and repeated negative messages about the
self. As a result, they form the core of self-concept.
• They are tied to high levels of distressing emotion, or schema affect. Typically, schema
affect includes fear, shame, loneliness, a sense of emotional hunger or yearning, anger,
or a combination of these.
• They are activated by relevant events. For example, a failure schema is often activated
by criticism or confronting a challenging task.
• They attempt to predict the future. Schemas help organize people’s knowledge about
interactions between themselves and the world. At root, schemas are efforts to identify
what will happen in every circumstance of every relationship. Because these beliefs offer
the illusion that one can peer into the future and prepare for it, they are extremely hard
to give up.
The Role of Unmet Early Childhood Needs

Maladaptive schemas are created when early childhood core needs aren’t met. According to Jeffrey
Young (Young, 2004), six needs must be met for children to thrive. If neglected, these needs create
schemas that are problematic for people and their interpersonal relationships.
• Basic safety. Essential at birth, this need involves how children are treated by their fam-
ily or caregivers. When infants or small children aren’t provided with a stable and safe
environment, they may develop an abandonment and instability schema, a mistrust and
abuse schema, or both.
• Connection to others. When children don’t receive love, affection, empathy, under-
standing, and guidance from family members or peers, they may develop an emotional
deprivation schema, a social isolation and alienation schema, or both.
• Autonomy. Essential for childhood development, autonomy allows for healthy indepen-
dence and separation from parents. When children aren’t taught self- reliance,
responsibility, and good judgment, they are likely to develop a dependence and incom-
petence schema or a vulnerability schema. (Vulnerability isn’t one of the ten schemas
included in this treatment protocol.)
• Self-esteem. When children are loved, accepted, and respected, they develop self-
esteem. When family and peer support are absent, children may develop a defectiveness
and shame schema, a failure schema, or both.
• Self-expression. In a nurturing environment, children are encouraged to express their

needs and desires. When this self-expression is discouraged, children are made to feel
10
Introducing Schemas
that their needs and feelings matter less than those of their parents. Often these chil-
dren are punished and made to feel “less than.” When self-expression isn’t encouraged
and supported, children may develop a subjugation schema or an unrelenting standards
and hypercriticalness schema.
• Realistic limits. When children are raised in an environment that encourages respon-
sibility, self-control, self-discipline, and respect for others, they learn to operate within
realistic limits. When parents are permissive and overly indulgent, children grow up
without understanding the need to consider other people before acting. In the absence
of realistic limits, children may develop an entitlement schema.
Explaining Schemas to Clients

You can either explain to clients the properties of schemas as outlined in the handout Understanding
Early Maladaptive Schemas, or you can give them the handout to read.
Understanding Early Maladaptive Schemas

A maladaptive schema is essentially a belief about yourself and your relationship to the world. It cre-
ates a feeling that something is wrong with you, your relationships, or the world at large. Schemas
are formed in childhood and develop as a result of ongoing dysfunctional experiences with parents,
siblings, and peers during childhood, and they continue to grow as children try to make sense of
their experience and avoid further pain. Schemas come from repeated toxic messages that we get
about ourselves from our early experiences (for example, “You’re bad” or “You can’t do anything
right”) or from specific traumatic events. Once a schema is formed, it’s extremely stable and becomes
an enduring pattern that is repeated throughout your life.
Schemas are like sunglasses that distort all of your experiences. They color the way you see
things, and they make assumptions and predictions that tell you the schema is true or will turn out
to be true. Schemas formed during childhood are triggered repeatedly throughout your adult life.
Common triggers include stressful interpersonal events and difficult thoughts and feelings. Once a
schema is triggered, it brings up powerful automatic thoughts and feelings about yourself that can
lead to depression, panic, loneliness, anger, conflict, inadequate work performance, addiction, and
poor decision making. Schemas interfere with your ability to feel safe in relationships, your ability to
get your needs met, and your ability to meet the needs of others.
11
Characteristics of Early Maladaptive Schemas

• They are experienced as self-evident truths about yourself or your environment.
• They are self-perpetuating and resistant to change.
• They seem to predict the future, particularly what will happen in relationships. And
because they create the illusion that you can see what’s coming and prepare accordingly,
they are extremely difficult to give up.
• They’re usually triggered by stressful events, typically something painful in a relation-

ship that activates old beliefs about yourself.
• They are always accompanied by high levels of emotion, such as shame, fear, hurt, or
despair.
Identifying Clients’ Schemas

There are ten schemas associated with interpersonal problems. Each of these core beliefs has the
capacity to disrupt and damage interpersonal interactions. Most clients have more than one schema
influencing relationships, and several schemas may work in concert to create significant distress.
For example, a defectiveness and shame schema often shows up with an abandonment and instabil-
ity schema, so the belief that one is unlovable ends up driving the expectation that one will be
rejected. You can use the descriptions in the Ten Key Schemas handout to explain these schemas
to clients. We also recommend giving them the handout to study and refer to in the weeks to come.
Ten Key Schemas

Psychologist Jeffrey Young has identified eighteen early maladaptive schemas. Ten of these schemas
have significant relevance to interpersonal relationships. A schema is a core belief. Core beliefs
define who we are and direct how we live our lives. They create the internal monologue that charac-
terizes the thoughts, assumptions, and interpretations that inform each person’s individual worldview.
When a schema is activated, it produces intense emotions. Identifying your schemas and examining
how they impact your life and your interactions with others is essential to making positive changes
in your relationships. Study this list of the ten schemas relevant to problems in interpersonal rela-
tionships and keep it handy so you can identify which schemas are affecting your interactions:
12
Introducing Schemas
• Abandonment and instability: the belief that significant people in your life are unstable
or unreliable
• Mistrust and abuse: the expectation that you will be harmed through abuse or neglect
• Emotional deprivation: the expectation that your needs for emotional support won’t be
met, which may take several forms:
• Deprivation of nurturance: the absence of attention
• Deprivation of empathy: the absence of understanding
• Deprivation of protection: the absence of guidance
• Defectiveness and shame: the belief that you are defective, inferior, or unlovable
• Social isolation and alienation: the belief that you don’t belong to a group, are isolated,
or are radically different from others
• Dependence and incompetence: the belief that you are incapable or helpless and require
significant assistance from others, that you cannot survive without a certain person, or
both
• Failure: the belief that you are inadequate or incompetent and will ultimately fail
• Entitlement: the belief that you deserve privileges and are superior to others
• Subjugation: voluntarily meeting the needs of others at the expense of your own needs,
submitting to others to avoid real or perceived consequences, or surrendering control to
others due to real or perceived coercion
• Unrelenting standards and hypercriticalness: the belief that you must meet very high
internalized standards to avoid criticism, leading to impairment in such areas of life as
pleasure, health, and satisfying relationships
Schema Affect
As mentioned earlier, each schema is associated with one or more painful emotional states. Once a
schema is triggered by interpersonal events, the relevant schema affect immediately shows up and
begins influencing the person’s behavior. The following table identifies the typical affects for each
of the ten schemas.
13
Schema Affect
Abandonment and instability Fear, anger, and grief
Mistrust and abuse Fear, anger, and yearning
Emotional deprivation Loneliness, yearning, sadness, and anger
Defectiveness and shame Shame, sadness, and anger
Social isolation and alienation Loneliness, shame, fear, anxiety, anger, and
yearning
Dependence and incompetence Fear, anxiety, and anger
Failure Fear, sadness, anger, and shame
Entitlement Anger
Subjugation Sadness and anger
Unrelenting standards and hypercriticalness Anger
The emotions associated with schemas are so painful that people are often motivated to do
anything to cope with or try to avoid them. We’ll examine this in detail in chapter 3.
Assessing Schemas
We recommend three approaches to identifying early maladaptive schemas:
• Having the client fill out a schema questionnaire, such as the Young Schema
Questionnaire
• Reviewing thought logs filled out by the client
• Using imagery to trigger and identify schemas
Schema Questionnaires
The Young Schema Questionnaire has been widely used to identify the eighteen early maladap-
tive schemas. In appendix A, we’ve adapted the Young Schema Questionnaire, with the permission
and assistance of Jeffrey Young, PhD, to specifically identify the ten schemas that are relevant to
14
Introducing Schemas
interpersonal problems. Note that the version in appendix A is just for reference. If you wish to use
a similar questionnaire in your practice, please visit schematherapy.com, where you can purchase
the most current version of Jeffrey Young’s questionnaire for research or clinical use.
Thought Logs
A simple thought log can be a gateway to understanding clients’ schemas. Over a period of one
to two weeks, have clients keep a record of their thoughts using the Thought Log. Instruct them to
use the log after experiencing strong emotional reactions, such as sadness, anxiety, shame, or anger,
and ask that they record all significant thoughts experienced during the period of high affect,
describing triggering situations in the left-hand column, emotional reactions in the middle column,
and key automatic thoughts in the right-hand column.
When you review the thought log, choose several thoughts that appear to be related to schemas.
Then use the downward arrow technique to probe whether thoughts indicate operative schemas. In
this technique, you’d ask, “If [the thought] is true, what does that mean about you?” Encourage the
client to answer in terms of thoughts and beliefs, not feelings. Keep asking this key question about
each successive thought or belief until the client describes a thought or belief that fits one of the
schemas. Here’s an example dialogue:
Therapist: Your thought log includes a thought I want to explore with you. When your
daughter resisted doing her homework with you, you thought, “I can’t stand this.” If it were
true that you can’t stand this, what would it mean about you?
Client: It means I can’t deal with her…can’t deal with her resistance, the way she just ignores
what I want her to do.
Therapist: And if it’s true that she resists you and ignores what you want her to do, what does
that mean about you?
Client: It means I’m a screwed-up parent—that I don’t know what I’m doing.
Therapist: And if it’s true that you don’t know what you’re doing as a parent, what does that
mean about you?
Client: It means I’m incompetent. I screw up everything that matters to me.
Notice that it doesn’t take long to get down to the schema that this client is struggling with:
failure. If you use the downward arrow technique to inquire about what a particular thought means
about the client, you’ll eventually arrive at the underlying core belief—and schema—driving the
thought.
15
16
Thought Log
Triggering situation Emotional reaction Automatic thoughts
Introducing Schemas
Imagery
To use imagery to trigger and identify schemas, start by identifying a recent situation that cre-
ated high affect and might be related to a schema. Ask clients to visualize the scene, noticing what
they saw, heard, and felt (both physically and emotionally). When they are sufficiently immersed in
the scene to experience some affect, ask these questions:
• Who are you in the scene?
• What does viewing this scene make you feel about yourself?
• In this scene, what do you fear will happen?
• How does the other person see you in this scene?
• What are you telling yourself during this scene?
The answers to these questions often provide a relatively clear indication of which schema is
involved.
Giving Feedback to Clients

Whether you use a schema questionnaire, thought logs and the downward arrow technique, or
imagery, the assessment process will help you identify one or more key schemas that are driving
clients’ interpersonal problems. Then you can use the Ten Key Schemas handout from earlier in this
chapter to define and discuss relevant schemas with clients. As you do so, verify that clients recog-
nize the schema-related core beliefs as part of their thinking. Here’s an example dialogue showing
how to achieve this:
Therapist: When we looked at your thought record, there was something that came up over
and over again. It was the thought that you don’t fit anywhere—the sense that no one sees
or understands you. And when we looked at the different schemas on that list, social isola-
tion seemed to really fit for you—this feeling of not belonging, of being alone even when
you’re with people. Is that feeling of not fitting in something that’s familiar? Has it shown up
at other times in your past?
Client: Yes. I felt just like that in my family. They were these loud, high-energy people, and
I always felt meek and quiet. They just ran over me with their energy. I felt that in high
school too, and in college. I just didn’t belong to the groups around me.
Therapist: And later, in your adult life, has that also felt true?
17
Client: I feel like people don’t get me, almost like I’m a nonentity to them. I feel like I’m on
the outside looking in.
Therapist: So the schema of not fitting, of being somehow isolated from others, stretches all
the way from childhood to things you feel right now.
As you work with clients to identify their schemas, don’t be attached to labels and descriptions
from this book (or elsewhere). It’s often a good idea to use clients’ language to describe and label
their schema experience, as illustrated in the preceding dialogue.
Helping Clients Recognize Schema Affect

Once you’ve confirmed the schema or schemas that influence clients’ interpersonal interactions,
you can begin to explore schema-related affect. To help clients link their schemas to emotions, you
can ask direct questions; for example, “When that defectiveness schema shows up, what emotion
seems to go with it?” or “When you begin to have that sense of emotional deprivation and you think
you won’t get what you need, what feeling comes up with that?”
Clients usually have a very clear sense of the affect that arises when their schemas are triggered.
They’re well aware of the emotional pain that suddenly wells up in those situations. As you talk
about schemas, always acknowledge the schema-related emotions that begin to hammer clients
when schemas are activated. It’s important to recognize and validate clients’ emotional state so that
you can work together to tackle the schema-driven affect and maladaptive coping behavior.
Schema Triggers
Virtually any interpersonal situation can potentially trigger schemas and schema affect. Once cli-
ents are aware of their schemas and the emotional impact of those schemas, you can work on
identifying the interpersonal situations that most typically trigger schemas. You can explain these
situations to clients as outlined in the Schema Triggers handout. We recommend that you also give
clients the handout for their reference.
Schema Triggers
Schemas distort our view of others and interpersonal situations. When our schemas get triggered,
we react in ways designed to protect ourselves from the emotional pain that results. Triggers are
unavoidable. However, if you can identify the triggers for each of your schemas and consciously
notice when those situations arise, you’ll be one step closer to changing the reactions that typically
18
Introducing Schemas
follow, and therefore one step closer to minimizing the pain associated with the schema and the
problematic coping behavior that follows. Here are some of the typical triggers for each schema:
• Abandonment and instability. This schema is likely to be triggered when you’re with
someone who is unpredictable, unstable, or unavailable. When this schema is triggered,
you’ll experience anger, fear, and grief.
• Mistrust and abuse. This schema is likely to be triggered when you believe that people
you’re interacting with will hurt or betray you. When this schema is triggered, you’ll
experience anger, fear, and yearning.
• Emotional deprivation. This schema is likely to be triggered if you feel lonely, if you’re
with a detached partner, or if you don’t feel understood, protected, or loved. When this
schema is triggered, you’ll experience sadness, loneliness, and anger.
• Defectiveness and shame. This schema is likely to be triggered when you start to get close
to someone and feel that your defects will be exposed, when others criticize you, or when
you’re in a situation that makes you feel that others will find you inadequate, flawed, or
unworthy. When this schema is triggered, you’ll experience shame, anger, and sadness.
• Social isolation and alienation. This schema is likely to be triggered when you’re in situ-
ations or groups of people and feel different or left out. When this schema is triggered,
you’ll experience fear, anxiety, anger, loneliness, and shame.
• Dependence and incompetence. This schema is likely to be triggered by any life changes
or new situations or the end of a relationship with someone you rely on heavily. When
this schema is triggered, you’ll experience anxiety, fear, and anger.
• Failure. This schema is likely to be triggered when you’re with people who are more suc-
cessful than you or when you’re in situations that make you feel that you’re lacking in
terms of accomplishments, talents, competence, or intelligence. When this schema is
triggered, you’ll experience sadness, shame, anger, and fear.
• Entitlement. This schema is likely to be triggered when things don’t go your way or
when your needs and desires aren’t put first. When this schema is triggered, you’ll expe-
rience anger.
• Subjugation. This schema is likely to be triggered when you’re in situations and relation-
ships where the needs of others come first or where you feel controlled by others. When
this schema is triggered, you’ll experience sadness and anger.
• Unrelenting standards and hypercriticalness. This schema is likely to be triggered when

you feel that you or others haven’t met your high standards. When this schema is trig-
gered, you’ll experience anger.
19
Interpersonal Domains
Events that can trigger schemas occur within six interpersonal domains: work, friends, family, inti-
mate relationships, parenting, and community. Bring the focus to these domains to help clients
identify and understand their vulnerability to schemas in a variety of relationships. For each domain,
ask, “With regard to your schema [ideally, you’d mention a specific schema], what situations seem
to trigger it at work?” If clients identify a particular interpersonal event, keep pushing. Ask if there
are additional experiences, conflicts, or interactions that activate the schema and its related affect.
Keep asking until you’ve identified as many situations and interpersonal events as possible. Use the
Schema Triggers Worksheet to list these situations. Work through all relevant domains to identify a
number of schema-triggering events that the client struggles with across a wide range of situations.
Encourage clients to observe schema-triggering events as they occur and note the related affect
as it emerges. However, also explain that the point is not to control triggers and the accompanying
painful emotions; rather, the point is to learn to recognize when schemas and schema-related affect
are activated in relationships. To help clients develop this awareness, you can give them the Schema
Events Log and ask them to complete it as homework, recording triggers and emotions any time
they notice that a schema has been activated.
The Schema Events Log is designed to help clients recognize and observe schema-related events
as they occur. The more clients are able to mindfully watch schema-triggering events, the more
likely it is that they’ll be able to exert control over their responses in the future.
It’s important to acknowledge and validate the painful emotions associated with each schema-
triggering event. When experiencing painful emotions, it’s a natural reaction to want to escape the
pain. It’s useful to help clients observe and document each step of the triggering process. The more
clients know about their triggers and the better they can recognize them as they occur, the greater
the chances that they will be able to change problematic interpersonal behaviors. The following
example dialogue shows how you can do this:
Therapist: (Looks at the client’s Schema Events Log.) I see your coworker said something that
felt very critical.
Client: Yeah, that I don’t seem to give a shit about the job—that I look disinterested.
Therapist: And that seemed to activate your defectiveness schema?
Client: Yeah. I felt sick, like I was really screwing up. And then I started to get angry, like
who the hell is this person?
Therapist: So it felt like something was wrong with you, and that was…
Client: Like a kick in the stomach. It was this worthless feeling.
Therapist: And then you got angry.
Client: I told her to mind her fucking business and said that I didn’t care what she thought.
20
Schema Triggers Worksheet
Domain Schema Triggers Emotions
Work
Friends
Family
Intimate
relationships
Parenting
Community
21
Introducing Schemas
Emotions
Schema Events Log
Schema
Trigger
22
Introducing Schemas
ACT and Schemas

ACT recognizes that pain is inherent in human existence. From the ACT point of view, schema-
related pain isn’t pathological, nor is it something that can be overcome. Because schema-related
pain has its origins in early childhood, it is an enduring part of the individual’s experience. No mat-
ter what age we are or how long we have been in therapy, we are unlikely to fully emancipate
ourselves from schemas and schema-related affect. For example, among people who had early aban-
donment experiences and learned to expect them, the abandonment and instability schema is likely
to be triggered during every relevant interpersonal event. The criticism, withdrawal, and anger of
others will activate the schema and the fear that goes with it.
The focus of ACT for interpersonal problems is not to eliminate schemas and schema-related
pain; rather, it is to learn to respond differently when schemas are triggered. ACT makes a clear
distinction between the primary pain that is part of the human condition and the secondary pain,
or suffering, that results from the struggle to avoid the unavoidable. From the ACT point of view,
schema affect is primary pain—an unavoidable by-product of living. Therefore, the target of the
treatment protocol in this book is not to stop or block the primary pain related to schema activa-
tion. Instead, the focus is on easing secondary pain: the suffering generated by attempts to avoid
schema affect.
Schema coping behaviors (SCBs) lie at the root of interpersonal problems. Whenever people try
to avoid or block primary pain due to schemas, relationships sustain damage. Therefore, the focus
of this treatment is on clients’ schema coping behaviors. SCBs correspond to the ACT concept of
experiential avoidance, which involves maladaptive strategies to suppress, numb, manage, and con-
trol pain. From an ACT point of view, the problem isn’t schemas or the emotions they generate; the
problem is trying to avoid schema-related pain with a variety of strategies that damage or destroy
relationships.
Summary
As clients begin to observe their schema triggers and reactions in day-to-day life, they’ll develop a
growing awareness of the powerful role schemas play in interpersonal events. In the next chapter,
we’ll focus on schema coping behaviors, which are a form of experiential avoidance, and how they
damage relationships. Helping clients develop an understanding of this dynamic is essential to cre-
ating motivation for the arduous work ahead: learning to accept schema-related pain in the service
of values-based interpersonal behavior.
23
chapter 3
Understanding Schema Coping Behaviors
A
fter helping clients understand schemas, their roots in childhood experiences, and the pow-
erful role they play in everyday life and relationships, you can begin to explain schema
coping behaviors and assess their costs. Although these behaviors often provide a bit of
short-term relief, they usually damage relationships in the long run. As mentioned, understanding
this can provide clients with powerful motivation to engage in the challenging work of changing
long-term patterns of behavior in relationships.
Introducing Schema Coping Behaviors

Here’s an example of how you might introduce schema coping behaviors to clients:
Therapist: Schema coping behaviors are responses aimed at blocking or controlling schema-
related pain. These coping behaviors may offer temporary relief in the moment, but in the
long run they contribute to the schema, make it feel more true, and actually increase
schema-related emotional pain.
Both environment and temperament can contribute to the formation of schema coping
behaviors. We often learn these coping behaviors by watching our parents and other family
members deal with pain. Dad may have gotten angry and gone on the attack when he was
hurt. Mom may have collapsed and given up. A sister may have withdrawn in her bedroom.
A brother may have started to drink.
In addition, sometimes we come up with schema coping behaviors on our own. When a
schema is triggered, over time we learn a way of responding that feels like it offers at least
temporary relief from the intense emotional pain. Because it seems to work, we stick with it,
doing the same thing again and again in similar situations.
The trouble with schema coping behaviors is that they tend to hurt other people, rela-
tionships, and, ultimately, the person who’s using them. When we withdraw, surrender, or
go on the attack, relationships stop feeling good to the people who are important to us.
After a while they may give up on us or harden and withdraw. So, although schema coping
behaviors may offer some temporary relief, in the long run they make us feel worse about
ourselves—and may cause us to lose people we love.
Common Schema Coping Behaviors

Although schema coping behaviors are highly individualized, they tend to follow similar patterns.
The SCBs most damaging to interpersonal relationships can be broadly classified into ten types,
described in the handout Ten Common Schema Coping Behaviors (Young, 2012). The first five
schema coping behaviors all involve overcompensation. The easiest way to understand this type of
coping behavior is to think of it as a more aggressive response to a schema-triggering event. When
people engage in one of these coping responses, they are fighting the schema. This is akin to the
“fight” part of the fight, flight, or freeze reaction. The sixth schema coping behavior involves sur-
render. It can best be described as a more passive response to a schema-triggering event. Think of
it as the “freeze” aspect of the fight, flight, or freeze reaction to the schema-triggering event. The
last four schema coping behaviors involve avoidance. These responses to schema-triggering events
are attempts to avoid the pain associated with those events. Think of them as the “flight” compo-
nent of the fight, flight or freeze response.
You can use the Ten Common Schema Coping Behaviors handout to describe maladaptive
behaviors to clients, then give them the handout for their reference.
Ten Common Schema Coping Behaviors

Overcompensation
• Aggression or hostility: If you use this coping behavior in response to a schema-triggering
event, you’ll find yourself counterattacking by blaming, criticizing, challenging, or being
resistant.
• Dominance or excessive self-assertion: If you use this coping behavior in response to a
schema-triggering event, you’ll find yourself trying to control others in order to accom-
plish your goals.
• Recognition seeking or status seeking: If you use this coping behavior in response to a
schema-triggering event, you’ll find yourself overcompensating by trying to impress oth-
ers and get attention through high achievement and status.
• Manipulation or exploitation: If you use this coping behavior in response to a schema-

triggering event, you’ll find yourself trying to meet your own needs without letting
26
others know what you’re doing. This may involve the use of seduction or not being com-
pletely truthful to others.
• Passive-aggressiveness or rebellion: If you use this coping behavior in response to a

schema-triggering event, you’ll appear to be compliant but will rebel by procrastinating,
complaining, being tardy, pouting, or performing poorly.
Surrender
• Compliance or dependence: If you use this coping behavior in response to a schema-
triggering event, you’ll find yourself relying on others, giving in, being dependent,
behaving passively, avoiding conflict, and trying to please others.
Avoidance
• Social withdrawal or excessive autonomy: If you use this coping behavior in response to a
schema-triggering event, you’ll find yourself isolating socially, disconnecting, and withdraw-
ing from others. You may appear to be excessively independent and self-reliant, or you may
engage in solitary activities, such as reading, watching TV, computer use, or solitary work.
• Compulsive stimulation seeking: If you use this coping behavior in response to a schema-
triggering event, you’ll find yourself seeking excitement or distraction through compulsive
shopping, sex, gambling, risk taking, or physical activity.
• Addictive self-soothing: If you use this coping behavior in response to a schema-triggering

event, you’ll find yourself seeking excitement with drugs, alcohol, food, or excessive
self-stimulation.
• Psychological withdrawal: If you use this coping behavior in response to a schema-
triggering event, you’ll find yourself escaping through dissociation, denial, fantasy, or
other internal forms of withdrawal.
Although these categories are helpful, it’s important to keep in mind that clients may have dif-
ferent coping behaviors for different schemas, or even different coping behaviors for the same
schema. For example, a client with an emotional deprivation schema may sometimes demand that
his or her needs be met and at other times give in or surrender. It is critical to work with clients to
identify all the coping strategies they use to avoid schema-related pain.
Once you’ve introduced the concept of schema coping behaviors and clients have had a chance
to review the handout, you can begin a general discussion about which SCBs they use most often.
The following dialogue provides an example of how to begin exploring the role of SCBs. The client
in this dialogue has a social isolation and alienation schema:
27
Therapist: When you look over that list—the ways people tend to cope with the emotional
pain from their schemas—is anything familiar?
Client: Withdrawal. Total disconnection. It’s like, “Screw it. What are you bothering with
these people for?”
Therapist: Anything else? What comes up when you see how different from you other people
are, or when they seem caught up in their lives and pretty much unaware of you?
Client: Anger. I get very critical and disgusted. If I don’t feel included in something, I can go
on the attack.
Therapist: So when you feel excluded—not belonging or not part of things—you can go
either way: withdrawing or being more critical or perhaps attacking. Do you have any sense
of why you’d choose one or the other of these coping behaviors?
Client: I think I get angry when I try to make my needs known and people don’t get it—
when they don’t seem to have any concern for me.
Linking SCBs to Specific Interpersonal Situations

Next, clients need to link schema coping behaviors to particular relational triggers. To achieve this,
help them examine schema-triggering situations and the resulting SCBs in each of the six interper-
sonal domains: work, friends, family, intimate relationships, parenting, and community. Completed
Schema Events Logs, from chapter 2, provide a list of schema-triggering situations. Have clients
transfer these to the left-hand column of the Schema Coping Behaviors Worksheet. (A sample
filled-out worksheet follows the blank form.)
At this point in the treatment process, clients may know a good deal more about schema trig-
gers than when they first filled out the Schema Events Log, so encourage them to write down as
many additional triggering situations as they can think of. The more comprehensive this list is, the
better prepared clients will be to recognize schema-triggering events when they occur.
Next, for each schema-triggering situation, have clients identify their schema coping behavior
and describe it in the right-hand column. If they have any difficulty identifying their coping behav-
iors, have them review the Ten Common Schema Coping Behaviors handout. The following brief
visualization may also help:
1. Ask the client to visualize a specific triggering situation.
2. Ask the client to notice the emotion that situation sets off and to name the schema.
3. Ask the client to notice any action impulses that arise while visualizing the situation.
What does the client want to say or do to cope with the pain?
28
Schema Coping Behaviors Worksheet

Schema-triggering situation Schema coping behaviors
29
Beth’s Schema Coping Behaviors Worksheet

Schema-triggering situation Schema coping behaviors
Making a mistake at work. Stop working on whatever I’m doing; put it off.
My boss pointing out something I’m doing wrong. Raise my voice; defend myself; later, stop talking to
him.
Getting to work late and people noticing. Withdraw; stop talking.
Coworkers going to lunch without me. Withdraw; stop talking.
My friend Jane always giving me advice. Criticize stupid things she does.
Jane being concerned about my shopping sprees. Get angry; tell her it’s none of her business; stop
calling.
My friend Norma forgetting something we Get angry; tell her off.
planned to do.
Norma talking about her big job and big salary. Criticize problems she has.
Norma talking about the accomplishments of her Withdraw; stop talking.

kids.
My mother not wanting to come to my house. Withdraw; shut down.
My mother not calling. Call her; tell her off angrily.
My husband criticizing me. Counterattack angrily; blame him.
My husband talking to me in a clipped and cold Cling; stay close; demand attention.
manner.
My son not listening to me or ignoring what I say. Get angry; raise my voice; demand attention.
My son getting angry and saying I’m stupid. Counterattack angrily.
30
My son constantly playing video games even when Get angry; raise my voice.
I told him not to.
My son smirking or rolling his eyes at me. Withdraw; stop talking.
My son not greeting me when he comes in. Try to be close; do things for him.
My son saying, “What now?” when I try to talk to Get angry; raise my voice; tell him he’s rude.
him.
My son criticizing stuff I buy. Criticize his taste.
Not being called on at the school board meeting. Write an angry letter.
Examining the Costs of SCBs

Once clients have recognized the link between schema triggers and SCBs, do an in-depth explora-
tion of some of the most salient triggering situations—those where schema coping behaviors are
impacting important relationships. The goal is for clients to differentiate between the short-term
and long-term effects of these behaviors. Here’s a dialogue that exemplifies this process, based on
the sample worksheet filled out by Beth:
Therapist: There are a couple of triggering situations with your husband: when he criticizes
something you do, and when he seems kind of clipped, cold, and uncommunicative.
Beth: Yes. I feel vulnerable with him.
Therapist: Because he can trigger that feeling of unworthiness—the defectiveness schema,

the sense that you’re somehow wrong or bad.
Beth: Right.
Therapist: So let’s look at how you cope. (Examines Beth’s worksheet.) When he criticizes, you
counterattack—you get angry and talk about all the things he does wrong. But when he’s
cold and withdrawn, you find yourself clinging and demanding attention. Those are two
very different coping responses.
Beth: When he criticizes, I feel hurt…and ashamed. And I can’t stand that, so I blow up. But
his withdrawal is scary. I feel like he’s getting sick of me. So I try to pull him close.
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Therapist: When you use those schema coping behaviors—getting angry or trying to pull
your husband close—does it make you feel better or worse?
Beth: I guess I feel better at first. When I lash out, I don’t feel as bad about myself. And when
I get clingy and demanding, I feel like I’m holding on to him, so I’m a little less scared.
Therapist: And then what? Does the schema coping behavior continue to help you?
Beth: No. He gets annoyed, and then I feel like something has gone wrong between us.
Therapist: So the coping behavior helps in the short term, but after a while…
Beth: Yeah. I feel like I’m screwing things up.
Therapist: So the coping behaviors aren’t a long-term solution. They seem like they might
even strengthen that old schema—the sense of being unworthy.
As in the above dialogue, work with clients to examine their most powerful triggers and SCBs.
The goal is to help clients see that schema coping behaviors provide short-term relief from schema
affect but that over time they tend to strengthen schemas and actually produce more schema-related
pain. During this exploration, clients may develop a growing recognition of how SCBs impact their
relationships in different domains.
Encourage clients to recognize their most common SCBs and which interpersonal situations
typically trigger particular coping responses. With this awareness, clients can begin to watch for
these triggering situations and notice how they react. Explain that changing behavior starts with
recognition: seeing SCBs when or soon after they occur.
Examining schema coping behaviors is hard. Listing and discussing these maladaptive responses
can trigger significant shame. It can also activate various schemas, particularly defectiveness and
failure. Be gentle with this material. Validate how painful it feels when schemas are triggered and
how normal it is to do almost anything to stop or mask that pain. As you discuss SCBs, try to
describe the behavior nonpejoratively. If SCBs show up in the session directed toward you—for
example, attack, withdrawal, or surrender behaviors—supportively describe what the client is doing,
identify the schema that has been triggered, and validate the pain. Then have the client add the
in-session triggering situation to the Schema Coping Behaviors Worksheet.
For homework, encourage clients to keep observing schema triggers throughout the week and
to use the Schema Coping Behaviors Worksheet to document any SCBs they engaged in.
ACT and SCBs

As you explore the long-term results of schema coping behaviors with clients, it should become
obvious that these behaviors have strained many relationships—and that, despite damaged and lost
32
relationships, the pain associated with their schemas continues. This makes it clear to clients that
trying to avoid schema-related pain with SCBs doesn’t ultimately get rid of the pain. If anything, it
can exacerbate the pain over time.
As noted in chapter 2, schema-related pain is inevitably triggered in relevant interpersonal situ-
ations. ACT calls this unavoidable experience primary, or “clean,” pain. In essence, SCBs are always
attempts to avoid this unavoidable pain. Although each SCB looks different behaviorally, all share
the same purpose—to avoid or temporarily block schema affect. This leads to what ACT describes
as secondary, or “dirty” pain: suffering that results from avoidance and maladaptive choices. This
secondary pain is the target of treatment, and diminishing such suffering is the goal of ACT.
Summary
This final introductory step of treatment provides clients with a more complete understanding of
how schemas work. As they identify specific avoidance strategies and the interpersonal situations in
which they are employed, clients begin to see a pattern and become familiar with their particular
coping response repertoire.
As you normalize SCBs and validate their role in the management of schema-related pain, you
can also begin to reveal the role these behaviors play in schema maintenance and how they damage
relationships in the long term. The next chapter begins to apply ACT principles and processes to
this theme as you examine the specific emotional and relational costs of SCBs.
33
chapter 4
Cultivating Creative Hopelessness and

Developing Mindfulness Skills
T
hus far, you’ve helped clients identify their schemas relevant to interpersonal interactions
and the schema coping behaviors they tend to engage in. This chapter will guide you in
helping clients assess the costs of those SCBs and how they impact relationships in the key
domains of work, friends, family, intimate relationships, parenting, and community life. This lays
the groundwork and provides motivation for the ACT approach known as creative hopelessness—
the territory where new solutions and behaviors can be discovered.
An important part of this process is exploring workability by assessing the impact of SCBs on
clients’ relationships. Workability immediately precedes creative hopelessness. When exploring
workability, help clients recognize the outcomes of their schema coping behaviors. Also explore
whether these behaviors help them feel better, whether they improve relationships, and whether
they bring clients closer to their values. Recognizing the costs of SCBs and that they aren’t workable
in the long run helps clients arrive at creative hopelessness—the point where they realize that their
schema-related pain is unavoidable and that the problem isn’t the pain but rather attempts to avoid
this pain. Workability and creative hopelessness are both processes that continue to occur and need
to be addressed throughout therapy.
This chapter also covers teaching clients mindfulness skills—one of six core processes in ACT.
These skills aren’t intended as stress-reduction techniques; rather, they help clients develop more
awareness of schema affect and the urge to engage in SCBs. They also help create space for clients
to make more authentic choices—values-based choices—about how they wish to respond to schema-
related pain and the urge to engage in SCBs.
Assessing the Costs of SCBs

You can use either a formal or an informal approach to help clients evaluate the costs of SCBs in
significant relationships. Either way, take a session or two to explore this topic and assess the costs
in a wide range of relationships in all relevant domains. Appreciate and validate the pain these
SCBs create. Mourn, for a moment, the losses that truly mattered and acknowledge the weight of
these relational difficulties. The motivation to change is largely driven by such experiences, so the
time you devote to this aspect of the therapy will pay dividends later on.
Formal Assessment of the Costs

For a formal exploration of the costs of SCBs, ask clients to fill out the Outcomes Worksheet.
For each significant SCB, have clients identify negative outcomes in the six interpersonal domains.
Obviously, not all domains will be negatively affected; those that aren’t relevant may be left blank.
(A sample filled-out worksheet follows the blank form.)
36
Cultivating Creative Hopelessness and Developing Mindfulness Skills
Outcomes Worksheet
Schema coping behavior:
Domain Negative outcomes

Work
Friends
Family
Intimate relationships
Parenting
Community
37
Jim’s Outcomes Worksheet

Schema coping behavior: Hostility
Domain Negative outcomes

Work I got a bad performance rating regarding working
with colleagues.
I had a fight with my boss and was forced out of
my department.
Friends My friendships often end in conflict.

I had a fight with Steve and haven’t seen him
since.
Family My brother has criticized my temper several times.

Now I only see him on holidays.
Intimate relationships Lori’s main complaint when we broke up was

my anger.
Parenting
Community I quit the bike club after having a fight with

the president.
38
Because clients using the Outcomes Worksheet often focus on behavioral consequences—
things that happened—you may need to direct them toward exploring emotional outcomes. Ask
whether they experienced sadness, loss, loneliness, hurt, guilt, shame, or fear in any domain as a
result of SCBs. As mentioned above, this emotional pain can provide motivation for the difficult
work ahead, so take your time reviewing this material.
Informal Assessment of the Costs

An alternative to the Outcomes Worksheet is tracing outcomes for one or more SCBs on a
whiteboard. You probably don’t need to write down all the domains; just work with the client col-
laboratively to list as many problematic outcomes as possible. At some point during the whiteboard
work, express your growing concern about how much pain these SCBs have caused and the diffi-
culty of the struggles they’ve created in the client’s life.
An even less formal assessment of SCB outcomes can be done by asking about several key
domains and how schema coping behaviors have impacted relationships in those domains. Encourage
the client to tell some stories about this, then explore a few of the painful outcomes in depth.
Afterward, summarize and validate, as illustrated in the following example:
Therapist: I’m starting to really understand how that coping strategy of withdrawing and
shutting down has affected you. The old schema-related pain—feeling somehow wrong and
defective—would clobber you. You didn’t know how to protect yourself from those feelings
except by shutting down. It was all you could do, and for a little while it seemed to insulate
you from the pain. (Validation.)
But while withdrawing seemed to protect you, it was damaging your relationships.
(Assessing the cost of SCBs.) Your wife got lonely and was kind of dying on the vine. And
finally she just drifted away, which triggered a tremendous amount of loneliness in you. At
work, when you got criticized and had those “something’s wrong with me” feelings, you
often pulled away and moved on to another job. But that meant starting over somewhere
else, and it kept putting your career back. I hear a lot of regret about that now.
And then there was your father—a kind of gruff, hard-boiled guy who hurt you with his
opinions. So you pulled away, and then you never really got a chance to say good-bye when
he died. There’s a lot of sadness about that.
And now, when your girlfriend asks you to change something or complains, it sets off
the same feelings. Then you shut down, and she withdraws from you in turn.
As I listen, I can feel how much you’ve lost because of that way of coping—how much
pain it’s brought into your life. It helps with the feelings of defectiveness, but only very
briefly, and then it damages the relationships that really matter to you.
39
Creative Hopelessness
Once you have worked with clients to assess the workability of SCBs and establish the relational
costs of these behaviors, it’s time to make a directional shift in treatment and move into ACT ter-
ritory: cultivating creative hopelessness. This is a critical step in ACT. Creative hopelessness marks
the moment when a client—having recognized the price of experiential avoidance—considers a
new relationship and new response to pain.
Clients begin to recognize that everything they’ve tried in order to control and minimize
schema-related pain hasn’t worked and that, if anything, the pain is worse. At this point, you pose
a question that will shape the remaining treatment process: “If running from pain and trying to
suppress or avoid it hasn’t worked, could the answer lie in something quite the opposite? Could it
involve not running away? Could the answer lie in the pain itself? What if letting yourself feel the
difficult emotions connected to your schemas was the answer?”
The core message is that the more we try to avoid schema-related pain, the more we have that
pain. For things to be truly different, clients must, in a sense, give up. They must lose hope that any
of their old control efforts will work in the long run. They must see that SCBs haven’t worked and
will never work. The false belief that controlling schema-related pain is possible has simply been an
immobilizing trap.
This is painful, but out of creative hopelessness new hope is born—hope that facing and feeling
schema-related pain is possible and even desirable, in that it might not exact the terrible toll associ-
ated with SCBs. Because clients take significant risks when they finally face their schema-related
pain, take your time (a session or two) with developing the creative hopelessness theme. Until cli-
ents understand and accept the basic ACT premise that experiential avoidance (in the form of
SCBs) is the cause of, not the solution to, interpersonal problems, they will probably continue their
habitual avoidance strategies. If you’d like to give clients something to read that explains creative
hopelessness, the Creative Hopelessness handout may be useful.
Because creative hopelessness can be such a challenging idea, you may find it useful to have
several ways to help clients grasp this key concept. Metaphors can often be quite effective in explain-
ing creative hopelessness. Here are two that you might present to clients: the quicksand metaphor
(Hayes & Smith, 2005) and the metaphor of digging a hole (Hayes et al., 1999).
Struggling in quicksand. The struggle to suppress schema-related pain, or any painful emotional
experience, can be likened to falling into quicksand. The more you try to escape, using SCBs or any
kind of emotion control strategy, the faster you sink. All of your struggle only gets you more stuck.
What if you were to stop struggling and resisting? What if you relaxed, fell back, and gently maneu-
vered yourself through the quicksand instead of fighting it?
Digging a hole. Imagine that you’re trapped in a deep hole. The only tool you have is a shovel (your
old schema coping behaviors), and the only solution you know is to dig. But digging only makes the
40
hole bigger and deeper. So you dig into the sides of the hole, but the edges collapse and the dirt
pours in on you. You try to dig steps, but this only dislodges more dirt, which also pours in on you.
So what do you do if you’re in a hole and all you have is a shovel? The first step is to put the shovel
down and stop digging (stop using old SCBs). Only then can you find a more workable solution.
Creative Hopelessness
Feeling stuck and at your wits’ end is an important moment, because it offers a lesson that can
change your life. Knowing in your mind and in your heart—with absolute certainty—that the things
you’ve done to manage schema-related pain don’t work is the first step on a new road. Admitting and
accepting that trying to stop schema-related pain has only created more suffering for yourself and
the people you’re close to creates a paradoxical new freedom. Because all of your old ways haven’t
worked and won’t work, you can choose to do something new.
This is a watershed. It starts with acknowledging that your experience is your best guide. What
does your experience with your schemas and schema coping behaviors tell you? In the long term, do
your coping behaviors work or not? Do they help you or not? Are they good for your relationships
or not? Take some time to really consider those questions.
When you answer these questions, the situation may feel hopeless. Yet there is hope because
there is another way. Hope starts when you give up all of your old efforts to control schema-related
pain. They haven’t worked, and they won’t work in the future. In fact, the false belief that control is
possible, that somehow you can stop the pain, has kept you trapped in a strategy that doesn’t work.
Your experience tells you that efforts to control pain aren’t working and that things only seem to
get worse. All of your old strategies for coping with schema-related pain led to a dead end. That’s
why you need to try something new. If running from pain and trying to suppress or avoid it hasn’t
worked, could the answer lie in something quite the opposite—in not running away? Could the
answer lie in the pain itself? What if facing the pain connected to your schemas is the answer?
Stopping the Struggle

How can clients stop the struggle with schema-related pain? From the ACT point of view, schema-
related pain is as unavoidable as bad weather. But like bad weather, schema-related pain comes and
goes. It’s triggered by negative interpersonal events that cause a surge in schema affect (shame, fear
of loss, hurt, sadness, and so on) and schema-driven cognitions (“I’m a failure,” “I’m unlovable,” “I’m
not good enough,” “I’ll never get what I need,” and so on). However, every day we have dozens of
emotions and, by some estimates, sixty thousand thoughts. So thoughts and emotions are
41
temporary events that keep shifting and changing. If clients can learn to observe and wait, rather
than fight and resist, these private events will evolve and recede, making way for the next thought
or emotion.
Another metaphor, one that is both simple and profound, can be very effective for helping cli-
ents see their experience as transitory: the metaphor of being the sky, not the weather. Harris
(2009) notes that this metaphor appears in Buddhist, Taoist, and Hindu teachings. The sky is
always there, holding the constantly changing weather. The weather is sometimes cloudy and dark,
sometimes snowy, sometimes rainy, and sometimes sunny, with a gentle breeze and fluffy white
clouds. While wind, storms, rain, and sunshine come and go, the sky remains, receiving each change
of weather with perfect willingness. The sky is the self, holding an endless stream of ever-changing
private events. Here’s an example of how you might present this metaphor:
Therapist: Having different kinds of weather is necessary in life. After all, we wouldn’t take
the same delight in a beautiful sunny day if every day was bright and blue. Plus, we need rain
and snow to supply water. Similarly, we need difficult emotions to let us know when we’re
off course or have lost sight of what’s important.
Do you think you could observe all of your weather without struggling with it or trying
to change it? Could you just observe the sensations in your body, the thoughts in your head,
and the emotions that surge up and recede? Sometimes you’re happy, sometimes sad, some-
times fearful. Would you be willing to notice all of your experience as it unfolds, moment to
moment?
Difficult thoughts and emotions, like the ones triggered by your schemas, are like a ter-
rible, scary storm with thunder, lightning, and howling wind. Eventually the storm quiets
and the air clears. The sky simply holds these storms. Could you be like the sky and stop
struggling with the weather? Could you learn to just watch it as it comes and goes, just see-
ing painful thoughts and feelings show up and then fade away?
Cultivating Mindfulness
You are proposing radical change to clients at this point: watching pain without struggling with it;
being the steady, clear self that allows passing thoughts and feelings to have their moment; and see-
ing that no matter how painful these private events are, they are temporary and are not the self. But
how can clients learn to observe rather than try to control their experience? Fortunately, humans
have known the answer for several thousand years: mindfulness.
In this section, you’ll find several exercises to help clients cultivate mindfulness: Mindful
Focusing, the Five Senses exercise, and mindful activities. Once you’ve taught Mindful Focusing,
42
ask clients to practice daily for several weeks until the skill is well developed, and be sure to check
in weekly to determine how often they’re practicing. We also recommend starting each session with
about three to five minutes of Mindful Focusing to help underscore the importance of this
technique.
Mindful Focusing
The following simple focusing exercise is an easy way to teach mindfulness in session and also
a good practice to assign for homework between sessions. To begin, have clients observe their breath,
all the way from their nose down to stretching sensations in their diaphragm. Then have them
notice when private events arrive, labeling them simply as “thought,” “emotion,” or “sensation.” If
you wish, you can also make an audio recording of the guided practice for clients to use at home.
Here’s a sample script for a five-minute practice (adapted from McKay, Davis, & Fanning, 2011):
Therapist: Close your eyes and take a deep breath, noticing the experience of breathing.
Observe perhaps the feeling of coolness as the breath passes through your nose or throat…
Notice the sensation of your ribs expanding as the air enters your lungs… Be aware of your
diaphragm muscle, which separates the lungs from the abdomen and is located just below
the rib cage. Feel it stretching with the breath and relaxing as you exhale.
Just keep watching your breath, letting your attention move along the path of flowing
air… In and out…in and out. As you breathe, you will also notice other experiences. You
may be aware of thoughts. When a thought comes up, whatever it may be, just say to your-
self, “thought.” Simply label it for what it is: “thought.” If you’re aware of a sensation, whatever
it may be, just say, “sensation,” to yourself. And if you notice an emotion, just say to yourself,
“emotion.” Simply label it for what it is: “emotion.”
Try not to hold on to any experience. Just label each one and let it go. Then wait for the
next experience. You are simply watching your mind and body and labeling thoughts, sensa-
tions, and emotions. If something feels painful, just note the pain and remain open to the
next thing that comes up. Keep watching each experience, whatever it may be, labeling it,
letting it pass, and noticing what comes next.
Let it all happen while you watch: thoughts…sensations…feelings. It’s all just passing
weather, while you are the sky. Just watch…and label…and let go.
Let the meditation continue in silence for another two minutes, then end it by asking clients to
open their eyes and return their attention to the room.
Encourage clients to do this exercise daily to help them become more comfortable with and
skilled at observing private experiences.
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The Five Senses Exercise

Another way to teach observational skills is to guide clients in sequentially focusing on each of
their five senses. Have them attend to each for about thirty seconds: hearing, smelling, seeing, tast-
ing, and touching. Although the whole exercise lasts only two and a half minutes, in this brief time
clients are encouraged to observe as many experiences as possible in each modality.
Mindful Activities
An optional process for increasing clients’ ability to observe their experience is encouraging
them to engage in mindful activities. Each week, ask clients to add one more mindful activity to
their repertoire until they reach a maximum of four to six. Encourage them to do these mindful
activities daily. Here are some suggested activities:
• Mindful dish washing. Notice all of the sensory experiences of washing dishes: the
warm water, the slippery soap, the hard edges of dishes and utensils, the sound of run-
ning water, the smell of the soap, and so on.
• Mindful walking. Notice how pressure shifts through different areas of the feet with
each step, how balance shifts, and how the arms swing. It’s fine to count steps, but not
necessary. Also notice the sights, sounds, and smells while walking. This can be done in
the course of normal daily walking; for example, to and from work or school.
• Mindful gardening. Notice the temperature of the soil, the feeling of resistance while
pulling weeds, the thrust of pushing in a trowel, the scent of flowers and other vegeta-
tion, the colors and shapes of the plants, and so on.
• Mindful bathing or showering. Notice the sound and feel of the water, the slipperiness
of the soap, the scents of soap and shampoo, and the shifting sensations as water sprays
on various parts of the body.
• Mindful eating. Notice the color and texture of the food, its temperature, the aromas
and flavors, the sensations of lifting a fork or spoon, and so on.
• Mindful drinking. Notice the feeling of the liquid in the mouth, including its tempera-
ture and viscosity. Also notice its aromas and flavors, feelings in the throat and stomach,
the texture and weight of the glass or cup, and so on.
When engaging in mindful activities, the goal is to stay with sensory experience. If thoughts or
other private events come up, they should simply be noted while returning attention to the five
senses.
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Working with Resistance to Mindfulness Practice

Because Mindful Focusing operates both as exposure to painful private events and as training
in observational skills, some clients will avoid it. This is where you have to encourage, cajole, and
push clients to practice this new skill. Here are a few things you can try with clients who have sig-
nificant noncompliance:
• Make an audio recording of the Mindful Focusing exercise and set a specific time and
place for the client to practice it each day.
• Alternate with less challenging mindful processes, like the Five Senses exercise or a
simple mindful activity, such as walking or eating an apple mindfully.
• In session, gradually increase the time devoted to Mindful Focusing from five minutes
to ten minutes or even longer.
Observing Interpersonal Experience

Once clients’ mindfulness skills have improved over three or four sessions, begin to guide them
toward observation of interpersonal experiences. It’s helpful to begin with a list of schema triggers
so clients can be on the lookout for these events and remember to use their observation skills as
triggers arise. We recommend that you first teach clients to observe schema-related emotions,
thoughts, sensations, and action urges in session, using imagery from recent upsetting events.
Listing Schema Triggers

Begin by listing interpersonal experiences that the client identifies as schema triggers. The
Interpersonal Triggers Worksheet can facilitate this process. A sample worksheet filled out by Maria,
a forty-three-year-old elementary school teacher, follows the blank form. Maria, who is divorced and
lives with her thirteen-year-old son, has very active abandonment and defectiveness schemas.
Maria’s SCBs include aggression or hostility, social withdrawal, and compliance (in the form of
excessive attempts to please her son), but that isn’t what’s important now. First, she needs to hone
her observational skills so that she can take note of these triggering interpersonal situations as they
occur.
45
Interpersonal Triggers Worksheet

Triggering people Triggering behaviors or events
46
Maria’s Interpersonal Triggers Worksheet

Triggering people Triggering behaviors or events
My mother She criticizes my clothes and lifestyle.
She seems distracted and withdrawn when I visit.
My ex-husband He criticizes decisions I make regarding our son.

He’s very cold when we talk on
the phone.
My son He ignores me and shuts himself in his room.

He refuses to do things with me when I invite him.
He complains about my rules and how I run the
house.
My friend Elizabeth She doesn’t return calls, and when

I reach her, she seems uninterested.
She criticizes my parenting and says my son is out
of control.
She’s often late for get-togethers.
The principal at my school He criticizes my lesson plans.
I often get upset at our monthly feedback sessions
and in meetings regarding problem students.
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Observing Schema-Triggering Events in Day-to-Day Life

In this step of treatment, help clients make a list of potential interpersonal events that could
activate their schemas over the following week, including triggering people and specific behaviors
or events. For Maria, this might include her weekly call to her mother, picking up her son on Sunday
from his weekend with her ex-husband, the feedback meeting with her principal, and her son’s criti-
cizing behavior.
In each of the triggering situations listed, and particularly when clients notice the first rush of
schema affect, the focus should be on observing inner processes. Encourage clients to watch the
following private experiences:
• Noticing schema-based affect: observing how feelings wax and wane, and how they
sometimes morph into other feelings (for example, hurt into anger)
• Noticing schema-relevant thoughts: observing thoughts come and go and trying not
to become attached to any of them
• Noticing physical sensations: observing sensations that accompany the interpersonal

event, like feeling flushed or tense
• Noticing impulses: noting the urge to act and somehow avoid the schema affect—
typically urges to engage in SCBs
• Noticing that they have a choice: realizing that it isn’t necessary to act on the urge
This last point is the most important component of the observational experience. It allows cli-
ents to learn that the impulse or urge to act doesn’t require action. Actual behaviors need not be
synonymous with the SCBs clients feel the urge to engage in. Encourage them to see the moment
when the impulse enters their awareness and, at that moment, to recognize they have a genuine
choice about whether to do what the mind and body urge.
If you wish, you can have clients use the Interpersonal Experiences Diary to record their obser-
vations during schema-triggering events.
Over the next three to five weeks, question clients about interpersonal events that triggered
schema affect. What did they observe? When they experienced schema-driven urges, did they
choose to act or not? If you keep encouraging them to use mindfulness skills to notice these crucial
moments, they will gradually become more skillful at watching private events. The key is consistent
attention so that clients come to expect that you’ll explore these themes. If you pay attention to
mindfully observing triggering events, they will too.
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Interpersonal Experiences Diary

Event:
Schema emotions:
Schema-related thoughts:
Physical sensations:
Schema-driven urges:
Circle one: Acted on urges Didn’t act on urges
Event:
Schema emotions:
49
Event:
Schema emotions:
50
Practicing Interpersonal Observation Skills in Session

You can assist clients in learning interpersonal observational skills in session by using schema-
triggering imagery. Have clients recall and visualize a recent interpersonal event that caused schema
affect. Encourage them to recall visual, auditory, and kinesthetic aspects of the encounter. Take
some time to let the emotion build. When they report significant affect, encourage them to provide
a verbal description of the event, covering all of the components detailed in the Interpersonal
Experiences Diary: emotions, thoughts, sensations, and urges. Here’s a transcript showing this
process:
Therapist: Try to notice as much as you can about that moment when your mother criticized
your blouse as cut too low. Notice where you are, what the room looks like… Hear all the
sounds: your mother’s voice, any other sounds in the environment… Notice how your body
feels and whether you’re touching anything. Are you there? Are you in the experience?
Client: Yes. It’s pissing me off all over again!
Therapist: Even though it’s upsetting, that’s what we want. Now you have a chance to just
watch the experience. Okay, so the feeling is anger? Can you describe it a little more?
Client: I’m humiliated, really. That’s where it starts. A little girl who’s done the wrong thing.
Therapist: And the anger shows up as part of that?
Client: Yes. Ashamed and then angry.
Therapist: Okay, just keep observing your experience. Are there thoughts that go with the
feeling?
Client: She’s done it to me again. She got me again. I’ve screwed up.
Therapist: Are there feelings in your body? Notice what’s happening there.
Client: I’m hot—in the face. I’m blushing.
Therapist: And what do these feelings make you want to do? Do they urge you to some
action?
Client: I want to yell at her. I want to just explode—to scream.
Therapist: Okay. Just watch that. Notice that it’s just an urge, and that you could have a
choice about whether to follow through.
Client: Well, I’m not going to yell at her in your office.
51
Therapist: (Laughs.) Right. You wouldn’t do it here. But just notice the push inside to do it—
the drive. Notice that it’s something you could act on or not. If you were with your mom,
you could choose to turn that into behavior, or you could choose not to. Or maybe you
could choose to do something completely different.
Client: Yeah. There’s this urge to yell, but maybe…I don’t have to.
Therapist: Right. So this is what I’m encouraging you to observe every time something hap-
pens in one of these triggering situations. Notice the emotion—or there may be several
emotions, like this time. Also watch any thoughts that come up. Try not to get involved in
them or attached to them. Just notice that the old defectiveness schema is pushing up some
thoughts. Also see if you can observe any sensations—things happening in your body. And
then notice any action urges. Watch them just like you did here, and notice that you have a
choice, right in that moment—that you could turn them into action, or you could choose
not to.
Client: (Nods.)
Therapist: This week you’ll undoubtedly have several opportunities to observe your schema
feelings, thoughts, and urges. Sometimes you may get involved in the moment and forget to
observe. But if you commit to observing your experiences, there’s a good chance that you’ll
be able to notice them sometimes, watching all of this weather inside of you, along with the
urges to engage in SCBs. And, most of all, notice that you have a choice about whether to
act on them.
Client: I’ll do my best, particularly with my mother and my son. I don’t like what I’m doing
in those relationships.
Therapist: Fair enough. Observe what happens there.
You may want to repeat this exercise several times, particularly for clients who resist keeping an
Interpersonal Experiences Diary or who don’t notice the moment of choice and continue to slip into
old SCBs.
Summary
The focus of this chapter is teaching clients to recognize the presence and impact of schema coping
behaviors (in ACT terms, experiential avoidance). Identifying the costs of SCBs lays the ground-
work for creative hopelessness. At this stage, clients must confront the reality that, in the long term,
52
control strategies have failed. Trying to escape pain is merely creating more pain and deepening it
into suffering. The key here is to recognize that doing more of the same can only yield more of the
same. Once clients recognize this and arrive at creative hopelessness, treatment moves from learn-
ing about the problem to processes for actively changing the situation. This starts with developing
mindfulness skills, with an eventual focus on observing interpersonal interactions. Helping clients
become more aware of schema-triggering events and the related emotions, thoughts, sensations, and
behavioral urges will begin to open space for them to make authentic, values-based choices about
how to respond to schema-related pain.
53
chapter 5
Clarifying Values and Committing

to Values-Based Action
A
s clients become more proficient at observing schema affect and action urges, the focus
shifts to making changes in patterns of interpersonal behavior. At this point, clients should
be increasingly noticing the moment of choice: the point where they can choose between
falling back on old schema coping behaviors and doing something different. Together, you and the
client are now ready to address two critical goals:
• Creating a plan for behavior change. The old schema coping behaviors must stop. But
trying not to do something leaves a behavioral vacuum and often fails. So the ACT
approach helps clients develop specific intentions that reflect their interpersonal values
and then helps them transform those intentions into committed actions in
relationships.
• Developing a values-based rationale for facing schema-related pain. In ACT termi-

nology this is called willingness, and it hinges on having a reason for facing and accepting
schema-related pain: so that clients can live and engage in relationships in a way that’s
based on core values rather than avoidance (SCBs).
This work begins with clarifying core values in regard to relationships and then identifying
specific behavioral intentions to increase values-based living. The next step is to begin assessing the
degree to which clients are living in accordance with their values. Through all of this work, contrast
committed action with resorting to old coping behaviors.
Explaining Values
Over the course of a session or two, help clients identify and clarify their core values in all relevant
interpersonal domains (work, friends, family, intimate relationships, parenting, and community).
The goal is to help clients identify ways of relating that truly matter to them in each of these areas.
This opens the door to differentiating between schema coping behaviors and ways of relating that
are based on values. Here’s a suggestion for how to introduce values into the therapeutic dialogue:
Therapist: All of these schema coping behaviors we’ve talked about are having a big impact
on your relationships. But it doesn’t have to be that way. There are probably ways you’d
rather be and rather act—ways based on your values—that could make relationships feel
very different. If it’s okay with you, I’d like to explore what some of your values regarding
relationships might be. Then maybe we can figure out what you could do differently if you
brought those values into your relationships.
Next, define what values are and aren’t, being sure to distinguish between values and goals:
Therapist: Your values are a direction you want to go. They help you figure out who you want
to be and how you want to act in each domain of your life. Here’s an example: If someone
says, “I want to be the kind of friend who is there for people, who listens and helps and is
always on their side,” that’s a value. It sets a course in relationships in the realm of friend-
ship. A value indicates where a person wants to go and how the person wants to be.
A value is different from a goal. A goal might be to help a friend fix his car or give him
a ride to the airport. Unlike values, those are specific actions that you can finish. You can
say, “I accomplished that.” But a value is a way of living that matters to you. In relationships,
it’s a way of being with people. You never “accomplish” a value; you just keep going in that
direction.
I’d like to spend a little time exploring some of your values in relationships. Would that
be okay with you?
When you introduce and define the concept of values, be sure to indicate that values are per-
sonal, not dictated by social norms, other people’s expectations, or even what clients think they
should value. In ACT, the definition of values includes the phrase “freely chosen” to reflect this key
quality of authentic values.
Clarifying Interpersonal Values and Intentions

Now it’s time to get specific. Explore the six domains of interpersonal relationships and, for each
that is salient to the client’s life, work collaboratively to identify at least one interpersonal value. In
56
Clarifying Values and Committing to Values-Based Action
this chapter, we’ll use examples involving a client named Rebecca, a thirty-five-year-old woman
who struggles with failure and mistrust schemas. The dialogue might begin like this:
Therapist: Rebecca, when you think about your work relationships, are there some guiding
principles for how you’d like to be and act with work colleagues, or even your supervisors?
Rebecca: I don’t know.
Therapist: Okay. I’m wondering what sort of person you want to be with colleagues or bosses.
Maybe it’s different for each; I don’t know. But think about how, if you acted on your values,
you would be in those relationships.
Rebecca: I guess I’d want to give honest feedback about what we’re doing but not be mean
or critical, like I can be. Just say what needs to be done, in a supportive way.
Therapist: Okay. You want to tell a supportive version of the truth about what’s going on
with tasks and projects. Anything else?
Rebecca: I think I’d like to support my coworkers’ initiatives and creative ideas—not be full
of judgments and criticisms.
You can do this process in session and record the client’s responses on the Valued Intentions
Worksheet. An alternative is to assign the worksheet as homework and discuss the values the client
identifies in the next session.
When using the worksheet, whether as homework or to structure a discussion, have clients
assign a rating of importance to each domain using a scale of 0 to 2, where 0 means not important,
1 means moderately important, and 2 means very important. For any domain rated above 0, clients
should identify one or two key values in regard to relationships in that domain. Values can often be
stated as general principles and usually indicate a way of being; for example, being honest, being
open, or being supportive.
The next step is to convert these general values into specific behavioral intentions. For example,
how, exactly, would a client turn the parenting value “giving my children the experience of being
loved” into action? Specific intentions might include “spending time each evening finding out what
their day was like” or “using validation rather than anger while setting limits.” Generating specific
intentions allows clients to develop a targeted plan for behavioral change based on their values.
57
Valued Intentions Worksheet

Domain Importance Value Intention
(Rate 0–2)
Work
Friends
Family
Intimate
relationships
Parenting
Community
58
Rebecca’s Valued Intentions Worksheet

Domain Importance Value Intention
(Rate 0–2)
Work 2 1. Give honest (not mean) 1. Supportively and honestly say
feedback. what I think about our new
2. Support coworkers’ creativity. software project.
2. Take each new initiative
seriously and look for positives.
Friends 2 Be a caring friend. Instead of withdrawing, make

contact with friends at least
once per week.
Family 1 Be a loving, supportive Rather than focusing on how I

daughter. wish she was, tell Mom some-
thing I appreciate about her in
each phone call.
Intimate 2 Be a loving, supportive Rather than focusing on things

relationships girlfriend. to criticize, look for one thing to
appreciate out loud each day.
Parenting 0
Community 1 Help kids in my community. Apply to be a Big Sister and

follow through by participating
in the training.
59
Contrasting Values-Based Behaviors with SCBs

As you help clients map their values, it’s useful to draw a contrast between schema coping behaviors
and behavior based on interpersonal values. Start by identifying an SCB that shows up in a specific
domain. Then ask clients to explore differences between the SCB and how they would act in that
relationship and situation based on their values. Here’s an example dialogue with Rebecca:
Therapist: I know that old failure schema gets triggered by your boyfriend. When you feel
you’re not doing it right, not living up to what he expects, you get drawn into schema coping
behaviors—usually withdrawal or being critical. How do your values about this relationship
contrast with those old coping behaviors?
Rebecca: I want to validate and appreciate him rather than criticize him.
Therapist: What about the old failure feelings?
Rebecca: I know. That’s why I criticize. I try to make it seem like he’s got a problem, not me.
Therapist: So how is your new intention going to change that?
Rebecca: I want to focus on what’s really great about him and tell him that, not all the criti-
cal stuff.
Cultivating Willingness to Accept Schema Affect

The good news is that values-based intentions regarding relationships can often replace problematic
SCBs. But the bad news is that clients must be willing to accept painful schema affect. Acting on
values rather than running away from schema-related pain means clients must look at and face that
pain. They have to be with feelings of defectiveness, deprivation, failure, or whatever schema-related
affect shows up. And at this point, clients haven’t learned all of the ACT processes that will help
them face this pain. Still, you do need to clearly acknowledge that this is the task. Here’s a dialogue
outlining how you might do so:
Therapist: When you stop criticizing and instead say out loud the things you appreciate
about your boyfriend, what’s going to happen with the old failure feeling?
Rebecca: I don’t know—it will probably be worse.
Therapist: Why?
Rebecca: Because when I’m not focused on his screwups, I’ll fall back into my crap.
60
Therapist: Could I ask you this: Would you be willing to feel that when it comes up—the old
failure pain—so you could act on your values in this relationship? Could you experience
those painful feelings so that you can validate and appreciate your boyfriend?
Rebecca: That’s what I want to do. But that failure stuff is like a screaming banshee.
Therapist: I know. It’s a hard choice.
Rebecca: (Nods.) I do want to change this.
Assessing Values-Based Living

Once you’ve identified clients’ interpersonal values, you can begin measuring how effectively they
stay on course week by week. The simplest way to do this is to review actions in each domain using
a values compass.
A values compass is made by drawing a circle and putting a dot in the middle of it. Where north
would appear at the top of a compass, write a V, for values. Have clients rate how much or little their
behavior over the past week reflected their values in each domain by drawing an arrow from the dot
in the middle of the compass to a point on the circle. The closer the arrow points to the V, the more
their behavior matched their values in this domain. Conversely, the farther from the V—at worst
pointing straight down—the less their behavior was aligned with their key values.
An alternative to the compass is to simply rate each week’s adherence to values in each domain
on a scale of 0 to 10, where 0 indicates no values-based behavior and 10 means that essentially all
behavior in that domain was values-based.
An easy way to set up either assessment is using multiple copies of the list of six domains. As
you discuss clients’ efforts to align their interpersonal behavior with their values over the previous
week, you can use the scale of 0 to 10 to indicate the degree of values-based behavior. Alternatively,
you can draw a circle for a values compass next to each domain and have clients draw in an arrow
to indicate degree of compliance. Either way, the assessment can lead to a discussion about barriers
to values-based action in certain domains.
Using Commitment to Overcome Barriers

Encourage clients to regard their intentions as commitments—commitmentsto themselves to do
what matters, to be who they want to be in relationships. A commitment to one’s values is no less
sacred than a promise to a loved one. In essence, it means saying, “I will do this because it’s impor-
tant, because old schema coping behaviors are damaging my relationships, and because there’s
another way to live.”
61
Emphasize how effective formal commitments can be in motivating and assuring behavioral
change. Also emphasize that commitments—particularly commitments to values-based behavior—
often run into barriers. Validate how hard this is.
It’s worthwhile to review these commitments during most sessions. Have any of the intentions
changed? Did specific barriers to values-based behavior arise? Are clients willing to renew their
commitment to key intentions out loud with the therapist? Remind clients that making a commit-
ment in this way, formally and in public, increases its power and the likelihood of following through.
Here’s an example dialogue where the therapist helps Rebecca review and renew her commit-
ment to values-based behavior in her relationship with her boyfriend:
Therapist: Rebecca, this turned out to be a hard week with your boyfriend. He complained
about your work schedule, and that set off feelings of failure. And then you slipped into criti-
cizing to try to protect yourself from that pain. I understand.
Rebecca: I was on him for all this little stuff.
Therapist: And the arrow you put on the values compass is pretty close to straight down.
Rebecca: Yeah. I kind of lost my way last week.
Therapist: Okay, that was last week. The failure feeling really got to you. But this is a new
week, a fresh start. And even though some of that old pain might show up, do you want to
recommit to your intention to validate and appreciate rather than criticize?
Rebecca: Yes, that’s what I want.
Rebecca is struggling with significant barriers to her commitment. There are emotional barriers,
such as her sense of failure and incompetence in the relationship. At one point, Rebecca said, “I feel
like a relationship idiot.” There are also cognitive barriers: negative self-labeling and thoughts about
past relational failures. In addition, there are behavioral barriers. Rebecca wonders whether she
even knows how to show appreciation or give praise. In her words, “It sounds stupid and contrived
when I say stuff like that.”
This is a critical point in treatment. Clients have to acknowledge and face these barriers while
also maintaining a commitment to their values and intentions in relationships.
Labeling Barriers
The first step in dealing with barriers is to label what they are. The mere act of describing the
obstacles to values-based behavior can make them seem less overwhelming. To do this, use the
Assessing Barriers Worksheet to help clients identify specific emotional and cognitive barriers that
are likely to show up for each values-based intention. Take your time with this important step,
devoting at least one session to exploring barriers.
62
The emotional barriers to values-based action in relationships are usually schema affect: fear of
rejection, abandonment, hurt, or failure, plus shame, emotional hunger, and anger. These have usu-
ally already been named as you explored schema-related pain and its impacts on relationships. The
cognitive barriers are schema-relevant thoughts that predict rejection, abandonment, hurt, or fail-
ure. They also show up as cognitions about past losses, failures, and so on and negative judgments
about oneself and others. These thoughts serve to intensify both schema affect and SCBs.
Behavioral barriers, which aren’t on the worksheet and are beyond the scope of this book,
include skill deficits (for example, lacking key interpersonal skills) and logistical problems, such as
physical distance, financial costs, or time constraints.
Facing Barriers
As clients move toward values-based interpersonal behavior, emotional and cognitive barriers
are likely to emerge. An excellent way to recognize and work with them is through the monsters on
the bus metaphor (Hayes & Smith, 2005). Hold this metaphor in reserve for exploring a value or
intention of great importance to clients, then devote about half a session to developing the meta-
phor. It provides a powerful explication of the key ACT concept that avoiding uncontrollable
schema-related pain results in dysfunctional and damaged relationships, whereas willingly facing
and accepting the pain opens the door to creating functional relationships based on core interper-
sonal values.
To begin, ask clients to focus on one important relational value. Then suggest that living and
directing one’s life is analogous to driving a bus. As clients steer the bus (their life) toward a key
value, certain monsters (barriers) show up to block the way. There are emotional monsters (schema
affect) and cognitive monsters (schema-driven thoughts). Here’s a sample dialogue with Rebecca
that shows how to engage clients in this metaphor:
Therapist: Okay, Rebecca. Let’s imagine that you’re driving your bus, which means steering
your life, toward your value of being honest and supportive with your coworkers. That value
is up ahead, and you’re driving toward it. What specifically will you do as you turn that
value into action?
Rebecca: I’m going to state my concerns about the new software, but I’m going to do it gently,
not harshly. My usual mode is to go on the attack—kind of snipe and exaggerate problems
so I can look super-competent. And when people have good, creative ideas, I’m going to
support them, even if it makes me look less smart or like I’m not doing that great of a job.
Often I kind of snipe at people’s ideas.
Therapist: Because their good ideas set off that failure feeling.
Rebecca: Yes.
63
Assessing Barriers Worksheet

Intention Emotional barriers Cognitive barriers
64
Therapist: So you’re driving your bus toward these values, and I guess we can already see one
of the monsters that jumps up in front of you. That failure feeling—the fear that you’re not
as smart or not doing as good a job.
Rebecca: Right. It’s a big, ugly one.
Therapist: Are there other emotional monsters?
Rebecca: Yeah. The feeling that I can’t trust these people—that they’ll climb up on top of
me to get ahead. I’m afraid they’ll make me look stupid or like I’m not contributing.
Therapist: So you have a feeling of distrust, fearing that colleagues might hurt you. Anything
else?
Rebecca: A fear that I’m going to lose my job.
Therapist: What about those mental monsters—the scary or painful thoughts?

Rebecca: Like I just said, the thought that they’ll lay me off. I also have this judgment about
myself—that I’m not that smart or capable and that I’ll be exposed.
Therapist: Anything else? Imagine that you’re acting on your value at work: being supportive
and gentle, not harsh.
Rebecca: Here’s a monster: the thought that some of them don’t like me and are waiting to
screw me.
Therapist: Okay, so the emotion monsters and the mental monsters are all jumping up and
down in front of your bus. They’re trying to stop you. What happens if they make you stop
or force you to steer in another direction?
Rebecca: I go back to my old crap.
Therapist: The old schema coping behaviors: sniping, criticizing, and attacking.
Rebecca: (Nods.)
Therapist: What happens then?
Rebecca: I screw up my relationships at work. I get isolated and angry. This has happened at
other jobs.
Therapist: Okay. That doesn’t work. You’ve gone that direction with your bus before and bad
things happened. But the monsters are still jumping up and down, blocking your way. What
are you going to do?
65
At this point, let clients struggle to figure this out. After you’ve given clients some time with this
conundrum—that experiential avoidance and SCBs don’t work but the barriers are formidable—
reveal the solution: The answer is to let the monsters on the bus and keep driving in a valued
direction.
Therapist: What if you opened the bus door?
Rebecca: And let them on?
Therapist: Right. Let all the monsters take seats behind you on the bus—all of them jumping
up and down and screaming, “You’ll be a failure,” “You’ll be fired,” “People don’t like you,”
“They’ll hurt you,” and on and on. What if you just take them with you, along with all of
their caterwauling, while you drive in the direction of your values?
Rebecca: It’s hard even just listening to that.
Therapist: Right, but if you take them with you, you can go where you want to go. You’re free
to move and be the person you want to be.
This metaphor can be a touchstone throughout treatment. It highlights the key choice in ACT:
avoidance versus facing and feeling the pain while living one’s values. The barriers (monsters) will
always show up, but clients don’t have to let those obstacles control their behavior.
Here’s a recap of the steps for developing the monsters on the bus metaphor:
1. Introduce the basic metaphor, in which navigating through life and moving in the direc-
tion of values is imagined as driving a bus.
2. Focus on specific values-based behaviors (intentions) in a particular domain. Have cli-

ents take some time to describe and visualize this behavior.
3. Encourage clients to identify emotional and cognitive barriers (monsters) that may come
up as they engage in the new behavior.
4. Explore the outcome of avoidance and SCBs: steering the bus away from the monsters—
and away from their values.
5. Explore how clients can move toward their values with the monsters.
Awareness with Willingness

It’s important to continue to encourage clients to mindfully observe interpersonal events. In the
earlier work, clients began to observe interpersonal interactions that triggered their schemas and
66
used the Interpersonal Experiences Diary to record their schema-related emotions, thoughts, physi-
cal sensations, and behavioral urges.
Now these same observational skills are applied to situations where clients are acting on their
values. Because values-based interpersonal behavior frequently entails facing barriers (schema affect
and cognitions), this is exactly the time to encourage mindful awareness. In addition to watching
their cognitive and emotional barriers to valued living, clients can also observe their willingness to
face this pain. You can use the Awareness and Willingness handout to guide clients in mindfully
observing their experience. You can also give them the handout and even assign this practice as
homework.
Awareness and Willingness

Whenever you choose to act on your values, watch what happens:
• Observe and mentally label emotional barriers that make you want to avoid taking val-
ued action; for example, fear, shame, sadness, or anger.
• Observe mental barriers; for example, thoughts of danger or attacks on or judgments

about yourself or others.
• Observe impulses to act. What urges to engage in old coping behaviors do you
experience?
As much as possible, hold on to a willingness to experience whatever thoughts and feelings arise
while acting on your values.
If you want, you can write these observations down, or you can simply keep them in mind for the
next session.
In the Interpersonal Experiences Diary in chapter 4, each entry ended with the question of
whether clients acted on urges to engage in SCBs. In addition, they were encouraged to make the
choice of whether to do so mindfully. Now there’s a new question: Can clients be willing to face and
experience these monsters—to bring them on the bus so they can continue moving in the direction
of their values in relationships? Notice that we’re using the word “willing” again. That’s because this
is essentially an exposure exercise. Clients are asked to experience and observe schema-related pain,
however it shows up and for as long as it lasts. They’re encouraged to stay with it, to be willing to
have these painful cognitive and emotional experiences without running away. Why? So that they
can act based on their values in relationships, even though that often brings pain. Here’s another
example dialogue with Rebecca that focuses on this issue:
Therapist: So this week’s intention with your boyfriend is to validate something you appreci-
ate about him each day—and to do this instead of complaining, which sometimes protects
67
you a little from the failure feelings. Would you also observe what happens when you praise
him and afterward use your mindfulness skills to see what feelings and thoughts come up?
Rebecca: I’ll do my best.
Therapist: Remember willingness? Would you be willing to let the monsters on the bus—let
them chatter and say all of their painful stuff, and still act on that commitment to be sup-
portive with your boyfriend?
Rebecca: (Long pause.) I’ll let the failure stuff on the bus. But I don’t know how long I can
keep it there. Okay?
Therapist: Just keep watching and see what happens.
Awareness with willingness returns to two themes that run throughout treatment:
• Mindful awareness allows clients to observe their experience and make conscious
choices.
• In the face of painful affective and cognitive barriers, clients can choose to engage in
either avoidance or willingness. Willingness to be with whatever there is to experience
creates the foundation for values-based behavior.
You should touch on these themes in most of the remaining sessions. Also, note that mindful
awareness of experience is a form of exposure. Throughout treatment, facilitating exposure to emo-
tional and cognitive barriers, while also encouraging willingness, will anchor the therapy process.
Summary
This phase of the work focuses on identifying core relational values, identifying specific behavioral
intentions, and measuring clients’ adherence to values—and, throughout this process, contrasting
clients’ values-based intentions with old coping behaviors. Once valued intentions are identified,
the focus shifts to helping clients distinguish between values-based behaviors and old ways of cop-
ing, while also continuing to help them see the costs of avoidance and the benefits of willingness,
even in the face of challenging barriers. This is the key to commitment and therefore the key to
overcoming barriers. The monsters on the bus metaphor can be a powerful way of reinforcing this
concept, setting the stage for developing awareness with willingness. This returns the focus to
themes that have great relevance to the remainder of the treatment: observing one’s experience and
making conscious choices, and choosing values-based behavior in spite of barriers and schema-
related pain.
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chapter 6
Defusing from Thoughts and Developing

the Observer-Self Perspective
T
he work in the previous chapter firmly established the ACT formulation that efforts to avoid
uncontrollable pain (including schema-related cognitive barriers) only result in secondary
pain, or suffering. This provides crucial motivation for clients to abandon avoidance in favor
of their values. As they do so, however, schema-driven thoughts tend to show up in a big way, so
now the focus shifts to cognitive barriers. Here are some typical examples:
• This won’t work. I can’t do this.
• Others will see how screwed up I am.
• I’ll be rejected or left.
• Others will hurt me.
• I can’t do anything right.
• If I’m honest, others will be disgusted.
Schema-driven thoughts tend to fall into three categories: predictions of rejection, hurt, or fail-
ure; memories of past losses or failures; and negative judgments about oneself or others. The
cumulative effect of these cognitions is pressure to return to old, familiar schema-driven behaviors:
attack, surrender, or avoidance. If clients are to make real changes in how they relate, they need new
resources to deal with these painful and discouraging thoughts.
Building Awareness of Thoughts

In order to respond differently to schema-driven cognitions, clients must first notice them and begin
to understand how they work. Explain that thoughts occur spontaneously and that we have little
control over their frequency or content—that they’re going to show up whether we like it or not.
Schema-driven thoughts are likely to arise whenever clients attempt to engage in new, values-based
behavior—and in response to any schema-relevant interpersonal event. For example, if a client who
struggles with an abandonment and instability schema experiences the slightest hint of rejection,
thoughts predicting loss and abandonment will almost certainly come up.
Explaining this concept shouldn’t take long. You can accomplish it in a few minutes using a
couple of helpful metaphors: the popcorn machine metaphor and the tug-of-war metaphor (Hayes
et al., 1999).
The popcorn machine metaphor. Suggest that the mind is a popcorn machine that keeps popping
up thoughts eternally. Nothing can turn it off. Pop after pop, kernel after kernel, the mind contin-
ues generating thoughts. Emphasize that blocking or stopping these thoughts isn’t an option. The
mind is a machine that keeps creating whatever thoughts it likes, whenever it likes.
The tug-of-war metaphor. Suggest that trying to resist or argue with schema-driven thoughts is
like getting into a tug-of-war with your mind. The more you struggle and try to get rid of or refute
a thought, the harder the mind pulls on the other end of the rope. It can always cook up more judg-
ments, predictions, and negative memories. The only way out is to drop the rope and stop trying to
control the mind. Encourage clients to let thoughts come and go, even those that are painful and
disturbing. Every effort at control is just picking up the rope and returning to that tug-of-war.
Not Buying Into Thoughts

When painful thoughts occur, clients need to know that, once again, they do have a choice about
how to respond. They can attempt to suppress the thought, they can buy into the thought, or they
can simply notice it and let it go. The first two strategies simply aren’t workable. As the tug-of-war
metaphor indicates, and as research has proven (Wegner, 1989), attempting to suppress or block
thoughts doesn’t work. And buying into thoughts—taking them seriously and accepting them as
true—can lead to cognitive chaining, where one negative thought begets another in long, themati-
cally related sequences.
You might take up to half a session to cover this material, perhaps using the metaphor of a sales
representative to explain why it isn’t a good idea to buy into thoughts (Vuille, 2006a):
Therapist: Picture your thoughts as sales representatives. If you don’t express interest, some
of them go away quietly; they aren’t very insistent. But then there are the pushy salespeople.
They’ll hang around and keep popping up, trying to entice you with a suitcase full of prod-
ucts. If you say okay and give them your attention, before long the suitcase is open and stuff
is spread out all over your living room. If you go for one product, suddenly the salesperson
has a bunch of other things to sell you.
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Defusing from Thoughts and Developing the Observer-Self Perspective
Some thoughts, like the hardcore sales rep, are very compelling, and they keep coming
back to bother you. But as soon as you take them seriously and give them a lot of attention,
or buy into them, you’ll get bombarded with another related thought, and then another, and
then another.
Remember the monsters on the bus and the thought monsters you encountered? Which
of the thought monsters connected to your schemas are really good sales reps? Which of
those thoughts do you tend to buy into? Go ahead and list a few of them for me now.
This metaphor is getting at two key concepts: First, some thoughts are more compelling than
others. It’s relatively easy to let go of thoughts that aren’t relevant to painful schemas. But it’s tempt-
ing to buy into charged, schema-related thoughts, opening the door to the chaining effect. Second,
buying into thoughts is a choice. It doesn’t have to be an automatic response when a compelling
thought shows up, but it’s much more likely when clients give thoughts significant attention and seri-
ous consideration.
So if suppressing thoughts and buying into them only makes them stronger and more disturbing,
what else can clients do? They can choose the third option: simply noticing thoughts and then let-
ting them go. This more effective response to schema-driven thoughts is the ACT process known
as cognitive defusion.
Cognitive Defusion
Cognitive defusion has its roots in the Buddhist practice of observing and distancing from thoughts
(Hayes et al., 1999). ACT offers a wide array of defusion techniques, all with the effect of changing
one’s relationship to the mind. Observing thoughts and then labeling and releasing them facilitates
detachment, or defusion. As a result, the thoughts are given less attention and are taken less seri-
ously. As clients learn defusion, they find that instead of being a thought (for example, “I’m selfish”
or “I’m unlovable”), they can simply have the thought (“I’m having a thought that I’m selfish” or “I’m
having a thought that I’m unlovable”). Being a thought makes a thought seem absolutely true. Clients
gets fused to it and stuck with it. Having a thought promotes the understanding that it’s just a
thought, one of tens of thousands each day.
Cognitive defusion has four component skills: watching thoughts, labeling thoughts, letting go
of thoughts, and distancing from thoughts. In this chapter, we’ll offer a variety of exercises and
thought experiments (all adapted from McKay et al., 2011, and some based on Hayes et al., 1999)
to help clients develop each component skill.
Fusion with thoughts tends to be very deeply ingrained, arising as a result of our earliest learning
about language and communication. Therefore defusion can be a challenge. Take two to three ses-
sions to guide clients through all four components of defusion sequentially. The first week assign
homework of a daily watching exercise, the second week assign homework of a daily labeling and let-
ting go exercise, and the third week have clients experiment with various distancing techniques daily.
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One final note before we get into specific defusion techniques: In practice, ACT therapists fre-
quently work on schema-driven thoughts and emotions at the same time, merging defusion with
emotion exposure. However, we’ll cover exposure to emotions in the next chapter, presenting the
two techniques sequentially for greater clarity. This isn’t meant to imply that these approaches
should be implemented sequentially in therapy.
Watching Thoughts
The starting point of defusion is learning how to watch the mind. There are several effective
methods for teaching this. In this protocol, we use Mindful Focusing (see chapter 5) and the White
Room Meditation. As you introduce defusion, we recommend that you start with the White Room
Meditation.
The White Room Meditation

The White Room Meditation is an eyes-closed practice in which clients imagine their mind as
a white room through which their thoughts pass. You can either describe key elements of the prac-
tice or read the following script:
Therapist: Imagine that you’re in a white room, completely empty of furniture or any adorn-
ments. You can position yourself anywhere in the room: at the ceiling, on the floor, in one
of the corners—wherever you like. But wherever you put yourself, visualize an open doorway
on your left and a second open doorway to your right. The doors open onto darkness; you
can’t see anything beyond.
Now imagine that your thoughts are entering from the doorway on your left, passing
across your field of vision, and exiting through the doorway on your right. As your thoughts
cross the room, you can attach them to a visual image—a bird flying, an animal running, a
hulking mafioso, a balloon, a cloud, or anything else. Or you can simply say the word
“thought” to yourself. Don’t analyze or explore your thoughts. Allow each to have a brief
moment in your awareness and then exit through the doorway to your right.
Some thoughts may feel urgent or compelling. Some may want to stick around longer
than others. Just let each one move on out the door to make room for the next thought. As
new thoughts show up, make sure you’ve relinquished the old ones, but don’t worry if they
show up again. Lots of thoughts tend to repeat themselves, and the visitors to your white
room may be no exception.
After the meditation, discuss with clients whether their pace of thinking changed, how easy or
difficult it was to let go of thoughts, and the relative urgency of various thoughts.
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Mindful Focusing
Once clients have explored the first process for watching thoughts (the White Room Meditation),
revisit Mindful Focusing, from chapter 5. Guide clients in Mindful Focusing for four to five minutes,
encouraging them not to pay a lot of attention to the thoughts. Ask them to simply label each one
(“There’s a thought”) and then observe their breath until a new thought shows up. For at least two
weeks, give clients a homework assignment of doing five minutes of Mindful Focusing each day. As
they get more experience observing cognitive processes, discuss whether they are experiencing any
changes in their relationship to thoughts. Is there any shift in terms of intensity, believability, or
intrusiveness?
Labeling Thoughts
Building on observing thoughts, the defusion skill of labeling thoughts emphasizes that cogni-
tions are products of the mind (Hayes et al., 1999). They aren’t real or a priori truths. They are just
thoughts.
In ACT, a key approach to thought labeling is to teach clients the phrase “I’m having the
thought that .” Here are some examples: “I’m having the thought that Linda will
leave me.” “I’m having the thought that I can’t be honest.” “I’m having the thought Bill is distant
because he sees how screwed up I am.”
Alternatively, clients can use the phrase “Now my mind is having a thought.”
Labels you could recommend for this exercise might include “fear” thought, “judgment” thought,
“should” thought, “I’m bad” thought, “why” thought (explaining why something happened), and so
on. Work collaboratively with clients to develop labels that reflect their use of language and their
schema beliefs.
Next, have clients observe a sequence of thoughts, labeling each as it comes up: “Now my mind
is having an ‘I’m bad’ thought… Now my mind is having a ‘she’s bad’ thought… Now my mind is
having a ‘fear’ thought… Now my mind is having another ‘fear’ thought… Now my mind is having
a ‘why’ thought,” and so on.
Whenever clients express schema-driven thoughts, help them label the cognition as often as
possible. Here’s an example dialogue:
Client: I realize when my girlfriend tells me how I don’t talk about my feelings that she’s try-
ing to make me feel bad about myself—trying to make me feel wrong.
Therapist: Is that thought familiar?
Client: Yes.
Therapist: Does it connect to any of the schemas we’ve talked about?
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Client: (Long pause.) Defectiveness, I guess. That’s how it makes me feel, anyway.
Therapist: What happens if you just label the thought: “I’m having the thought that…”?
Could you try that?
Client: I’m having the thought that she wants to make me feel bad.
Therapist: What do you notice when you label it?
Client: It sounds weird, like it’s a little ridiculous.
Therapist: Yeah, like it’s just a thought…not quite as serious. Remember those other labels we
came up with, like “judgment” thought and “fear” thought? What sort of thought is this?
Client: I guess it’s a “why” thought. I’m trying to figure out why she tells me that.
Therapist: What do you notice now about the thought?
Client: It feels farther away, not as big a deal.
Next, the therapist confronts the problem of getting the client to use this process on his own:
Therapist: How could you remember to do this when you’re not in here—for example, when
something comes up between you and your girlfriend?
Client: (Long pause.) I guess when I’m upset…
Therapist: That could be a cue. What could you do when you’re upset?
Client: I could see what my mind is doing—notice my thoughts.
Therapist: Okay, and what could you do then?
Client: Just say, “My mind is having a ‘such and such’ thought.”
Letting Go of Thoughts
Once clients have practiced observing and labeling thoughts, you can teach them a variety of
techniques to help release thoughts and let them go. Recommend that they experiment with several
of the following exercises to see which are most effective for them.
Leaves on a stream. Encourage clients to imagine each thought as an autumn leaf falling from a
tree and landing on the surface of a swiftly moving stream. As each leaf hits the water, it gets swept
into the current and disappears around a bend downstream. With each new thought, clients should
visualize the same set of images.
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Billboards. Have clients imagine driving down a long stretch of highway. As each thought shows
up, it appears on a billboard ahead. Encourage clients to briefly note the thought and then imagine
their car sweeping past.
Balloons or clouds. Have clients visualize a clown holding the strings to a dozen helium balloons.
As each new thought arrives, a balloon detaches and floats away on the wind. Alternatively, have
clients visualize a blue sky with occasional clouds passing overhead. They can put each thought on
a cloud and let it drift away.
Computer pop-ups. Have clients imagine each thought as a pop-up advertisement or reminder on
a computer screen. They can briefly take note of each thought and then let it disappear until the
next pop-up appears.
Trains or boats. Have clients imagine a railroad crossing with a slow freight train grinding past.
Each new thought is yet another boxcar rolling by. Alternatively, have them visualize fishing boats
passing beneath a bridge one by one, with each boat carrying a single thought out of sight.
Physically letting go. Whereas all of the previous letting-go exercises are based solely in imagery,
this one is somewhat physical. We encourage you to practice this exercise together with clients.
Have clients hold out their right hand, palm up, as you do the same. As each thought arrives, imag-
ine briefly holding it in your hand. Then rotate your hand so your palm is facing down and imagine
the thought dropping down and out of sight. Then return your hand to the palm-up position to
receive the next thought. Keep dropping thoughts each time they show up. Making the letting-go
process physical helps it feel more powerful and real.
Combining Watching, Labeling, and Letting Go

Once clients understand the first three components of defusion—watching, labeling, and let-
ting go—they can put them together in a single process. The easiest way to accomplish this is to
have clients choose one labeling technique and combine it with one of the letting-go visualizations
or the physical letting-go technique. We recommend that you have the client choose and then prac-
tice together. This allows you to both model the behavior and encourage a bit of risk taking as both
of you reveal the frequency, if not the content, of thoughts. Here’s a sample dialogue:
Therapist: Okay, let’s see if we can put labeling and letting go together. Which labeling strat-
egy do you want to use?
Client: I like “I’m having the thought that…”
Therapist: Fine. And letting go—do you want to use a visualization or drop the thought
from your hand?
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Client: Drop it from the hand.
Therapist: Okay, let’s do it together. As soon as either of us has a thought, we’ll say to our-
selves, “I’m having the thought that…” And then we’ll turn our hands to drop it. (Therapist
and client randomly turn their hands as they drop thoughts.)
If the client chooses a visual letting-go strategy, there won’t be any outward indication of a pass-
ing thought. In this case, keep a running tally, out loud, as you each let go of thoughts. Continue
the exercise until one of you reaches about twenty thoughts.
Some clients prefer physically letting go by turning their hand but are embarrassed about doing
so in public. To deal with this, suggest more subtle movements, such as a slight spreading of the
fingers, a gentle lifting of the fingers as if waving good-bye, and so on.
Encourage clients to practice labeling and letting go daily at specific times. When the time
comes, it doesn’t matter whether their thoughts are troubling. It’s important that they master this
defusion technique, and rehearsing at times when they aren’t distressed will help them remember to
use defusion when difficult, schema-driven thoughts show up. Also practice the technique in ses-
sion as salient situations arise:
Therapist: Can you just label that thought and let it go?
Client: Right now?
Therapist: Yes.
Client: My mind is having a “fear” thought. (Pauses.) Okay, I put it on a leaf.
Therapist: Now what do you notice?
Client: I’ve sort of moved on from it.
Therapist: If it comes up again, could you say so and do the same thing—just label and let it go?
Distancing from Thoughts

Certain defusion exercises are especially effective for creating space between the self and the
thought. Practicing these techniques helps clients learn to take cognitions less seriously. Distancing
processes have a common element: They embrace a painful thought while, paradoxically, allowing
it to diminish in importance. Here are several distancing exercises. Encourage clients to experiment
with all of them to see which techniques are most effective for them.
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Thank You, Mind

Explain to clients that the mind is always trying to help them survive. It’s constantly working to
protect them from danger, make judgments about what’s good or bad for them, or explain why
things happen. But sometimes the mind goes overboard, finding danger when there isn’t any, mak-
ing painful negative judgments, or explaining things in such a way that clients feel ashamed or
wrong. One way to respond to these thoughts is to thank the mind for its efforts. As each painful,
schema-driven thought shows up, encourage clients to use the mantra “Thank you, Mind, for that
thought,” and then let it go.
This exercise can be done as a long sequence of thank-yous: “Thank you, Mind, for that ‘fear’
thought… Thank you, Mind, for that ‘I’m bad’ thought… Thank you, Mind, for that ‘judgment’
thought,” and so on.
Negative Label Repetition

Negative label repetition is also called Titchener’s repetition (Titchener, 1916), based on Edward
Titchener’s discovery that repeating any word fifty or more times begins to rob it of all meaning.
Even highly disturbing words or phrases spawned from schema-driven thoughts lose most of their
punch with repetition. When clients present a self-judging thought that they find disturbing, encour-
age them to use negative label repetition. Before starting, try to reduce the thought to something
pithy, like “bad husband,” “selfish,” or “hurtful and mean.” Have clients repeat the word or phrase
out loud quickly, while still pronouncing it clearly, for at least one minute.
Then help them explore what happened to the meaning of the word or phrase. In most cases,
clients report that the word or phrase began to feel odd or empty—more a sound than a word. If
this technique works for clients, encourage them to use it at home when they notice schema-driven
self-judgments.
Objectifying Thoughts
One way to shrink the power of painful thoughts is by objectifying them, imagining them as
physical objects (Hayes et al., 1999). To use this technique, ask clients to imagine the thought as an
object, then tell you its color, size, shape, texture, and so on. It’s easier for clients to distance them-
selves from thoughts that have been assigned physical properties.
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Card Carrying
In this defusion technique, clients carry index cards on which they write down schema-driven
thoughts as they come up. Then, whenever these painful cognitions recur, clients can remind them-
selves, “It’s on the card,” and let it go.
Wearing Labels
Painful self-judgments that show up repeatedly can be defused by actually wearing them. Do
this exercise together with clients so you can model the process and share some of the embarrass-
ment. Each of you should write a recurring self-judgment on a sticky note or name tag and wear it
for the remainder of the session. Toward the end of the hour, share with each other how the impact
of the negative label has changed. Although the judgment was probably disturbing at first, the
words may have lost much of their power by the time you remove the labels.
The Four Key Questions

Once a client has gained some understanding of defusion and is starting to use it with schema-
driven thoughts, you’ll both begin to recognize which thoughts are the most frequent and powerful.
For these recurring cognitions, especially any that block values-based behavior, ask the client four
key questions:
1. How old is this thought? How long has the client been thinking this? Five years? Ten?
Since childhood?
2. What is the function of this thought? What is the mind trying to achieve? Most
schema-driven thoughts, at root, are designed to help people avoid some kind of pain. A
slightly different way to get at the function of a thought is to ask the client what this
thought is trying to protect him or her from feeling.
3. How is the thought working? Is the thought effective at protecting the client? Or does
the client still struggle with the very feelings this thought was supposed to help him or
her avoid?
4. Would you be willing to have this thought and still act on your values in relation-
ships? Even though this difficult thought shows up and tries to drive the client back to
old coping behaviors, would he or she be willing to have the thought while taking action
on valued intentions?
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These questions usually help clients gain distance from schema-driven thoughts as they realize
that these thoughts don’t work and haven’t worked for a long time. The fourth question embodies
one of the two key points interwoven throughout this therapy: that clients can choose to be the
person they want to be in relationships, understanding that in most cases this requires a willingness
to have painful, old thoughts—to take these thoughts with them as in the monsters on the bus
metaphor.
Here’s an example dialogue with Rachel, a forty-six-year-old woman with defectiveness and
emotional deprivation schemas, illustrating how the four key questions can facilitate the distancing
process:
Rachel: I tried not to shut down and go cold. I really did. But every time my brother repeats
all of his horror stories about growing up with Mom, I… I want to appreciate his struggle, to
really listen. But I turn to ice.
Therapist: What thoughts come up when you try to listen to him?
Rachel: He’s an asshole. All he really cares about is himself. I took just as much shit from her,
but he doesn’t even know about it, much less care.
Therapist: What’s the schema?
Rachel: No one cares. (Blending defectiveness and deprivation.)
Therapist: And you’re thinking that?
Rachel: Yeah. I don’t matter. To him or my mother. I’m a nothing—just someone to com-
plain to.
Therapist: That thought really gets to you. How old is it, do you imagine?
Rachel: How long have I had it? Since I was a kid.
Therapist: What do you imagine the purpose of that thought might be? What’s your mind
trying to do?
Rachel: It’s trying to keep me from being hurt, I guess—trying to stop me from caring about
them.
Therapist: Is that working? Do you feel less hurt and vulnerable?
Rachel: No. I get hurt all the time.
Therapist: So what’s the outcome of those “nobody cares” thoughts? What happens after you
buy into them?
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Rachel: I’m angry and hurt. I’m tremendously upset that they don’t give a shit. It kills me that
nobody cares what I go through.
Therapist: Does anything else come out of those “nobody cares” thoughts?
Rachel: Like I said, I get cold. I withdraw. And then my brother complains about that! He
gets upset and says I’m not listening.
Therapist: So, if anything, those thoughts make you feel more hurt, rather than less hurt.
And they also pull you away from your value of listening and understanding. Are they work-
ing at all? Are they doing anything positive for you?
Rachel: (Shakes head.) No.
Therapist: Those thought monsters are likely to show up any time you’re intending to really
listen to and connect with your brother. The schema gets activated, and then the thoughts
come up, right? I’d like to ask you something: Would you be willing to have those thoughts
and still listen to your brother? Would you be willing to stay focused so you can really under-
stand him?
Rachel: (After a silence.) Just assume I’m going to have the thoughts because I always do?
And then keep listening, regardless? (Sighs.)
Therapist: It’s a hard thing, isn’t it?
Rachel: It is, but I can work on that.
Notice how the distancing questions about the age, function, and workability of thoughts pre-
pare clients to experience schema-driven cognitions as less useful and believable. They also make it
possible to ask for a key commitment: being willing to experience painful thoughts while choosing
to act in alignment with interpersonal values. In this example, Rachel won’t be able to hear and
understand her brother until she accepts and gains some distance from those “nobody cares”
thoughts.
Practicing Defusion Skills

As you can see, there are many techniques for helping clients defuse from thoughts. All can be
effective. Sometimes the challenge is simply remembering the techniques and deciding which will
be effective in different circumstances. To help with this, give clients the Defusion Skills handout,
which lists all of the skills covered in this chapter. (Appendix C includes an alternative handout,
which lists fewer skills and provides brief descriptions of the skills listed. You can use whichever
version you prefer.)
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Once you’ve taught clients all of the techniques and have given them the handout, use the fol-
lowing exercise to give them some practice in choosing and using defusion skills. Start by having
clients identify four to six schema-driven thoughts that have created barriers to values-based inter-
personal behavior. Then briefly review the defusion skills they’ve been learning, using the Defusion
Skills handout to provide a reminder.
Next, start giving voice to clients’ schema-driven thoughts, throwing them at clients randomly.
Clients can then use any defusion skill that seems appropriate in response. Here’s an example of this
exercise with a client named Bill, who has a subjugation schema.
Therapist: You’re being so cruel and selfish to tell your girlfriend about things that bother you
in the relationship.
Bill: Thank you, Mind, for that thought.
Therapist: You’re being very inconsiderate of others’ feelings.
Bill: My mind is having a “judgment” thought.
Therapist: She’s going to get sick of you.
Bill: I’m having the thought that she’s going to get sick of me. It’s just a thought.
Therapist: You have to realize how selfish you’re being. If you don’t think about this, nobody
will want to be around you.
Bill: I hear that thought, and now I’m going to let it go. (Spreads his fingers as if dropping
something.)
Therapist: She’s probably already mad at you.
Bill: I’ll let that one go, too. It’s drifting away, a silly red balloon.
Therapist: You’re too demanding.
Bill: That’s a very old thought—my mother used to say it. All it’s doing is trying to shut me up.
Therapist: You’re just going around hurting people, and then you’ll be alone.
Bill: Thanks, Mind, for the “judgment” and “fear” thoughts.
We suggest that you do this exercise with clients several times as they’re learning defusion skills.
Continue to practice defusion in session through the rest of treatment whenever clients experience
schema-driven thoughts in session. Carefully listen for fused thoughts. Ignoring and failing to defuse
these thoughts in session is perilous because clients will go home and do the same. You’ll also lose
opportunities for clients to practice key defusion skills under your supervision. In addition, you’ll be
modeling inattention to cognitive processes.
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Defusion Skills
Watching Thoughts Distancing from Thoughts

• White room meditation • Thank you, Mind
• Mindful focusing • Negative label repetition
• Objectifying thoughts
Labeling Thoughts
• Card carrying
• “I’m having the thought that .”
• Wearing labels
• “Now my mind is having a
thought.” • The four key questions
• How old is this thought?

Letting Go of Thoughts
• What is the function of this
• Leaves on a stream thought?
• Billboards • How is this thought working?
• Balloons or clouds • Would you be willing to have this
• Computer pop-ups thought and still act on your values in
relationships?
• Trains or boats
• Physically letting go: turning a hand to

“drop” the thought
Combining Watching, Labeling,

and Letting Go
• Combining a labeling technique with a
letting-go technique
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If clients report fusion with schema-driven thoughts between sessions, ask which defusion strat-
egy they might have used with this thought, then practice it in session. Encourage them to consider
other defusion techniques as well, and rehearse those in session too.
Changing Perspective
When clients are fused with thoughts or emotions, their identity is merged with those private expe-
riences. If they think, “I’m afraid” (versus “I’m having the thought that I’m afraid,” the self and the
fear are essentially indistinguishable. One goal of ACT is to help clients detach the self from emo-
tions and cognitions. This is a shift from self-as-content to self-as-context, or the observer self.
Once clients have made significant progress with defusion, self-as-context work can be introduced
over a session or two.
Explain the observer self to clients using the concepts outlined in the handout The Observer
Self. Because this concept can be a little challenging, you can also give clients the handout to
review later.
As is often the case in ACT, metaphors can help clients grasp the concept of self-as-context—
and may even help them directly experience this perspective. Two metaphors that we find helpful
here are the movie screen metaphor and the chessboard metaphor. You can also use a brief experi-
ential exercise to help develop the observer perspective. All three approaches are outlined below.
Movie Screen Metaphor

Suggest to clients that the observer self is a movie screen. Every day a new movie plays on the
screen—tragedies, comedies, adventures, love stories. All of them are full of emotions, like loss,
hope, joy, and fear. And all have an unending stream of ever-changing dialogue, analogous to the
thoughts the mind constantly churns out. Though the movies, the emotions, and the dialogue con-
stantly change, the screen is always there and remains the same.
Encourage clients to detach from current emotions and thoughts and simply notice all of the
experiences that have shown up on the movie screen today and in the moment. Suggest to clients
that they can be the screen, allowing experiences to come and go and allowing thoughts to come
and go.
The Chessboard Metaphor

With the chessboard metaphor, clients come to see themselves as the chessboard itself, rather
than any of the pieces or the outcome of the game (Hayes et al., 1999). We recommend keeping a
chessboard in your office to fully utilize this excellent metaphor.
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The Observer Self

Sometimes your self—the essential you—gets merged with thoughts and feelings. For example, you
might have the judgment “I’m bad” as if that were you, as if your essential self were bad. That’s fused
thinking—the thought and the self seem like the same thing. This contrasts with defusion, where
you say, “My mind is having the thought that I’m bad.” You and the thought are not the same.
You can also get merged with feelings. Saying or thinking, “I’m afraid,” makes it seem like you
are the fear, as if your core self is characterized by fear. That’s different from noticing in a given
moment that you feel afraid—which is a passing emotion and doesn’t define you. When you have a
feeling of fear, you’re observing something that will change and pass—something that isn’t you.
When you are afraid, you are the fear.
Thoughts and feelings constantly change. They come and go, and throughout all of these changes
you are the one who is watching. This perspective is sometimes called the observer self. See if you
can be aware of this observer self, this self behind your eyes who watches what you think, what you
feel, and what you do and is separate from all of that. As you observe your self-judgments, you see
that you aren’t the same as those judgments. You aren’t your thoughts, feelings, or sensations. You
are the one who observes, notices, and holds all of these experiences.
Many parts of you have changed over the years: you’ve gotten older, you’ve learned things, and
you see some things differently than you used to. Throughout all of this, you’ve experienced a con-
tinuous stream of ever-changing thoughts and feelings. And throughout all of this, your observer self
has always been there, never changing. See if you can sense this deeper you.
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Start by having the client list at least ten positive and ten negative labels about himself or her-
self. Then sit across the chessboard from the client and initiate a dialogue using the labels. Begin by
putting down a chess piece and stating one of the negative labels out loud, then have the client put
down a chess piece and state one of the positive labels out loud. Continue until all of the labels have
been stated.
This sets the context for exploring the metaphor as follows:
Therapist: Some of these pieces are good, and some are very painful. We humans struggle to
get rid of all these painful thoughts and feelings that show up when our schemas are acti-
vated. There are moments when you feel insecure, and moments when you feel very
confident; moments when you feel competent, and moments when you feel like a failure.
There are moments when you feel awkward, and moments when you feel real and genuine.
But what if you weren’t these chess pieces? What if you weren’t either the good pieces or the
bad pieces? Is there anything you could be besides these chess pieces? (This isn’t a rhetorical
question; elicit a response from the client.)
If you were a player, you could try to move these pieces around in an effort to win, but
that doesn’t change anything; the player is still caught in the game and invested in whether
the good or bad thoughts and feelings win. The games just go on and on. Sometimes the
good pieces win, sometimes the bad. Can you think of anything else you might be other
than the pieces or the player? (Again, elicit a response.)
Here’s an idea: What if you were the board? That way you could have the pieces but not
be the pieces. The board is in contact with the pieces. It’s aware of the pieces and experi-
ences the pieces. But the board itself never changes, whether there are more black or white
pieces and no matter where they move. The board stays the same. It doesn’t care about the
game or who wins or loses. So from this space, the space of being the board, can you see how
you can hold all of your experiences, observing them and yet not being them?
An Experiential Exercise in Being

the Observer Self
One effective way to help clients take the perspective of the observer self is to guide them in
watching and describing their experience. Simply have them identify and label thoughts, emotions,
and physical sensations out loud; for example, “I’m having the thought that …
I’m having a feeling… I’m having a sensation in
my ,” and so forth.
As with defusion, it’s important to continue to encourage clients to develop the observer-self
perspective throughout the remainder of treatment. You can use this exercise to do so, or simply ask,
“Can you just watch that thought or feeling—just observe your experience as it comes and goes—
without being the experience? Can you be the observer and not the thought or feeling?”
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Summary
The focus of this phase of treatment is on cognitive defusion and developing the self-as-context
perspective. Defusion has four components that are best developed sequentially: watching thoughts,
labeling, letting go, and distancing. It’s important to devote sufficient time and practice to this
important work, and it’s essential to note all fused thoughts that occur in session and help clients
defuse from them.
Learning to watch experience as the observer self is made easier by all of your work with defu-
sion. And, in fact, it is closely related to defusion skills. Being the observer self is a stance you
encourage throughout treatment, one you can facilitate with simple questions such as “If you were
the sky, what would your weather be right now?” or “What’s playing on your movie screen right
now?”
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chapter 7
Conducting Exposure with Defusion
A
s mentioned in chapter 6, ACT therapists frequently work on affect and cognitions at the
same time, merging defusion with emotion exposure. Although we’re presenting emotion
exposure separately, we encourage you to integrate work on schema-driven affect with work
on schema-driven thoughts.
As with defusing from schema-driven cognitions, clients need to learn to face schema affect so
emotional barriers won’t block them from acting on values in their relationships. This requires
developing acceptance and willingness. Emotion exposure, in which clients learn to observe and
describe schema affect, is the path to acceptance of difficult emotions. It promotes willingness to
experience whatever emotional pain is necessary as clients act on their interpersonal values.
Emotion Exposure
When clients experience schema affect in session, fully bring the emotion into the room. This is
done by exploring, in sequence, physical sensations, the emotion itself, related thoughts, urges to
avoid the experience, and urges to react with typical coping behaviors. This sets the stage for asking
clients whether they’d be willing to have their difficult emotions in the service of acting on their
values-based intentions.
We recommend starting with physical sensations because it’s often easier for clients to describe
a feeling in the body than to explore emotions. You can conduct in-session exposure either via dia-
logue with clients or through guided visualization.
Exposure via Dialogue

To conduct exposure via dialogue, follow the sequence of steps outlined below:
1. Start with physical sensations. Ask clients what they are feeling physically. You might
use the objectifying approach from chapter 6 here, asking them to imagine what
physical attributes the sensation would have if it were a physical object; for example, “If
the sensation had a color, what color would it be? What shape or size would it be?”
2. Focus on the actual emotion. Ask clients what emotion goes with the physical sensa-
tions they’ve just described. Then ask them to describe the emotion. Again, it may be
helpful to use the objectifying approach, asking them to assign physical characteristics,
such as size, shape, color, and texture, to the emotion. Encourage them to keep finding
new ways to describe the emotion.
3. Ask clients to notice and label thoughts. After exploring the emotion, ask clients to
notice and label any related thoughts. Guide them in defusing from these thoughts using
the techniques in chapter 6. For example, encourage them to use such phrases as “I’m
having the thought that ” or “Now my mind is having a thought,”
or to simply say, “There’s a thought.” (Letting-go imagery typically isn’t used during
exposure because it distracts from the main task: experiencing the emotion. Deal with
thoughts quickly—just briefly labeling them—then get back to the emotion.)
4. Ask clients to notice any impulse to suppress the emotion. If they observe any avoid-
ance, encourage them to resist it and instead focus on the emotion, trying to be as open
to the feeling as possible.
5. Help clients notice any action urges. Ask clients whether they notice any urges to
engage in old coping behaviors, such as withdrawing, getting aggressive, or saying some-
thing dismissive. If this is happening, suggest that they can simply have those urges
while still focusing on their feelings.
6. Keep circling back to emotions and sensations. Here are some questions you might
ask:
• “What are you feeling right now? Try to describe everything you notice.”
• “Has anything about the emotion changed? Does it feel more or less intense? Has it
transformed into a different emotion?”
• “What are you noticing physically?”
• “Have your physical sensations changed in any way? Describe how they’re
different.”
7. Ask about willingness. After clients have observed and explored the feeling in detail,
ask this key question: “Would you be willing to have this feeling and still follow through
on your commitment to your values-based intention?” (Ideally, you’d state a specific
intention here.) If the answer is no or the client isn’t sure, you probably need to do addi-
tional emotion exposure.
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The following dialogue illustrates this emotion exposure process. In this example, the client is a
twenty-one-year-old man struggling with subjugation and mistrust schemas. Upon noticing the cli-
ent’s schema-driven emotional pain, the therapist brings the client’s attention to the emotion:
Therapist: When you had lunch with your father this week, you knew the topic would come
up about your dropping out of the engineering program. Your intention was…
Client: I know… I meant to tell him in a gentle way what I really want. It didn’t happen.
Therapist: What got in the way?
Client: The fear that he’d tell me I screwed up—that he’d be angry and maybe walk out. So
I was curt and refused to talk about it.
Therapist: What are you noticing right now as you remember that?
Client: The fear that he would be disgusted with me.
Once the emotion is acknowledged, you can move through the process outlined above. Here’s
an example, continuing the previous dialogue, to illustrate how this might play out:
Therapist: What are you noticing right now in your body? Are you experiencing any physical
sensations?
Client: I feel hot in my chest. I have a tight feeling there.
Therapist: Does that sensation feel big or small?
Client: Pretty big. It fills my chest.
Therapist: If it had a color, what would it be?
Client: Black—ugly black.
Therapist: Can you identify the emotion connected to that feeling?

Client: I’m afraid.
Therapist: How could you describe the fear right now?
Client: It’s like he’s going to kill me emotionally—just kick me and kick me until I’m
broken.
Therapist: How big is the feeling?
Client: Huge! The size of a truck… It doesn’t fit inside of me. It’s too big.
Therapist: And the color?
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Client: The same—black.
Therapist: If thoughts come up, just label them, saying to yourself, “There’s a thought.” Then
get back to the feeling. What are you noticing now about the emotion?
Client: I’m just scared that he’s going to reject me. I feel alone, like there’s no one. He’s going
to crush me if I don’t do what he wants.
Therapist: Okay, just thank your mind for that thought. What do you observe about the feel-
ing now?
Client: I’m still scared, but I’m noticing that there’s also a little anger.
Therapist: See if there’s a part of you trying to get away from the feeling—trying to distract
or distance yourself from it.
Client: Yeah, I’m thinking about applying to school next fall.
Therapist: Just notice that and then see if you can really open yourself to the fear that your
dad is going to reject you. Stay with that. Do you still have the heat and tightness in your
chest?
Client: The tightness is there, but the heat not so much.
Therapist: What do you notice now?
Client: It’s just there. I’m afraid of him. I remember him hitting me when I was a kid, his big
hands.
Therapist: Just notice that thought and let it go. Does the fear make you want to do
something?
Client: It makes me want to be very cold, very walled off.
Therapist: What’s happening with the fear?

Client: It’s kind of sitting there, in my chest. And I’m looking at it, like it’s some wild animal
in the zoo.
Therapist: I want to ask you something that might be important. Would you be willing to
have this fear and still gently and directly tell your dad what you want?
Client: You mean be honest, not cold?
Therapist: Yes.
Client: (Long pause.) Okay. I’m seeing him Thursday. I’ll talk to him then.
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Notice that in this example the fear doesn’t go away or change much. What’s important is that
the client stays with it, that he observes and learns about the experience. This is a way of practicing
willingness: the willingness to feel pain in the service of his values. Following the in-session exposure,
he’s able to make a commitment that wasn’t possible before: to take the fear with him and assert his
needs with his father. Also notice that the emotion is the center of the work. The therapist acknowl-
edges thoughts and avoidance impulses but keeps returning to the affect and sensations. This is how
you keep the exposure going: by repeatedly asking, “What are you noticing about the emotion now?”
The Special Case of Anger

Anger is a tricky emotion to do exposure with because it can show up both as schema affect and
as a schema coping behavior. Anger is often a component of schema affect, particularly with emo-
tional deprivation and entitlement schemas. Exposure work is necessary for clients to develop
willingness to carry the anger while acting on their values-based intentions in relationships.
On the other hand, with defectiveness, failure, abandonment, and unrelenting standards sche-
mas, angry feelings and aggressive behavior tend to fall into the category of schema coping behaviors,
covering other, more painful emotions. In the case of defectiveness and failure, anger often helps
people avoid the primary pain of shame. With abandonment and unrelenting standards, anger can
form an emotional bulwark against fear.
If anger or aggression is functioning as a schema coping behavior, you must look beneath to
uncover the hidden, avoided affect. The focus of exposure should be the underlying emotions.
Exposure via Guided Visualization

As mentioned, you can also conduct emotion exposure via guided visualization, and that
approach is described below. As you’ll see, the visualization uses steps similar to those outlined
previously, starting with physical sensations before moving to emotions. The client in this example
is struggling with an abandonment and instability schema that was triggered when her boyfriend
had a busy period at work and wasn’t available for several days. When they finally spoke, instead of
following her intention of exploring his feelings about the relationship, she exploded. The anger was
functioning as a schema coping behavior, to help her avoid the fear of abandonment, so exposure to
the fear was the ultimate goal:
Therapist: Close your eyes and visualize your boyfriend. Look back for a moment at that
argument… Let yourself be aware of your anger and what you’re saying… Notice your physi-
cal reactions, paying close attention to your body’s sensations. Notice any difficult,
uncomfortable sensations, perhaps in your stomach, chest, head, or shoulders. If you note an
uncomfortable sensation, just stay with it. See if you can stop wrestling with that sensation
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and just observe it. The point isn’t to like the feeling, but to experience it as what it is: a
sensation in part of your body. Keep observing it and see if you can feel exactly where that
sensation is located, where it begins and ends… You might even imagine that it has a shape
or color. See if you can let go of any struggle or sense of defense against this sensation.
As you observe physical sensations, notice whether any thoughts, judgments, or evalua-
tions come up… If they do, just notice them and label them, then let them go. Say to yourself,
“There’s a judgment” or “Thank you, Mind, for that thought.” Then let it go without getting
involved with it. Just keep noticing your thoughts and letting go of each as it arises.
Now notice any impulses. How do you feel pulled to react as you visualize the argument?
Are you feeling pulled to escape? Do you want to attack? Notice the urges to engage in old
schema coping behaviors.
As you’re observing all of the sensations, thoughts, and impulses that your anger brings
up, notice how the pain is connected to your schema and see if you notice any other emo-
tion underneath the anger. Perhaps you were feeling afraid when you became angry. See if
there is fear there now… Are there any other emotions, such as shame or sadness?
Just observe any feeling that is below your anger. Stay with the feeling and watch it. See
how big it is. See its shape. Notice if it might have a color.
If you find yourself wanting to escape these feelings, gently bring your attention back to
them. These are the feelings that your anger was covering.
Continue in this way for another few minutes, having clients watch and explore the feelings
beneath their anger. Then, before asking clients whether they would be willing to feel the underly-
ing emotions while acting on their values-based intentions, have them visualize doing so:
Therapist: Now bring back the image of your boyfriend and see him clearly. Imagine that
this is the moment when you intend to gently ask him about his feelings about the relation-
ship. Let yourself be aware of your feelings: the anger, if it’s there, along with the feelings
beneath your anger, the emotions that are so painful to experience. Now imagine gently
asking your boyfriend about his feelings. Notice your schema emotions as you ask, and sim-
ply let them be whatever they are. Are you willing to have them while you explore his
feelings?
Encourage clients to continue with this aspect of the visualization for a few moments, simulta-
neously holding the schema-related affect and an image of their new, intended behavior.
Exposure and Defusion Combined

Several techniques and exercises merge exposure and defusion into a single process. At root, these
exercises are all aimed at acceptance of schema-driven thoughts and feelings, which leads to greater
willingness to act on interpersonal values.
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Exploring the Flip Side

In the exercise Exploring the Flip Side, exposure consists of listing and considering schema-
driven thoughts and feelings and the costs of old schema coping behaviors. The physical properties
of the written list are used to help facilitate defusion. Then related values are written on the oppo-
site side of the paper, creating the context for an experiential exercise revealing that values-based
behavior and schema-related pain are inseparable. This sets the stage for exploring willingness.
Here are the specific steps:
1. On a large index card or sheet of paper, list clients’ frequently triggered schema-driven
thoughts and feelings.
2. Label all of these thoughts and feelings “Schema-Related Pain,” then encourage clients
to observe the thoughts and feelings.
3. Help clients defuse from the thoughts by having them count the number of words in
each thought, then the number of letters. Have clients notice the color of the ink and
ask them to read the thoughts backward.
4. Ask clients, “What have these thoughts and feelings cost you? What specific things do
they keep you from doing?”
5. Explore how these thoughts and feelings have acted as barriers to values-based behavior
and write the underlying value(s) on the flip side.
6. While clients are in contact with their schema-related pain, ask them what they want to
do with the list of thoughts and feelings. Do they want to push it further away, tear it up,
or throw it away?
7. Have clients notice that pushing the list of thoughts and feelings away or throwing it
away also moves away the value(s) written on the flip side.
Here’s a sample dialogue illustrating this process. In this example, the client is a fifty-two-year-
old woman struggling with an unrelenting standards schema:
Therapist: That sadness keeps showing up, doesn’t it? Those high, high standards keep get-
ting triggered. And when you don’t live up to them…
Client: I start feeling down and get angry at myself.
Therapist: (Folds a sheet of paper.) Let’s write that schema-related pain down. There’s the
sadness. And there’s anger at yourself. Can you get in touch with your anger? It happened
just a few days ago with your business partner.
Client: Yeah, I can feel it.
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Therapist: And how about thoughts—what thoughts go with the anger?
Client: Thoughts like “I’m doing it wrong” and “This isn’t good enough.”
Therapist: (Writes everything down.) What are you noticing in your body?
Client: I feel heavy.
Therapist: Still sad?
Client: Yeah.
Therapist: Okay, just be with that. Let’s look at the two thoughts you mentioned. (Shows the
list to the client.) How many words in each of them?
Client: Um…four…and four.
Therapist: Okay, let’s count the letters in that first thought.
Client: Are you kidding? Okay…fourteen.
Therapist: And how many letters in the second one?
Client: Eighteen.
Therapist: What color is the ink?
Client: Green.
Therapist: Can you read the first thought backward?
Client: Wrong it doing I’m.
Therapist: Okay, can you have these fourteen green letters and observe them? Can you have
them just as they are, just letters and lines on the paper? What’s that like after a while?
Client: They kind of lose their meaning.
Therapist: What’s happening with your sadness and anger?
Client: They are still there.
Therapist: That’s fine. This schema-related pain—the sadness and anger, and the thoughts
(tapping the paper)—what has this pain kept you from doing in your relationships?
Client: It’s kept me from keeping my word—from doing what I said I was going to do even if
it isn’t perfect.
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Therapist: Right. Let’s write that down on the other side. (Turns the paper over and writes the
value on the opposite side, then turns the paper back to the side with the schema-related emotions
and thoughts.) What could you do with this paper, with these feelings and thoughts, if you
wanted to get rid of them? Could you put it across the room—maybe even throw it away?
(Moves the paper far from the client.) You can put the sadness, anger, and thoughts farther
away from you, but if you do, notice what else is farther away. What else is on the paper?
Client: My value.
Therapist: Right. The farther away your sadness, anger, and difficult thoughts are, the far-
ther you are from your values. I’m wondering if you could take this piece of paper with you
and keep it with you for the rest of the week. Would you be willing to have the feelings and
thoughts on this piece of paper if it means that you’ll also be closer to your value of keeping
your word even if you have to do things imperfectly?
Exposing the “Worst Self”

Exposing the “Worst Self” is a guided visualization in which exposure consists of having clients
vividly recollect a time when schema coping strategies led to regrettable behavior. To begin, have
clients think of a time when they behaved as their “worst self” with others. Then, to facilitate defu-
sion, help them notice that they have an observer self that watches the “worst self” and sees
everything it does. Help them take the self-as-context perspective and observe the feelings, thoughts,
and behaviors of their “worst self.” As they observe this “worst self,” help them notice the distinction
between the core, unchanging self and the schema-driven thoughts, feelings, and behaviors. This
distinction reveals to clients that they are not synonymous with their worst self. Rather, they are the
self that watches and has always watched every thought and feeling, both good and bad. Here’s an
example script for this visualization (based on Ciarrochi & Bailey, 2008):
Therapist: You’ve told me about times when schema thoughts and feelings were so strong
that you acted in ways you regret. You might say you behaved as your “worst self” with oth-
ers. Think back to a time when you were at your worst… Imagine, as vividly as you can,
being this “worst self”… Notice the feelings that push and pull at you. Notice how your
“worst self” thinks. Let yourself be aware of specific thoughts… See how your “worst self”
behaves with others and how far this is from your values.
Now notice that, within you, there’s somebody looking at this “worst self.” This is a self
that watches your “worst self” and witnesses everything it experiences. This part of you is
the observer self.
Even though your thoughts, feelings, urges, and sensations are continuously changing,
there is still a consistent you throughout. There is a you that can watch all of your
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experiences without being those experiences or struggling with them. Just become aware of
this person behind your eyes that watches your “worst self.” Can you experience what it feels
like to be the observer?
Now consider this: If you can observe your “worst self,” then you are not the same as that
“worst self.” If you can observe the thoughts and feelings connected to your worst self, then
you aren’t equivalent to those thoughts and feelings. You are the observer. Remember the
chessboard? You aren’t the pieces on either side, fighting all those battles. You aren’t your
thoughts, feelings, and sensations. You are the one who observes, notices, and holds all of
these pieces.
Can you imagine that you are not your breathing and your body and its sensations, that
you are not your emotions or your thoughts? Many parts of you have changed over the years.
Your age has changed. Your appearance has changed. Your thoughts and feelings are con-
stantly changing. But the observer self has always been there, never changing. See if you can
sense this deeper “you.” Think of yourself as being like the sky, being an unchanging per-
spective from which you notice and hold the ever-changing weather of your awareness. See
if you can let go of your attachment to and struggle with difficult emotions, thoughts, sensa-
tions, and impulses.
Now notice all of the experiences that have shown up today—particularly the difficult
thoughts and feelings of your “worst self.” And as you do, notice that you’re here now, watch-
ing all of it. See if you can make space to be the observer right now. You are exactly who you
should be. Nothing needs to be changed. Nothing needs to be fixed.
This visualization goes to the heart of ACT: developing a new relationship with private events.
It helps clients learn to observe thoughts and feelings, rather than being drawn into maladaptive
interpersonal behavior. While clients can’t stop the thoughts and feelings that arise as manifesta-
tions of childhood trauma and conditioning, they can learn to watch these private experiences with
detached nonjudgment while choosing to act on valued intentions, rather than reacting with old
coping behaviors.
Dropping the Rope

Dropping the Rope is an experiential exercise that combines exposure with lessons about behav-
ioral flexibility. You’ll need a somewhat short piece of rope—about six feet long—for this exercise.
1. Ask about a recent schema-triggering situation and have the client describe the associ-
ated feelings and thoughts, then objectify this schema-related pain by asking questions
about its shape, size, color, weight, texture, and so on. You can also ask whether any of
these physical qualities are changing or whether the pain is moving in any way.
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2. When the client has clearly described the schema-related pain as an object, explain that
you’re taking the object out of him or her and putting it in you. Act out this process of
transferring the pain.
3. Hold one end of a rope and ask the client to hold the other end. Then inquire about how
the client has been relating to this pain when it shows up.
4. Pull on the rope and let the client struggle with you as the schema-related pain. Remind
the client of the feelings and thoughts. Pull the client around or let the client try to get
away by pulling you for a minute or two.
5. Encourage the client to explore alternative solutions. If necessary, suggest dropping the
rope.
6. After the client drops the rope, continue to represent the pain and follow the client
around wherever he or she goes.
7. Help the client notice that even after he or she drops the rope, the schema-related pain
is still there. However, the client is now free to move around, including toward impor-
tant values. Even though the pain is still there, the client is setting the direction rather
than being constrained and locked in a struggle.
Clients may not arrive at the idea of dropping the rope on their own. You may need to guide
them to this solution, as in the following dialogue. The client in this exchange has a subjugation
schema that’s been activated by her relationship with her roommates. She has trouble with their low
standards of cleanliness in the kitchen and bathroom but hasn’t mentioned this because she believes
that the feelings of others always come first. Recently she got up the nerve to schedule a meeting to
discuss the problem. However, doing so set off fear that she’ll be asked to move out, along with
schema-driven thoughts, such as “After this they won’t even talk to me,” “I’ll have to find another
place to live,” and “I can’t stand the mess, but I’d better not rock the boat.” As the dialogue begins,
client and therapist are holding either end of the rope:
Therapist: (Pulls.) Okay, I’m the fear. I’m the thought that they won’t even talk to you and
that you’ll have to find a new place to live. (Pulls the rope harder.) What are you going to do?
This is a big worry, a big struggle.
Client: (Pulls on her end.) I don’t know. I hate this. I’m always so afraid—afraid to say what
bothers me.
Therapist: (Starts to pull the client out of her chair.) I’m pulling you. You have to come with me
wherever I pull you. You can’t do what you want to do. They’re going to kick you out… They
won’t even talk to you…
Client: What am I supposed to do?
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Therapist: I don’t know. What are your choices? (Pulls hard.) You can go where I take you.
Just be quiet and don’t rock the boat.
Client: I don’t want to do that.
Therapist: Okay. But I’m going to keep pulling you around anyway. I’m your fear and your
thought that they’ll reject you. (Pulls the client in one direction after another.)
Client: Hey, I could drop the rope. (Lets go of the rope.)
Therapist: How does that feel? Go ahead; move around.
Client: I feel freer.
Therapist: (Following the client closely.) Look at what’s happening. Even though you dropped
the rope, the schema-related pain is still there. It’s close by. But notice what it feels like to
have it there without the struggle to get away or to fix it, without wondering whether to
speak up or be quiet. Notice how, when you aren’t struggling with the rope, you have more
freedom to choose where you want to go.
Client: Yeah, now I can move anywhere.
Therapist: Notice how your hands and feet are no longer occupied and you can choose your
path. The pain is still there, but it isn’t controlling your destination anymore.
Summary
In essence, this book’s approach to recurring, schema-driven interpersonal problems revolves around
two key processes: clarifying values and then committing to specific values-based intentions. As
long as clients are able to move in the direction of their values, the work remains action oriented.
But when cognitive and emotional barriers show up, the focus must shift to exposure and defusion.
At the end of every exposure or defusion exercise, it’s important to bring the focus back to willing-
ness. Would clients be willing to carry difficult feelings or thoughts with them as they act on
particular intentions? Would they be willing to have all of the experiences that come up as they
choose to relate to others based on their values? If the answer to these questions is yes, the focus can
shift back to planning and acting on valued intentions. If the answer is no, you’ll need to continue
to work on barriers using exposure and defusion techniques.
In the end, what matters is that clients be free to choose how they relate to others, rather than
letting schema-driven affect, thoughts, and behaviors choose for them. The goal is to help them
learn to watch the pain—waves of fear or shame, seemingly endless streams of frightening or judg-
mental thoughts—and still act in ways that support the relationships they care about.
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chapter 8
Working with Six Key Processes
T
his chapter covers common treatment issues that come up in both individual and group
therapy for interpersonal problems and gives some suggestions on how to address them.
There are six processes integral to this treatment, and all will arise throughout the treat-
ment process, regardless of the order presented in the protocol:
• Creative hopelessness and workability
• In-session activation of schemas
• Activation of schemas in day-to-day life
• Values-based planning
• Defusion
• Exposure
All of these processes are recurring features of treatment, and the therapy will continue to cycle
through them. Learning how to navigate these processes and when to implement them is critical to
good outcomes. In this chapter, we’ll focus on five aspects of each key process:
1. How to recognize when to use the process—the distinguishing cues or signals that indi-
cate that a particular process is appropriate
2. How to discuss the process with clients—how to label and introduce the process in
therapy
3. Criteria to help guide treatment choices
4. Key techniques for implementing the process in therapy
5. Common problematic client reactions and how to respond

Note that the criteria section (item 3) will help you determine whether you need to work on
other processes before continuing with the key techniques outlined in the next section. If the issues
mentioned in the criteria section don’t apply to a given client, you can proceed to implement the
techniques and strategies discussed in the next section (item 4, on key techniques for implementing
the process in therapy).
Creative Hopelessness and Workability

Creative hopelessness is a critical process in therapy, and one that reemerges quite often. This pro-
cess is especially crucial for getting a “buy in” for treatment. If clients don’t accept that avoidance
and control are the problem and the target of treatment, you can’t proceed with the approach in this
book. These clients won’t have the willingness and motivation to experience the difficult schema-
related pain that comes up during exposure and values work, yet this pain must be accepted if
clients are to take steps in valued directions. Therefore, throughout therapy it is critical to remind
clients of the long-term costs of old coping behaviors and help them recognize that schema-related
pain is unavoidable.
1. Recognizing When to Use Creative Hopelessness and Workability

Several key signals can alert you that working with creative hopelessness and workability would
be timely and appropriate:
• When clients are attempting to avoid or change a difficult private experience. Clients
may say things like “I just want to feel like I belong; I don’t want to feel so lonely and
different” or “I want to feel less depressed.”
• When clients are using schema coping behaviors. Clients may use schema coping
behaviors in session with the therapist, or they may describe situations when they have
recently used a schema coping behavior in a relationship outside of session. If a client
pushes you away, creates distance, minimizes the importance of the relationship, or gets
angry with you in session, this may be a schema coping behavior. Also be alert to
instances when clients describe these kinds of behaviors outside of therapy, saying things
like “I yelled at her,” “I didn’t go to the job interview,” or “I kept calling her over and over
again and she wouldn’t pick up.”
• When avoidance was a barrier to following through on values-based intentions.

Clients may reveal this by saying things like “I didn’t tell her how I felt because I felt too
guilty” or “I didn’t do the homework you assigned because it made me too anxious.”
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2. Discussing Creative Hopelessness

First, work with clients to identify all of the different ways in which they have attempted to
avoid or get rid of particular feelings, thoughts, or experiences connected to their schemas. Help
them assess the costs of avoidance, including both short-term and long-term outcomes. Creative
hopelessness hinges on recognizing that schema-related pain is unavoidable and that attempting to
avoid it only leads to more pain and suffering in the long run.
3. Criteria to Guide Treatment Choices Regarding Creative Hopelessness

If clients don’t accept that their schema-related pain is unavoidable, use the strategies in the
next section, on key techniques, to help develop willingness to experience primary pain. Likewise,
if clients don’t recognize that schema coping behaviors only work temporarily and then make things
worse in the long run, again use the strategies in the next section to help engender creative hope-
lessness. Once clients accept these two key points, proceed to assessing barriers to alternative
behaviors and working on exposure, defusion, and values clarification to help them face their
barriers.
4. Key Techniques for Cultivating Creative Hopelessness

There are several effective techniques for helping clients arrive at the difficult but pivotal place
where they experience creative hopelessness. Start by identifying their maladaptive coping behav-
iors and avoidance strategies. For example, you might ask about a specific incident, saying something
like “What did you do when you felt this mistrust or fear that this person will leave you?” Or you
might ask a more general question, like “How do you usually behave when you feel this fear?”
Next, explore the outcome of old coping behaviors. For example, you might ask, “What hap-
pened after you called her again and again? What was the outcome? How did she respond? Did you
feel better or worse?” Once you’ve established that schema coping behaviors haven’t managed to
permanently remove this pain and have actually led to more pain, help clients realize that the pri-
mary pain is unavoidable and is in them. Suggest that they don’t have to remove this pain in order
to behave differently and that perhaps the answer lies in relating to this pain differently: getting
closer to it and more curious about it rather than running away from it.
Finally, connect all of these schema-related experiences, and especially the costs of old coping
behaviors, to various relational domains and a variety of past experiences. Here are some examples
of questions you might ask: “How many times did this feeling of deprivation come up for you with
your partner yesterday?” “How many times did this come up with your friends over the past week?”
“How many times did this come up at work over the past month?” Help clients notice that this feel-
ing has been with them for a long time and may be unavoidable. You might ask something like
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“Could it be that every time you take a step toward being more intimate with someone, this fear
that the person will leave you will come up, along with the urge to create distance and
disconnect?”
5. Responding to Problematic Client Reactions to Creative Hopelessness

When trying to arrive at creative hopelessness, the most typical problematic reaction is when
clients can’t accept that their primary pain is unavoidable and therefore continue to try to eliminate
and decrease this pain. In this case, you can have a discussion about avoidable versus unavoidable
pain, including the things we can and cannot control. You can also describe the relationship
between primary and secondary pain. To this end, help clients notice the specific ways that avoid-
ance makes their pain worse in the long run.
You can use specific creative hopelessness metaphors, such as the quicksand metaphor or the
metaphor of digging a hole (described in chapter 4), or you can simply ask clients about it directly,
saying something like “Check in with your own experience. Have you ever managed to permanently
get rid of this feeling? Have you ever been able to permanently eliminate or control the thoughts
and feelings connected to your schema?”
You can also bring up commitment, saying something like “Would you be willing to have this
feeling of shame if it brings you closer to being the honest and genuine person that you want to be?
Would you be willing to bring this feeling of shame with you and still express your needs in the
relationship?”
Activation of Schemas in Session

Schemas are frequently triggered in session in both individual and group therapy. For example, cli-
ents who have a defectiveness schema will feel criticized by the therapist. In group therapy, they will
also sometimes feel criticized by other group members or by the group in general. These incidents
provide an excellent opportunity to respond to schema activation.
Help clients notice when their schemas are triggered in session and how they react. Work with
them to identify the schema and the trigger and to label various aspects of their experience, includ-
ing thoughts, emotions, sensations, urges, and behaviors connected to the schema, with a particular
focus on schema coping behaviors. The objective is to help clients become increasingly mindful of
schema-related experiences, especially the costs of their typical coping behaviors, to help build
motivation to choose to respond differently in their relationships.
It’s worthwhile to take every opportunity to connect clients’ in-session coping behaviors to out-
comes of these coping behaviors in other relationships. This is a powerful move because it provides
an opportunity for clients to practice acceptance of schema-related pain in the service of values-
based behavior.
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1. Recognizing In-Session Activation of Schemas

There are a couple of key signals that indicate a schema has been triggered in session:
• When clients show strong affect. If clients seem to be feeling angry, ashamed, embar-
rassed, guilty, disappointed, or afraid, this may indicate schema activation.
• When clients use a schema coping behavior with you. Watch for times when clients
create distance, seek reassurance, get clingy, withdraw, become submissive, or blame,
attack, or avoid you. Schema coping behaviors may also show up in the form of explain-
ing or justifying their behavior or getting defensive.
2. Discussing In-Session Activation of Schemas

When introducing schemas and identifying which schemas are relevant to clients, explain that
everyone has schemas, including you, the therapist. Also explain that it’s inevitable that schemas
will sometimes be triggered in the course of therapy. As you work with clients to identify the
thoughts, feelings, sensations, and urges that come up when the schema is triggered, don’t be
attached to labels and descriptions from this book (or elsewhere). It’s often a good idea to use clients’
language to describe and label their schema experience.
Also, seek permission from clients to point out moments when their schemas have been acti-
vated in session, and ask them to try to notice and point out those moments as well. Ask for
permission to stop them in moments when identified schema coping behaviors occur in the room.
Predict that, although this will be an uncomfortable experience, this exposure to schema affect will
be an important part of treatment. Point out that there’s something positive about these situations,
in that they provide opportunities to learn about their schemas and coping behaviors and to try out
new behaviors.
3. Criteria to Guide Treatment Choices Regarding In-Session

Activation of Schemas
If clients can’t recognize when their schemas have been triggered, use the strategies in the next
section, on key techniques, to help them notice that this is happening. If they do generally notice
when this is occurring, proceed to assessing barriers to alternative behaviors and working on expo-
sure, defusion, and values clarification to help them face their barriers.
If clients aren’t aware of potential triggers that may activate their schemas, use the Interpersonal
Triggers Worksheet from chapter 4 to help them identify people and events that commonly trigger
their schemas.
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If clients haven’t accepted that schema-related pain is unavoidable, shift the focus back to cre-
ative hopelessness.
If clients can’t identify and bring mindful awareness to their schema-related experiences (the
thoughts, feelings, urges, sensations, and memories that come up when schemas are triggered), shift
the focus to developing mindfulness.
If clients are highly fused with their schema content, it’s probably a good idea to work on defu-
sion techniques.
If clients haven’t recognized that avoidance is creating distance from their values, shift the focus
to values clarification and committing to values-based action to help them differentiate how they
have been interacting with how they would like to be in relationships.
If clients don’t have much willingness to experience their schema-related pain, work on creative
hopelessness and values clarification.
4. Key Techniques for Working with In-Session Activation of Schemas

Mainly at the beginning of treatment, but sometimes later, you’ll need to help clients recognize
moments when their schemas have been triggered. Ask them about it directly. Here are some exam-
ples: “I’m wondering if you’re feeling controlled right now, like you have no choice.” “Are you feeling
like I’ve shamed you somehow?” “It seems like you’re feeling as though I don’t get you—maybe even
deprived, like I won’t meet your needs. Does it seem that way to you?” Then explore which schema
was activated, the thoughts and emotions that came up for clients in the moment, and any coping
behaviors they are using.
Next, link clients’ in-session activation of schemas to similar situations in various interpersonal
domains; for example, “Do you notice how the same feeling that comes up between you and your
girlfriend—where you feel like you’re the bad guy and will be blamed and punished—is coming up
for you right now with me?”
Also identify the coping behaviors clients are using with you and then connect those to coping
behaviors they use in other relationships; for example, “It seems like you’re trying to explain or jus-
tify yourself right now, as if you feel you’ve done something wrong. Does it feel that way to you?” or
“I wonder if your pattern of being late to therapy is similar to the coping behavior we identified that
you use with your boyfriend, where you create distance and withdraw in order to protect yourself
from feeling abandoned. Do you think that may be coming up in here?”
In a group setting, you can ask either the person whose schema has been triggered or other
group members which schema they think has been activated and then explore what the trigger
might have been. However, when inviting other group members to comment on one person’s sche-
mas or schema coping behaviors, be sure to encourage the group to relate to the experience,
normalize it, and explore it compassionately.
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5. Responding to Problematic Client Reactions to In-Session

Activation of Schemas
After clients become more aware of their schemas and the costs of old coping behaviors, they
may still have difficulty behaving differently. One possible reason for this is that they don’t notice
the opportunity to behave differently. Another probable factor is that they habitually attempt to
avoid their schema-related pain, whereas staying in contact with this pain is necessary for behav-
ioral change. Here are a few strategies that may help:
• Increase clients’ exposure to schema affect and have them notice the moment when
urges to engage in old coping behaviors come up for them. You can do this via visualiza-
tions of recent schema-triggering events and keeping clients immersed in the schema
experience. Methods for keeping them in contact with schema experience include
mindful breathing, identifying sensory experiences in the moment, and recognizing the
current behavior as an avoidance strategy. For example, you could say, “What would it
be like to stay with this feeling that you’ll never feel that your partner understands you
or will meet your needs? What is that experience like? Where do you feel that in your
body?”
• Help clients recognize the moment of choice by pointing out that a schema coping
behavior just occurred in the room, identifying what happened to trigger the schema,
and exploring the thoughts, feelings, and urges that led to the schema coping
behavior.
• When clients use old coping behaviors in session, identify the coping behavior and help
them come up with alternative responses. For example, if a client says that feeling
deprived or misunderstood creates an urge to demand or explain, explore alternative
behaviors they can engage in when they have that urge, such as express a feeling, state
some sort of appreciation, or write about their experience in a journal.
• Provide positive reinforcement when clients display new behaviors in session. Either
directly or indirectly, acknowledge that they used a different behavior.
Working with Activation of Schemas in

Day-to-Day Life
When clients describe problematic interpersonal interactions in day-to-day life, help them figure out
whether schema activation played a role in the difficulty. Explore which schema may have been
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activated and what the trigger was. Then have them label various aspects of the experience, including
thoughts, emotions, sensations, urges, and behaviors connected to the schema, with a particular focus
on schema coping behaviors. As with in-session activation of schemas, the objective is to help clients
become increasingly mindful of schema-related experiences, especially the costs of their typical coping
behaviors, to help build motivation to choose to respond differently in their relationships.
1. Recognizing When Schemas Have Been Activated out of Session

There are a couple of key signals that indicate clients’ schemas were triggered in day-to-day
interactions:
• When clients describe a situation where they used schema coping behavior. Watch
for stories about interpersonal interactions that include clients’ schema coping behav-
iors, such as giving in, demanding, distancing, attacking, or withdrawing.
• When clients have strong affect while telling a story. Watch for times when clients
display strong anger, sadness, shame, guilt, or embarrassment while describing interper-
sonal interactions.
2. Discussing Schema Activation in Day-to-Day Life

When clients report day-to-day interactions that seem schema related, ask directly whether they
think a schema was triggered. If they aren’t sure, suggest some possible schemas; for example, “As I
listen to you describe this situation with your wife, I’m wondering if that ‘bad guy’ feeling was trig-
gered for you at that time.”
Also help clients identify the problematic coping behavior. For example, you might ask, “What
did you do in that moment when you felt deprived? How did you behave?” In situations where clients
didn’t actually fall back on old coping behaviors, ask about any urges; these can provide insight into
clients’ typical maladaptive behavior patterns.
Finally, and crucially, identify the impact and cost of the coping behavior in clients’ relation-
ships; for example, “What happened after you withdrew? Did the relationship feel better or worse?
What did the other person do?”
3. Criteria to Guide Treatment Choices Regarding Schema

Activation in Day-to-Day Life
If clients haven’t accepted that schema-related pain is unavoidable, shift the focus back to cre-
ative hopelessness.
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If clients understand and accept that the pain is unavoidable but still continue to employ old
coping behaviors in day-to-day interactions, shift the focus to values clarification and committing
to values-based action to help them differentiate how they have been interacting with how they
would like to be in relationships. Also help them notice the various moments of choice to behave
differently by slowing down the story and identifying the specific thoughts, feelings, or urges that
were driving their behavior. Assist them in identifying alternative behaviors to engage in at those
times.
4. Key Techniques for Responding to Schema Activation in

Day-to-Day Life
If clients are to choose to behave differently when their schemas are activated, they must be able
to notice triggering situations as they occur or, better yet, be able to foresee that certain situations
may activate their schemas. The Schema Events Log and Schema Triggers Worksheet, both in
chapter 2, began to build these skills, and the Schema Coping Behaviors Worksheet, in chapter 3,
helped them identify the coping behaviors they tend to use in specific situations. The Interpersonal
Experiences Diary, from chapter 4, brings all of these skills together and allows clients to identify
signals that can serve as indicators that a schema has been activated.
In session, use entries from the Interpersonal Experiences Diary to conduct in-session visual-
izations bringing clients back into salient situations. Have them observe all aspects of the
interaction or situation, including emotions, thoughts, physical sensations, and schema-driven
urges. Then ask what they actually did and whether they resorted to problematic coping
behaviors.
Focus on the moment of choice—that key point when a schema has been activated but clients
haven’t yet responded. This is the time when they can choose to engage in values-based behavior
rather than old coping strategies. Help them identify and list signals that will allow them to mind-
fully recognize that they’ve reached this critical point. These signals include both triggering
situations and the resulting emotions, thoughts, sensations, and urges. These can serve as red flags
that a schema has been activated, providing an opportunity to take advantage of the moment of
choice.
You can help clients notice the moment of choice by slowing down the story and identifying
moments when they could have chosen a different behavior. For example you can point out that any
time they have an urge to criticize their partner, they can choose to appreciate their partner instead,
or that any time they have the thought that they want to end their relationship, they can hug their
partner instead. Help clients identify specific thoughts, urges, or feelings that drive them to use a
particular schema coping behavior and then explore alternative, values-based behaviors they can
engage in instead.
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5. Responding to Problematic Client Reactions to Schema

Activation in Day-to-Day Life
As mentioned in regard to in-session schema activation, even after clients become more aware
of their schemas and the costs of old coping behaviors, they may still have difficulty behaving dif-
ferently. The approach outlined above will help them identify the moment of choice, but even then
they may struggle to engage in new behaviors. In this case, work with clients to identify specific new
responses to replace old coping behaviors.
You can use role-playing exercises based on recent triggering situations to help clients practice
these new behaviors. For example, you might play the role of the client’s critical mother and have
the client notice his or her experience and urges and practice responding differently.
Values-Based Planning
Values-based planning is an integral component of treatment and will reemerge frequently through-
out therapy. Clients who are struggling with recurring interpersonal problems are often unclear
about their values in relationships or how they’d rather be interacting. Their behaviors in relation-
ships have mainly been driven by the desire to avoid schema-related pain and feared outcomes.
Once clients understand the costs of maladaptive coping behaviors, values-based planning can
begin. Help clients identify key interpersonal values in all relevant interpersonal domains, then use
these as the basis for developing specific intentions. Work with clients to review past triggers and
predict future situations where they can engage in their new, values-based behaviors.
As therapy proceeds, frequently check in about whether clients’ behaviors are consistent with
their values. When they resort to old, maladaptive coping behaviors, help them notice and label
what’s going on and assess the costs while also reminding them of their commitment to new ways
of responding. From time to time, review the effectiveness of current intentions based on previous
outcomes and new or evolving issues in relationships and help clients plan new values-based actions
as appropriate. Because a crucial aspect of values is that they are personal and freely chosen, it’s
essential that you keep clients’ stated values in mind and effectively discriminate between avoidant
and values-based behavior.
1. Recognizing When to Use Values-Based Planning

Several key signals can alert you that values work would be timely and appropriate:
• When clients use maladaptive coping behaviors in session. This can show up in sev-
eral forms. Clients may make demands of you, minimize the importance of the
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relationship, attempt to quit therapy, seek reassurance, worry about you, comply with all
of your interventions and statements, or blame or attack you.
• When clients tell you a story about using maladaptive coping behaviors in day-to-
day life. Clients may say things like “I yelled at my husband,” “I ignored her,” “I kept
trying to explain,” “I told him he’s a jerk,” or “I kept insisting that she listen to me.”
• When clients are about to enter a previously identified triggering situation. An

example is a holiday dinner with a critical mother, an interaction with a demanding
boss, or needing to set limits and boundaries with a child who’s acting out.
2. Discussing Values-Based Planning

Explore the costs of old coping behaviors. Directly ask whether specific behaviors moved clients
closer to or farther away from their values and whether the behavior made the relationship feel bet-
ter or worse. You can also explore the costs of problematic coping behaviors in the therapeutic
relationship and whether something similar is occurring in other relationships. For example, you
might say, “When I notice you withdrawing and disconnecting in session with me, it feels like it
creates distance between us and I feel confused about what’s going on for you. Do you think that
withdrawing creates distance in your relationship with your boyfriend as well?”
Help clients explore how they can behave differently both in session and in day-to-day life.
Continuing with the previous example, in session you might say, “So, in those moments when you’re
triggered and get the urge to withdraw and disconnect from me, how can you let me know what’s
going on for you? What could you do differently to bring yourself closer to your value of being inti-
mate and expressive in relationships?” Then you can extend this to clients’ key relationships; for
example, saying “In those moments when you feel rejected by your boyfriend and you get the urge
to run away and disconnect from him, what can you do to let him know what’s going on for you?
What can you do or say that will bring you closer to being the expressive and open person you want
to be in your relationship?”
Remind clients of the barriers to valued action that you’ve previously identified and ask them
whether they’d be willing to have those difficult thoughts and feelings while taking action on their
new, values-based intentions.
3. Criteria to Guide Treatment Choices Regarding

If clients aren’t clear on their interpersonal values, use the Valued Intentions Worksheet in
chapter 5 to help them clarify their values. If they aren’t clear on the thoughts and feelings that act
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as barriers to their values, use the Assessing Barriers Worksheet in chapter 5 to explore and identify
barriers. If clients aren’t willing to feel the emotional pain that comes up as they act on valued inten-
tions, focus on creative hopelessness to build willingness or use exposure and defusion techniques
to help clients accept and tolerate their primary pain.
4. Key Techniques for Implementing Values-Based Planning

After helping clients identify key values in relevant interpersonal domains, to work collabora-
tively to identify values-based intentions: specific behaviors that would reflect those values in
current relationships. One way to identify specific values-based intentions is by exploring clients’
schema-related pain, thoughts, and coping behaviors. These often reveal a lot about clients’ values.
For example, someone with an abandonment and instability schema who copes by disconnecting,
withholding, and distancing from others may describe not wanting to be vulnerable and intimate
with people for fear of being abandoned. This may reveal a desire for connection and intimacy. This
information can be used to explore specific intentions related to being vulnerable and expressing
feelings in relationships. Another example would be a client with a defectiveness schema who fears
disappointing others and who copes through compliance and surrender. This may reveal a value of
being more authentic, genuine, and assertive in relationships. In this example, you could even ask
something like “What if you could be 100 percent certain that your husband would never abandon
you—how would you behave differently? Would you be more honest or ask for what you want more
often?”
Another way to use clients’ schema-related pain to identify potential values-based intentions is
similar to the exercise Exploring the Flip Side, from chapter 7. Write clients’ schema-related thoughts
and feelings on one side of a piece of paper and then, on the other side, list what these thoughts and
feelings have stopped them from doing. This helps clients identify specific values-based intentions
while also clearly illustrating the costs of avoidance.
Once values-based planning commences, help clients come up with specific intentions for the
week and also underscore that these new behaviors are alternatives to their old schema coping
behaviors—that these are behaviors to be used when they experience that moment of choice, when
they have the opportunity to respond by moving in valued directions rather than reacting in habit-
ual ways.
5. Responding to Problematic Client Reactions to

A common problem when doing values work is clients being overly invested in the outcome of
a particular intention (something they cannot control), rather than being invested in taking the
steps toward being the kind of person they want to be (something they do have control over). In this
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case, a hoped-for outcome is driving clients’ behavior more than values are. For example, a client
with a subjugation schema may have an intention to express particular needs to his or her partner
but not follow through because of fear that the other person will get mad or feel hurt. Here are some
strategies to use in such situations:
• Help clients defuse from stories about ideal and feared outcomes.
• Help clients recognize that ideal or feared outcomes are connected to their schemas—
that they exist in the mind and not in the world.
• Assess the function of the stories and whether the desire for a particular outcome is
moving clients closer to or farther away from their values.
• Return the focus to the value and reassess its importance, as well as the costs of not
acting on this value in relationships.
• Revisit the topic of what we can and cannot control. Help clients notice that, no matter
what the outcome, by acting on their intentions they are getting closer to their values
and how they want to relate to others. Remind them that we can’t control how others
will respond; we can only control how we conduct ourselves.
• Explore creative hopelessness in regard to the pain that clients are trying to avoid.
• Do exposure work with any schema affect that clients are trying to avoid.
Defusion
Defusion techniques create distance from cognitive barriers and promote willingness to have
schema-driven thoughts in the service of acting on values-based intentions. To begin this work, help
clients recognize that painful thoughts have been barriers to acting on their values and suggest that
in order to relate to others differently they must learn how to relate to their thoughts differently.
A wide variety of exercises, metaphors, and other strategies can be employed to help clients with
defusion, and chapter 6 provides a great deal of guidance on these approaches. However, defusion is
also a stance that you should model in how you relate to clients and their thoughts. Take every
opportunity to notice clients’ schema-related verbal behavior, including thoughts, memories, stories,
explanations, justifications, reasons, interpretations, and assumptions, then model a defused stance
by bringing awareness to the process of thinking by labeling these behaviors as thoughts, memories,
stories, explanations, and so on, and by holding them lightly. Holding clients’ verbal behavior lightly
involves labeling it for what it is and suggesting alternative thoughts, explanations, and reasons. You
might also connect particular thoughts and explanations to specific schemas and past experiences or
identify the function of the verbal behavior in the moment. For example, you might say, “That’s an
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interesting explanation. What schema is that reason connected to?” or “How is having this rule
working for you? To me, it seems like one of those deprivation thoughts that pulls you toward making
demands.”
Note that although defusion and exposure are discussed separately in this section, in practice
they often go hand in hand and are conducted simultaneously. As soon as clients begin to defuse
from schema-related thoughts, schema affect typically shows up. And as soon as schema affect
shows up, it triggers schema-related thoughts. Therefore, it’s often necessary to alternate between
defusion and exposure techniques or to work on defusion and exposure simultaneously.
1. Recognizing When to Use Defusion

There are a couple of key signals that can alert you that defusion work would be timely and
appropriate:
• When clients bring up thoughts connected to their schemas. This includes stories,
explanations, predictions, worries, reasons, and judgments. Here are some examples:
“I’m just going to fail at whatever I try.” “She always makes me feel bad.” “I don’t trust
him.” “I’m ugly.” “I disappoint people.” “I never get it right.” “It’s because he’s too selfish.”
“She broke up with me because I’m boring.”
• When clients bring up schema-related stories about other people’s behaviors. This
includes assigning motives or intentions to others and predictions about how others will
respond: Here are some examples: “She’ll just end up hating me and leaving me.” “He’s
going to cheat on me.” “She’ll get angry if I express how I feel.”
2. Discussing Defusion
As mentioned, chapter 6 provides a wide variety of techniques for cognitive defusion, and work-
ing with these will go a long way toward helping clients understand and cultivate this skill. In
addition, call attention to mental activity, thoughts, and stories connected to clients’ schemas using
such phrases as “You’re having a prediction that…” or “Your mind is telling you a story that…” Look
for opportunities to externalize clients’ mind, saying something like “What’s your mind saying to
you about that situation?” You might even give the client’s mind a name, choosing a name other
than the client’s. For example, with a client named Rebecca, you might establish the name Suzie for
her mind and then sometimes say “What is Suzie telling you to do?” or “That sounds like something
Suzie would say.”
Also try to connect particular verbal behaviors associated with clients’ schemas to all the differ-
ent domains in which they show up. This helps clients see that schema thoughts show up across
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different relationship domains—an indication that they exist inside the client, rather than being
specific to particular relationships or interactions. For example, if clients have a frequent thought
related to their partner not meeting their needs or not understanding them, you can help them
notice the many different relationships where that thought comes up—with their boss, with their
mother, and so on. Alternatively, ask them to them recall the first time this thought came up for
them in a relationship or point out times when that thought has come up in regard to you, the
therapist.
3. Criteria to Guide Treatment Choices Regarding Defusion

Defusion strategies can be used with most of the cognitive content that clients bring up. The
only case in which you might delay defusion is with thoughts that describe an outcome of a particu-
lar schema coping behavior. For example, consider a client who brings up a thought that she believes
her husband is thinking about divorcing her. Before jumping in with defusion, you want to assess
the workability of her schema coping behaviors and help her understand how this thought drives
her to behaviors that may actually lead to being abandoned. If she copes with her abandonment and
instability schema through constantly accusing, clinging, and seeking reassurance from her hus-
band, then it’s likely he may indeed be feeling frustrated with her. In this situation, it would be
better to use strategies that focus on creative hopelessness or values. You could also work on creative
hopelessness, values, and defusion simultaneously by helping the client recognize that the thought
“He’s going to divorce me” pulls her toward using coping behaviors (such as accusing or blaming)
that maintain her abandonment schema and pull her farther away from her values. It’s critical to
distinguish between thoughts that predict actual likely outcomes of the client’s coping strategies
versus fusion with thoughts that block values-based behavior. For the former, start with assessing
the workability of behaviors and values clarification before moving into defusion; for the latter,
defusion would be appropriate.
4. Key Techniques for Implementing Defusion

When you notice clients buying into a particular explanation or interpretation, work with them
to develop several alternative explanations or interpretations for the same event, then help them
notice that they can arbitrarily choose which explanation or interpretation they decide to buy into.
In a group setting, you could also ask other group members for alternatives and use this to lead into
a discussion of how different people are more likely to buy into certain thoughts depending on their
schemas.
Discuss the function of schema-driven thoughts with clients. To this end, you might say some-
thing like “Once a schema gets triggered, many thoughts will serve the purpose of avoiding
schema-related pain. These thoughts will try to pull you toward using old coping behaviors and
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running away from the difficulty.” Explain that schema-related thoughts are often strongest when
people start taking steps toward their values. Encourage clients to notice the function of their
thoughts whenever they take steps in valued directions. You might ask something like “When you
started acting on your intentions this past week, what did you notice your thoughts trying to do?
How were they pulling you to behave? What was their goal or purpose?”
Ask clients whether they are willing to have difficult or painful thoughts in the service of acting
on their values. Here are a couple of examples: “Would you be willing to have the thought that your
girlfriend will get angry if you express yourself and still let her know that your feelings were hurt?”
“Would you be willing to have the thought that your husband is selfish and unable to meet your
needs and still ask him to give you a ride to work on Tuesday?”
In a group setting, you can ask group members to label schema-driven thoughts that come up
for individuals during the session; for example, “What kind of thought is that—a predicting thought,
a judgment, an explanation?” or “What schema might that thought be connected to?” Encourage
the group to notice which thoughts and stories are connected to which schemas. Also encourage
group members to notice judgments and label them as such.
In a group setting, you might also ask group members how they think a particular thought is
working for one group member—whether that thought moves the person toward or away from his
or her interpersonal values. You could even ask other group members how strongly they believe or
buy into a particular thought, story, or explanation that one group member has expressed.
5. Responding to Problematic Client Reactions to Defusion

A common problematic issue that arises with clients regarding defusion is that they are so fused
with the content of their thoughts that they view these thoughts as reality, which leads them to
want to understand their thoughts rather than create distance from them. Clients believe that these
thoughts represent a truth about themselves or their problems and that analyzing and assessing
these thoughts will help them change their behavior, understand who they are, solve problems, or
predict and prevent certain outcomes and patterns. Here are some strategies to use in such
situations:
• Help clients notice how particular thoughts act as barriers to values.
• Discuss the difference between problem solving and ruminating, worrying, and fusion.
Explore which thoughts are productive, bring clients closer to their values, and help
them solve problems, and which thoughts are repetitive, damaging schema-driven
thoughts.
• Explore whether these thoughts have brought clients closer to solving a particular prob-
lem or have helped change their behavior, and whether realizations necessarily lead to
behavioral change.
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• Assess the workability of holding thoughts too tightly and whether particular thoughts
make clients feel better or worse.
• Explain that we don’t have to defuse from all of our thoughts, that defusion is just a
choice we have in the moment. We can let our minds control us, or we can choose to
create distance from mental content and hold it lightly. It’s an option, not a strategy to
use with every negative thought.
Exposure
Emotion exposure techniques promote willingness to face schema-driven affect. The goal of expo-
sure is to help clients build acceptance of unavoidable schema-related pain and willingness to have
that pain in the service of acting on values-based intentions. To begin this work, help clients recog-
nize that painful emotions have been barriers to acting on their values and suggest that in order to
relate to others differently they must learn how to relate to their emotions differently. Exposure is
difficult work, so it’s essential to focus on clients’ key values, which will provide motivation for them
to experience schema-related pain. Be careful to use exposure only with clients’ primary pain, not
the secondary pain due to maladaptive coping behaviors, which is both avoidable and
unnecessary.
As mentioned in the section on defusion, exposure to schema affect will bring up thoughts con-
nected to the schema. Therefore, when schema-related thoughts show up during exposure, help
clients defuse from those thoughts, then get back to the emotion. Thoughts that come up during
exposure are attempts to avoid painful schema affect. Much of this aspect of the work involves care-
fully balancing defusion and exposure or working with these two processes simultaneously.
1. Recognizing When to Use Exposure

Several key signals can alert you that exposure to emotions would be timely and appropriate:
• When clients’ schemas are triggered in session. Watch for times when clients are
angry, ashamed, or defensive or express any strong schema affect.
• When clients engage in maladaptive coping behaviors in session or recount an event

where they engaged in those behaviors. Watch for times when clients seek reassur-
ance, offer justifications, or are demanding, distancing, compliant, belittling, minimizing,
and so on. Also be alert for stories of behaving in these ways in day-to-day life.
• When clients identify an emotion as a barrier to a values-based intention. Examples

are such statements as “I didn’t express my feelings because I felt ashamed,” “I didn’t ask
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for help because I felt guilty,” and “I didn’t take time for myself because I didn’t want to
be alone.”
• When clients display emotionally avoidant behaviors. Examples of this are ruminat-
ing, intellectualizing, and incongruent affect, such as laughing when talking about a
shameful experience.
2. Discussing Exposure
When clients accept that the problem isn’t schema-related pain, but rather attempts to elimi-
nate or avoid that pain, they are in a position to experience and explore creative hopelessness. That
sets the stage for discussing exposure. Explain that part of the solution is to get closer to the pain
and relate to it differently, rather than running away from it. As ever, highlight the many costs of
emotional avoidance and suggest acceptance and willingness as an alternative.
You can use various techniques from chapter 7, such as the exercise Exploring the Flip Side, to
help clients see that the farther away their schema-related pain is, the farther away their values are.
Explain that schema-related pain will often be part and parcel of acting on their values, and also
acknowledge that exposure is difficult and painful, but also a necessary step if they are to engage in
new behaviors. For example, you might say something like “It seems like every time this deprivation
schema shows up, it feels so painful and unbearable that you run away from it by getting angry and
making demands. We’ve been discussing that you want to be able to express your needs nonjudg-
mentally and calmly with your partner. It seems that this painful sense of being deprived has stood
in the way of expressing your needs differently. To help you express your requests calmly and non-
judgmentally, maybe we need to bring up that deprivation feeling right here, in this room, and really
look at it, sit with it, and learn how to relate to it differently. Maybe that would help you behave
differently when it shows up. Would you be willing to give that a try?”
3. Criteria to Guide Treatment Choices Regarding Exposure

Before conducting exposure, obtain clients’ permission and provide a rationale for doing so.
Always conduct exposure fairly early in the session so that time remains to process and discuss the
experience; otherwise, clients may leave the session feeling unsettled.
4. Key Techniques for Implementing Exposure

An effective way to conduct exposure is to use imagery with a recent schema-triggering event.
Have clients visualize the situation and events leading up to the moment when they engaged in old
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coping behaviors. As they approach that moment, have them label all of the emotions, sensations,
and urges coming up just before they engaged in the problematic behavior. Help them identify this
as the moment of choice, when they can differentiate between urges and actions and choose to
respond in alignment with their values. This can provide a visceral experience that they can have
a very strong urge to engage in one behavior and still choose to do something else.
During emotion exposure, help clients observe and describe their emotional experience. You
might objectify a specific emotion by asking clients to describe its shape, size, color, texture, and
weight, along with where it is located in the body and any movement of the emotion. You can also
make comments about clients’ nonverbal behavior, such as “Your shoulders look heavy,” “It seems
like you’re holding your breath right now,” or “Your hands are tightened into fists.” Help them notice
all of the physiological sensations that accompany the emotion.
You can also connect a recent schema-triggering event and the associated emotions to other
situations in the client’s life, including early childhood memories, and to other interpersonal
domains. You can ask questions like “How many times has this feeling come up for you this week?
How many times this month?” “With whom has this feeling come up? Can you think of anyone
close to you that this feeling hasn’t come up with?” “Can you remember a time during your child-
hood when this feeling came up?” The goal of these questions is to help clients recognize that this
feeling is unavoidable and exists within them, not in external circumstances. For example, if a client
believes that his failure schema gets triggered only in his current romantic relationship, you can ask
him whether it has ever shown up in other romantic relationships, in relationships with siblings or
parents, or at work.
During any exposure, encourage clients to make space for their experience and to be compas-
sionate and gentle with it. Here are some examples of how you might help them create a little more
space for painful feelings: “How much of this emotion are you experiencing right now—40 percent,
70 percent? Would you be willing to have 5 percent or 7 percent more of this experience if that
would bring you closer to acting on your values?” “See if you can be willing to breathe in just a little
bit more of this pain.” “Can you make the space in your body to have all of your experience?”
You can also ask clients to put a hand on the part of their body where they feel their emotional
pain and then send warmth and compassion to that area. Alternatively, have them imagine that
their schema-related pain is a crying baby who needs to be nurtured with soothing kindness.
Another approach is to help clients notice how harsh they’ve been with their own pain. Than ask
them to think about how they would relate to a friend who was experiencing this pain. Yet another
option is to have clients welcome their schemas out loud; for example, “Welcome deprivation.
Welcome defectiveness.”
5. Responding to Common Problematic Client Reactions to Exposure

A common problem that arises around exposure is that clients have difficulty remaining in
contact with schema affect and the discomfort that arises for both client and therapist. Clients
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struggle with staying with the schema experience, and therapists may have difficulty bringing cli-
ents back to the exposure. The following strategies can be used to help clients build willingness to
stay in contact with schema-related pain:
• Explain the rationale for exposure. You can do this using the exercise Exploring the Flip
Side or by working with the monsters on the bus metaphor. Make sure clients agree that
being farther away from schema pain creates further distance from their values. Also
remind them that schema-related pain is unavoidable.
• Clarify clients’ values and reassess the level of importance of values related to the
exposure.
• Explore the workability of avoidance through creative hopelessness. Work with clients
to get very clear on the specific costs of their avoidance of schema-related pain and what
impact this has on particular relationships. Connect specific instances of avoidance or
unwillingness to have pain to specific schema coping strategies that have been damag-
ing clients’ relationships.
• Assist clients in cultivating self-compassion through mindfulness exercises.

• Use defusion simultaneously with exposure.
Summary
As you can see from how the six processes discussed in this chapter are interwoven, conducting
ACT for interpersonal problems is, by necessity, very fluid. Always be sensitive and responsive to
what’s occurring in the room in any given moment and be willing to shift focus if that’s what’s called
for. Further, because of the number of potential schemas, the possibility of multiple schemas, and
the many forms schema coping behavior can take, this approach must also be tailored to the indi-
vidual client. Keep clients’ personal values in mind throughout, and be sure to understand their
particular situation, including which emotions tend to be primary schema affect and which show up
as coping behaviors, and in what situations.
That said, when first using this approach in individual therapy, you may want to consult the
protocol outlined in appendix C for guidance on the general sequence of events. And even if you
won’t be using this approach in group therapy, we recommend that you read through appendix C to
get an idea of how the processes and techniques might evolve.
Conducting ACT for interpersonal problems can be a delicate balance. You may have occa-
sional missteps, especially at first. But if you follow your own values in regard to helping clients
overcome schema- related pain and interpersonal difficulties, you will chart a course toward
healing—one that helps clients enjoy a richer and more satisfying life where their interpersonal
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interactions are informed by their values, rather than by early maladaptive schemas and old coping
behaviors that aren’t relevant to current circumstances. Using the approach in this book, you can
help clients be who they want to be—with friends, family members, lovers, and others—and this is
surely one of the most powerful transformations any of us can hope for.
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appendix A
Schema Questionnaire
T
he following questionnaire, adapted from the Young Schema Questionnaire with the per-
mission and assistance of Jeffrey Young, PhD, is useful for determining which schemas are
most relevant to clients. The version below is just for reference. If you wish to use a similar
questionnaire in your practice, please visit schematherapy.com, where you can purchase the most
current version of Jeffrey Young’s questionnaire for research or clinical use.
Rate the following statements using the scale below:
1 = Completely untrue of me
2 = Mostly untrue of me
3 = Slightly more true than untrue of me
4 = Moderately true of me
5 = Mostly true of me
6 = Describes me perfectly
Abandonment and Instability (ab)

1. I am fearful that people I love will die or leave me.
2. I get clingy with people when I feel that they are going to leave me.
3. My support system feels unstable.
4. I find myself falling in love with people who aren’t capable of or willing to commit to me.
5. People have always moved in and out of my life.

6. When someone I love pulls away, I feel desperate.
7. My obsession with the idea that my lovers will leave me drives them away.
8. The people I have the closest relationships with are unpredictable. Sometimes they are
there for me, and sometimes they are not.
9. I feel like I need people more than others do.
10. I feel like I will be alone toward the end of my life.
Mistrust and Abuse (ma)

1. I have the expectation that people will hurt me or use me.
2. People close to me have consistently abused me.
3. I know that it is only a matter of time before the people who are important in my life will
betray me.
4. I must protect myself and be on guard.
5. People will take advantage of me if I am not careful.
6. I regularly set up tests for people to determine whether they are really on my side.
7. I tend to hurt others before they can hurt me.

8. I fear that people will hurt me if I allow them to get close to me.
9. When I think about what people have done to me, I get angry.
10. The people who I should have been able to trust have physically, verbally, or sexually
abused me.
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Emotional Deprivation (ed)

1. I don’t get as much love as I need.
2. I feel like no one really understands me.
3. I am usually attracted to cold partners who can’t meet my needs.
4. I don’t feel connected, even to the people who are closest to me.
5. I have not had one special person in my life who wants to share himself or herself with me
and cares about what happens to me.
6. I don’t have anyone in my life to give me warmth, holding, and affection.
7. I do not have a person in my life who really listens and is tuned in to my true needs and
feelings.
8. I find it difficult to let people guide or protect me even though it is what I want.
9. I find it difficult to let people love me.
10. I feel lonely most of the time.
Defectiveness and Shame (ds)

1. If others really knew me they couldn’t love me.
2. Because I am inherently flawed and defective, I am not worthy of love.
3. I have secrets that I will not share even with the people closest to me.
4. I am to blame for my parents being unable to love me.
5. I present a false self that hides the real me because the real me is unacceptable.
6. I tend to be drawn to people who are critical and rejecting of me.
7. I tend to be critical and rejecting of others, especially those who seem to love me.
8. I tend to devalue my positive qualities.
9. I feel a lot of shame about myself.
10. Exposure of my faults is one of my greatest fears.
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Social Isolation and Alienation (si)

1. I feel very awkward in social situations.
2. I don’t know what to say at parties and other gatherings. I feel dull and boring.
3. I feel like the people I want as friends are above me in some way, such as appearance, status,
wealth, education, career, or popularity.
4. I would prefer to avoid rather than attend most social gatherings.

5. I feel that I am unattractive—too thin, fat, short, tall, ugly, and so on.
6. I feel like I am different from other people.
7. I don’t feel like I belong. I am a loner.
8. I feel like I am on the outside of groups.
9. My family was different from the other families when I was growing up.
10. I feel like I am not part of the community at large.
Dependence and Incompetence (de)

1. I feel less like an adult and more like a child when it comes to dealing with responsibilities
of daily life.
2. I do not have the capability to get by on my own.
3. I do not cope well by myself.
4. Other people are better at taking care of me than I am at taking care of myself.
5. If I don’t have someone to guide me, I have trouble tackling new tasks.
6. I can’t do anything right.
7. I am inept.
8. I don’t have common sense.
9. I do not trust my own judgment.
10. Everyday life is overwhelming to me.
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Failure (fa)
1. I feel that I am less competent than other people.
2. I feel like a failure when it comes to achievement.
3. I feel like most people my age are more successful in their work than I am.
4. I was a failure as a student.
5. I feel like I am the least intelligent person in my group.

6. I feel humiliated by my failures in the area of work.
7. I feel that I do not measure up in terms of my accomplishments, and it makes me feel embar-
rassed around other people.
8. I feel that people believe that I am more competent than I really am.
9. I feel that I don’t possess any special talents that really count in life.
10. I work at a level that is below my potential.
Entitlement (en)
1. “No” is an answer that I have trouble accepting.
2. When I don’t get what I want, I get angry.
3. I am special and should not have to accept or be held to normal restrictions.
4. I always put my needs first.
5. I have a very difficult time getting myself to stop drinking, smoking, overeating, or engaging
in other problematic behaviors.
6. I lack discipline when it comes to completing routine or boring tasks.
7. I act on impulses and emotions that result in consequences.

8. When I cannot reach a goal, I become frustrated and give up.
9. I insist that things get done my way.
10. M
y need for immediate gratification can get in the way of my reaching a long-term goal.
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Subjugation (su)
1. I let other people control me and my life.
2. I worry that if I don’t fulfill the wishes of others, they will get angry, retaliate, or reject me.
3. The major decisions in my life are not in my control.
4. I have difficulty demanding that other people respect my rights.
5. I really worry about pleasing people and getting their approval.

6. I go to great lengths to avoid conflict or confrontations with others.
7. I give more to others than they give to me.
8. I experience the pain of other people deeply, which leads me to take care of the people I’m
close to.
9. If I put myself first, I feel guilty.
10. I am a good person because I think of others more than I think of myself.
Unrelenting Standards and Hypercriticalness (us)

1. I do not accept second best. I must be the best at most of what I do.
2. I feel like nothing I do is ever quite good enough.
3. I strive to keep everything in perfect order.
4. I need to look my best at all times.
5. I don’t have time to relax because I have so much to accomplish.
6. I push myself so hard that my personal relationships suffer.
7. I put myself under so much pressure that my health suffers.
8. When I make a mistake, I deserve strong criticism.

9. I am very competitive.
10. Wealth and status are very important to me.
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Interpreting Your Client’s Schemas

10–19: Very low. This schema probably does not apply to your client.
20–29: Fairly low. This schema may apply only occasionally.
30–39: Moderate. This schema is an issue in your client’s life.
40–49: High. This is definitely an important schema for your client.
50–60: Very high. This is definitely one of your client’s core schemas.
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appendix B
Research Outcomes
T
his appendix outlines results of a study of the effectiveness of a ten-week group therapy ACT
protocol for interpersonal problems. (The protocol used was the basis for the approach out-
lined in appendix C.) The randomized, controlled study, conducted by Avigail Lev at the
Wright Institute, used the protocol with a group of forty-four male clients at a community-based
clinic for recovery from substance abuse in Berkeley, California. Participants were assigned to one
of two groups: treatment as usual (consisting of 22 participants) and the ten-week protocol plus
treatment as usual (22 participants). (Treatment as usual was a day-treatment recovery program
that included 12-step study, relaxation training, anger management, relapse prevention, and a host
of other services.) The Inventory of Interpersonal Problems (IIP-64; Horowitz, Alden, Wiggins, &
Pincus, 2000) was used as an assessment tool before and after the ten-week treatment program.
Researchers looked at several hypotheses, but the main hypothesis of this study was that ACT
treatment would result in a reduction of maladaptive interpersonal functioning as compared to
treatment as usual. This hypothesis was tested via an examination of participants’ pre- and post-
treatment scores on the IIP-64. The table at the end of this appendix compares pre- and post-treatment
test scores for participants in the treatment versus control group. (As a side note, the IIP-64 dem-
onstrated excellent internal consistency, with Cronbach’s a = 0.96 at post-treatment, consistent
with prior research.)
A mixed factorial analysis of variance (ANOVA) was performed to examine whether partici-
pants in the treatment versus control group exhibited differential changes in their IIP-64 scores over
time. Overall, there was a main effect of assessment time, such that participants had lower IIP-64
scores at the post-treatment assessment (M = 1.20, SD = 0.63) as compared to the pre-treatment
assessment (M = 1.45, SD = 0.66), F(1, 42) = 13.074, p < 0.01, η2 = 0.237. The effect size indicates
that assessment time explained 23.7 percent of the variance in IIP-64 scores. This main effect is
qualified, however, by a significant interaction between experimental group and assessment time,
F(1, 42) = 18.35, p < 0.001, η2 = 0.304, such that participants in the ACT condition group exhib-
ited a significant decrease in IIP-64 scores from pre-treatment (M = 1.64, SD = 0.66) to
post-treatment (M = 1.09, SD = 0.62), t(21) = 5.41, p < 0.001, while control group scores did not
change significantly from pre-treatment (M = 1.27, SD = 0.62) to post-treatment (M = 1.31, SD =
0.64), t(21) = –0.486, p = 0.63, ns. Participants did not differ significantly on their IIP-64 scores by
group, F(1, 42) = 1.84, p = 0.67, ns, indicating that the two samples were matched on their levels of
maladaptive interpersonal functioning prior to treatment. The effect size of the interaction term
indicates that the interaction between treatment group and assessment explained 30.4 percent of
the variance in IIP-64 scores. This effect size can be considered quite large (J. Cohen, 1988), imply-
ing that the ACT treatment resulted in a large and potentially meaningful reduction of participants’
maladaptive interpersonal functioning, beyond the reduction in these behaviors in the control
group.
An independent samples t-test comparing the pre- and post-treatment IIP-64 score differences
between the two treatment groups supported the hypothesis that participants in the ACT treat-
ment group (MPost – MPre = –0.55) would exhibit a greater reduction in maladaptive interpersonal
functioning as compared to those in the control group (MPost – MPre = 0.05), t(42) = –4.28, p <
0.001, d = –1.23. The Cohen’s d represents quite a large effect size and indicates that the difference
between the mean scores for the treatment group is 1.23 standard deviation units larger than the
difference between the mean scores for the control group.
In sum, the main hypothesis was supported by the data from the IIP-64. Participants who com-
pleted a ten-week ACT treatment exhibited greater improvement in their interpersonal functioning
as compared to participants in the control group. Given prior research establishing empirical sup-
port for ACT treatment for a wide variety of psychological problems (see Ruiz, 2010), these results
are quite promising for the treatment of interpersonal problems, although caution must be used in
the interpretation of these data, given the small sample size.
Inventory of Personal Problems (IIP-64)

Scores Pre- and Post-Treatment
ACT + TAU TAU (control group)
M SD M SD
Pre-treatment 1.64 0.66 1.27 0.62
Post-treatment 1.09 0.62 1.31 0.64
Difference –0.55 0.48 0.05 0.44
Note: Negative difference scores indicate a reduction in problem behaviors from pre-treatment
to post-treatment.
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appendix C
Group Protocol
(Written with Koke Saavedra)
T
his appendix provides a complete protocol for conducting ACT for interpersonal problems
in a group setting over the course of ten ninety-minute sessions. The ideal group size is eight
to ten members. However, the protocol can easily be adapted to other group sizes and for-
mats. In addition, you may wish to adjust the amount of time devoted to different elements of each
session, depending on the needs of group members or the focus of the group.
A similar protocol has been tested and showed good results (see appendix B), although it must
be noted that the sample size in that study was relatively small. Still, given prior research establish-
ing empirical support for ACT treatment for a wide variety of psychological problems (Ruiz, 2010),
we feel that this protocol, if conducted with sensitivity and flexibility, will be beneficial for most
clients.
We’ve provided guidance on the amount of time to spend on each procedure in each session.
However, these are only rough guidelines. Depending on the group, you may need to devote more
or less time to particular procedures. If a session runs long and you can’t fit everything in, simply
cover the remaining elements in the next session. The last two sessions aren’t as full and therefore
provide flexibility at the end of the protocol.
Session 1
Session 1 begins with a brief mindfulness practice to help group members begin cultivating this
important skill. Most of the session is dedicated to psychoeducation about the ten schemas with the
greatest impact on interpersonal relationships and associated schema coping behaviors. The session
also includes whiteboard exercises to facilitate group discussion and exploration of these topics.
Procedures
1. Administer a pre-treatment assessment (such as the Young Schema Questionnaire; see
appendix A) and any outcome measures you’d like to use.
2. Guide the group in a mindfulness practice (Mindful Focusing or the Five Senses
Exercise; 5 minutes).
3. Provide psychoeducation on schemas (Ten Key Schemas handout; 20 minutes).
4. Conduct a whiteboard exercise exploring why schemas are so powerful (15 to 20

minutes).
5. Provide psychoeducation on typical schema coping behaviors (Ten Common Schema

Coping Behaviors handout and monster at a party metaphor; 20 minutes).
6. Conduct a whiteboard exercise exploring how schemas affect clients emotionally and
cognitively (20 minutes).
7. Assign homework (5 minutes).
1. Administer a Pre-Treatment Assessment

Have clients fill out a schema questionnaire before the session. (We recommend the Young
Schema Questionnaire, which you can purchase at schematherapy.com; see appendix A for an
example.) The schema questionnaire is used to identify members’ schemas, not as an assessment
measure. The purpose is to identify which schemas are most salient for each member. Group mem-
bers can then choose which schemas resonate with them the most and which they would like to
focus on. Also administer any outcome measures you’d like to use, such as the Valued Living
Questionnaire (VLQ; Wilson, Sandoz, Kitchens, & Roberts, 2010), the Automatic Thoughts
Questionnaire (ATQ; Hollon & Kendall, 1980), the Acceptance and Action Questionnaire–II
(AAQ-II; Bond et al., 2011), or the Inventory of Interpersonal Problems (IIP-64; Horowitz et al.,
2000).
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Group Protocol
2. Lead a Mindfulness Practice

Guide the group in a brief mindfulness practice: either Mindful Focusing or the Five Senses
Exercise (see chapter 4).
3. Provide Psychoeducation on Schemas

Give the group members their results from the schema questionnaire you administered, along
with the handout Ten Key Schemas. Have members circle the three schemas where they scored
highest and ask them whether these schemas seem to correlate with their experience. Then discuss
the concept of schemas and how they arise. Here’s a script showing how you might do so:
A maladaptive schema is essentially a belief about yourself and your relationship to the world. It
creates a feeling that something is wrong with you, your relationships, or the world at large.
Schemas are formed in childhood and develop as a result of ongoing dysfunctional experiences with
parents, siblings, and peers during childhood, and they continue to grow as children try to make
sense of their experience and avoid further pain. Schemas come from repeated toxic messages that
we get about ourselves from our early experiences, such as “You’re bad” or “You can’t do anything
right,” or from specific traumatic events. Once a schema is formed, it’s extremely stable and
becomes an enduring pattern that is repeated throughout your life.
Schemas are like sunglasses that distort all of your experiences. They color the way you see
things, and they make assumptions and predictions that tell you the schema is true or will turn out
to be true. Schemas formed during childhood are triggered repeatedly throughout your adult life.
Common triggers include stressful interpersonal events and difficult thoughts and feelings. Once a
schema is triggered, it brings up powerful automatic thoughts and feelings about yourself that can
lead to depression, panic, loneliness, anger, conflict, inadequate work performance, addiction, and
poor decision making. Schemas interfere with the ability to feel safe in relationships, to get your
needs met, and to meet the needs of others.
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Ten Key Schemas

Psychologist Jeffrey Young has identified eighteen early maladaptive schemas. Ten of these schemas
have significant relevance to interpersonal relationships. A schema is a core belief. Core beliefs
define who we are and direct how we live our lives. They create the internal monologue that charac-
terizes the thoughts, assumptions, and interpretations that inform each person’s individual worldview.
When a schema is activated, it produces intense emotions. Identifying your schemas and examining
how they impact your life and your interactions with others is essential to making positive changes
in your relationships. Study this list of the ten schemas relevant to problems in interpersonal rela-
tionships and keep it handy so you can identify which schemas are affecting your interactions:
• Abandonment and instability: the belief that significant people in your life are unstable
or unreliable
• Mistrust and abuse: the expectation that you will be harmed through abuse or neglect
• Emotional deprivation: the expectation that your needs for emotional support won’t be
met, which may take several forms:
• Deprivation of nurturance: the absence of attention
• Deprivation of empathy: the absence of understanding
• Deprivation of protection: the absence of guidance
• Defectiveness and shame: the belief that you are defective, inferior, or unlovable
• Social isolation and alienation: the belief that you don’t belong to a group, are isolated,
or are radically different from others
• Dependence and incompetence: the belief that you are incapable or helpless and require
significant assistance from others, that you cannot survive without a certain person, or
both
• Failure: the belief that you are inadequate or incompetent and will ultimately fail
• Entitlement: the belief that you deserve privileges and are superior to others
• Subjugation: voluntarily meeting the needs of others at the expense of your own needs,
submitting to others to avoid real or perceived consequences, or surrendering control to
others due to real or perceived coercion
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Group Protocol
• Unrelenting standards and hypercriticalness: the belief that you must meet very high
internalized standards to avoid criticism, leading to impairment in areas of life such as
pleasure, health, and satisfying relationships
4. Explore Why Schemas Are So Powerful

Discuss clients’ specific schemas and what makes them so powerful and hard to change. List
ideas from the group on the whiteboard. Possible reasons include the power of core beliefs, how
intractable old habits can be, that schemas predict the future and therefore help us feel safe, that
schemas are self-perpetuating, that they are experienced as truths about ourselves, or that they
bring up a lot of strong emotions and thoughts.
5. Provide Psychoeducation on Schema Coping Behaviors

Take some time to explain schema coping behaviors (SCBs), perhaps starting with the meta-
phor of a popcorn machine to illuminate how thoughts are generated spontaneously and
continuously:
The mind is a popcorn machine, eternally popping up thoughts and judgments connected to our
schemas and pulling us to use old, habitual ways of responding to the associated pain. When a
schema is triggered, we tend to respond with behaviors that attempt to control or block the pain
connected to the schema. I’ll refer to these as schema coping behaviors. Once a schema is triggered,
we want desperately to get rid of the thoughts and feelings that come with it, such as shame, fear,
rejection, or hurt. We tend to use one or more of three broad strategies to attempt to get rid of our
schema-related pain: attack, surrender, and avoidance. Here’s a handout that outlines ten com-
mon schema coping behaviors that tend to be most damaging to relationships.
Give group members the handout Ten Common Schema Coping Behaviors (based on Young et
al., 2003). After reviewing these common coping behaviors, begin to address the costs of these
behaviors, along with the importance of willingness to have difficult private experiences that come
up when engaging in valued actions.
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Ten Common Schema Coping Behaviors

Overcompensation
• Aggression or hostility: If you use this coping behavior in response to a schema-triggering
event, you’ll find yourself counterattacking by blaming, criticizing, challenging, or being
resistant.
• Dominance or excessive self-assertion: If you use this coping behavior in response to a

schema-triggering event, you’ll find yourself trying to control others in order to accom-
plish your goals.
• Recognition seeking or status seeking: If you use this coping behavior in response to a
schema-triggering event, you’ll find yourself overcompensating by trying to impress oth-
ers and get attention through high achievement and status.
• Manipulation or exploitation: If you use this coping behavior in response to a schema-

triggering event, you’ll find yourself trying to meet your own needs without letting
others know what you’re doing. This may involve the use of seduction or not being com-
pletely truthful to others.
• Passive-aggressiveness or rebellion: If you use this coping behavior in response to a

schema-triggering event, you’ll appear to be compliant but will rebel by procrastinating,
complaining, being tardy, pouting, or performing poorly.
Surrender
• Compliance or dependence: If you use this coping behavior in response to a schema-
triggering event, you’ll find yourself relying on others, giving in, being dependent,
behaving passively, avoiding conflict, and trying to please others.
Avoidance
• Social withdrawal or excessive autonomy: If you use this coping behavior in response to
a schema-triggering event, you’ll find yourself isolating socially, disconnecting, and with-
drawing from others. You may appear to be excessively independent and self-reliant, or
you may engage in solitary activities such as reading, watching TV, computer use, or soli-
tary work.
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Group Protocol
• Compulsive stimulation seeking: If you use this coping behavior in response to a schema-
triggering event, you’ll find yourself seeking excitement or distraction through
compulsive shopping, sex, gambling, risk taking, or physical activity.
• Addictive self-soothing: If you use this coping behavior in response to a schema-

triggering event, you’ll find yourself seeking excitement with drugs, alcohol, food, or
excessive self-stimulation.
• Psychological withdrawal: If you use this coping behavior in response to a schema-

triggering event, you’ll find yourself escaping through dissociation, denial, fantasy, or
other internal forms of withdrawal.
The metaphor of a monster at a party (similar to Joe the Bum in Hayes et al., 1999) can be use-
ful here. When working with this metaphor, invite group members to think about their own coping
behaviors and share what they would do at the party if their schema was activated. This metaphor
is intended to be used interactively, not just as a didactic device:
To give an example of how the thoughts and feelings that come with a schema can cause you to
use unhelpful coping strategies, and to help you understand how your struggle to avoid the pain of
a schema may lead you to behave in a way that actually exacerbates the schema, think of schemas
as loud, obnoxious monsters. Imagine that you’re throwing a party—the biggest party you’ve ever
hosted, and you’re extremely excited about it. You send out invitations saying that everyone is
invited to the party.
This party is extremely important for you. You want it to be a huge success. So, not surpris-
ingly, your failure schema shows up at the party and tells you, “This party is horrible. The guests
aren’t going to enjoy themselves. No one will want to come to any of your parties again. The food
is terrible. The music is terrible. You can’t get anything right. People look bored.” You try to get rid
of your failure schema. You try to close the door in his face, but he pushes his way in. You try to
wrestle him out the door, but he fights back and the two of you make a huge commotion. And the
more you fight, the less your guests are enjoying themselves.
You might try to disprove your failure schema by seeking reassurance and asking everybody at
the party if they’re having a good time, if they’re bored, if they like the music, if they need anything,
if the food is okay. You might try to avoid your failure schema by withdrawing or keeping busy with
trying to make sure everything is perfect. You might buy into your failure schema’s ideas that people
are having a bad time and behave in a defensive or attacking way, saying things to your guests like
“You never enjoy my parties. You never dance at any of my parties. You always complain about
my cooking. I wouldn’t do this at one of your parties.” You might decide to surrender completely,
isolating yourself in your bedroom and giving up on the whole party.
You wanted to have a good time at the party, but you’re so preoccupied with avoiding your
schema and trying to get rid of him that you haven’t been able to enjoy yourself. But what if this
137
schema-related pain is unavoidable? What if it will always show up under certain circumstances?
What if every time you try to do something that’s important to you, like pull your life together, go
to a job interview, have a loving relationship, or throw a fantastic party, this pain is going to show
up? Could you be willing to allow your schema of failure, defectiveness, abandonment, or what-
ever to simply be there as you do something you value, like being present for and enjoying your
party? Could you be willing to have all of the feelings and thoughts that come with your schema
and still be engaged and present at the party without struggling against it? Would you be willing to
learn to relate to your schema in a different way—maybe invite him in, keep some distance from
him, observe him, and know that you can choose whether or not to let him impact your behavior?
Can you recall a time when schema thoughts and feelings tried to stop you from doing something
important, but you did it anyway?
6. Explore How Schemas Affect Clients Emotionally and Cognitively

Guide the group in exploring how schemas affect them emotionally and cognitively. What emo-
tions and thoughts typically accompany each schema? List the ten key schemas on the whiteboard
and have group members identify thoughts and feelings that come up when particular schemas are
activated. List the relevant emotions and thoughts next to each schema. Using the handout Ten
Common Schema Coping Behaviors, have group members identify the schema coping strategies
they most often use to avoid their schema-related pain. Explore the outcome of using a particular
schema coping behavior when a schema is triggered.
7. Assign Homework
Educate group members about the importance of following through with homework assign-
ments and explain that homework is a core mechanism for promoting change and making progress
in therapy. Homework provides clients with an opportunity to practice new skills in their relation-
ships and explore workability. Then assign the following homework to group members to be practiced
throughout the week:
• Ask clients to notice when schemas are triggered and identify which schema has been
activated. Have them observe what happened to trigger the schema and note any reac-
tions or urges to react.
• Do at least three minutes of Mindful Focusing every day.
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Group Protocol
Session 2
Session 2 also begins with a brief mindfulness practice to help group members continue cultivating
this skill. The focus of this session is on cultivating creative hopelessness (Hayes et al., 1999). This
is accomplished by examining group members’ typical schema coping behaviors and assessing their
costs and effectiveness. In addition, by exploring their schema triggers and schema-related thoughts,
feelings, and coping behaviors, clients are also developing more awareness of signals that can alert
them to when their schemas have been triggered, which can eventually lead to responding to these
events more mindfully.
Procedures
2. Review group members’ experiences with the homework from session 1 (15 to 20
minutes).
3. Explore schema triggers, coping behaviors, and outcomes through a whiteboard exer-
cise (Schema Triggers, Thoughts, Feelings, and Coping Behaviors Worksheet; 40
minutes).
4. Conduct a whiteboard exercise exploring creative hopelessness (20 minutes).

1. Guide the group in a brief mindfulness practice: either Mindful Focusing or the Five Senses
2. Review Homework
Ask group members to share what they noticed when their schemas were triggered over the past
week.
139
3. Explore Schema Triggers, Coping Behaviors, and Outcomes

Briefly review what schema coping behaviors are, then explain how they arise:
As we talked about in the previous session, schema coping behaviors are responses aimed at block-
ing or controlling schema-related pain. These coping behaviors may offer temporary relief in the
moment, but in the long run they contribute to the schema, make it feel more true, and actually
increase schema-related emotional pain.
You may wonder where these unhelpful behaviors come from. We learn them by watching our
parents and other family members deal with pain. Dad may have gotten angry and gone on the
attack when he was hurt. Mom may have collapsed and given up. A sister may have withdrawn
in her bedroom. A brother may have started to drink.
In addition, sometimes we come up with schema coping behaviors on our own. When a
schema is triggered, we may stumble upon a way of responding that feels like it offers some relief
from the emotional pain. Because it seems to work, at least temporarily, we stick with it, doing the
same thing again and again in similar situations.
The trouble with schema coping behaviors is that they tend to hurt other people, relationships,
and, ultimately, the person who’s using them. Our relationships stop feeling good to the people who
are important to us. After a while they may give up on us or harden and withdraw. So, although
schema coping behaviors may offer some temporary relief, in the long run they make us feel worse
about ourselves—and may cause us to lose people we love.
Introduce the six domains of interpersonal relationships: work, friends, family, intimate rela-
tionships, parenting, and community. Then hand out the Schema Triggers, Thoughts, Feelings, and
Coping Behaviors Worksheet.
Ask group members to think of the schema that most affects them and then write it at the top
of the worksheet. Alternatively, you can have them write down different schemas for various
domains. For example in the work domain, a failure schema may be most relevant, and for intimate
relationships, abandonment may be a bigger issue. Next, ask them to consider what triggers the
schema in each relevant domain of relationships. Spend a few minutes discussing such triggers as
criticism, anger, withdrawal, and demands from others, and feeling close, vulnerable, or jealous.
Work with one group member to list his or her triggers in each relevant domain on the whiteboard
and have the other group members list their own triggers on their worksheets as you do so.
Have group members recall incidents when their schemas were triggered, then ask them to try
to identify thoughts and feelings that tend to be connected with particular schemas. Help them get
very specific and come up with as many thoughts and feelings as they can, then have them list those
thoughts and feelings on the worksheet.
Next, explore schema coping behaviors with a few questions:
When your schema gets triggered, what do you do? For example, if you have a defectiveness
schema, how do you cope when you get criticized? What do you do to deal with the shame or hurt?
140
Schema Triggers, Thoughts, Feelings, and Coping Behaviors Worksheet
Domain Schema Triggers Schema thoughts Schema feelings Schema coping
behaviors
Work
Friends
Family
Intimate
relationships
Parenting
Community
Group Protocol
141
Again, work with one group member and list his or her coping behaviors on the whiteboard and
have the other group members list their own schema coping behaviors on their worksheets as you
do so. Discuss what happens when they use an SCB and how this is working for them. Get specific
by exploring the outcomes of one group member’s schema coping behaviors in a particular relation-
ship. Long-term, did the relationship get better or worse? Long-term, did the client feel better or
worse? Explore schema maintenance and the way the coping behaviors maintain, contribute to, and
exacerbate the schema-related pain. For example, you might point out that the more we attempt to
avoid being abandoned by using such coping behaviors as getting suspicious, accusing, and blaming,
the more likely we are to actually get abandoned, which maintains the abandonment schema.
4. Explore Creative Hopelessness

Use the coping behaviors group members identified on the Schema Triggers, Thoughts, Feelings,
and Coping Behaviors Worksheet to begin working with creative hopelessness. This key ACT strat-
egy is very effective but also challenging, so provide motivation by exploring how effective old
strategies have been in reducing schema-related pain in the long run:
Let’s write down all of the behaviors that you’ve tried in an effort to get rid of the painful feelings
that come with schemas. Since many of you have identified a failure schema, let’s use that for this
exercise. What strategies have you used to try to avoid feelings of defectiveness, fear, hopelessness,
lack of self-worth, inadequacy, anxiety, and so on?
As you list strategies on the whiteboard, explore whether any of these techniques have been
successful in permanently eliminating the pain. Continue exploring this and writing down avoidant
behaviors to get to the underlying control strategies that group members have used to avoid schema-
related pain:
So here are all of these strategies that you’ve been using to avoid this deep pain. But what I’m hear-
ing is that none of them have actually worked to get rid of it in the long run. You might feel a little
relief in the moment, but over time, the pain gets worse. You’ve put in so much effort, and for so
long, but that pain still comes back. You’ve tried so many different strategies to avoid this pain, and
yet the problem still remains. The struggle is still there; the pain still shows up.
What if this pain is unavoidable? What if this schema-related pain is never going to go away?
What if it’s in you? Maybe the answer isn’t getting rid of this pain. What if the answer lies in the
pain itself? What if this familiar pain is going to have a tendency to show up whenever you take a
step toward something meaningful in your relationships? Maybe the answer lies in relating to this
pain in a different way: observing your schema, being curious about it, and being willing to have it
come up when you’re about to do something important and meaningful.
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Group Protocol
What do we have control over? What can we change? Can we change our schemas and the
thoughts and feelings that come up when they’re activated? Can we change our schema coping
behaviors?
5. Assign Homework
Assign the following homework to be practiced throughout the week:
• Ask clients to watch for moments when schemas are triggered, notice coping behaviors,
and assess their outcomes.
• They should do at least ten minutes of Mindful Focusing every day.
143
Session 3
As in sessions 1 and 2, begin with a brief mindfulness exercise. This session continues the work of
exploring the outcomes of old coping behaviors to establish that they aren’t helpful in the long run.
This work helps group members arrive at creative hopelessness, which must occur before proceeding
further with therapy, as it sets the stage for trying something new.
Procedures
2. Review group members’ experiences with the homework from session 2 (15 to 20
minutes).
3. Explore the costs of schema coping behaviors through a whiteboard exercise (Schema
Coping Behavior Outcomes Worksheet; 30 minutes).
4. Discuss creative hopelessness and use such metaphors as quicksand and digging a hole
to help group members grasp this key concept (20 minutes).
5. Help group members stop the struggle for control using a visualization based on a
metaphor of the sky and the weather (10 minutes).

2. Review Homework
Ask group members to share moments over the past week when their schemas were triggered
and to describe how they reacted.
144
Schema Coping Behavior Outcomes Worksheet
Domain Schema coping behavior Outcomes
Work
Friends
Family
Intimate
relationships
Parenting
Community
Group Protocol
145
3. Explore the Costs of Schema Coping Behaviors

Hand out the Schema Coping Behavior Outcomes Worksheet and ask group members to fill in
what happens in each relevant domain when they use their typical coping behaviors, with a focus
on the main outcomes. Explain that the outcome of a coping behavior is the effect it has on a par-
ticular relationship and the other person in that relationship. Ask clients to consider how the
relationship changes as a result of using that coping behavior.
Work with one group member to list his or her outcomes on the whiteboard and have the other
group members fill out their own worksheets as you do so. Maintain a running inquiry with the
group member you’re working with directly, asking about his or her sense of whether each outcome
was positive or negative. This discussion can help group members see how maladaptive coping
behaviors often exacerbate schemas, schema- related feelings, and, ultimately, interpersonal
problems.
4. Discuss Creative Hopelessness

Understanding the costs of maladaptive behaviors sets the stage for creative hopelessness—a
painful but pivotal point where group members discover new solutions and commit to new, values-
based behaviors. Begin by asking the group to acknowledge the costs. After they’ve responded,
introduce the term “creative hopelessness” and suggest that the solution lies in accepting and facing
their pain:
Most of your efforts with these old ways of coping with schemas seem to result in more pain—for
you and the people you love. Is this true?
Creative hopelessness is the realization that everything you’ve done to control and to minimize
schema-related pain hasn’t worked, and that, if anything, these efforts have made the pain worse.
Now that you know your old coping behaviors have created more pain, you can think about alter-
native solutions. If running from and avoiding schema-related pain hasn’t worked, perhaps the
answer is to stop running. Perhaps the answer lies in the pain itself. What if facing and accepting
the fear, shame, or hurt connected to your schemas is the answer?
Group members may remain attached to avoidance as a strategy or have difficulty accepting the
basic premise that avoidance only leads to more pain. You might try to explain this dynamic
didactically:
The problem with struggling with our thoughts and feelings is that the more we struggle, the stron-
ger these thoughts and feelings become. The more we try to avoid pain, the stronger the pain
becomes.
146
Group Protocol
Metaphors can be useful here. Use the quicksand metaphor (Hayes & Smith, 2005) and possibly
also the metaphor of digging a hole (Hayes et al., 1999), both described in chapter 4, to illustrate
the concept. After presenting the metaphors, explore group members’ thoughts as follows and list
their responses on the whiteboard:
What are the costs of struggling in quicksand and trying to make painful thoughts and feelings go
away? What are the interpersonal and emotional costs?
5. Help Group Members Stop the Struggle for Control

The simple yet profound metaphor of how the sky holds the weather (Harris, 2009) can help
group members see that painful experiences are transitory, which can help them let go of the strug-
gle to control their experience. It can also open the door to developing the observer-self perspective.
Here’s a script for a visualization based on the metaphor of the sky and the weather:
So, if struggling and trying to control your thoughts, feelings, and internal experiences doesn’t
work, what can you do? I’d like to guide you in a visualization that will help you see how you can
relate to them differently. If you’re willing, close your eyes, then pay close attention to your breath,
feeling the air going in and out of your nostrils. Feel your feet on the floor. Get in touch with where
you are right now, in this moment.
Now imagine that you are the sky. The sky is always there, holding the constantly changing
weather. The weather is sometimes cloudy and dark, sometimes snowy, sometimes rainy, and
sometimes sunny, with a gentle breeze and fluffy white clouds. As wind, storms, rain, and sun-
shine come and go, the sky is always there, just receiving each change of weather with perfect
willingness. The sky isn’t invested in what the weather should be. Difficult thoughts and emotions
also come and go, just like sunny and cloudy days.
Having different weather is necessary in life. You wouldn’t take the same delight in a beautiful
sunny day if every day was bright and blue. We need rain to supply water. Similarly, we need our
pain to let us know when we’re off track or have lost sight of what’s important.
Do you think you could just observe and have all of your weather, without trying to change or
struggle with it? Could you simply observe the sensations in your body, the thoughts going through
your head, and your emotions? Sometimes you’re sad, and sometimes you’re happy. Sometimes
you’re insecure, and sometimes you’re confident. Would you be willing to just notice all of your
experiences as they unfold, moment by moment?
Being the sky is like being an observer of your experience. The observer self is clear and bound-
less and always willing to simply hold passing experiences, just like the sky. The observer self is a
place from which you can have all of your experiences without resisting or wrestling with them. It’s
also a place from which you can choose actions that are consistent with the kind of person you
want to be in your relationships.
147
To the observer self, thoughts and emotions are like the weather, ever passing, ever changing.
Difficult thoughts and emotions, including those triggered by your schemas, are like terrible, scary
storms with thunder, lightning, and howling wind. Eventually, the storm quiets and the air clears.
There are storms in the sky. That’s unavoidable; it’s just part of the weather. When we learn to
stop struggling with our weather and instead simply observe it mindfully, we can begin to notice
that painful thoughts and emotions come and go, just like the weather in the sky.
6. Assign Homework
• Ask group members to watch for their two most powerful schemas throughout the next
week, watching for them in conversations and other interactions. Remind them that
painful emotions, such as anger, sadness, or shame, can serve as red flags that their
schemas have been activated. As they watch their experience, have them notice the
moment when they’re tempted to use old coping behaviors. Identify this as “the moment
of choice”: the point where they have the option to do something different, even if they
aren’t yet able to do so.
• Have them do at least ten minutes of Mindful Focusing every day.
148
Group Protocol
Session 4
Once again, begin with a brief mindfulness exercise to help group members continue to develop this
skill. In this session, the focus turns to values. Various worksheets and exercises are employed to
help group members clarify their values, develop values-based intentions, and identify barriers to
valued action. A role play based on the metaphor of monsters on the bus (Hayes & Smith, 2005) is
used to help group members find new ways of relating to perceived barriers.
Procedures
2. Review group members’ experiences with the homework from session 3 (10 minutes).
3. Provide psychoeducation on values (10 to 15 minutes).
4. Assist group members in clarifying values and identifying valued intentions (Valued
Intentions Worksheet; 25 to 30 minutes).
5. Explore obstacles to valued action (Assessing Barriers Worksheet; 15 to 20 minutes).
6. Conduct a role-playing experiential exercise based on the monsters on the bus meta-
phor (10 to 15 minutes).

2. Review Homework
Ask group members to share their experience in watching for the moment of choice. Ask
whether they were able to notice when their schemas were activated and any associated urges to
engage in old coping behaviors. Also ask whether they were able to identify this as the moment of
choice.
149
3. Provide Psychoeducation on Values

Before beginning the work of clarifying values and identifying values-based intentions, explain
values from the ACT perspective. Be sure to address that values are freely chosen and personal and
to establish the distinction between values and goals. Here’s a sample script (based on Vuille,
2006b):
As we’ve discussed in previous sessions, problematic old coping behaviors are having a big impact
on your relationships. But it doesn’t have to be that way. There are ways you’d rather be and rather
act—ways based on deep values—that could make your relationships feel much better. Choosing
the direction you want to go in your life is similar to being the director of the movie of your life,
except that you have limited control. You can only control the actor who’s playing your role in the
movie. You can choose how that actor responds, behaves, talks, and acts, but you can’t control any
of the other actors or the events taking place in the movie. But you can have the actor playing your
role behave exactly like the person you want to be—your own ideal version of yourself.
How would you want this actor to relate to others and behave in relationships? What this boils
down to is what you want to stand for. This is where you’ll find your deepest, most meaningful
values. As you start thinking about your values, there are a couple of things to keep in mind. The
first is that values are personal and must be authentic. Think about what really matters to you,
not what you think “should” matter, and not what you think other people believe you should value.
The second thing is that values are different from goals. Values are like a direction you want
to travel in, whereas goals are specific steps along the way. A value reflects how you want to be.
A goal, or intention, is a specific action you can take in the service of that value.
4. Clarify Values and Identify Valued Intentions

Next, hand out the Valued Intentions Worksheet, then introduce the six interpersonal domains.
To help group members identify their core values, you might ask them to think about their own
funeral or epitaph and how they’d like to be remembered (Hayes et al., 1999):
In today’s session, we’re going to explore your core values. To learn more about how you want to
be in your relationships, we’ll look at six domains of relationships: work relationships, friendships,
family relationships, partner relationships, parenting, and community relationships. For each
domain that’s relevant to you, identify at least one core value about how you’d like to be—how
you’d like to interact with others in those relationships. Imagine that you are at your own funeral;
imagine you are hearing your own eulogy. What would you like people to say about you? What
kind of person would you like to be? How would you want to be remembered?
150
Valued Intentions Worksheet
Domain Importance Value Intention Importance
(Rate 0–2) (Rate 1–10)
Work
Friends
Family
Intimate
relationships
Parenting
Community
151
Group Protocol
Working with one group member at the whiteboard to exemplify the process, ask group mem-
bers to assign a rating of importance to each domain using a scale of 0 to 2, where 0 means not
important, 1 means moderately important, and 2 means very important. Next, ask them to select
one of the domains with the highest rating to work on in this session. Then have them identify one
or two key values in regard to relationships in that domain. Explain that the group will continue to
work on values in all remaining sessions, so they’ll have a chance to work on other domains in
upcoming sessions.
The next step is to convert these general values into specific behavioral intentions, which are
essentially goals, as described above. For example, how, exactly, would a group member turn the
parenting value “giving my children the experience of being loved” into action? Specific intentions
might include “Spend ten minutes on Thursday night reading to them” or “Spend ten minutes
Thursday night asking them how their day went or how their friends are doing.” Generating specific
intentions allows group members to develop a targeted plan for behavioral change based on their
values. Explain that the group will also continue to work on valued intentions in all remaining ses-
sions, that you’ll ask them to identify and commit to one intention each week from this point
forward, and that therefore they need not begin with something highly challenging.
If time allows, you can have the group clarify values and identify valued intentions in several
domains. If group members have listed several intentions, ask them to rate the importance of their
each intention on a scale from 1 to 10, where 1 means it hardly matters and 10 means it’s of the
greatest importance. Before moving on, ask group members to select an intention that they are will-
ing to commit to acting on over the next week.
5. Explore Obstacles to Valued Action

Next, ask group members to envision acting on this intention. Hand out the Assessing Barriers
Worksheet. Work with one group member at the whiteboard and ask the rest of the group to fill out
the worksheet, listing potential barriers to acting on the intention they’ve committed to. What
emotions or thoughts might get in the way?
6. Role-Play the Monsters on the Bus Metaphor

As discussed in chapter 5, the monsters on the bus metaphor (Hayes & Smith, 2005) is an
excellent way to help clients work with barriers. In group therapy, you can have the group role-play
the metaphor. Have each member focus on the intention they committed to for the week and on
the barriers that show up for them regarding this intention. Ask one group member whether he or
she would be willing to come up to do an experiential role play, or ask for a volunteer. Begin to
describe the metaphor to this client, along these lines:
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Assessing Barriers Worksheet
Intention Emotional barrier Cognitive barrier
153
Group Protocol
Imagine that you’re a bus driver, and that the bus is your life. You want to steer toward your values
and the things that are important to you, but there monsters that try to stop or divert you. These
monsters are your barriers. They know your deepest insecurities and know exactly what to say to
stop you from going in the direction you want to go.
Ask six other group members whether they’d be willing to come forward and participate. Assign
each of the six a specific thought, feeling, or memory from the first member’s list of barriers, then
have them role-play the monsters while the first client attempts to drive toward her or his value.
Have these seven group members act out the scenario, with the first member trying to go toward
a specific intention as the monsters keep showing up in front of the bus. Ask the driver what he or
she would like to do about the monsters. Drivers will probably try a number of different strategies,
such as trying to run over the monsters, bargaining with them, and threatening them. As the role
play continues, help the driver see that these strategies aren’t working and haven’t been working.
Ask the driver what he or she might do differently. If the driver doesn’t come up with the option of
letting the monsters onto the bus, ask the group for suggestions. Typically, a group member will
eventually come up with this option. If no one in the group suggests the option of bringing the
monsters onto the bus, eventually suggest this as an option that allows for more freedom to travel in
valued directions.
7. Assign Homework
• Ask group members to commit to following through on one intention throughout the
next week. When schemas are activated and present barriers to acting on that inten-
tion, notice the moment of choice and persist in the valued behavior anyway.
• Have them do at least ten minutes of Mindful Focusing every day.
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Group Protocol
Session 5
Again, begin with a brief mindfulness exercise to help group members continue to develop this skill.
In this session, the focus turns to cognitive defusion. Metaphors are used to illustrate how schema-
related thoughts can serve as barriers to values-based action and how the mind is continuously
generating thoughts. The rest of the session is devoted to explaining specific defusion techniques
and practicing a few of them in session. Several of these techniques may also be helpful with emo-
tions and other private experiences.
Procedures
2. Review group members’ experiences with the homework from session 4 and set a new
intention for the coming week (Valued Intentions Worksheet; 15 to 20 minutes).
3. Provide psychoeducation on defusion (monsters on the bus and sales representative

metaphors and Assessing Barriers Worksheet; 10 to 15 minutes).
4. Teach specific defusion techniques (Defusion Skills handout; 10 to 15 minutes).
5. Have group members practice defusion techniques in session (visualization of putting

thoughts on clouds, objectifying, and role-playing a group member’s mind and schema
thoughts; 25 minutes).
6. Assign homework (5 to 15 minutes).

2. Review Homework
Ask group members to share their experience in following through on their valued intention.
Ask whether they were able to notice the moment of choice. Explore any barriers that came up and
brainstorm strategies to deal with those barriers, then have them set a new intention for the
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following week. For those who didn’t follow through, it’s best to continue working on the previously
identified intention unless they have determined that the intention doesn’t genuinely reflect their
values.
3. Provide Psychoeducation on Defusion

Begin by explaining that this session will continue the work of exploring values. Remind the
group that thoughts and feelings can function as barriers to valued action and that in order to
change how they interact with others, they may need to learn to relate to their internal experiences
differently. Use the monsters on the bus metaphor to explore the idea of relating to thoughts differ-
ently. The sales representative metaphor from chapter 6 (Vuille, 2006a) can also be helpful. Here’s
an example of how you can weave these two metaphors together to set the stage for defusion:
Let’s revisit that metaphor of monsters on the bus, from the end of the previous session. What do
you do when you’re driving your bus in a certain direction and those monsters pop up and try to
stop you or make you turn around? How can you relate to these monsters in a way that keeps you
in control of the direction you’re traveling? The human mind has a tendency to be full of these
monsters, and some of them are thoughts that keep popping up and trying to stop us from going
toward our destination. If you buy into these thoughts, they can become real barriers. But you can
also notice that they aren’t real monsters—that they’re just part of the same old schema thoughts
that the mind seems to be so fond of producing.
In a way, these thoughts are like sales representatives. They push their way in and try to sell
you a bunch of products that you really don’t want. Some of these thoughts are persistent and
relentless, and if you buy one product, they’ll continue throwing more and more products at you.
Some products aren’t very enticing and are easier to resist, but those schema-driven thoughts seem
so true that it’s hard not to buy into them.
So how can you relate to these sales representatives differently? Instead of buying the thoughts
they offer or trying to explain why you don’t want to buy them, you can let those pushy sales rep-
resentatives into your house, look at what they’re offering, and then say, “Thank you for all of
these products that you’re offering to sell me, but I’m not interested in buying any of them.”
Look at your Assessing Barriers Worksheet. Which of the schema-related thoughts that you
listed are really good sales representatives? Which of these thoughts do you buy often? Let’s practice
noticing what they’re trying to sell you, like “I’m never going to hold a job,” “If people really knew
me, they wouldn’t like me,” “People just use me,” or “I’m going to mess everything up.” Then thank
the sales representative for the offer and say you aren’t interested in buying that product.
Take some time to establish that the mind tends to generate thoughts near constantly and that
we have very little control over their frequency or content. The metaphor of the popcorn machine,
first introduced in session 1, can be helpful here:
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Group Protocol
Notice that many of the random thoughts your mind throws at you aren’t very helpful. Like those
monsters, they block your path. They keep you stuck by pulling you to use old coping strategies that
are ineffective or even damaging. Like we discussed before, the mind can be like a popcorn machine.
It’s constantly throwing thoughts at you, whether you like it or not. Stories, evaluations, reasons,
and judgments keep coming, and you can’t stop them, can you? So who’s in charge, you or your
mind? Can you stop your mind from popping thoughts? Can you choose the thoughts your mind
pops?
Thoughts include explanations for what’s going on, old stories about why things happened,
and problem solving to try to figure out how to eliminate pain. They also include judgment—lots
and lots of judgment. Notice that many of the reasons and explanations that your mind throws at
you are just stories that tell you your schemas are true and give you rules about how you can avoid
schema-related pain. So how can you relate to your mind differently? How can you gain some
distance from the thoughts that keep popping in your head? How can you free yourself from
schema-related thoughts? The answer lies in practicing observing your thoughts, as well as your
feelings, sensations, and urges, from a distance—disentangling from them and simply having them,
like the sky has the weather. Then you can notice them without struggling with them, which will
increase your ability to notice those moments of choice when you have the option to behave
differently.
4. Teach Specific Defusion Techniques

Give group members the Defusion Skills handout and briefly explain defusion:
This handout lists things that you can do to help you observe your thoughts from a little distance
without getting hooked into them or buying them, so that you can be in control of your destination
and the direction you’re steering your bus. These techniques are called defusion skills. “Defusion”
may seem like an odd word, and it is unusual. What it’s getting at is that these skills help you
become less fused or entangled with particular thoughts.
Briefly describe each technique using the handout and provide instruction in several of them.
If you’re unfamiliar with any of these techniques or would like more details, consult chapter 6,
which discusses many of them. (Also note that chapter 6 includes an alternative Defusion Skills
handout, which lists more skills and doesn’t provide descriptions of them. You can use whichever
version you prefer.)
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Defusion Skills
1. Naming the mind. Give your mind a name (other than your own name, of course!).
2. Scheduling a time to worry, obsess, ruminate, get angry, blame, and so on. An example
would be “I’ll put this aside for now and worry about what a failure I am at eight
o’clock tonight.”
3. Assigning descriptive labels to whatever passes through your mind. As you observe
your experience, you can simply acknowledge and label your internal experience with
broad terms like “thought,” “memory,” “desire,” “feeling,” “urge,” “regret,” “yearning,”
“image,” “impulse,” “wish,” “plan,” and “idea.”
4. Having (not being) your experiences. You can use the phrase “I’m having…” to help
you separate yourself from your experiences; for example, “I’m having the thought
that…” “I’m having the evaluation that…” “I’m having the sensation that…” “I’m hav-
ing the feeling that…” “I’m having a thought that is predicting…”
5. Labeling thoughts. When you notice specific thoughts, labeling them can help you let
them go; for example, “That was a ‘harsh’ thought,” “That was a ‘judgmental’ thought,”
That was a ‘prediction’ thought,” “That was a ‘fear’ thought,” or “That was a ‘self-
hating’ thought.”
6. Thanking your mind. Sometimes the mind will quiet down a bit if it feels it’s been
heard. Try thanking your mind for its sometimes not-so-helpful efforts to help you:
“Thank you, Mind, for that thought [judgment, prediction, memory, or whatever].”
You can even use the name you’ve come up with for your mind or say you aren’t inter-
ested at this time: “Thank you, Amanda, for that thought, but I don’t want to buy it
right now.”
7. Repeating the thought out loud in a silly voice. You can also sing thoughts.
8. Putting thoughts on clouds. You can visualize putting your thoughts on clouds and
then watching them drift away. Or you may prefer a different image, such as boxcars
on a train passing by, balloons floating away in the sky, or leaves being carried away on
a stream.
9. Objectifying, or thinking of thoughts as physical objects. Imagine what physical char-

acteristics your thought might have—size, color, texture, shape, density, consistency,
weight, flexibility, temperature, and so on. This technique is also very useful for disen-
tangling yourself from emotions and other internal experiences.
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Group Protocol
10. Physically letting go. As thoughts arrive, rotate your hand so your palm is facing down
and imagine the thought dropping out of sight.
11. Card carrying. In this defusion technique, you carry a card with you and write down
thought monsters as they come up. Then, whenever these painful cognitions recur,
you can remind yourself, “It’s on the card,” and let it go.
5. Practice Defusion in Session

After reviewing all of the techniques, practice a few of them in session. Putting thoughts on
clouds works well as a visualization and is a good place to begin. Here’s a script for guiding the group
in this visualization (Hayes, Strosahl, and Wilson, 1999):
Close your eyes and imagine that clouds in the sky are drifting past in front of you, one after
another. You’re simply sitting and watching the clouds floating by. Notice that this takes no effort
on your part. Your awareness, in which these clouds are floating, is very simple and effortless.
Now look at the thoughts arising in your mind. You might notice various images, concepts,
desires, hopes, fears, and more, all spontaneously arising in your awareness. They rise up, linger a
bit, and pass. All you need to do, if you are willing, is let your mind think whatever thoughts it is
already thinking and then put each thought or image on a cloud and watch it drift away. Simply
observe as your thoughts drift by, one after another. If you don’t like the image of clouds, you can
think of boxcars on a passing train, balloons floating into the sky, or leaves being carried away by
a stream. Whatever image you use, put your thoughts, memories, evaluations, judgments, and
predictions on them and just watch them flow away, one after another.
You can see the clouds float by because you are not those clouds; you are the witness of those
clouds. You can feel bodily feelings because you are not those feelings; you are the witness of those
feelings. You can see thoughts float by because you are not those thoughts; you are the witness of
those thoughts. Once you notice that your mind has tricked you and you’ve gotten caught up in
thoughts rather than putting them on clouds, congratulate yourself for noticing that, then just
continue putting your thoughts on the clouds and watching them flow past, one after another. If
you find yourself thinking, “This isn’t working,” “This is weird,” or “I’m not doing this right,” just
put that thought on a cloud too and watch it float past.
Objectifying, or assigning physical qualities to thoughts (or emotions or any other internal expe-
riences), lends itself to an in-session exercise. Start by asking one group member to focus on a typical
schema-driven feeling. Then ask him or her to imagine what physical characteristics this thought
would have if it were an object within the body. Ask about size, color, texture, shape, density, con-
sistency, weight, flexibility, temperature, and so on. Then say that you’re going to take the object out
of the person. Act this out and put the imaginary object in front of the group member and ask him
159
or her for any reactions to having this object standing in front of him or her. Then objectify this
reaction in the same way.
Once the group is familiar with the various defusion techniques, you can use a role-playing
exercise to have them practice choosing defusion techniques to use in the moment. Ask a group
member to list about six typical schema-driven thoughts and give them to you. Then play the role
of that person’s mind, throwing those thoughts at the person randomly. Have the person choose
defusion techniques from the handout in response to the thoughts. If the client gets stuck, ask other
group members to make suggestions. Here’s a dialogue showing how this might play out. In this
example, the client has given her mind the name Amanda:
Therapist: Don’t share your feelings with your boyfriend. If he really knew you he would
leave you.
Client: Thank you, Amanda, for that thought.
Therapist: He doesn’t get it. You don’t need him; just keep your distance and he won’t be able
to hurt you.
Client: I’m just going to notice that thought and put it on a cloud.
Therapist: He’s going to leave you and you’re never going to find anyone better than him.
Client: I’m having the thought that I’ll never find a better boyfriend than Bill.
Therapist: You need to think about how to keep him from leaving you. Call him and demand
that he explain himself. If you don’t think about this and figure it out, you’ll end up alone.
Client: Thank you, Amanda, for that thought. I’ll schedule a time to come back to it. I’ll
think about it tonight at eight o’clock.
Therapist: If you don’t think about this right now, you’re just going to continue to get
abandoned.
Client: I’m having the sensation of my heart beating really fast and the feeling of anxiety.
After demonstrating this approach in front of the group, have group members get into pairs to
continue practicing the exercise. In each pair, one client acts as the mind, reading from the other’s
list of cognitive barriers on the Assessing Barriers Worksheet, and the second client practices
responding with various defusion techniques. After about five minutes, have them switch roles.
Afterward, reconvene the group and have everyone explore their reactions to the exercise.
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Group Protocol
6. Assign Homework
• Ask group members to commit to following through on the valued intention identified
at the beginning of the session and to using cognitive defusion techniques from the
handout while engaging in committed actions.
• Ask that they do at least ten minutes of Mindful Focusing every day.
• Encourage group members to notice a thought that’s a pushy sales representative. What
are the consequences of believing this thought? What are the consequences of not
believing it? What are the pros and cons of believing this thought?
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Session 6
At this point, halfway through the ten-week protocol, group members have probably made signifi-
cant strides in mindfulness. Therefore, sessions 6 through 9 begin with a review of homework
(following through on committed actions) and setting a new intention for the coming week. Session
6 focuses primarily on defusion, and specifically on evaluations and negative self-labels. The session
concludes with a visualization to help group members begin to cultivate the observer- self
perspective.
Procedures
2. Provide psychoeducation on defusion, with a focus on evaluations versus descriptions

(evaluations as prison bars and describing versus evaluating a chair; 10 to 15
minutes).
3. Conduct an experiential exercise in evaluations versus descriptions (telling a story and

noting evaluations; 15 minutes).
4. Explore self-evaluations via discussion and a whiteboard exercise (self-evaluations

being mood dependent; 20 to 25 minutes).
5. Cultivate self-as-context with an experiential exercise and a visualization (chessboard

metaphor and worst self visualization; 15 minutes).
1. Review Homework
Explore any barriers that came up and brainstorm strategies to deal with those barriers, then have
them set a new intention for the following week. For those who didn’t follow through, it’s best to
continue working on the previously identified intention unless they have determined that the inten-
tion doesn’t genuinely reflect their values.
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Group Protocol
2. Provide Psychoeducation on Evaluations vs. Descriptions

Helping group members defuse from old stories and labels about themselves is essential to help-
ing them get some distance from their schemas. You can start by assisting them in distinguishing
between facts, which exist in the world and can be tested, versus evaluations, which are in us and
are based on our subjective reality.
Here’s a script (based on Ciarrochi & Bailey, 2008, and Hayes et al., 1999) for helping explain
the distinction between evaluations and descriptions. You’ll need to modify the description of the
chair to match a chair in the room that you use for the purposes of this discussion:
We’ve been exploring your values and looking at some of the thoughts and feelings that trigger your
schemas, as well as some of the thoughts and feelings that act as barriers and stop you from acting
on your values. A particularly problematic type of thoughts is evaluations. They can seem so pow-
erful, and even though they’re just opinions, they tend to feel real and true—so much so that they
can be like prison bars. But like all other types of thoughts, they are just products of the mind that
come and go. We can choose to buy into them and let them hold us back, or we can choose not to
buy into them so we can take steps in the directions we want to go. As with the monsters on the
bus, we can bring those thoughts with us to our destination. Thoughts, feelings, predictions, and
evaluations connected to our schemas aren’t real. They don’t exist in the external world; they are
inside of us. But when you try to take steps toward doing something that’s important to you, they
have a tendency to come up and seem very real, and that can stop you in your tracks.
Distinguishing between an evaluation and a description is crucial because the mind would
have us believe that our evaluations are actual descriptions. It is useful to notice this so we don’t
fall into that mind trap. Let’s take a look at what happens when we use language to evaluate.
Consider the question “Would you call this a good or a bad chair?” People might answer with
“This is a good chair,” “This is a bad chair,” or “This is a gorgeous chair.” These are evaluations,
but they sound just like descriptions of the chair—just like someone saying, “This is a wooden
chair,” “This is a brown chair,” or “This is a chair that doesn’t recline.” But can the evaluations
really be considered descriptions? Is “This is a good chair” the same type of statement as “This is
a wooden chair”? The mind would have you believe so.
Now, notice that if we were all to leave this room and there were no one here to evaluate the
chair, it would still be “a wooden chair,” “a brown chair,” and “a chair that doesn’t recline.” But it
won’t be “a good chair,” “a bad chair,” or “a gorgeous chair” anymore. Our evaluations are not
descriptions of the chair, or of any object or any person. Our evaluations are within us. If every-
body in the world were to die tomorrow, the chair would still be wooden and brown, but it
wouldn’t be good or bad. Because of how language works, the mind can obscure the difference
between an evaluation and a description. Both kinds of statements look the same: “This is a such-
and-such chair.” But if “good” and “bad” are seen for what they are—mere evaluations, and not
descriptions as the mind says they are—that makes a huge difference. Evaluations aren’t real, like
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a color, wood, or the mechanics of the chair. They’re just ideas or opinions that exist in the mind.
We don’t have to let them control our behaviors. They are just thoughts.
3. Conduct an Experiential Exercise in Evaluations vs. Descriptions

Explain that everyone tends to engage in evaluation much of the time; this is just how the mind
works. Then ask group members to pair up and sit across from each other. Explain that the task is
for one person in each pair to tell a story—perhaps about a recent event or interaction—for three
minutes. When the other person notices an evaluation, he or she is simply to label it, saying only
“evaluation” in a neutral, almost scientific tone. The only word the listener is allowed to say is
“evaluation.” The speaker is simply to continue talking, without changing the subject to the lis-
tener’s observations. The point is simply to gain some practice in noticing when evaluations are
occurring. After three minutes, have speaker and listener switch roles and repeat the exercise.
Afterward, have group members share their experience without analysis or interpretation. You
might ask something like “What was your experience of observing your evaluations?” Then point
out that group members can use a similar approach with their own evaluations and other thoughts,
as well as with physical sensations, emotions, and impulses. You can also highlight how the approach
in the experiential exercise is similar to some of the defusion techniques covered in session 5:
Notice that you can do the same thing with your own evaluations and other thoughts, as well as
with emotions, impulses, and physical sensations. You can say “emotion” when you notice an emo-
tion, or you can label specific emotions, saying, “That’s anger” or “That’s shame,” or simply
“sadness.” It’s like noticing what’s going on with the weather: “Oh, it’s raining” or “It’s warm.”
4. Explore Self-Evaluations
The work on evaluations helps set the stage for exploring self-evaluations. You can simply con-
tinue with the previous line of thought and describe applying defusion techniques to
self-evaluations:
If you notice a thought like “I’m an awful person,” you can name it for what it is using one of the
defusion techniques we talked about last time. You can even add a description to help distinguish
the evaluation. With “I’m an awful person,” you could first describe yourself, saying, “I am a per-
son,” and then add “and I am having the evaluation that I am awful.” This sounds a bit weird, but
that’s the point. Because it’s odd, it disrupts the normal language conditions that the mind uses to
trick us. So if you notice that you’re evaluating yourself or what you’re doing, or even evaluating
your evaluations, simply note that your mind has tricked you once again and say, “Oh, there’s an
evaluation,” one more time.
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Group Protocol
Take some time to explain why self-evaluations are a particularly problematic type of thought:
Evaluations about ourselves are especially dangerous because they can turn into labels about our-
selves, who we are, and how we “should” be. We start putting ourselves in boxes that limit our
choices. Sometimes our labels and self-evaluations come from stories others have told us regarding
who we are and how we should be.
And while some of our self-evaluations are positive, like “I’m a good student,” “I’m intelligent,”
“I’m beautiful,” or “I’m funny,” some of them are really negative, like “I’m ugly,” “I’m stupid,” “I
always fail,” or “People always leave me.” These labels can then lead to rules aimed at maintaining
our image of ourselves—rules that tell us how we “should” behave or interact with others. But the
truth is, our sense of self and the stories we tell ourselves about ourselves are constantly changing.
Depending on your mood or the day, you may choose to buy into different stories and labels about
yourself.
Use this explanation to lead into a whiteboard exercise exploring how group members’ self-
evaluations vary depending on the context. Start by asking the group to give examples of their
typical self-evaluations when they’re in a great mood or feeling at their best. List a number of these,
then ask for examples of their typical self-evaluations when they’re in a bad mood or feeling at their
worst.
5. Cultivate Self-as-Context
Work on defusing from self-evaluations overlaps and leads naturally to cultivating self-as-
context, or the observer self. An experiential exercise using the metaphor of a chessboard (and an
actual chessboard) can be useful here (Hayes et al., 1999). Ask for a volunteer to come up and do
the exercise. Have the volunteer list ten positive self-evaluations on one piece of paper and ten nega-
tive self-evaluations on another. Keep the list of negative self-evaluations and give the positive list
to the volunteer. Sit facing the volunteer with the chessboard between you, then begin putting
pieces on the board, alternating between the two of you and stating one of the labels out loud each
time.
Once all of the pieces have been placed, suggest that the person isn’t any of the pieces, or even
either of the players. Help the volunteer arrive at the realization that he or she can be the chess-
board, in contact with thoughts, feelings, and other internal experiences without being them. Here’s
an example of how you might do so:
Some of these pieces are good, and some are very painful. We humans struggle to get rid of all these
painful thoughts and feelings that show up when our schemas are activated. There are moments
when you feel insecure, and moments when you feel very confident; moments when you feel com-
petent, and moments when you feel like a failure. There are moments when you feel awkward, and
moments when you feel real and genuine. But what if you weren’t these chess pieces? What if you
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weren’t either the good pieces or the bad pieces? Is there anything you could be besides these chess
pieces? (This isn’t a rhetorical question; elicit a response from the client.)
If you were a player, you could try to move these pieces around in an effort to win, but that
doesn’t change anything; the player is still caught in the game and invested in whether the good or
bad thoughts and feelings win. The games just go on and on. Sometimes the good pieces win,
sometimes the bad. Can you think of anything else you might be other than the pieces or the player?
(Again, elicit a response.)
Here’s an idea: What if you were the board? That way you could have the pieces but not be
the pieces. The board is in contact with the pieces. It’s aware of the pieces and experiences the
pieces. But the board itself never changes, whether there are more black or white pieces and no
matter where they move. The board stays the same. It doesn’t care about the game or who wins or
loses. So from this space, the space of being the board, can you see how you can hold all of your
experiences, observing them and yet not being them?
Visualization can also be very useful for letting go of self-evaluations and cultivating the observer
self. You can guide the group in a visualization where they first think of a time when they behaved
as their “worst self” and did something they truly regret. Have them recall and observe specific
thoughts, feelings, and behaviors from that incident. Then guide them to see that the part of them-
selves that observes their “worst self” is distinct and separate from that self. Here’s a script for this
exercise (based on Ciarrochi & Bailey, 2008):
Close your eyes and take a few moments to notice your breath and the sensations in your body.
Now think back to a time when you were at your worst… Imagine, as vividly as you can,
being this “worst self”… Notice the feelings that push and pull at you. Notice how your “worst self”
thinks. Let yourself be aware of specific thoughts… See how your “worst self” behaves with others
and how far this is from your values.
Now notice that, within you, there’s somebody looking at this “worst self.” This is a self that
watches your “worst self” and witnesses everything it experiences. This part of you is the observer
self.
Even though your thoughts, feelings, urges, and sensations are continuously changing, there is
still a consistent you throughout. There is a you that can watch all of your experiences without
being those experiences or struggling with them. Just become aware of this person behind your eyes
who watches your “worst self.” Can you experience what it feels like to be the observer?
Now consider this: If you can observe your “worst self,” then you are not the same as that
“worst self.” If you can observe the thoughts and feelings connected to your worst self, then you
aren’t equivalent to those thoughts and feelings. You are the observer. Remember the chessboard?
You aren’t the pieces on either side, fighting all those battles. You aren’t your thoughts, feelings, and
sensations. You are the one who observes, notices, and holds all of these pieces.
Can you imagine that you are not your breathing and your body and its sensations, that you
are not your emotions or your thoughts? Many parts of you have changed over the years. You have
aged. Your appearance has changed. Your thoughts and feelings are constantly changing. But the
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Group Protocol
observer self has always been there, never changing. See if you can sense this deeper “you.” Think
of yourself as being like the sky, being an unchanging perspective from which you notice and hold
the ever-changing weather of your awareness. See if you can let go of your attachment to and
struggle with difficult emotions, thoughts, sensations, and impulses.
Now notice all of the experiences that have shown up today—particularly the difficult thoughts
and feelings of your “worst self.” And as you do, notice that you’re here now, watching all of it. See
if you can make space to be the observer right now. You are exactly who you should be. Nothing
needs to be changed. Nothing needs to be fixed.
6. Assign Homework
at the beginning of the session.
• Have them notice when evaluations occur, and then practice cognitive defusion tech-
niques with these thoughts.
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Session 7
Like session 6, session 7 begins by checking in on how group members did on following through on
their valued intention for the week and setting a new intention for the coming week. Sessions 5 and
6 focused primarily on cognitive defusion techniques, although these techniques may have been
applied to other internal experiences as well, including emotions. From this point forward, there
will be more emphasis on emotions and emotional exposure—facing the pain that comes up when
schemas are triggered. However, it’s essential to conduct exposure only with primary pain, which is
unavoidable and must be accepted, and not with secondary pain due to maladaptive schema coping
behaviors. Because anger shows up so often as a schema coping behavior, this session focuses on
anger so that the exposure work in sessions 8 and 9 can target the primary pain beneath the anger.
Procedures
2. Explore willingness via a discussion of the inevitability of pain and loss in relationships
(10 to 15 minutes).
3. Discuss anger as a coping strategy and explore the costs of anger (15 to 20 minutes).
4. Provide psychoeducation on anger (five stages of anger; 10 to 15 minutes).
5. Explore the costs of resentment (courtroom metaphor; 5 minutes).
6. Use a mindfulness practice and visualization to explore the moment of choice and let-
ting go of resentment (mindfully eating chocolate and visualizing a resented person;
15 minutes).
1. Review Homework
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Group Protocol
2. Explore Willingness
To help group members develop willingness to face emotional pain, begin by explaining that
emotional pain is unavoidable in important relationships:
All close relationships come with pain and loss. Schemas inevitably get triggered in these relation-
ships. You may feel hurt, rejected, or misunderstood. You may feel attacked, unappreciated, or
criticized. Opening up and being vulnerable in relationships comes at the risk of feeling these pain-
ful emotions. Never having to experience any of the pain connected to your schemas means being
alone in the world, without honest, authentic, and supportive relationships, whereas having caring,
loving, intimate relationships means sometimes having painful schema-driven thoughts and feel-
ings. If you had a choice, which would you choose? Would you be willing to experience the pain,
including disappointment, hurt, abandonment, rejection, and all of those other difficult feelings if
that would bring you closer to having authentic and meaningful relationships?
3. Discuss Anger as a Coping Strategy

As mentioned, anger is a common schema coping behavior; therefore, many group members
may struggle with this way of reacting. Because you must look beneath the anger to uncover the
hidden, avoided affect, the session now turns to exploring anger and developing alternative
responses. Here’s a script showing how you might address this topic:
One of the ways we cope when our schemas get activated in relationships is with anger and aggres-
sion. This is the fight-or-flight reaction at work. When you sense a threat, your body is wired to
either run and escape the situation or fight for survival. It’s a protective evolutionary mechanism,
and it’s useful when you’re actually in a life-threatening situation, but it usually doesn’t work very
well in close relationships. In relationships, running away or fighting back usually only makes the
situation worse. Plus, it often increases the likelihood that what you fear will actually come true.
Fighting may make others fight back; withdrawing may make them give up on the relationship.
When the fight-or-flight system is activated, the heart starts beating fast and pumping blood
harder to prepare us for action. Our thoughts, feelings, sensations, and urges are also caught up in
the fight-or-flight response. Everything seems urgent, and we feel highly reactive.
What kinds of thoughts do you have when you get angry? Typically, when we’re angry our
thoughts are more judgmental, hostile, suspicious, and fearful. Our fears are exaggerated and our
interpretations of other people’s actions and motives are skewed. The impulse to act can feel so
urgent that it may be difficult to take even a brief moment to evaluate the long-term consequences
and costs.
The experience of anger is kind of like having a tornado in your body pulling you to use old
coping behaviors to escape the terrible internal storm. Sometimes anger feels like a combination of
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forces, pushing and pulling in different directions. But what if there’s another way to deal with
these moments? What if you could simply notice the pull to engage in old coping behaviors to try
to escape the feelings and still make the choice to move in the direction of your values instead?
What if you could just stay with the storm and observe it like you would a storm in the sky: just
noticing the feelings, sensations, memories, images, and urges that come up? You may not be able
to control those feelings, just like we can’t control the weather. But you can remember that weather
comes and goes—that the storm will eventually pass—and that in the meanwhile you can choose
not to react in ways you’ll regret later.
Guide the group in a discussion of how using anger as a coping strategy has impacted their
relationships, the people they care about, and themselves. Here are some questions you might ask:
• Have you used anger to cope with other, more painful feelings?
• What kind of thoughts do you have when you get angry?
• Does buying into these thoughts bring you closer to or take you farther away from your
values?
• When you’ve used anger as a coping strategy in the past, what have the consequences been?
Are there benefits? Are there costs?
• When you get angry, are you moving closer to or farther away from your values?
• Can you be productive when you’re angry?
• Do you make good decisions in this mode?
4. Provide Psychoeducation on Anger

Provide psychoeducation to help group members understand anger, observe their experiences
with anger, and identify the moment of choice, when they have the option of responding differently.
Here’s an outline of the five stages of anger (Eifert, McKay, & Forsyth, 2006) and how you might
explain them:
1. Emotions prior to anger: Anger is usually preceded by a feeling like guilt, shame, anxiety,
or a sense of defectiveness or deprivation. These emotions are related to schemas, past experi-
ences, and assumptions about how you’re going to be treated. When you get angry, which
schemas have been activated? What emotions do you typically feel before getting angry?
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2. Anger trigger thoughts: Anger is often triggered by certain types of thoughts, such as judg-
ments about others, “shoulds,” memories, blaming thoughts, and suspicious thoughts. What
kinds of thoughts tend to trigger your anger?
3. Anger feelings: Once anger has been triggered, many other emotions arise, such as shame,
fear, feeling threatened, and feeling helpless, along with physical sensations like trembling
hands, rapid heartbeat, and rapid breathing. What feelings and sensations come up for you
when you get angry?
4. Impulses to act: The feelings associated with anger create an urge to act—often by engaging
in old, problematic schema coping behaviors and avoidance strategies. What do you feel an
impulse to do when you get angry?
5. Anger behavior: The final stage of an anger episode is what you actually do in that situation.
For many people, this means yelling, attacking, accusing, blaming, and so forth, which are all
schema coping behaviors. How have you behaved in the past when you got angry? What spe-
cific schema coping behaviors have you engaged in?
Next, engage the group in a discussion of these five stages and what they can control; in other
words, where they can find the moment of choice. Ask the following questions and allow group
members to discuss them:
Keeping in mind that we can’t control other people’s behaviors, what parts of the anger experience
can we actually control? Can we control our thoughts when we get angry—actually stop ourselves
from having certain thoughts? Can we control our feelings when we get angry? Can we control the
impulses that come up for us when we get angry? Which of these five stages of anger can we
control?
If group members don’t arrive at the correct answer (we can control our behaviors), remind
them of this before proceeding.
5. Explore the Costs of Resentment

Habitual anger tends to result in resentment, so this may be a significant issue for group mem-
bers. Because resentment (like schemas) is a long-term pattern of thinking about and relating to
others, letting go of it can be challenging. Much of the remainder of the session is devoted to help-
ing group members with this. Begin by discussing resentment. The metaphor of a courtroom can be
helpful here:
When we feel that another person has hurt or harmed us and can’t seem to let go of our anger, it
can build into a long-term pattern of resentment. With resentment, we end up hurting ourselves
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more than anyone else. When we become invested in getting others to feel and understand our pain
or to take responsibility for our pain, we tend to get stuck. Life becomes more about having others
feel bad about our pain and make up for that pain than about accepting and healing our pain. This
can hold us back from living the kind of life we want to live, as our lives become more about getting
revenge and gathering evidence against the person who has hurt us, rather than about taking steps
toward our values.
It’s like life turns into a courtroom, and the main goal is to prove the other person guilty—to
make sure the person is convicted of the crime and sentenced appropriately. We may devote our-
selves to carrying a briefcase of evidence everywhere we go and continue to add more and more
evidence. Eventually the briefcase becomes so heavy that it bogs us down. Attempts at punishing
others and making them feel the pain and suffering they’ve caused us ends up limiting our own
movement and choices. Being so invested in proving that they’ve wronged us ends up punishing us.
The question is, how can we move on and let go of our desire for the other person to get it?
How can we leave the briefcase of evidence at home, knowing that it’s still there, that the crime
hasn’t been dismissed or discounted, but that it doesn’t have to be a burden we must carry with us
everywhere we go? We can acknowledge that we’ve been hurt and wronged and that we still have
the choice to leave the evidence at home. This way we can live the life we want to live, free from
the burden of carrying this evidence.
6. Use Mindfulness and Visualization to Explore the Moment of Choice

The session concludes with a mindful eating practice to explore feeling urges and resisting
them, followed by an extended visualization on resisting the impulse to act on anger and, ultimately,
replacing resentment with compassion. Begin by briefly explaining mindfulness of the anger
experience:
As we’ve discussed, when we get angry, we become reactive and tend to act impulsively, but those
impulsive behaviors have a high cost in our relationships. So what can we do to slow things down
so that we can see what’s going on and make the choice to behave differently? We can practice
noticing our anger and all of the different parts of it: thoughts, feelings, and urges. It’s especially
important to be aware of our urges and notice the moment of choice that we have right after an
urge comes up and before we act on it. This is the moment when we can still choose different
actions. In some ways, this is a lot like observing and describing how something tastes and the urge
to chew or swallow, so let’s do a brief mindfulness exercise with eating chocolate to explore how it
works.
Give the group members each a small piece of chocolate and ask them to notice every aspect of
the chocolate. Before they put it in their mouths, have them notice what it looks like, how it smells,
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and its temperature and texture. Then have them put the chocolate in their mouths and observe
how it feels, its flavor, and, most importantly, the urge to chew or swallow the chocolate. Ask them
to let the chocolate melt in their mouths as slowly as possible while noticing what it feels like to not
act on an urge or impulse. Help them identify this as the moment of choice, when they have an urge
to do something but can choose to do something else.
Next, conduct visualization that explores using a similar approach to anger, having group mem-
bers focus on a specific person whom they tend to get angry with or resent. Here’s a sample script:
Now we’ll practice a similar exercise with anger. Close your eyes and visualize a person you some-
times struggle with—a person you think has wronged you in some way. Recall a specific incident
with this person—maybe an argument or other difficult interaction. Let’s explore the anger slowly,
just like we did with the chocolate. Hold the image of the incident in your mind and notice all of
the different aspects of it. Where are you? Who are you with? What are you saying? Notice the
sounds, sights, and smells in that situation. Let yourself feel some of the pain that this relationship
causes you.
Bring your focus to any difficult or uncomfortable physical sensations, perhaps in your stom-
ach, chest, head, or shoulders. Once you’ve identified a difficult physical sensation, raise a hand.
(Pause and wait for signals. Stay with this for a good while if group members are having
trouble.)
Now see if you can stop wrestling with that physical sensation and just observe it. The point is
not to like the feeling, but to experience it as what it is: a sensation in a part of your body. Keep
noticing that sensation. See whether you can notice exactly where that sensation is located in your
body—where it begins and ends and what shape it has. As you do this, see if you can drop any
struggle or sense of defense with this sensation and just have it as a sensation… When you are a
bit more open to this sensation, raise a hand. (Pause and wait for signals.)
Notice any emotions that are arising. Maybe you’re feeling hurt, shame, fear, or guilt.
Now gently turn your attention to your thoughts in this situation with this person you have
trouble with. Simply watch as judgments and evaluations come up. Just notice and label them,
then let them go. You can say to yourself, “There’s a judgment” or “Thank you, Mind, for that
thought,” but then let it go without getting involved in it. Just keep noticing judgments, stories, and
criticisms and letting go of each.
Now notice your impulses. How do you feel pulled to react in the difficult interaction you’re
imagining? Do you want to escape? Do you feel an urge to attack? Notice the storm within, pulling
you to use old coping behaviors, and identify the specific behavior you’re pulled to engage in.
Now, as you’re observing all of the sensations, emotions, thoughts, and impulses that your
anger brings up in you, see if you can notice whether this pain is connected to a schema. Also see
if you can notice any other emotions underneath the anger. Maybe you were feeling shamed when
you became angry. Maybe you were feeling rejected when you became angry. Maybe you were
feeling criticized and your defectiveness schema was activated. When you’ve identified a schema
that has been activated, raise a hand. (Pause and wait for signals.)
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Now turn your attention to this person who you feel has done you wrong. Notice his or her
behaviors. Can you try to imagine what schema might have been activated for that person? Maybe
he or she criticized you because of feeling rejected. Perhaps this person feels guilt or shame and is
blaming you for it. Maybe this person feels unworthy and is trying to avoid that feeling by attacking
you. See if you can get a sense of what schema this person might be trying to avoid.
Now I’ll ask you to see if you can find some empathy for this person. Can you notice how the
other person’s behaviors in that situation brought more pain to him or her? Notice the other per-
son’s pain. See if you can begin to feel some acceptance of this person. This is who the person is
and how he or she is in the world. Sometimes this person is difficult to be with because of struggling
so much to avoid his or her own pain. In this moment, see if you can accept this person just as he
or she is, even with the behavior that brings you pain. See if you can extend compassion to this
person and let go of your anger and resentment.
Afterward, take a few minutes to discuss group members’ experiences during the visualization.
7. Assign Homework
• Have clients commit to following through on the valued intention identified at the
beginning of the session.
• Encourage them to notice moments when schemas get activated, then try to slow things
down and identify related thoughts, feelings, and urges. Ask group members to also
notice their actual response and whether they feel better or worse afterward.
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Session 8
Session 8 also begins with checking in on how group members did on following through on their
valued intention for the week and setting a new intention for the coming week. Having explored
anger and the emotions beneath anger in session 7, you can now turn to exposure to the primary
pain associated with schema activation. From this point forward, defusion and exposure work pro-
ceed in tandem, as difficult thoughts often bring up difficult emotions, and vice versa. To that end,
session 8 includes a variety of visualizations and experiential exercises with a focus on letting go of
old control strategies and not identifying with painful schema-related affect and cognitions.
Procedures
2. Practice defusion through an experiential exercise in wearing labels (5 minutes).
3. Provide psychoeducation on emotions and the unworkability of control strategies

(understanding what we can and cannot control and that we can’t get rid of internal
experiences; 20 to 25 minutes).
4. Explore the costs of avoidance of painful emotions using an experiential exercise

(Exploring the Flip Side; 15 to 20 minutes).
5. Discuss the experience of defusing by wearing labels (5 minutes).
6. Explore letting go of old control strategies using an experiential exercise (Dropping

the Rope; 10 to 15 minutes).
7. Conduct a visualization for developing the observer-self perspective and defusing

from schemas (visualizing schema-triggering events from various stages of life; 5 to 10
minutes).
1. Review Homework
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2. Practice Defusion by Wearing Labels

Have group members select a particularly painful schema-related self-evaluation. You might
bring up the sales representative and ask them to choose a self-evaluation that’s an especially pushy
sales rep. Have them write the evaluation on an index card and then tape it to themselves and wear
it as the session proceeds. Write and wear a self-evaluation yourself so you can model the process
and share some of the embarrassment.
3. Provide Psychoeducation on Emotions and Control Strategies

To help group members develop more willingness to have difficult emotions, spend some time
discussing emotions and the problems with control strategies. A metaphor of a hungry lion (based
on Hayes & Smith, 2005) can be useful in explaining the problems with efforts to control internal
experience. Here’s a script showing how you might cover these topics:
We’ve been talking about emotions that come up for us related to our schemas, such as shame,
hurt, and anger. We’ve been exploring how we’ve been relating to this pain. In the last session when
we were talking about anger, we explored whether we can really control the pain or get rid of it and
worked on learning to simply observe our pain, watching it with acceptance and without trying to
change it. Just to be clear, this doesn’t mean condoning the pain or liking it; it just means acknowl-
edging the pain without trying to push it away. This is a place where we can stop and observe our
experiences and urges without acting on them.
The Serenity Prayer, which is used in 12-step programs, can be helpful here. It says, “God,
grant me the serenity to accept the things I cannot change, courage to change the things I can, and
wisdom to know the difference.” The most difficult part of this is distinguishing between the things
we can and cannot control. For the most part, the things that we can control are our behavior, our
actions, and what we want our life to stand for—our values and the choices we make. As far as
the things that we cannot control, the list is long, but some of the key things are thoughts, memo-
ries, bodily sensations, urges, impulses, and feeling—and the behavior of others.
If you don’t like this chair, what can you do? You could pick it up, just like this, put it outside,
and get rid of it. You could throw it out and permanently get rid of it. But what about your
thoughts, feelings, and memories? Can you do that with them? Why can’t you throw thoughts out?
Why can’t you permanently get rid of them? Thoughts and feelings aren’t tangible objects. They
can’t be held, touched, or permanently moved. Controlling internal experiences simply doesn’t
work in the same way as controlling objects in the outside world.
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However, our culture gives us a lot of messages that we can control our internal experiences
in the same way as we can control objects in our environment. We hear these kinds of messages all
the time: “Calm down,” “Don’t worry,” “Pull yourself together,” “Chill out,” “Where there’s a will
there’s a way,” and so on. As a child, you learned not to touch a hot stove—to avoid it—and that’s
a good thing. But internal pain cannot be avoided. Yet we often try to respond to emotional pain
and other difficult internal experiences as if they are a hot stove—as if thoughts, feelings, impulses,
and sensations can actually harm us, and as if we can avoid them.
We cannot arbitrarily choose to have more or less of any emotion connected to our schemas.
Since fear is an emotion that comes up with most schemas, let’s use it as an example. Here’s a little
thought experiment that helps demonstrate the problem with trying to control emotions. Suppose I
tell you that in a moment a lion will enter the room and that this lion preys only on people who
show fear or attempt to run away. This lion is incredibly sensitive and will be able to detect the
slightest trace of fear that comes up for you. As long as you don’t feel afraid or try to run away,
you’ll be completely safe and the lion won’t eat you. But if you experience even a trace of fear or
try to run, the lion will notice this and eat you.
What would happen? You’d probably start feeling terrified. Can you control that fear? Can
you make yourself not feel afraid? How about running? Do you think you could control whether
you’d run? Can you make yourself not run? You’d probably be able to stop yourself from running,
but could you stop yourself from feeling afraid in the same way?
Now think about what would happen if I told you that as long as you pet the lion, it won’t eat
you. What would you do? You’d probably start petting it, right? What if I told you that as long as
you feed the lion, it won’t eat you? What would you do? You’d probably offer it some food. The
point here is that controlling our behaviors and what we do with our hands and feet is very differ-
ent from trying to control our emotional responses. Thoughts, feelings, and sensations aren’t like
objects in the world. We can’t move them around and control them.
Changing and controlling our behaviors is very different from attempting to change our inter-
nal experiences. We simply cannot relate to our internal experiences the way we do to objects in
the world. It just doesn’t work. Our thoughts, sensations, emotions, impulses, and memories are in
us, and we can’t run away or escape from ourselves.
Pain and suffering happen to 100 percent of people. At one point or another, everyone feels
disappointed, criticized, lonely, or sad. Have you ever managed to permanently remove an emo-
tion? Have you been able to get a certain thought to never show up in your brain again? It almost
seems like the more you don’t want those experiences, the more you have them. The more you don’t
want to be angry, the angrier you get. The more you don’t want to be depressed, the more depressed
you become. If you’re prone to anxiety, you might start getting anxious about your anxiety. You
might start wondering, “Why am I anxious? Should I be this anxious? Where did this anxiety
start? Are other people as anxious as I am?” All of that just builds more anxiety. In the end, strug-
gling with difficult emotions actually causes more pain.
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4. Explore the Costs of Avoiding Painful Emotions

To help the group understand the costs of avoidance, conduct an exercise similar to Exploring
the Flip Side, in chapter 7. Ask for a volunteer from the group to come up and do an exercise related
to the thought that he or she wrote on the index card that he or she is wearing.
Ask the volunteer which schema this thought might be connected to and continue to write
down more thoughts and feelings that are connected to this schema on the volunteer’s index card.
After you’ve written down five or six thoughts and feelings on the card, put the card in front of the
volunteer, really close to the person’s face. Almost taunt the volunteer with the card in an effort to
get him or her to look away from it or physically push it away. You can even read the card out loud,
playing the role of the volunteer’s mind while holding the card up in front of him or her. Ask, “How
do you usually relate to these thoughts and feelings when they come up for you?”
Show the volunteer how he or she gets caught in the struggle of not having certain thoughts and
feelings and tries to push them away, avoid them, or look away from them. Have the volunteer
notice the struggle involved in attempting to avoid these thoughts and feelings. Explore how these
thoughts and feelings may be functioning as barriers:
Let’s look at the thought or feeling on this card. Has this thought or feeling ever stopped you from
doing something that was important to you? What specific thing has this thought kept you from
doing?
On the back of the index card write down the valued intention for which this thought or feeling
has been a barrier. Identify the related value and write that as well, and have all of the group mem-
bers do the same. Then bring the front of the index card, with its schema-driven thought or feeling,
closer to the volunteer and help the volunteer see that the farther away he or she pushes the pain,
the farther away the value is:
What could you do with this card if you wanted to continue escaping and running from this
experience—if you wanted to get rid of this thought or feeling? You can continue to try to push it
away or even throw it away. (Move the card farther away from the client, crumple it up, or
put it in the garbage.)
But have you ever managed to permanently remove this thought or feeling? Have you man-
aged to keep it far away from you? And if you do toss this card away, even if it does get it farther
away from you, what else is farther away? What else is on that card? The farther away that
thought or feeling is, the farther away your value is. The closer the thought or feeling is, the closer
the value is. Can you get closer to this value without getting closer to this pain? So the question is,
would you be willing to have the thought or feeling on this card if it means that you’ll also be closer
to the value that’s on the other side?
Having suggested that the only way to be closer to the value is through willingness to be closer
to schema-related pain, help the group see how they might make space for difficult thoughts and
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Group Protocol
feelings. Take the volunteer’s index card and place it on his or her lap. Ask what this feels like, then
explore defusion from difficult thoughts and feelings using questions such as these:
How many words are there on the front of your card? How many letters are there? What color ink
are they written in? Can you read them backward? Can you have these letters and words and just
observe them? Can you have them just as they are, without pushing them away or struggling?
Ask group members to carry the index card with them for the following week as an exercise in
having painful thoughts and feelings without buying into them:
Now I’m wondering if you would be willing to take this card with you and keep it in your pocket
for the next week. Look at the thought or feeling on the front once a day. Don’t argue with it. Don’t
avoid it. Don’t buy into it. Just look at it, stay in contact with it, and put it back in your pocket.
Would you be willing to do that? And how about a further step? Would you be willing to commit
to doing the action on the back of that card, bringing the card with you as you take that step?
5. Discuss the Experience of Defusing by Wearing Labels

Ask clients what it felt like to wear the labels with painful self-evaluations. Ask whether their
feelings or discomfort about the labels changed over the course of the session or stayed the same.
Did they forget they were wearing these labels, or did they feel self-conscious about it throughout
the session?
6. Explore Letting Go of Control Strategies

The experiential exercise Dropping the Rope, discussed at length in chapter 7, can help group
members understand the limitations of control strategies. It also helps demonstrate the benefits of
behavioral flexibility in the face of perceived barriers. In a group setting, ask for a volunteer to do
the exercise. You’ll need a somewhat short piece of rope—about six feet long—for this exercise.
1. Ask about a recent schema-triggering situation and have the volunteer describe the
associated feelings and thoughts, then objectify this schema-related pain by asking ques-
tions about its shape, size, color, weight, texture, and so on. You can also ask whether
any of these physical qualities are changing or whether the pain is moving in any way.
2. When the volunteer has clearly described the schema-related pain as an object, explain
that you’re taking the object out of him or her and putting it in you. Act out this process
of transferring the pain.
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3. Hold one end of a rope and ask the volunteer to hold the other end. Then inquire about
how the volunteer has been relating to this pain when it shows up.
4. Pull on the rope and let the volunteer struggle with you as the schema-related pain.
Remind the volunteer of the feelings and thoughts. Pull the volunteer around or let him
or her try to get away by pulling you for a minute or two.
5. Encourage the volunteer to explore alternative solutions. If the volunteer doesn’t come
up with the idea of dropping the rope, solicit additional solutions from the group. If
necessary, you can eventually suggest dropping the rope.
6. After the volunteer drops the rope, continue to represent the pain and follow the volun-
teer around wherever he or she goes.
7. Help the volunteer notice that even after he or she drops the rope, the schema-related
pain is still there. However, the volunteer is now free to move around, including toward
important values. Even though the pain is still there, the volunteer is setting the direc-
tion rather than being constrained and locked in a struggle.
7. Conduct a Visualization for Developing the Observer Self

Another way to help group members develop the observer-self perspective and disidentify with
their self-evaluations and other schema-driven thoughts and feelings is with a visualization that
explores a recent schema-triggering event and how it relates to similar situations earlier in life. Then
the visualization shifts to a recent positive experience to help underscore how thoughts, feelings,
and other private experiences are always changing and therefore do not and cannot define us.
Here’s an outline for the visualization (based on Hayes et al., 1999):
1. Have group members sit comfortably and close their eyes.
2. Ask them to remember a moment during the past week when a schema was triggered.
Guide them in vividly recalling the incident and all of the associated images, sounds,
physical sensations, emotions, and thoughts. Direct them to particularly notice thoughts,
stories, judgments, and predictions and whether these thoughts seem familiar—like old,
often-repeated stories.
3. Have them notice that the self observing the memory is the same as the self in the
memory.
4. Have group members let go of the recent memory and ask them to try to recall one of
the first times when the schema from that memory was triggered and that familiar story
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Group Protocol
began to arise—an early experience perhaps with a parent or caregiver, at school, or

with friends. Guide them in vividly recalling the event and all of the associated images,
sounds, physical sensations, emotions, and thoughts. Ask whether the stories connected
to this early event seem to manifest in current relationships, or whether they find them-
selves trying to escape or avoid this experience of themselves. Ask them to compassionately
make space for this difficult memory and their younger self and guide them in accepting
all of these experiences, perhaps using the metaphor of the sky and the weather.
5. Have them notice that the self observing this childhood memory is the same as the self
in the memory.
6. Have group members let go of that early memory and recall a recent situation where
they experienced thoughts and feelings opposite those triggered by the schema—perhaps
a situation where they felt confident, secure, or loving toward themselves. Again, have
them bring to mind all of the details of the situation: where they were, who they were
with, and what was said, along with the associated images, sounds, physical sensations,
emotions, and thoughts.
7. Finally, have them notice that the self observing this memory is the same as the self in
the memory—and in all of the memories brought to mind in this visualization, both
positive and negative.
8. Assign Homework
at the beginning of the session, as well as the intention on the index card to be carried
over the course of the week.
• Have them notice whether they can make space for any uncomfortable feelings that
come up while acting on values.
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Session 9
Again, the session begins with checking in on how group members did on following through on
their valued intention for the week and setting a new intention for the coming week. Because this
is the next-to-last session, it reviews many of the topics and skills from previous sessions and gives
group members an opportunity to practice and commit to new behaviors. An important focus of
this session is teaching group members effective communication skills. This session isn’t as full as
sessions 1 through 8, creating some flex time to cover material that didn’t fit in earlier sessions. You
can also use the extra time to address any lingering issues group members may be experiencing.
Procedures
2. Conduct a visualization exploring reactions to recent schema-triggering events (5 to

10 minutes).
3. Discuss effective communication (A Formula for Effective Communication handout;

5 to 10 minutes).
4. Conduct a role-playing exercise to practice defusion and alternative responses to the

event visualized earlier in the session (Defusion Skills handout; 45 minutes).
5. Conduct a visualization bringing mindfulness and compassion to schema-related pain,

again exploring the event visualized earlier in the session (5 minutes).
1. Review Homework
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Group Protocol
2. Conduct a Visualization Exploring a Recent

Schema-Triggering Event
Ask the group to close their eyes and visualize a recent event in which their schemas were trig-
gered in an important relationship and they didn’t respond in a way that aligned with their values.
As always with visualization, provide guidance on attending to visual, auditory, kinesthetic, and
other sensory aspects of the experience. Ask them to see where they were, hear what was said, and
notice what they felt physically—both at the time and in the moment, during the visualization.
Have them observe thoughts and feelings as well, then help them turn their attention to urges,
impulses, and their actual behavior. In the process, you can revisit the moment of choice, under-
scoring that it isn’t necessary to act on behavioral urges, and guide the group toward assessing the
costs of continuing to resort to old coping behaviors:
How are you pulled to behave? What do you want to say or do? Notice that you don’t have to act
on any impulse. You can watch the urge to engage in old coping behaviors while still keeping your
commitment not to do so. How did you actually behave? What did you say and do? What was the
impact on the other person? Did it make your relationship closer, or did it create more distance?
Slow everything down and just watch the scene unfold in slow motion.
Afterward, explore what this experience was like for the group. Have group members envision
a values-based response to the situation. What would they have liked to do differently? How could
they have behaved in a way that would enhance the relationship?
3. Discuss Effective Communication

An optional module of the group protocol (absent from the individual protocol) is assertiveness
training. It is included here because clients treated in a group setting often display poor interper-
sonal skills. When schemas are triggered, these clients frequently lack the ability to communicate
their needs and feelings effectively.
If covering effective communication in group therapy, give group members the handout A
Formula for Effective Communication.
183
A Formula for Effective Communication

Here’s a straightforward formula for communicating effectively and making assertive requests.
Simply fill in the blanks as appropriate to your situation:
1. When [describe the specific event objectively and nonjudgmentally],
2. I felt [describe how you felt].
3. I need [describe your need in terms of values] (for example, “I need connection,
[respect, honesty, and so on]”).
4. Would you be willing to [specific request describing how this person can meet your
need]?
Here’s an example:
1. When we had plans to meet at two in the afternoon on Saturday and you showed up a half hour late,
2. I felt hurt and concerned.
3. I need to be able to count on you and trust you.
4. Would you be willing to be more prompt in the future and make sure that you follow through with our
plans?
4. Conduct a Role-Playing Exercise to Explore Alternative Responses

Ask a volunteer to come up to the front of the room to role-play the situation from his or her
visualization and practice responding differently. Ask for details about the event so you can role-
play the other person in the situation. Provide the volunteer with a copy of the Defusion Skills
handout. Ask the volunteer to use mindfulness and defusion skills—and effective communication
skills as needed—to respond in a way more aligned with his or her values and in a way that will
enhance the relationship.
Afterward, engage the group in a discussion about the role play and ask group members to share
the values-based behaviors they wish they had used in their visualized situations. Ask them to set
an additional intention, beyond those committed to at the beginning of the session, to act on a
specific value in an important relationship. Have them write this intention down.
184
Group Protocol
5. Conduct a Visualization Bringing Mindfulness and Compassion

to Schema-Related Pain
To conclude the session, conduct a visualization bringing mindful attention to the schema-
related pain associated with the event visualized throughout this session. The goal of the visualization
is to help group members open to acceptance and willingness with painful emotions and to help
them extend compassion to themselves. Here’s a script you might use:
Get comfortable in your chair and gently close your eyes. Begin by focusing your attention on your
breathing for a few breaths.
Now recall that moment when your schema was triggered in an important relationship—the
event you’ve been visualizing throughout this session. Maybe you felt deprived, abandoned, defec-
tive, or ashamed. Try to contact the core feeling in that moment when the schema was triggered.
Where in your body do you experience that schema feeling?
Look back and try to recall how many times that feeling came up for you today. How many
times over the past week? How many times over the past month? Try to see if you can recall the
very first time you had this feeling or one of the first times you had it. When you have that earliest
memory in mind, raise a hand.
Has this feeling been with you for a long time? Does it come up in many different relationships?
How have you related to this feeling? Stay with this pain and breathe with it. If you notice any
urges to escape or push away this experience, just notice that urge and see if you can allow yourself
to stay with this experience. What does it feel like to fully experience this feeling without struggling?
Can you allow yourself to feel 100 percent of your experiences with compassion and gentle kind-
ness toward yourself? Can you make space for all the parts of your experience? Does this experience
have to be pushed away or avoided? Or is this pain something you can handle—something you
can observe nonjudgmentally and fully experience?
Notice any thoughts, emotions, sensations, and urges that are coming up or getting more
intense and just observe them all with kindness and willingness, as if this schema-related pain is a
crying baby. See if you can allow yourself to invite this pain in and embrace it as a part of you, a
part that’s always been there with you and always will be there. Nothing needs to be fixed; nothing
has to be changed. You are exactly where you should be. When you are ready, gradually widen
your attention and slowly open your eyes.
185
6. Assign Homework
• Have clients commit to following through on the valued intention identified at the
beginning of the session, as well as the new intention in an important relationship,
established after the role play on alternative responses.
• Ask group members to practice willingness to feel schema-related feelings while not act-
ing on the related behavioral impulses.
• Encourage them to look for opportunities to practice alternative, values-based responses

to schema-triggering situations.
186
Group Protocol
Session 10
As with session 9, this final session isn’t as full as the first eight, creating some flex time to cover
material that didn’t fit in earlier sessions and to address any lingering issues group members may be
experiencing. This concluding session begins with an expansive mindfulness exercise that contin-
ues the work of fostering self-compassion and compassion toward others as an avenue toward
healing. Time is devoted to exploring members’ experiences in the group, and then group members
are given a final opportunity to practice alternative responses. The main priority of this session is
giving group members the opportunity to come up and practice new values-based behaviors and get
feedback from the group. The session concludes with an exploration of potential barriers and plan-
ning strategies that will allow group members to follow through with committed actions in spite of
these barriers.
Procedures
1. Conduct a mindfulness meditation promoting self-compassion and compassion toward
others (5 minutes).
2. Review group members’ experiences with the homework from session 9 (10 minutes).
3. Discuss group members’ experiences over the past ten weeks (10 to 15 minutes).
4. Conduct a role-playing exercise to practice defusion and alternative responses to spe-

cific schema-triggering events (Defusion Skills handout and A Formula for Effective
Communication handout; 35 minutes).
5. Discuss potential barriers and develop strategies for acting on valued intentions in
spite of barriers (15 minutes).
6. Have group members commit to a new intention (10 minutes).

7. Administer post-treatment assessments.
1. Conduct a Mindfulness Meditation Focused on Compassion

Helping group members build compassion for themselves and others will increase their willing-
ness to be present with their own pain and the pain of others. This acceptance of schema-related
pain is a necessary step in taking action in valued directions. Here’s a script for a visualization to
build compassion (Eifert and Forsyth, 2005):
187
Start by closing your eyes and turning your attention to the natural rhythm of your breath. You
need not control your breath in any way. Just tune in to your body and your breath.
Now bring to mind a moment when a schema was triggered in a relationship. Get in touch
with the pain and hurt that this schema brings up in you. Then, with your next inhalation, breathe
in all of the negativity and pain. Breathe in that discomfort with the realization that what you are
feeling at this very moment is being felt by millions of people all over the world. You are not alone
with this. Everyone has schemas. Everyone feels hurt, rejection, shame, and fear in relationships.
This pain is part of being a human being in this world. Someone in the world is probably experi-
encing this same pain, right now, this very moment.
Allow yourself to breathe in this pain more deeply. With each breath, breathe in your pain, as
well as the pain and suffering of others who are experiencing pain. Make space in your body for all
of the pain that comes with the experience of being human.
Now, with each exhalation, breathe out relief, compassion, and kindness to others who are
suffering. Continue opening up the space inside you to breathe in more of this pain—your own and
that of others—and each time you exhale, breathe out relief, tenderness, and compassion. Find the
natural rhythm of your breathing. Then, each time you inhale, open yourself up and be more will-
ing to make space for all your experience. You don’t have to push away and escape the hurt and
pain that shows up for all human beings. We were made to handle and contain all of these
experiences.
Now, whenever you’re ready, gradually open your eyes with the intention to continue practic-
ing kindness and compassion toward the pain of humanity.
2. Review Homework
Ask group members to share their experience in following through on their valued intention
and discuss any barriers that came up. (Later in the session, you’ll conduct a thorough discussion of
potential future barriers and strategies to deal with them and also ask members to commit to a new
intention.)
3. Discuss Members’ Experiences in the Group

Engage in a group discussion regarding group members’ experiences with the group in general
and with exploring and acting on their values. Explore which strategies worked for them and which
didn’t work so well. Ask what they feel they’ve gained and what was difficult for them. Ask them to
share anything that they learned about themselves or their behaviors in relationships. Also ask what
they feel they still need to work on and what values they’re going to continue to act on. Encourage
188
Group Protocol
group members to continue to identify valued intentions and follow through with them on a weekly
basis.
4. Conduct a Role-Playing Exercise to Explore Alternative Responses

Reprise the role-playing exercise from session 9, asking for volunteers and using schema-
triggering events that occurred over the past week. With each volunteer, begin by asking the person
to role-play his or her old, maladaptive coping behavior, then have other group members give feed-
back and offer suggestions regarding new, values-based behaviors. Next, do the same role play again,
but this time with the volunteer practicing a values-based response characterized by honest and
effective communication and vulnerability. (If necessary, give group members the handouts Defusion
Skills and A Formula for Effective Communication.) Ask each volunteer in turn to explore the old
and new behaviors and what it felt like to behave differently.
5. Discuss Potential Barriers and Strategies for Working with Them

To conclude the session, explore difficulties with willingness and committed action. Ask group
members to identify current barriers to valued intentions. Spend some time discussing strategies for
following through on valued intentions despite these barriers. Then devote some time to exploring
possible future barriers and having group members suggest strategies for those. Have group members
predict future situations where their schemas might get triggered and what new coping strategies
they will use to ensure they seize the moment of choice and respond based on their values, rather
than reacting based on old, maladaptive schemas.
6. Have Group Members Commit to a New Intention

Finally, have group members come up with a commitment to values-based behavior in a fre-
quently encountered triggering situation. Then have each group member stand up and share that
commitment.
7. Administer Post-Treatment Assessments

If you chose to administer any pre-treatment assessments for use as outcome measures, have
group members complete those questionnaires again at the end of the session.
189
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193
Matthew McKay, PhD, is professor at the Wright Institute in Berkeley, CA. In private practice, he
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Relaxation and Stress Reduction Workbook, Thoughts and Feelings, Self-Esteem, Your Life on Purpose, and
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work at the University of California, San Francisco, and maintains a private practice in San Francisco,
CA, where she lives and works. She hosts a radio show and is author of The Critical Partner.
www.michelleskeen.com
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at the University of Nevada, Reno. He is author of hundreds of scientific articles and many books,
including Acceptance and Commitment Therapy, Relational Frame Theory, and Get Out of Your Mind
and Into Your Life.
Index
A assertiveness training, 183–184

Assessing Barriers Worksheet, 62, 64, 153
abandonment and instability schema, 13, 19,
assessing schemas, 14–17; ACT group protocol
122, 134
and, 132; imagery used for, 17; schema
abuse and mistrust schema, 13, 19, 122, 134
questionnaires for, 14–15, 121–127, 132;
Acceptance and Action Questionnaire–II
thought logs for, 15–16
(AAQ-II), 132
Automatic Thoughts Questionnaire (ATQ),
acceptance and commitment therapy (ACT):
132
group protocol for interpersonal problems,
autonomy, 10, 27, 136
131–189; research on effectiveness of, 3,
avoidance: experiential, 5, 40; exploring the
129–130; schema coping behaviors and,
costs of, 178–179; SCBs related to, 27, 40,
32–33; schema-related pain and, 23, 33;
136–137; willingness vs., 68
treating interpersonal problems with, 7–8,
Awareness and Willingness handout, 67
129–130
activation of schemas: in day-to-day life,
105–108; in therapy sessions, 102–105 B
activities, mindful, 44 balloons or clouds exercise, 75
addictive self-soothing, 27, 137 barriers to values-based living, 62–66, 152, 189
affect, schema, 13–14, 18, 48, 87. See also bathing/showering mindfully, 44
emotions behavior change: converting values into,
aggression or hostility, 26, 136 57–59, 152; creating a plan for, 55
alienation and isolation schema, 13, 19, 124, behavioral barriers, 63
134 behavioral flexibility, 6, 7, 96, 179
alternative responses, 184, 189 beliefs, pathogenic, 4–5
anger: exposure work with, 91; group Berkeley Cognitive Behavioral Therapy Clinic,
discussion of, 169–170, 171; mindfulness of, 1
172; providing psychoeducation on, 170–171; billboards exercise, 75
visualization about, 173–174 boats or trains exercise, 75
C coping behaviors, 4–5; based on pathogenic

beliefs, 4–5; driven by experiential
card carrying technique, 78
avoidance, 5; inflexible, 4. See also schema
chessboard metaphor, 83, 85, 165–166
coping behaviors
childhood schema creation, 10–11
costs: of avoiding painful emotions, 178–179; of
choice, moment of, 48, 55, 70
resentment, 171–172; of schema coping
“clean” pain, 33
behaviors, 31–32, 35–39, 146
clients: assessing schemas in, 14–17; explaining
courtroom metaphor, 171–172
schemas to, 11–12, 17–18; identifying
creative hopelessness, 40–41, 100–102; criteria
schemas in, 12–13; introducing SCBs to,
to guide treatment using, 101; discussing
25–26; role-playing new behaviors with, 108;
with clients, 101; group exploration of,
values explanation for, 55–56
142–143, 146–147; key techniques for
clouds or balloons exercise, 75
cultivating, 101–102; problematic client
cognitive barriers, 63, 69
reactions to, 102; recognizing when to use,
cognitive defusion, 71–83, 111–115; criteria to
100
guide treatment using, 113; discussing with
Creative Hopelessness handout, 41
clients, 112–113; distancing from thoughts,
76–80; exposure combined with, 92–98;
group visualization exercise, 159; key D
techniques for implementing, 113–114; day-to-day schema activation, 105–108; criteria
labeling thoughts, 73–74, 176, 179; letting go to guide treatment of, 106–107; discussing
of thoughts, 74–76; practicing skills in, with clients, 106; key techniques for
80–83, 159–160, 176; problematic client responding to, 107; observing interpersonal
reactions to, 114–115; providing events triggering, 48–50; problematic client
psychoeducation on, 156–157; recognizing reactions to, 108; recognizing signals
when to use, 112; self-evaluations and, 164, indicating, 106. See also in-session schema
176, 179; teaching techniques in, 157–159; activation
watching thoughts, 72–73 defectiveness and shame schema, 13, 19, 123,
commitment to values-based behavior, 61–66 134
communication, effective, 183–184 Defusion Skills handout, 82, 158–159
compassion, 185, 187–188 defusion strategies. See cognitive defusion
compliance or dependence, 27, 136 dependence and incompetence schema, 13, 19,
compulsive stimulation seeking, 27, 137 124, 134
computer pop-ups exercise, 75 dependence/compliance coping behavior, 27,
connection to others, 10 136
control strategies: exploring the letting go of, descriptions vs. evaluations, 163–164
179–180; psychoeducation on emotions and, dialectical behavior therapy, 6, 7
176–177; schema-related pain and, 41, dialogue, exposure via, 87–91
176–177; visualization for working with, diary of interpersonal experiences, 48, 49–50
147–148 digging a hole metaphor, 40–41, 147
198
References
“dirty” pain, 33 F
dish washing mindfully, 44
failure schema, 13, 19, 125, 134
distancing from thoughts, 76–80
feelings. See emotions
dominance coping behavior, 26, 136
Five Senses exercise, 44
drinking, mindful, 44
flexibility, behavioral, 6, 7, 96, 179
Dropping the Rope exercise, 96–98, 179–180
focusing, mindful, 43, 73
Formula for Effective Communication
E handout, 184
eating, mindful, 44, 172–173 fusion with thoughts, 71, 83. See also cognitive
educating clients. See psychoeducation defusion
emotion exposure, 87–98, 115–118; anger as
special case of, 91; conducting via dialogue, G
87–91; criteria to guide treatment using, 116;
gardening, mindful, 44
defusion combined with, 92–98; discussing
group protocol using ACT for interpersonal
with clients, 116; Dropping the Rope
problems, 131–189; session 1 procedures,
exercise, 96–98; Exploring the Flip Side
131–138; session 2 procedures, 139–143;
exercise, 93–95; Exposing the “Worst Self”
session 3 procedures, 144–148; session 4
visualization, 95–96; guided visualization
procedures, 149–154; session 5 procedures,
used for, 91–92; key techniques for
155–161; session 6 procedures, 162–167;
implementing, 116–117; problematic client
session 7 procedures, 168–174; session 8
reactions to, 117–118; recognizing when to
procedures, 175–181; session 9 procedures,
use, 115–116
182–186; session 10 procedures, 187–189
emotional barriers, 63
guided visualizations. See visualization
emotional deprivation schema, 13, 19, 123, 134
exercises
emotions: associated with schemas, 13–14, 18,
48, 87, 138; control strategies related to,
176–177; costs of avoiding painful, 178–179;
H
in-session exposure to, 87–98; related to handouts: Awareness and Willingness, 67;
anger, 170, 171; values-based action and, 63 Creative Hopelessness, 40, 41; Defusion
entitlement schema, 13, 19, 125, 134 Skills, 80, 82, 158–159; Formula for
evaluations vs. descriptions, 163–164 Effective Communication, 184; Observer
events. See schema-triggering events Self, 83, 84; Schema Triggers, 18–19; Ten
experiential avoidance, 5, 40 Common Schema Coping Behaviors, 26–27,
exploitation, 26–27, 136 136–137; Ten Key Schemas, 12–13, 134–
Exploring the Flip Side exercise, 93–95 135; Understanding Early Maladaptive
Exposing the “Worst Self” visualization, 95–96 Schemas, 11–12. See also logs; worksheets
exposure: combining defusion with, 92–98; Hayes, Steven C., vi
mindful awareness of experience as, 68. See homework assignments, 138
also emotion exposure hopelessness. See creative hopelessness
hostility or aggression, 26, 136
199
hypercriticalness schema, 13, 19, 126, 135 isolation and alienation schema, 13, 19, 124,
134
I
imagery: assessing schemas using, 17; practicing K
observation skills using, 51–52. See also Kernberg, Otto, 6
visualization exercises
impulses, noticing, 48 L
inflexible coping behaviors, 4 labeling: barriers, 62–63; thoughts, 73–74, 88,
in-session schema activation, 102–105; criteria 176, 179
to guide treatment of, 103–104; discussing language, analytic dimensions of, v–vi
with clients, 103; key techniques for working leaves on a stream exercise, 74
with, 104; problematic client reactions to, letting go of thoughts, 74–76
105; recognizing signals indicating, 103. See Lev, Avigail, 8, 129
also day-to-day schema activation logs: Interpersonal Experiences Diary, 48,
instability and abandonment schema, 13, 19, 49–50; Schema Events Log, 20, 22; Thought
122, 134 Log, 15–16. See also handouts; worksheets
intentions: converting values into, 57–59, 152,
189; Valued Intentions Worksheet, 57, M
58–59, 151
maladaptive schemas. See schemas
interpersonal domains, 20–22
manipulation, 26–27, 136
interpersonal events: observing schema-
meditation practices: compassion building,
triggering, 48–50; Schema Events Log for
187–188; White Room Meditation, 72. See
recording, 20, 22
also mindfulness
Interpersonal Experiences Diary, 48, 49–50
metaphors: chessboard, 83, 85, 165–166;
interpersonal observation skills, 51–52
courtroom, 171–172; digging a hole, 40–41,
interpersonal problems: ACT treatment
147; monster at a party, 137–138; monsters
approach for, 7–8; criteria for treating, 5–6;
on the bus, 63, 65–66, 152, 154, 156; movie
current treatments for, 6–7; definition of,
screen, 83; popcorn machine, 70, 156–157;
3–4; group protocol using ACT for, 131–
quicksand, 40, 147; sales representative,
189; maladaptive schemas and, 12–13;
70–71, 176; sky vs. weather, 42, 147–148;
research outcomes on ACT for, 129–130;
tug-of-war, 70
schema coping behaviors and, 23
Mindful Focusing, 43, 73
interpersonal psychotherapy, 6, 7
mindfulness, 42–52; activities engaged with,
interpersonal situations: linking schema coping
44; anger experience and, 172; compassion
behaviors to, 28–31; schema-triggering
and, 185, 187–188; eating with, 44, 172–173;
events in, 20–22
Five Senses exercise, 44; group practice of,
Interpersonal Triggers Worksheet, 45, 46–47
133, 185, 187–188; Mindful Focusing
Inventory of Interpersonal Problems (IIP-64),
exercise, 43; observing interpersonal
8, 129–130, 132
experience with, 45–52; schema-related pain
200
References
and, 185; values-based action and, 67–68; practice: defusion skills, 80–83, 159–160, 176;
working with resistance to, 45 observation skills, 51–52
mistrust and abuse schema, 13, 19, 122, 134 pre-treatment assessment, 132
monster at a party metaphor, 137–138 psychoeducation: on anger, 170–171; on
monsters on the bus metaphor, 63, 65–66, 152, cognitive defusion, 156–157; on emotions
154, 156 and control strategies, 176–177; on
movie screen metaphor, 83 evaluations vs. descriptions, 163–164; on
schema coping behaviors, 135–138; on
N schemas, 133–135; on values, 150
negative label repetition, 77 psychological withdrawal, 27, 137
psychotherapy: treatments for interpersonal
O problems, 6–7. See also acceptance and
commitment therapy; therapy sessions
objectifying thoughts, 77
observer self, 83–85; cultivating in group
settings, 165–167; experiential exercise in
Q
being, 85; metaphors for explaining, 83, 85, questionnaires, schema, 14–15, 121–127, 132
165–166; visualization on, 166–167, 180–181 quicksand metaphor, 40, 147
Observer Self handout, 83, 84
observing interpersonal experience, 45–52; R
cognitive defusion and, 71–83; listing realistic limits, 11
schema triggers and, 45–47; noticing rebellion, 27, 136
schema-triggering events and, 48–50; recognition seeking, 26, 136
practicing in therapy sessions, 51–52; values- research study outcomes, 129–130
based action and, 67–68 resentment, costs of, 171–172
Outcomes Worksheet, 36–39 role-playing: alternative responses, 184, 189;
overcompensation behaviors, 26–27, 136 defusion techniques in groups, 160; monsters
on the bus metaphor, 152, 154; new
P behaviors with clients, 108
pain. See schema-related pain
passive-aggressiveness, 27, 136 S
pathogenic beliefs, 4–5 Saavedra, Koke, 131
perspective of observer self, 83–85 safety needs, 10
physical letting-go technique, 75–76 sales representative metaphor, 70–71, 176
physical sensations: emotion exposure and, schema activation: in day-to-day life, 105–108;
87–88; noticing in daily life, 48 in therapy sessions, 102–105
planning process. See values-based planning Schema Coping Behavior Outcomes
popcorn machine metaphor, 70, 156–157 Worksheet, 145
post-treatment assessment, 189 schema coping behaviors (SCBs), 5, 23, 25–45;
ACT approach to, 32–33; common types of,
201
26–27; discussing with clients, 27–28; interpersonal problems and, 12–13; pain
exploring the costs of, 31–32, 35–39, 146; related to triggering of, 23, 33, 40;
group exploration of, 140–142, 146; pathogenic beliefs and, 5; providing
introducing to clients, 25–26; linking to psychoeducation on, 133–135; reasons for
schema-triggering situations, 28–31; power of, 9–10, 135; triggers for, 18–19, 20,
providing psychoeducation on, 135–138; 21, 45–50
values-based behaviors vs., 60 schematherapy.com website, 2, 121
Schema Coping Behaviors Worksheet, 28, schema-triggering events: group visualization
29–31 on, 183; observing in day-to-day life, 48–50;
Schema Events Log, 20, 22 Schema Events Log for recording, 20, 22
schema questionnaire, 14–15, 121–127, 132 schema-triggering situations: interpersonal
Schema Triggers handout, 18–19 domains and, 20–22; linking schema coping
Schema Triggers, Thoughts, Feelings, and behaviors to, 28–31
Coping Behaviors Worksheet, 141 self-as-content, 83
Schema Triggers Worksheet, 20, 21 self-as-context, 83, 165–167
schema-driven thoughts: building awareness of, self-assertion, 26, 136
69–70; choosing your response to, 70–71; self-esteem, 10
cognitive defusion of, 71–83; four key self-evaluations: defusing by wearing labels,
questions about, 78–80; noticing in daily 176, 179; group exploration of, 164–165
life, 48; observer perspective and, 83–85; self-expression, 10–11
practicing defusion of, 80–83; three self-stimulation, 27, 137
categories of, 69; values-based action and, sensations. See physical sensations
63, 69 sessions in ACT group protocol, 131–189;
schema-focused therapy, v, 6, 7 session 1 procedures, 131–138; session 2
schema-related pain: ACT approach to, 23, 33, procedures, 139–143; session 3 procedures,
41; control strategies for, 41, 176–177; costs 144–148; session 4 procedures, 149–154;
of avoiding, 178–179; creative hopelessness session 5 procedures, 155–161; session 6
and, 40; mindfulness and compassion procedures, 162–167; session 7 procedures,
brought to, 185; stopping the struggle with, 168–174; session 8 procedures, 175–181;
41–42; values-based rationale for facing, 55, session 9 procedures, 182–186; session 10
60–61; willingness to observe and procedures, 187–189. See also therapy
experience, 67–68 sessions
schemas, 9–23; ACT approach to, 23; shame and defectiveness schema, 13, 19, 123,
assessment of, 14–17, 132; characteristics of, 134
12; childhood creation of, 10–11; definition showering/bathing mindfully, 44
of, 4, 9; discussing with clients, 17–18; situations. See interpersonal situations
domains and events triggering, 20–22; sky vs. weather metaphor, 42, 147–148
emotions associated with, 13–14, 18; social isolation and alienation schema, 13, 19,
handouts explaining, 11–13, 134–135; 124, 134
in-session activation of, 102–105; social withdrawal coping behavior, 27, 136
202
References
status seeking, 26, 136 V

stimulation seeking, 27, 137
Valued Intentions Worksheet, 57, 58–59, 151
subjugation schema, 13, 19, 126, 134
Valued Living Questionnaire (VLQ), 132
surrender coping behavior, 27, 136
values, 55–68; assessing adherence to, 61;
clarifying interpersonal, 56–57, 150–152;
T committing to behavior based on, 61–66;
Ten Common Schema Coping Behaviors converting into intentions, 57–59, 152, 189;
handout, 26–27, 136–137 dealing with barriers to, 62–66, 152, 189;
Ten Key Schemas handout, 12–13, 134–135 explaining to clients, 55–56, 150; and facing
Thank You, Mind exercise, 77 schema-related pain, 55, 60–61, 67; group
therapy sessions: activation of schemas in, process related to, 150–152; observational
102–105; exposure to emotions in, 87–98; skills applied to, 66–68; planning actions
practicing observation in, 51–52. See also based on, 108–111; providing
sessions in ACT group protocol psychoeducation on, 150; SCBs vs.
Thought Log, 15–16 behaviors based on, 60; willingness to live
thoughts: anger triggered by, 171; building by, 67–68
awareness of, 69–70; choosing your response values compass, 61
to, 70–71; cognitive defusion of, 71–83; values-based planning, 108–111; criteria to
distancing from, 76–80; fusion with, 71, 83; guide treatment choices, 109–110; discussing
key questions about, 78–80; labeling, 73–74, with clients, 109; key techniques for
88, 176, 179; letting go of, 74–76; noticing, implementing, 110; problematic client
48, 88; objectifying, 77; observer perspective reactions to, 110–111; recognizing when to
of, 83–85; practicing defusion of, 80–83; use, 108–109
schemas associated with, 138; values-based visualization exercises: anger experience,
action and, 63, 69; watching, 72–73 173–174; cognitive defusion, 159;
time-limited dynamic psychotherapy, 6, 7 compassion building, 187–188; emotion
Titchener’s repetition, 77 exposure, 91–92; Exposing the “Worst Self,”
trains or boats exercise, 75 95–96, 166–167; mindfulness of schema-
transference-focused psychotherapy, 6, 7 related pain, 185, 187–188; observer self,
triggers: group exploration of, 140–142; linking 166–167, 180–181; schema-triggering event,
SCBs to, 28–31; schema-related, 18–19, 20, 183; struggle for control, 147–148. See also
21, 45–50; worksheet for listing, 45–47 imagery
tug-of-war metaphor, 70
W
U walking, mindful, 44
Understanding Early Maladaptive Schemas watching thoughts, 72–73
handout, 11–12 wearing labels exercise, 78
unrelenting standards and hypercriticalness weather vs. sky metaphor, 42, 147–148
schema, 13, 19, 126, 135 web resources, 2, 121
203
White Room Meditation, 72 20, 22; Schema Triggers, Thoughts, Feelings,

whiteboard exercise, 39 and Coping Behaviors Worksheet, 141;
willingness, 55; to accept painful feelings, Schema Triggers Worksheet, 20, 21; Valued
60–61, 88, 91, 169; awareness combined Intentions Worksheet, 57, 58–59, 151. See
with, 66–68; group exploration of, 169 also handouts; logs
workability, 35, 100 “worst self” visualization, 95–96, 166–167
worksheets: Assessing Barriers Worksheet, 62, Wright Institute, 129
64, 153; Outcomes Worksheet, 36–39;
Schema Coping Behavior Outcomes Y
Worksheet, 145; Schema Coping Behaviors Young, Jeffrey, 2, 4, 10, 12, 14, 121, 134
Worksheet, 28, 29–31; Schema Events Log, Young Schema Questionnaire, 2, 14–15, 121
204
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“This intensely practical book offers a cutting-edge evidence-based framework for mental health profes-

New Harbinger Publications, Inc.

Distributed in Canada by Raincoast Books

Copyright © 2012 by Matthew McKay, Avigail Lev, and Michelle Skeen

All Rights Reserved

Library of Congress Cataloging-in-Publication Data

Printed in the United States of America

1 The Challenge of Treating Interpersonal Problems 3

3 Understanding Schema Coping Behaviors 25

4 Cultivating Creative Hopelessness and Developing Mindfulness Skills 35

5 Clarifying Values and Committing to Values-Based Action 55

6 Defusing from Thoughts and Developing the Observer-­Self Perspective 69

7 Conducting Exposure with Defusion 87

8 Working with Six Key Processes 99

A Schema Questionnaire 121

The Challenge of Treating

Defining Interpersonal Problems

Three Aspects of Maladaptive Coping Behaviors

• They are inflexible.

• They are driven by experiential avoidance.

Based on Pathogenic Beliefs

Driven by Experiential Avoidance

Criteria for Treating Interpersonal Problems

• To address and improve behavioral flexibility, it should encourage a broader repertoire

• Interpersonal psychotherapy: a time-­limited form of psychotherapy, originally devel-

• Transference-­focused psychotherapy: a form of psychoanalytic psychotherapy, devel-

• Time-­limited dynamic psychotherapy: a short-­term treatment for chronic interper-

• Dialectical behavior therapy: a behavioral treatment for borderline personality disor-

• Schema-­focused therapy: a cognitive behavioral therapy treatment targeting border-

An Alternative Treatment Approach

• It is designed to enhance behavioral flexibility in interpersonal settings and is focused

• It addresses the role of pathogenic beliefs, or schemas.

• It specifically targets experiential avoidance by providing specific methods for tolerating

The Role of Unmet Early Childhood Needs

• Self-­expression. In a nurturing environment, children are encouraged to express their

Explaining Schemas to Clients

Understanding Early Maladaptive Schemas

Characteristics of Early Maladaptive Schemas

• They are self-­perpetuating and resistant to change.

• They’re usually triggered by stressful events, typically something painful in a relation-

Identifying Clients’ Schemas

Ten Key Schemas

• Deprivation of nurturance: the absence of attention

• Deprivation of empathy: the absence of understanding

• Deprivation of protection: the absence of guidance

• Reviewing thought logs filled out by the client

• Using imagery to trigger and identify schemas

Client: It means I’m incompetent. I screw up everything that matters to me.

• Who are you in the scene?

• In this scene, what do you fear will happen?

• How does the other person see you in this scene?

• What are you telling yourself during this scene?

Giving Feedback to Clients

Helping Clients Recognize Schema Affect

• Unrelenting standards and hypercriticalness. This schema is likely to be triggered when

ACT and Schemas

Understanding Schema Coping Behaviors

Introducing Schema Coping Behaviors

Common Schema Coping Behaviors

Ten Common Schema Coping Behaviors

• Manipulation or exploitation: If you use this coping behavior in response to a schema-­

• Passive-­aggressiveness or rebellion: If you use this coping behavior in response to a

• Addictive self-­soothing: If you use this coping behavior in response to a schema-­triggering

Copyright © 2012 by Matthew McKay, Avigail Lev, and Michelle Skeen

6 Defusing from Thoughts and Developing the Observer-Self Perspective 69

• Interpersonal psychotherapy: a time-limited form of psychotherapy, originally devel-

• Transference-focused psychotherapy: a form of psychoanalytic psychotherapy, devel-

• Time-limited dynamic psychotherapy: a short-term treatment for chronic interper-

• Schema-focused therapy: a cognitive behavioral therapy treatment targeting border-

• Self-expression. In a nurturing environment, children are encouraged to express their

• They are self-perpetuating and resistant to change.

• Manipulation or exploitation: If you use this coping behavior in response to a schema-

• Passive-aggressiveness or rebellion: If you use this coping behavior in response to a

• Addictive self-soothing: If you use this coping behavior in response to a schema-triggering

Therapist: Because he can trigger that feeling of unworthiness—the defectiveness schema,

Observing Schema-Triggering Events in Day-to-Day Life

Client: I’m hot—in the face. I’m blushing.

Client: I want to yell at her. I want to just explode—to scream.

• Developing a values-based rationale for facing schema-related pain. In ACT termi-

Contrasting Values-Based Behaviors with SCBs

Rebecca: I don’t know—it will probably be worse.

Assessing Values-Based Living