German assertiveness training programme (Ullrich)

1. Introduction

Version followed: the Assertiveness-Training-Programm (ATP) of Rüdiger Ullrich and Rita Ullrich de Muynck (Pfeiffer, Munich, 1976 onwards; therapist volume reissued by Klett-Cotta, Leben Lernen 123, 1998/2002). The ATP volumes themselves are not drawn on, so the procedure is reconstructed from (a) Ullrich & Beth (2019), a detailed account of the current ATP practice combined with schema therapy, and (b) Güroff (2016), the authorised condensed successor (TSK, 30 scenes) by a student of the founders. Where these differ, the text says which one is followed. [source: Spektrum Lexikon ATP; socialnet review of Güroff 2016; Ullrich & Beth 2019; Güroff 2016 reading sample]

The ATP is a manualised, mainly group-based behaviour-therapy programme for social anxiety and insecurity ("soziale Störungen"), later also seen as the first manual for avoidant personality disorder (Sulz, as cited in the socialnet review). Clients work through a standardised hierarchy of 127 everyday social situations, ordered by anxiety and difficulty, in four classes: being evaluated or in the public eye (including making mistakes), making contact, making demands and asserting oneself, and saying no or setting limits. Each situation is shown by a model, rehearsed in role play with positive-only feedback and then carried out in real life. [source: Ullrich & Beth 2019, pp. 189, 194–196; Wikipedia "Training sozialer Kompetenzen"]

How change happens: insecurity is maintained by avoidance. Avoidance leads to fewer successes and less social reinforcement, which confirms the fear (Güroff's vicious cycle). Graded, successful confrontation at a moderate anxiety level, together with modelling (imitation learning), reinforcement and the extinction of avoidance, builds competence. Success experiences then raise self-efficacy and self-esteem, and anxiety falls. Insecurity is treated as three linked problems: skill deficits, low self-esteem and excessive social anxiety. [source: Ullrich & Beth 2019, pp. 186–190, 195; Güroff 2016, pp. 13–20; socialnet review]

2. Framework

Format. Original ATP: a closed therapy group running alongside individual therapy. Ullrich & Beth (2019, pp. 192–195) call the group with parallel individual therapy the ideal ("Königsweg"). Individual-only delivery and reduced variants are possible. Typical length: 25–35 double sessions of group work covering the 127 situations. Two therapists (or a co-therapist) are ideal so that one can model live. Group size is not stated in the sources [uncertain]; the related GSK uses about 10 participants with two trainers (Wikipedia), which is a reasonable guide [synthesis]. Güroff's TSK (2016, p. 15) uses 30 scenes, works in individual or group therapy, and fits a German statutory long-term therapy of 45–60 sessions. [source: Ullrich & Beth 2019; Güroff 2016]

Phase 0: Assessment, indication and preparation.

Goals: clarify whether the problem is a skill deficit, a deeper self-esteem problem, other social fears or another disorder; choose the full or a reduced ATP and the setting; motivate; sign a therapy contract.
Tools: condition (functional) analysis; the Unsicherheitsfragebogen (U-questionnaire) for the anxiety classes; the Fehlschlagangstfragebogen (FAF, fear of failure, aimed at self-concept).
Indication for the full ATP: at least three U-scales and the FAF each more than one standard deviation above the norm. Otherwise use a reduced, individually selected set. [source: Ullrich & Beth 2019, pp. 191–194]

Phase 1: Basic exercises (Grundkurs). Low-difficulty, standardised situations across the four classes (for example asking a stranger for directions, greeting, speaking loudly, a first short conversation, a first "no"). Goals: early success, learning the exercise routine, positive feedback culture, discrimination of assertive versus unassertive versus aggressive behaviour. The second ATP volume is titled the basic course (Grundkurs). [source: pwk catalogue record ATP 2; Güroff 2016 scenes 1–13]

Phase 2: Build-up exercises. Harder situations: standing out in public, returning goods, browsing without buying, handling pushiness or harassment, giving a short talk, stating dislike, retracting a decision, owning a "stupid" question or forgetfulness. Same procedure per situation. [source: Güroff 2016 scenes 14–30; Ullrich & Beth 2019, pp. 194–195]

Phase 3: Criticism and personal scenes. Giving and receiving constructive criticism is introduced only after about 15–20 double sessions, when self-esteem is stable enough (Ullrich & Beth 2019, p. 197). Clients then build and rehearse their own problem scenes (Güroff's personal scenes; the socialnet review calls this free training with individual scenes).

Phase 4: Transfer and aftercare. Real-life exercises continue as homework; Güroff has a chapter on what happens after the training (contents only seen) [uncertain].

Structure inside each exercise area (one documented implementation). Steiger et al. (1984, p. 362), working from the ATP, ran each area in six elements: motivation and relaxation (about 20 min); ranking the situations by difficulty (about 40 min); model demonstration and discussion (about 60 min); role plays (about 60 min); setting personal learning goals (about 20 min); transfer exercises (about 120 min). This was a 10-day intensive course, not the standard outpatient format.

Criteria for moving on.

Per situation: the client met the operational criteria in role play, then attempted it in real life. Practise at roughly 30% anxiety intensity; higher levels make learning fail (Ullrich & Beth 2019, pp. 193–195).
Between blocks: Güroff closes each block with a larger reward (after scenes 13 and 30, and at the end).
Re-measurement around sessions 12–14: expect the U-scores to have dropped by about one SD. FAF change is slower and may continue after therapy (Ullrich & Beth 2019, pp. 199–200). Güroff lets scenes be skipped when an interim measurement shows they are not needed (2016, p. 15).
Criticism work only once self-esteem has stabilised (see Phase 3).

3. Guiding principles

Graded hierarchy. Always start where success is likely and step up in small increments. In practice: never pick a situation the client rates as overwhelming; split it instead. [source: Ullrich & Beth 2019, p. 195; Güroff 2016, p. 14]
About 30% anxiety. Work at moderate arousal (Yerkes–Dodson). In practice: ask for a 0–100 rating before each role play and lower the step if it is well above about 30. Ullrich & Beth sum up the alternative as "Überleben geht vor Entwicklung" (survival before development). [source: Ullrich & Beth 2019, pp. 190, 195–196]
Positive-only feedback ("golden rule"). Mistakes and awkwardness are not pointed out; only met criteria are named. In practice: stop any group member who starts with "but" or advice. [source: Wikipedia "Training sozialer Kompetenzen"; Ullrich & Beth 2019, p. 196]
Concrete, operational criteria. Assertive behaviour is defined by observable features (for example eye contact held for about three seconds). In practice: state two or three criteria before every role play. [source: Ullrich & Beth 2019, p. 196]
Learning by imitation. Most social skills are learned from models; coping models (visibly nervous, then managing) beat calm mastery models. In practice: model with a little visible hesitation. [source: Ullrich & Beth 2019, p. 195]
Practice in real life. Role play is a rehearsal; change happens through in-vivo transfer. In practice: every session ends with a real-life task. [source: Ullrich & Beth 2019, p. 190; Steiger et al. 1984]
Reinforcement and self-reinforcement. External praise is gradually replaced by the client's own recognition of success, instead of habitual self-criticism. In practice: always end an exercise with the client naming what went well. [source: socialnet review; Ullrich & Beth 2019, p. 196]
Fairness, not dominance. The goal is a fair compromise between one's own rights and needs and the other person's, not winning. In practice: label aggressive solutions as such, as clearly as submissive ones. [source: Ullrich & Beth 2019, p. 190]
Authenticity over facade. The aim is not flawless behaviour or zero fear but acting towards one's goals despite fear, and standing by one's strengths and weaknesses. In practice: praise doing it anxious. [source: Ullrich & Beth 2019, p. 190]
Safe, structured group. A therapy contract (confidentiality, attendance, homework, role play, differentiated positive feedback) and clear instructions create a low-anxiety climate. [source: Ullrich & Beth 2019, pp. 190, 194]
Standardised but adaptable. Run the standard sequence but drop or vary situations according to the client's profile and interim measurements. [source: Ullrich & Beth 2019, p. 194; Güroff 2016, p. 15]
Attend to body and feeling, not just behaviour. Güroff adds mindfulness and the thinking–feeling–body–behaviour model; Ullrich & Beth anchor the felt moment of "I want to" in the body. [source: Güroff 2016, pp. 18–29; Ullrich & Beth 2019, pp. 198–199]

4. Intervention inventory

Note on completeness: the 127 ATP situations and their exact wording are in the copyrighted manual and material folder, which is not drawn on here. Individual ATP exercise numbers mentioned below (7, 14, 21, 41, 48, 52, 105) are those cited by Ullrich & Beth (2019). Situation examples otherwise come from Güroff's scene titles. All example language is illustrative. [uncertain: full ATP situation list not seen]

4.1 Condition analysis and questionnaire assessment

Purpose / when: Before the group, to choose full versus reduced ATP and setting, and to rule out cases for whom skills training alone is wrong. Repeat around sessions 12–14 and at the end. [source: Ullrich & Beth 2019, pp. 191–194, 199–200]
Steps:
1. Do a behavioural condition analysis (situation, cognitions, emotions, body, behaviour, consequences; Güroff uses the SORK scheme). Separate three components: skill deficit, self-esteem problem, social anxiety.
2. Give the U-questionnaire (Ullrich & Ullrich de Muynck; anxiety in evaluation, contact, demand and limit-setting situations) and the FAF (fear of failure). Do not reproduce items; score by the manual.
3. Indication for the full ATP: at least three U-scales and the FAF each above 1 SD over the norm. With fewer elevated scales, choose the situations of the elevated classes only.
4. Screen for contraindications (section 5) and for problems that need other treatment first.
5. Agree goals, variant and setting together.
Example language (illustrative): "Your answers show the most strain when you have to ask for something or turn someone down. Speaking in front of people is less of a problem. So we will start in those two areas."
Watch for: high FAF with only modestly raised U-scores suggests a self-esteem problem more than a skills problem; plan parallel individual work. [uncertain: the original U-questionnaire scale names and number of scales were not seen; older literature describes more than four factors. Follow the scoring sheet in the test folder.]

4.2 Therapy contract and group rules

Purpose / when: Before session 1, to create safety and reduce dropout. [source: Ullrich & Beth 2019, pp. 194–195]
Steps: Go through and sign a written agreement covering confidentiality, regular attendance, doing homework, taking part in every role play, and giving only differentiated positive feedback. Explain why each rule exists.
Example language (illustrative): "In this group everyone practises every scene, including me as a model. And we only say what went well. That is a rule, not politeness."
Watch for: clients who sign but already announce exceptions ("I won't do the street ones"). Discuss these individually before the group starts. [synthesis]

4.3 Psychoeducation and rationale

Purpose / when: First sessions, and in short pieces between exercises. [source: Güroff 2016, pp. 18–35; socialnet review]
Steps:
1. Explain the vicious cycle: anxiety leads to avoidance, avoidance leads to fewer successes and being overlooked, which confirms the anxiety.
2. Introduce the four levels (thinking, feeling, body, behaviour) and how they interact, using one of the client's situations.
3. Name the four situation classes and have each client place their avoidances in them.
4. Set the goal: not fearlessness but acting despite fear, fairly towards self and other.
5. Later, between blocks, give brief inputs (Güroff's topics: perfectionism, guilt, anger versus aggression, persistent negative thoughts, the two levels of communication).
Example language (illustrative): "Every time you avoid the phone call, the relief teaches your brain that the call was dangerous. We'll teach it the opposite, in small steps."
Watch for: the client recognising their own cycle in their own words; that is the cue to move to practice.

4.4 Building the hierarchy and rating difficulty

Purpose / when: At the start of each exercise area, and before each scene. [source: Steiger et al. 1984, p. 362; socialnet review; Ullrich & Beth 2019, p. 195]
Steps:
1. Present the standard situations of the area (ATP) or the next scene (TSK).
2. Each client rates expected anxiety or difficulty for each (0–100 is a practical scale [synthesis]; the scale used in the manual was not seen [uncertain]).
3. Order the situations from easiest to hardest for this person.
4. Start where anxiety is around 30. If the next step is much higher, create an intermediate step (shorter, with a friendlier partner, in a less public place).
Example language (illustrative): "Before we try it: how tense would you be, 0 to 100? Sixty is too high for today, so let's make it smaller."
Watch for: ratings of zero for everything, which may signal avoidance of the rating itself or a facade; check against observed behaviour.

4.5 Modelling (live or video)

Purpose / when: Before each new situation; social skills are largely learned by imitation. [source: Ullrich & Beth 2019, p. 195; Wikipedia]
Steps:
1. A therapist or co-therapist demonstrates the scene live, or a video model is shown (ATP: most scenes have video models; Ullrich & Beth cite Hellauer et al. 1998; Güroff's book includes a DVD).
2. Prefer a coping model: shows some nervousness, then completes the task.
3. Discuss what the model did in observable terms.
4. Optionally show contrasting models (submissive and aggressive versions; see 4.7).
Example language (illustrative): "Watch what I do with my voice and my eyes. I'm going to be a bit nervous, like you might be."
Watch for: clients saying "you can do that, you're the therapist". This is the reason to use coping models and to let a group member who has just succeeded model next. [synthesis]

4.6 Stating the operational criteria

Purpose / when: Right after the model and before every role play, so feedback is concrete. [source: Ullrich & Beth 2019, p. 196]
Steps: Name two to four observable features of the assertive solution for this scene (for example eye contact held about three seconds, audible voice, request stated as a clear sentence, no apology for asking). Write them on a flipchart.
Example language (illustrative): "For this one, success means: you look at the person, you say clearly what you want, and you don't apologise for asking."
Watch for: vague criteria ("be confident"), which make positive feedback impossible.

4.7 Discrimination training (assertive, unassertive, aggressive)

Purpose / when: Early in the programme and whenever clients confuse assertiveness with aggression or politeness with submission. [source: Ullrich & Beth 2019, p. 196, using GSK worksheets]
Steps:
1. Show or describe three versions of the same scene.
2. Have the group name which is which, and by which cues (voice, posture, words, outcome for both parties).
3. Transfer to observing others in daily life, then to observing oneself.
Example language (illustrative): "Version one got the seat but the other person felt attacked. Version two kept the peace but you stood all the way. What did version three do differently?"
Watch for: clients judging their own behaviour as all-or-nothing; teach graded, multi-dimensional observation instead (Ullrich & Beth 2019, pp. 196–197).

4.8 Personal goal for the attempt

Purpose / when: Before each role play and real-life attempt. [source: Ullrich & Beth 2019, p. 196; socialnet review; Steiger et al. 1984]
Steps: The client chooses one criterion (not all) to focus on this time, says it aloud, and is later asked whether they reached it.
Example language (illustrative): "Which one will you try today: the eye contact or the clear sentence?"
Watch for: perfectionists choosing every criterion; limit them to one.

4.9 Role play of the standard situation

Purpose / when: The core rehearsal for every situation in the hierarchy. In the ATP, every group member practises every exercise. [source: Ullrich & Beth 2019, p. 195; Wikipedia; socialnet review]
Steps:
1. Set the scene briefly (where, who, what the client wants). A therapist or group member plays the partner, at the agreed level of difficulty.
2. Get the anxiety rating; adjust if well above about 30.
3. Run the scene for one to three minutes. Do not interrupt unless the client freezes (then prompt with a single cue, or pause and restart smaller [synthesis]).
4. Positive feedback round (4.10), then self-assessment (4.11).
5. Repeat once if useful, possibly with the partner a little more resistant.
Example language (illustrative): "You're at the bakery counter, and the person behind you just pushed in. I'll be that person. Go ahead when you're ready."
Watch for: safety behaviours (whispering, looking away, rushing, apologising). Do not criticise them; make them the criteria for the next attempt. Signs it is working: ratings fall across repetitions and criteria are met more often.

4.10 Positive-only feedback round

Purpose / when: Directly after each role play. Called the golden rule in descriptions of the ATP. [source: Wikipedia; Ullrich & Beth 2019, p. 196]
Steps:
1. The partner and observers name only the agreed criteria that were met, specifically (what, when).
2. The therapist interrupts any criticism, advice or "but" and asks the speaker to rephrase as an observed success.
3. Early on, feedback stays on the operational level (Ullrich & Beth's example: noting that the client did not apologise).
Example language (illustrative): "Tell her one thing she actually did, not what she should do next time."
Watch for: clients who reject praise ("it was only a role play"). Thank them, then ask them to repeat the observed behaviour aloud. Persistent rejection signals a self-esteem problem for individual work (Ullrich & Beth 2019, p. 197).

4.11 Self-reinforcement and securing the result

Purpose / when: After every attempt, to replace habitual self-criticism with self-recognition. Introduced after external feedback has been established. [source: socialnet review (Güroff's step 5); Ullrich & Beth 2019, p. 196]
Steps:
1. Ask whether the personal goal was reached.
2. The client says what they did well, in specific terms.
3. Note the success in writing (diary or exercise sheet [synthesis]).
4. At the end of a block, give or take a larger self-chosen reward (Güroff: after scenes 13 and 30 and at the end).
Example language (illustrative): "Before anyone else says anything: what did you manage just now?"
Watch for: "Yes, but..." Stop at the "yes" and have them finish only that half.

4.12 Real-life (in vivo) transfer exercises and homework

Purpose / when: After each successful role play; weekly homework is treated as essential for transfer. [source: Ullrich & Beth 2019, p. 190; Steiger et al. 1984; Wikipedia; socialnet review]
Steps:
1. Agree the same situation, or a slightly easier version, in a real setting (street, shop, restaurant, office). Steiger et al. used street and traffic, shops and restaurants, public events and authorities.
2. Specify when, where, with what goal and which one criterion.
3. Optionally do the first trial during the session, with group or therapist nearby [uncertain: the sources do not say whether therapist-accompanied outings are a fixed part of the ATP].
4. Client records the anxiety before and after, and what they did well.
5. Review at the start of the next session with positive feedback only.
Example language (illustrative): "This week: ask two strangers for directions, at a time you choose. Write down your tension before and after, and one thing you did well."
Exposure safety and consent: Agree each task freely; the client may choose an easier version. Choose tasks that are socially ordinary and legal, and that do not put the client at physical or financial risk (for example returning goods with a receipt, not provoking strangers). Plan what to do if the other person reacts unpleasantly (leave calmly, count it as a success for trying). [synthesis]
Watch for: tasks done only half (for example asking then running off). Count it as a step and repeat the full task.

4.13 Relaxation and motivation phase

Purpose / when: At the start of an exercise area in the Steiger et al. (1984) implementation (about 20 minutes). [source: Steiger et al. 1984, p. 362]
Steps: Brief relaxation, then a motivating introduction to the area. The specific relaxation method was not described [uncertain]. Güroff uses a mindfulness body scan instead (4.15).
Example language (illustrative): "Let your shoulders drop and breathe out slowly. Today we start with making contact, the area most of you chose."
Watch for: relaxation being used as an avoidance ritual before every attempt. [synthesis]

4.14 Cognitive methods

Purpose / when: When thoughts block practice or devalue success. Ullrich & Beth list thought-stopping, attention focusing, discrimination training, reattribution and self-reinforcement; Steiger et al. list self-instruction, problem solving and attitude change. [source: Ullrich & Beth 2019, pp. 189–190; Steiger et al. 1984, p. 362]
Steps (procedures generic to CBT; ATP-specific wording not seen [uncertain]):
- Self-instruction: before the scene the client prepares one short, task-focused sentence to say to themselves.
- Attention focusing: shift attention from self-observation ("how do I look?") to the task and the other person.
- Thought-stopping: interrupt a looping self-critical thought and return to the task.
- Reattribution: after a disappointing outcome, examine other causes (the other person's mood, the situation) besides "I'm useless".
- Challenge dichotomous thinking and overgeneralisation ("it went badly" becomes "three criteria met, one missed").
- Problem solving: for difficult real-life situations, collect options, choose one, plan it and rehearse.
Example language (illustrative): "What will you say to yourself right before you speak? Keep it short: 'Look up, say it.'"
Watch for: cognitive work replacing the exercises. Keep it brief and in the service of the next attempt.

4.15 Mindfulness body scan (Güroff addition)

Purpose / when: Early in the TSK, as a strategy to regulate tension during exercises; the socialnet review calls it an "Anti-Panik-Strategie". Not part of the original 1976 ATP. [source: socialnet review; Güroff 2016, contents pp. 28–29]
Steps (generic body-scan procedure; Güroff's text not seen [uncertain]): Guide attention slowly through the body, noting sensations without changing them. Practise at home until it is familiar, then use a shortened version before and during demanding scenes.
Example language (illustrative): "Notice your feet on the floor, your hands, your breathing. You don't need to change anything, just notice it."
Watch for: the client using it to escape a scene rather than to stay in it.

4.16 Mirror exercise (ATP 14; TSK scene 7)

Purpose / when: In the basic phase, to work on self-image and on how inner self-talk shows in the face. [source: Ullrich & Beth 2019, p. 197; Güroff 2016, scene list]
Steps:
1. The client looks at their face in a mirror for a while.
2. They notice which inner comments come up and how the face changes with each.
3. They find which inner self-talk goes with a relaxed face.
4. In the schema-therapy variant, harsh inner comments are explored as demanding or punitive parent modes in individual sessions.
5. Güroff later has a further mirror exercise for the whole body (build-up phase).
Example language (illustrative): "What are you saying to yourself right now? And when you say something kinder, what happens around your eyes and mouth?"
Watch for: strong shame or distress. Shorten it, do it with the therapist present first, and take it to individual therapy if it persists. [synthesis]

4.17 Body anchoring of "I want to" (door exercise, ATP 7)

Purpose / when: In the schema-integrated variant, to connect assertive acts with the felt wish behind them, especially for clients who give up their needs. [source: Ullrich & Beth 2019, pp. 198–199]
Steps:
1. Use a simple act of self-assertion (in ATP 7 involving a door; the scene's exact content was not described [uncertain]).
2. At the moment the client feels "I want to", the therapist stops the action briefly.
3. The client notices where and how they feel the wish in the body.
4. Then completes the act, keeping that feeling. A related exercise uses body sensations to sense one's limits and permission to say no.
Example language (illustrative): "Stop for a second. Where do you feel the 'I want' right now?"
Watch for: guilt or anxiety straight after the wish appears. Ullrich & Beth, citing Jacob (2013), note that many Cluster-C clients feel strong guilt when they even allow themselves anger.

4.18 Graded practice in each situation class

Not a separate technique but the content of the hierarchy. Examples are from Güroff's scene titles and the Ullrich & Beth account; the ATP's own 127 situations were not seen [uncertain].

Public attention, mistakes and criticism (ATP 41, 52): speaking loudly, standing out in public, owning a "stupid" question or forgetfulness, giving a short talk, being looked at.
Contact (ATP 21): asking directions, greeting, starting and ending a first conversation, silent contact, mindfulness with others.
Demands and self-assertion (ATP 48): asking for something, browsing without buying, returning goods, taking back a decision, claiming an occupied place.
Saying no and limits (ATP 105): refusing a request, compromise, handling pushiness, manipulation and harassment, stating dislike, responding to a nickname.
Steps: apply 4.4 to 4.12 to each, from the bottom of the client's hierarchy upwards.
Watch for: clients who progress quickly in one class and avoid another. Track each class separately. [synthesis]

4.19 Constructive criticism: giving and receiving

Purpose / when: Only after about 15–20 double sessions, when self-esteem is stable enough. [source: Ullrich & Beth 2019, p. 197]
Steps:
1. Rehearse giving feedback that names a specific behaviour and a wish, not a judgement of the person.
2. Rehearse receiving it: listen, check you understood, accept or reject specific points, without self-attack.
3. Introduce into the group's feedback rounds gradually, still balanced by positive feedback.
Example language (illustrative): "One thing I noticed, and one thing I'd wish for next time. Then you can tell us what you'll take from that."
Watch for: the group culture shifting into criticism. Return to positive-only feedback if anxiety rises.

4.20 Personal scenes and free training

Purpose / when: After the standard hierarchy, to work on the client's own problem situations. [source: Güroff 2016, contents pp. 163–166; socialnet review]
Steps:
1. The client describes a real recurring situation (who, where, what they want).
2. Set criteria and a personal goal.
3. Rehearse as in 4.5 to 4.11, with a group member or therapist playing the other person as the client describes them.
4. Plan the real-life attempt and review it.
Example language (illustrative): "Tell us about Monday's meeting with your manager. Who should play her, and what is she like?"
Watch for: scenes that are too hard (for example a major conflict with a partner). Build intermediate steps first.

4.21 Interim measurement and tailoring

Purpose / when: Around sessions 12–14 (ATP) or at an interim point (TSK). Used to decide which situations to skip, vary or repeat. [source: Ullrich & Beth 2019, pp. 199–200; Güroff 2016, p. 15]
Steps: Repeat the U-questionnaire and FAF. Expect about 1 SD reduction in U-scores by then. Classes no longer elevated can be shortened; persistent FAF elevation points to more self-esteem work in individual therapy.
Example language (illustrative): "Your contact anxiety has come down a lot; saying no is still high. We'll spend more time there."
Watch for: good scores with continued avoidance in daily life. Trust the behaviour over the questionnaire. [synthesis]

4.22 Schema-therapy adjuncts (current Ullrich & Beth variant)

Purpose / when: In parallel individual therapy, for clients whose insecurity rests on dysfunctional schemas (for example "inadequacy"), in combination with the ATP group. Not part of the original ATP; no controlled trials of the combination yet (Ullrich & Beth 2019, p. 200). [source: Ullrich & Beth 2019, pp. 187–188, 198–199]
Steps (outline only): Identify modes (vulnerable child, demanding or punitive parent, coping modes such as submission or avoidance). Use chair dialogues and imagery rescripting to give the vulnerable child new, good experiences. Strengthen the healthy adult mode. The therapist may model expressing anger to normalise it. Full procedures belong to schema therapy, not to this guide.
Watch for: dependent clients staying in a cared-for role. Shift towards their own responsibility in time.

5. Handling problems

Contraindications and wrong indication. Do not use the ATP for acute psychosis, severe cognitive impairment or severe depression. Borderline clients are better served by specialised programmes. A pure skills training is not enough when severe anxiety and self-esteem problems dominate; add individual therapy. Alsleben & Hand exclude marked compulsive personality features; chronic OCD with Cluster-C traits may benefit if schema therapy comes first. [source: Ullrich & Beth 2019, pp. 192–193] If depression or suicidal thinking emerges during the course, assess risk by standard practice and pause the group until it is managed. [synthesis]

Overwhelm (anxiety far above about 30%). Ullrich & Beth warn that practising too high leads to failure and to clients merely complying with the therapist, which strengthens avoidance and safety behaviours (pp. 193–194). Response: stop, acknowledge, make the step smaller (shorter, friendlier partner, private setting, therapist alongside), repeat until it succeeds, and only then go back up. Use the body scan or a slow breath to come down before continuing (Güroff), not to escape. [source: Ullrich & Beth 2019; socialnet review; steps partly synthesis]

Stuck clients (no progress in one class). Check the indication: a persistent FAF elevation or rejection of positive feedback points to a self-esteem problem, best handled in parallel individual (schema) therapy (Ullrich & Beth 2019, pp. 197, 199). Look for hidden safety behaviours in role play and make dropping one of them the next goal. Add intermediate steps. [synthesis for the last two points]

Rejecting praise and self-devaluation. Expected in clients with low self-esteem; work on it in individual sessions (Ullrich & Beth 2019, p. 197). In the group: keep feedback factual, have the client repeat the observed success aloud, and limit "yes, but" (4.11). [synthesis for the group tactics]

Non-adherence to homework. Ullrich & Beth make homework part of the contract (p. 194). Response [synthesis]: check whether the task was too hard (rating), make it smaller and more specific (time, place), rehearse it in session, and review every task at the start of the next session with positive feedback for any part done. Do not shame missed tasks in the group.

Dropout. Reduced by parallel individual therapy and a signed contract (Ullrich & Beth 2019, p. 195). Contact absent members quickly and give them the next small step. [synthesis]

Group members who criticise or lecture. Re-state the golden rule and ask them to name one met criterion instead. If it continues, discuss it individually; it often reflects the person's own demanding inner critic (consistent with the mode view in Ullrich & Beth). [synthesis]

Assertiveness turning into aggression. Use discrimination training (4.7) and the fairness principle: the goal is a fair compromise, not winning (Ullrich & Beth 2019, p. 190). Show the aggressive version as a contrast model. Watch for clients with suppressed anger whose first assertive attempts come out too hard; treat it as a step and refine. [synthesis]

Guilt and shame after asserting oneself. Expect guilt, especially in Cluster-C clients who are rarely allowed anger (Jacob, cited by Ullrich & Beth 2019, p. 198). Güroff includes psychoeducation on guilt and on anger versus aggression. Response: name the guilt as a predictable after-effect, check whether the act was fair (usually yes), and do the next exercise anyway. [source as cited; response partly synthesis]

Perfectionism and narcissistic misuse. Some clients use the training to hide weaknesses behind a flawless facade (Ullrich & Beth 2019, p. 194). Response: make "doing it anxious" and admitting mistakes (public-attention scenes such as the "stupid" question) explicit goals. Limit the personal goal to one criterion. [source plus synthesis]

Dependent clients. Avoid keeping up highly caring behaviour for too long; move towards the healthy adult and own responsibility (Ullrich & Beth 2019, p. 194).

Unpleasant real-life reactions. Real-life tasks can meet rude responses. Response [synthesis]: plan for this in advance, count completion of the attempt (not the other person's reaction) as success, review with positive feedback, and repeat a slightly easier version before moving on. Do not set tasks that risk conflict with authorities or physical danger.

Ruptures with the therapist. Not addressed in the sources [uncertain]. Response [synthesis]: if a client feels pushed, acknowledge it, return control over task choice and level to them, and repair in an individual session. In group, model the assertive skills being taught (state the issue, listen, agree a fair solution).

Video feedback distress. Ullrich & Beth advise caution with video (pp. 186, 194). Use it only after self-esteem has stabilised, and only to show met criteria. [source plus synthesis]

Uncertain areas. The full text of the ATP volumes (1976–2006 editions, material folder, U-questionnaire test folder) is not drawn on. Session-by-session allocation, exact instructions for each of the 127 situations, the original scale names and number of U-questionnaire scales, and the founders' own wording are therefore not reproduced or confirmed. Ullrich & Beth (2019) describe a current, schema-therapy-integrated practice, which may differ from the 1970s original.

Sources

Sources: