Clarification-oriented psychotherapy

1. Introduction

Version followed: Rainer Sachse's Klärungsorientierte Psychotherapie (KOP; English: clarification-oriented psychotherapy, COP), developed at the Institut für Psychologische Psychotherapie (IPP), Bochum. The guide follows the "Therapeutic rules" chapter (Sachse, Fasbender & Sachse) with its four-phase model, the IPP/Klaus-Grawe-Institut training slides, and for personality disorders the five-phase model and dual action regulation model from Sachse (2020). Where the two phase models differ, both are given. [source: therapeutische-regeln-kop.pdf; kop_alle3foliensatze.pdf; Sachse 2020 sample]

What it is. KOP is an individual, verbal psychotherapy that grew out of Sachse's goal-oriented client-centred therapy (Zielorientierte Gesprächspsychotherapie). It keeps the client-centred basic conditions (empathy, acceptance, genuineness) but is explicitly directive about process: the therapist steers how the client works on a problem, while leaving the content and decisions to the client. Sachse describes it as fundamentally different from classic client-centred therapy, behaviour therapy and cognitive therapy. Its main application areas in the Bochum literature are personality disorders (which Sachse treats as interaction or relationship disorders), psychosomatic clients and clients with unclear, "alienated" motives. [source: r-sachse-kop.pdf; Hogrefe product pages]

How change happens. Problems are produced by dysfunctional schemas (self-schemas, relationship schemas, norms, compensatory schemas) that activate automatically and steer perception, affect and action, and by alienation: the person has lost access to their own motives and follows norms or schemas instead. A schema can only be changed after it has been validly represented: made explicit in words, checked with the client and understood in its implications. Clarification therefore comes before solution ("Klären vor Lösen"). Once represented, the schema is tested against experience, weakened, linked with resources and replaced by functional alternatives; the goal is better self-regulation, more action orientation and decisions that fit the client's motives. The relationship is necessary (it builds the trust that clarification needs and "relationship credit" for confrontation) but, per Sachse, not sufficient for change. [source: r-sachse-kop.pdf; folienhandout KGI 2025; Klärungsprozesse 2016 extract]

2. Framework

Format. Individual outpatient talk therapy; therapist acts as process expert. Group formats exist in training (role-play practice) but not as a described treatment format. [source: folienhandout KGI 2025] Typical session count: not given in the sources; Sachse stresses the process is recursive and cannot be planned in advance, and that schemas may be in different phases at the same time. [uncertain] [source: r-sachse-kop.pdf; Sachse 2020 sample]

Three working levels (used throughout, in every phase): content level (what is talked about: problems, goals, self-concepts, motives), processing level (how the client deals with the problem: internal vs external perspective, avoidance, whether feelings are used as information), relationship level (alliance, interactional games). Two cardinal errors: a level error (intervening on the wrong level, e.g. asking more content questions when the client is avoiding) and a tempo error (working on content, or confronting processing or relationship, before the relationship carries it). Default aim: always get back to productive work on content. [source: kop_alle3foliensatze.pdf; folienhandout KGI 2025]

Four-phase model (general KOP; Therapeutic rules chapter)

[source: therapeutische-regeln-kop.pdf §2.5]

Five-phase model (personality disorders; Sachse 2020)

1. Model and relationship: build the client model and a complementary, trusting relationship.
2. Game level and tests: deal with interactional games and relationship tests in the session; make them transparent and costly-to-keep.
3. Clarification of schemas.
4. Working through schemas.
5. Transfer: carry new behaviour and views into everyday relationships.

The phases are not strictly linear; clients may need to repeat them, and different schemas may be in different phases at once, but the order of process objectives should be respected (e.g. no schema work while games dominate the relationship). [source: Sachse 2020 sample pdf] Detailed phase criteria for each disorder are in the disorder chapters, which are not drawn on. [uncertain]

Explication (processing-mode) scale: the micro-framework

Within clarification, the client's current processing mode is tracked on a stepwise scale and the therapist makes an offer one step higher. Taught version (KGI 2025): (1) no processing of personal content → (2) intellectualising (theories, no personal data or feelings) → (3) report (what happened, no evaluation) → (4) attributive evaluation (value located in the other: "he is stupid") → (5) personal evaluation (owned as one's own) → (6) personal meaning (felt meaning in the moment) → (7) explication (relevant schemas and motives become conscious) → (8) integration (connections and new insights). Sachse's 2016 book uses related stage names: no personal problems, intellectualisation, vague report, concrete report, focus on the situation, clarifying processing, reconstructing schema aspects. Versions differ in labels; the logic (meet the client one step above where they are) is the same. [source: folienhandout KGI 2025; Klärungsprozesse 2016 extract] [uncertain: exact canonical scale wording]

3. Guiding principles

Source for all items unless noted: therapeutische-regeln-kop.pdf (rule numbers given) and folienhandout KGI 2025.

Relationship

• Build an active relationship (2.3.1): the aim is that the client trusts you and, through that, gains trust in themselves.
• Never harm the client (2.3.2): honesty that would hurt (e.g. disclosing dislike) is not appropriate.
• Offer experiences beyond everyday life (2.3.3): interrupt, name contradictions, skip social politeness; do not respond complementarily to game behaviour; be loyal to the client without taking sides against third parties.
• Realise the basic variables in phase 1 (2.3.4): empathy, acceptance, warmth, loyalty, genuineness, transparency.
• Client as valued customer (2.3.5): Sachse uses "client", not "patient".
• Complementary relationship design (2.3.6): respond to the reconstructed relationship motive (e.g. recognition), not to the game; this earns relationship credit.
• Strengthen confidence (2.3.7): implicitly and in explicit statements about the client's competencies.
• Neutrality and working distance (2.3.8): do not become a stabiliser of the client's system; KOP is not crisis intervention; do not share the client's views uncritically.
• Relationship message in every intervention (2.3.9): each intervention also says "I'm on your side" and "you have resources".

Expert role and process responsibility

• Therapist = process expert, client = content and decision expert (2.4.1).
• Set the rules, explain them, do not debate them (2.4.2).
• Take responsibility for your part only (2.4.3): hand responsibility for actions back to the client.
• Therapy is work (2.4.4): make demands; offer work on obstacles rather than comfort.
• Face the dragon (2.4.5): raise unpleasant or embarrassing content directly; never signal a topic is too hot.
• Only psychological aspects (2.4.6): reframe practical problems (job, money, law) into their psychological part, or leave them out.
• Steer explicitly via processing offers (2.4.7).
• Hold macro and micro view (2.4.8): macro = client model and long-term goals; micro = the "triple" client state, intervention, client reaction.
• Work at the edge of the possible (2.4.9): test limits carefully, avoid over- and under-challenging; not with schizophrenia or borderline presentations.
• Offer validated expert knowledge when needed (2.4.10): offered, not imposed, in plain words.
• Intervene as often as necessary (2.4.11): compensation model; step in early when the client rambles, to avoid therapist paralysis.
• Don't argue (2.4.12): client arguments serve a function (avoiding change); address the function, not the truth of the claim.
• Everything is a construction; nothing is plausible until examined (2.4.13): watch for "plausibility traps".
• The client may accept or reject the offer (2.4.14): do not invent a new therapy to suit them; be prepared to let a client go who will not accept the rules.

Clarification phase

• Support explication (2.5.2.1): deepening questions, saying back, following hot traces; offer explications as hypotheses and validate them.
• Content abstinence (2.5.2.2): give as little content as possible.
• Clarify before solving (2.5.2.3): build a complete problem definition first.
• Don't work for the client (2.5.2.4): interventions should set the client a task; avoid yes/no and multiple-choice questions.
• Clarify rather than console (KGI 2025).
• Internalise the perspective (KGI 2025): move from blaming others to the client's own part.

Processing phase

• Alternate clarification and processing (2.5.3.1) as the material requires.
• Content proposals are now allowed (2.5.3.2): the client evaluates and may reject them.

Client model

• Understand before intervening; build a client model early and keep testing it (2.6.1–2.6.2): problems, themes, goals, work mandate, avoidance, relationship style, schemas.
• Use synthetic and analytic modes (2.6.3): synthetic builds the model; analytic finds gaps and contradictions, which become your next questions.
• Heuristics must be filled with individual data and tested; seek disconfirmation (2.6.4–2.6.5): separate supported hypotheses from speculation.
• Reconstruct central schemas from the start; filter for core information (2.6.7–2.6.8).

Form of interventions

• Specific and easy to carry out (2.7.1).
• Low load (2.7.2): complex interventions consume the client's capacity and reduce clarification (reported as empirically shown).
• Short (2.7.3): a guide of about 4–6 words.
• Instruction last if longer (2.7.4); one instruction per intervention (2.7.5); simple, explicit language (2.7.6).
• Offers are retrospective, prospective and refusable (slides): anchor in what the client said, prompt the next step, allow the client to say no.

Limits and control (KGI 2025)

• Accept limits but make them transparent: the client names the limit and owns it; re-test later.
• Don't be bluffed or controlled: recognise "I don't know", threats or symptom-based control and respond constructively.
• Take criticism seriously and also hold the client accountable.
• Keep working towards the process goal; do not be diverted by avoidance.

4. Intervention inventory

Organised by the three levels (relationship, content, processing), then schema processing and transfer. KOP names these as interventions or strategies; step lists are written in my own words from the sources cited, and where the sources give only a name or a principle the steps are marked [synthesis]. German slide examples are quoted only in short fragments; all other example language is illustrative.

A. Relationship level

A1. Realising the basic variables (phase 1)

• Purpose / when: From the first session; the base for trust and for all later steering. [source: rules 2.3.4; r-sachse-kop.pdf]
• Steps: (1) Listen for the client's internal frame of reference and reflect it accurately. (2) Show acceptance of the person, without endorsing every view. (3) Be transparent about what you are doing and why. (4) Be loyal (on the client's side) without siding against absent third parties.
• Example language (illustrative): "So it hurts that he didn't even ask how you were." "I'll interrupt you now and then; that's so we stay with what matters to you."
• Watch for: Client begins bringing personal material and accepts your interruptions. Sachse's caution: the relationship alone does not produce change; do not stay in phase 1 indefinitely.

A2. Complementary relationship design (motive-oriented)

• Purpose / when: Mainly with personality disorders, once the client's central relationship motive (e.g. recognition, importance, reliability, autonomy, territoriality, solidarity) has been reconstructed. Builds relationship credit (Beziehungskredit) and allows corrective experience. [source: rules 2.3.6; folienhandout KGI 2025; kop_alle3foliensatze.pdf]
• Steps: (1) From the client model, identify the central frustrated motive. (2) Distinguish it from the game behaviour that serves it (e.g. repeated reassurance-seeking, flattery, helplessness). (3) Satisfy the motive proactively and genuinely, before the client has to use the game (e.g. explicit, specific recognition for a narcissistic client; signalled importance and attention for a histrionic client). (4) Do not reward the game itself. (5) Later, use the trust gained to make the game and its costs transparent (see C11).
• Example language (illustrative): To a client with a recognition motive: "You analysed that situation very precisely; that's a real competence." To a client with an importance motive: "What you bring here matters to me; I want to understand it properly."
• Watch for: Fewer tests and manoeuvres, more openness. Error: responding to the game (e.g. extending sessions on demand) rather than the motive. [synthesis on errors]

A3. Relationship messages inside interventions

• Purpose / when: Every intervention, especially confrontations. [source: rules 2.3.9]
• Steps: Add a short clause signalling alliance ("I'm on your side") and confidence in resources to directive or confronting statements.
• Example language (illustrative): "I think you can look at this, even though it's uncomfortable. What exactly happens in you when…?"
• Watch for: Client hears confrontation as help, not attack.

A4. Strengthening confidence / resource activation

• Purpose / when: Throughout; particularly before demanding steps and in schema processing, where positive self-aspects support restructuring. [source: rules 2.3.7; folienhandout KGI 2025]
• Steps: (1) Notice real competencies the client shows in session. (2) Name them specifically, not globally. (3) Link them to the task at hand.
• Example language (illustrative): "You've just named something you avoided for weeks. That shows you can face this."
• Watch for: Specific, believable feedback; generic praise can be heard as a game response.

A5. Defining roles, rules and the work mandate

• Purpose / when: Early, and whenever the client pushes the therapist out of the expert-for-process role. [source: rules 2.4.1–2.4.4, 2.4.14; folienhandout KGI 2025]
• Steps: (1) Explain: you are responsible for the process, the client for content and decisions. (2) State that therapy is work and will sometimes be uncomfortable. (3) Clarify the client's work mandate (what they want to change in themselves). (4) Make the rules transparent; if contested, explain once, do not debate. (5) If the client will not accept the frame, say so and discuss whether KOP is right for them.
• Example language (illustrative): "My job is to steer how we work; what you look at and decide stays yours." "What would you like to understand or change about yourself here?"
• Watch for: A mandate stated as change in the client, not in others. A purely external mandate ("make my boss fair") calls for internalising the perspective (B8).

A6. Building and testing the client model (diagnostic work)

• Purpose / when: From session 1, continuously; drives which intervention comes next. [source: rules 2.6.1–2.6.8; 2.4.8]
• Steps: (1) Collect core information: problems and their meaning, central themes, intentions, work mandate, avoidance, relationship style, role acceptance, control attempts, image and appeal messages. (2) Synthetic mode: assemble a provisional model (motives → schemas → game behaviour). (3) Analytic mode: list gaps, contradictions and unclear conclusions; each becomes a question. (4) Fill heuristics (e.g. typical schemas of a disorder) only with this client's data; actively look for disconfirming evidence. (5) Mark which parts are supported and which are speculation. (6) On the micro level, check each "triple": client state, your intervention, client response.
• Example language: Mostly internal work; validation questions as in B6.
• Watch for: Drowning in detail (novice error); stop collecting data that does not bear on central schemas.

A7. Offering validated expert knowledge (psychoeducation)

• Purpose / when: When the client lacks information needed to work (e.g. how schemas or avoidance operate). [source: rules 2.4.10]
• Steps: Offer, don't impose; keep it short and in everyday words; only validated knowledge; return to the client's material.
• Example language (illustrative): "May I offer an idea? Old assumptions about ourselves often fire automatically, faster than we can think. Does that fit what happens to you?"
• Watch for: Psychoeducation turning into intellectualising (processing mode 2).

B. Content level: clarification interventions

B1. Paraphrasing (synthetic)

• Purpose / when: Show understanding and keep the client's attention on their statement. [source: kop_alle3foliensatze.pdf; Klärungsprozesse 2016 TOC]
• Steps: Reflect the client's statement literally or slightly reworded; keep it short (about 4–6 words).
• Example language (illustrative): "You think you could fail."
• Watch for: Paraphrase-only sessions; alternate with analytic questions.

B2. Verbalising (synthetic)

• Purpose / when: Make explicit what is implied but not said, steering attention to the central element (often affect). [source: kop_alle3foliensatze.pdf]
• Steps: Pick the central word or feeling; name it briefly; stop.
• Example language (illustrative): "There's a lot of fear there."
• Watch for: Client takes the word and goes further into it.

B3. Therapist explication (synthetic, hypothesis-based)

• Purpose / when: Translate the client's internal frame of reference into explicit terms when the client cannot yet formulate it; also tests your model. [source: kop_alle3foliensatze.pdf; r-sachse-kop.pdf; Klärungsprozesse 2016 ch. 7]
• Steps: (1) Derive the likely implication from what the client said (implication structure). (2) Offer it tentatively as a hypothesis, staying close to the client's material. (3) Ask the client to check it against their experience. (4) Accept correction and reformulate. (5) Do not supply new content beyond what the material implies (content abstinence).
• Example language (illustrative): "If I understand you right, you're afraid of making a fool of yourself. Check if that fits."
• Watch for: Client adopts your formulation without checking (compliance) versus refining it in their own words (working).

B4. Information and concretising questions (analytic)

• Purpose / when: Fill gaps and make vague material concrete. [source: kop_alle3foliensatze.pdf]
• Steps: (1) Ask about meaning and relevance rather than external facts. (2) Ask what exactly a word means to the client. (3) Use "what" questions; avoid "why" (which invites attributions and an external perspective).
• Example language (illustrative): "That meeting is very important to you?" (preferred over asking what kind of meeting it was) "What do you mean by 'fail'?"
• Watch for: Interrogation feel; alternate with synthetic interventions.

B5. Deepening questions (analytic)

• Purpose / when: Move from situation to personal meaning and schema. [source: kop_alle3foliensatze.pdf; rules 2.5.2.1]
• Steps: Take the client's key term and ask what it would mean for them; repeat on the answer (laddering-like) until a self- or relationship-assumption appears.
• Example language (illustrative): "What would failing mean for you?" … "And if they saw that, what would that say about you?"
• Watch for: The answer shifts from "they" to "I" and from events to evaluations of self.

B6. Validation of the model

• Purpose / when: Before building further on a hypothesis. [source: kop_alle3foliensatze.pdf; folienhandout KGI 2025]
• Steps: Summarise your current understanding briefly and ask the client to confirm or correct.
• Example language: Slides give the form "habe ich richtig verstanden, dass…?" ("have I understood correctly that…?") [source: folienhandout KGI 2025]
• Watch for: Correction is good data; never argue with it.

B7. Following hot traces

• Purpose / when: Choose which of many strands to follow: those pointing to central internal determinants. [source: kop_alle3foliensatze.pdf; rules 2.5.2.1]
• Steps: Listen for markers of: self-concept (ability, attractiveness, worth); relationship concept (expectations, beliefs about relationships); motives (achievement, affiliation, power; relationship motives such as recognition, reliability, autonomy, territoriality); norms ("I must", "one should", control orientation). Follow that strand with a deepening question; leave peripheral detail.
• Example language (illustrative): "You said 'I'm not good enough for that.' Let's stay with that."
• Watch for: Affect rises when you are on a hot trace.

B8. Internalising the perspective

• Purpose / when: Client describes problems only as others' faults (attributive evaluation, external perspective). [source: folienhandout KGI 2025]
• Steps: (1) Acknowledge the client's view. (2) Redirect to the client's own reaction: what bothers them, what it triggers in them.
• Example language: The slide pairs the client's "he's an idiot" view with asking what displeases them about him [source: folienhandout KGI 2025]; illustrative: "What is it about him that gets to you?"
• Watch for: Movement from processing mode 4 (attributive) to 5 (personal evaluation).

B9. Concretising vague reports and clarifying labels

• Purpose / when: Rambling, general or abstract talk; global labels like "anxiety" or "stress". [source: kop_alle3foliensatze.pdf]
• Steps: (1) Ask for one concrete, recent situation. (2) Treat a label as the start of clarification and ask what it consists of for the client.
• Example language (illustrative): "Take one specific moment last week. What happened?" "What exactly do you mean by anxiety, in you?"
• Watch for: Shift from vague to concrete report and focus on the situation (scale steps 3–5).

B10. Strategies for deepening clarification: tempo, saying back, focusing, felt sense, biography

• Purpose / when: When the clarification process is progressing and nearing affective schema material. [source: kop_alle3foliensatze.pdf; rules 2.5.2.1; r-sachse-kop.pdf]
• Steps: (1) Take out tempo: slow down, fewer and shorter interventions, pauses. (2) Saying back: repeat the client's central phrase to keep them on track. (3) Direct focusing on feelings: instruct attention inward. (4) Felt sense: invite attention to the bodily, not-yet-verbal sense of the issue and let words come from it (Sachse draws on Gendlin's focusing to clarify affective schemas; detailed protocol not given in the sources). (5) Biographical work once a schema is activated: ask where the client knows this feeling or assumption from.
• Example language: Slide instruction "Achten Sie auf Ihre Gefühle!" ("Pay attention to your feelings!") [source: kop_alle3foliensatze.pdf]; illustrative: "Take your time… What do you notice inside as you say that?" "When did you first feel like this?"
• Watch for: Slower speech, longer pauses, new formulations; avoid rushing to solutions here. [uncertain: full focusing steps]

B11. Clarifying implicit motives

• Purpose / when: Alienated clients who follow norms and cannot say what they want. [source: Klärungsprozesse 2016 ch. 10 (title only); folienhandout KGI 2025; r-sachse-kop.pdf]
• Steps: (1) Ask what the client wants, which wishes remain unfulfilled and how much effort goes into them. (2) Separate "I want" from "I must / one should". (3) Use affect as an indicator (what brings relief, longing or anger). [steps 2–3 partly synthesis]
• Example language (illustrative): "Leaving aside what you should do: what would you want?"
• Watch for: Client recognises a wish as their own; often accompanied by emotion. [uncertain: chapter 10]

B12. Differentiating facts from evaluations and norms

• Purpose / when: Client presents evaluations or norm-driven conclusions as facts. [source: kop_alle3foliensatze.pdf]
• Steps: (1) Name the factual part. (2) Name the underlying norm or evaluation that makes it a problem. (3) Invite the client to examine the norm.
• Example language (illustrative): "Your work makes you unhappy… because you believe you have to fulfil your duty, no matter what?"
• Watch for: Client starts treating the norm as an assumption, not a given. Meta-evaluations ("I shouldn't feel this") are normally left alone as part of change motivation, unless they are dysfunctional standards. [source: kop_alle3foliensatze.pdf]

C. Processing level and relationship level: steering, confronting, working on avoidance

Processing and relationship interventions are confrontational and need relationship credit; a tempo error here is the commonest failure. [source: kop_alle3foliensatze.pdf; folienhandout KGI 2025]

C1. Processing offers matched to the client's processing mode (Bearbeitungsangebote)

• Purpose / when: Every clarification session; the core micro-skill. [source: folienhandout KGI 2025; rules 2.4.7, 2.7; kop_alle3foliensatze.pdf]
• Steps: (1) Identify the client's current mode on the scale in section 2 (e.g. report, attributive evaluation). (2) Make an offer for the next step up: from intellectualising, ask for their own data; from report, ask for their evaluation; from personal evaluation, ask for the felt meaning; from felt meaning, ask what assumption or motive is behind it; from explication, ask how things connect. (3) Make the offer explicit, short, one instruction, instruction last, and anchored in what the client just said (retrospective) while pointing to the next step (prospective). (4) Leave room to refuse; if refused, you may point out consequences. (5) Check the client's reaction (micro triple) and adjust.
• Example language (illustrative): From report: "And how was that for you?" From personal evaluation: "Notice what that 'unfair' feels like inside." From felt meaning: "What does that feeling say about you?"
• Watch for: Offers jumping several steps (client drops out) or offers below the client's level (process stalls). Unfavourable strategies to spot: distancing, topic switching when it gets threatening, staying in past narrative, solving before clarifying. [source: folienhandout KGI 2025]

C2. Activating affective processing

• Purpose / when: Content implies strong feeling that is absent; schemas must be activated to be represented. [source: folienhandout KGI 2025; kop_alle3foliensatze.pdf]
• Steps: (1) Invite feelings directly. (2) If emotion is missing though the content suggests it, confront that gently. (3) Phrase the triggering topic concretely so emotional distance is hard to keep. (4) Slow down once affect appears (B10).
• Example language: Slide fragment "schauen Sie, was das in Ihnen auslöst" ("look at what that triggers in you") [source: folienhandout KGI 2025]; illustrative: "Your sister didn't come to the funeral. Stay with that picture for a moment."
• Watch for: Overwhelm (see section 5); distinguish primary adaptive emotion from secondary emotion produced by fighting, avoiding or ruminating on the primary one (KGI 2025 slides, drawing on emotion-focused concepts).

C3. De-euphemising (Ent-Euphemisierung)

• Purpose / when: Client minimises or softens experiences. [source: kop_alle3foliensatze.pdf; folienhandout KGI 2025]
• Steps: (1) Name that the words sound milder than the event. (2) State the matter plainly. (3) Ask the client to check what they actually felt.
• Example language (illustrative): "You call it 'a bit annoying'. My impression is that doesn't come close to what you felt."
• Watch for: Affect and more precise language; if denial hardens, return to relationship work.

C4. Confrontation

• Purpose / when: Direct attention to what the client screens out: contradictions, the effects of their own behaviour, the therapist's differing view, avoidance, or relationship behaviour in the session. Only with enough relationship credit (slide phrase: "Eintrittskarte holen", "get your entry ticket"), especially with personality disorders. [source: kop_alle3foliensatze.pdf; r-sachse-kop.pdf; folienhandout KGI 2025]
• Steps: (1) Check credit: is trust established, has complementary work been done? (2) Name the observation concretely and briefly (content: avoidance or contradiction; relationship: the behaviour towards you). (3) Add a relationship message (A3). (4) Follow with clarification of the reasons, e.g. ask what makes it so important not to look at this topic. (5) Watch the reaction; repair if needed (section 5).
• Example language (illustrative): "You've said twice that it doesn't matter, and each time your voice changes. What's important about not looking at it?"
• Watch for: Defensiveness vs curiosity. Confrontation acts against the client's intention in the short term; that is expected.

C5. Processing the processing / working on avoidance (Bearbeitung der Bearbeitung)

• Purpose / when: When how the client deals with problems blocks clarification (avoidance, distancing, topic switching); phase 2 special strategy for psychosomatic clients. [source: rules 2.5; r-sachse-kop.pdf; kop_alle3foliensatze.pdf; folienhandout KGI 2025]
• Steps: (1) Make the avoidance transparent (confrontation, C4). (2) Clarify the avoidance itself: what the client fears would happen if they looked (slides' case: a man who ignores feelings first clarifies he fears pain, then finds courage to face them). (3) Name ambivalence: both the hesitation and the knowledge that it matters. (4) Turn avoidance into a working task: name the difficulty and offer a concrete small step. (5) Return to content clarification.
• Example language: Slide forms: "Sie zögern, sich dem zu stellen, Sie wissen aber auch, dass es wichtig ist" (you hesitate, but know it matters); and asking whether the client can try anyway despite the difficulty [source: folienhandout KGI 2025].
• Watch for: Client starts naming their own avoidance; strengthen approach tendencies.

C6. "Yes-but" strategy

• Purpose / when: Client exits processing by trivialising ("I'm managing fine really"). [source: kop_alle3foliensatze.pdf]
• Steps: (1) Agree fully with the true part. (2) Add "but": precisely because of that, it is worth looking closely. (3) Give the next task.
• Example language (illustrative): "I don't doubt for a second that you're coping. And that's exactly why it's worth looking at what this costs you."
• Watch for: Client re-enters the topic without feeling contradicted.

C7. "On the contrary" strategy

• Purpose / when: Client wants to leave a topic because it is unclear ("I don't really know, let's move on"). [source: kop_alle3foliensatze.pdf]
• Steps: (1) Name that the client wants to leave. (2) Say that the unclarity is precisely the point to stay with. (3) Invite one more step.
• Example language (illustrative): "You'd like to move on because it's unclear. On the contrary: the unclear part is exactly what we need to look at."
• Watch for: Distinguish from a real limit (see C12).

C8. "The whole thing again from the start"

• Purpose / when: Several rambling or broken-off attempts. [source: kop_alle3foliensatze.pdf]
• Steps: Stop, and ask the client to explain again from the beginning, slowly.
• Example language: Slide form: "Erklären Sie mir es am besten noch mal" (best explain it to me again). [source: kop_alle3foliensatze.pdf]
• Watch for: Clearer, more concrete second account.

C9. Re-asking unanswered questions

• Purpose / when: Client answers a different question or drifts away. [source: kop_alle3foliensatze.pdf]
• Steps: Take responsibility for not understanding; repeat the question plainly.
• Example language (illustrative): "I haven't understood yet, so I'd like to ask again: what did you feel at that moment?"
• Watch for: Repeated non-answers may signal avoidance (C5) or a game (C11).

C10. Building problem awareness (ego-syntonic personality disorders)

• Purpose / when: Phase 2 for personality disorders: clients see problems only in others or in symptoms, not in their own patterns. [source: rules 2.5; Sachse 2020 sample (ch. 2: ego-syntony and motivation for change)]
• Steps (partly synthesis): (1) Use complementary work to build credit (A2). (2) Gather concrete situations where the client's behaviour had costs for them. (3) Link the costs to the pattern, not to the person. (4) Ask whether the client wants to understand the pattern.
• Example language (illustrative): "This is the third job where you've ended up feeling unappreciated. Could it be worth understanding what happens in you in these situations?"
• Watch for: A work mandate that includes the client's own part. [uncertain: disorder-specific procedures in Sachse 2020 ch. 6–15]

C11. Working on games and relationship tests (making them transparent)

• Purpose / when: Five-phase model phase 2, when the client uses intransparent strategies in session: image games (create an impression), appeal games (get the therapist to do or not do something), manipulation, relationship tests (will the therapist stay or withdraw?), positive control (attention through achievement, charm, illness, helplessness) or negative control (withholding, withdrawing, distancing). [source: folienhandout KGI 2025; Sachse 2020 sample; kop_alle3foliensatze.pdf]
• Steps: (1) Recognise the game from its effect on you (the pull you feel). (2) Do not play along at game level; keep responding to the motive (A2). (3) Pass tests calmly: stay reliable and on the client's side without yielding to the appeal. (4) Once credit exists, name the pattern and its function. (5) Clarify the motive and schema behind it, then the costs of the game. (6) Work on alternative, transparent ways to meet the motive.
• Example (from slides, paraphrased): a client with an attention motive and "I'm boring" schema repeatedly checks whether the therapist really has time, says she can't decide without the therapist, and keeps talking after the session ends. Illustrative response once credit exists: "I notice you often check whether I really have time for you. I do. I'm wondering what you fear would happen if you didn't check."
• Watch for: Shift from manoeuvre to direct expression of the wish. Costs of games: they confirm the negative schemas and irritate partners.

C12. Accepting limits while making them transparent

• Purpose / when: Client genuinely cannot go further now. [source: folienhandout KGI 2025; rules 2.4.9]
• Steps: (1) Ask the client to name the limit in their own words. (2) Help them understand it and take responsibility for it (it is their decision). (3) Agree to return to it; re-test later.
• Example language (illustrative): "So you're deciding not to go further with this today. That's your choice. What makes it too much right now?"
• Watch for: Distinguish a true limit from avoidance used as control (section 5).

D. Schema processing (phase 4)

D1. Checking the clarified schema against experience and knowledge

• Purpose / when: After a schema is validly represented. [source: r-sachse-kop.pdf; rules 2.5.3; folienhandout KGI 2025]
• Steps: (1) State the schema in the client's own words (assumption, contingency, evaluation). (2) Ask the client to check it against their life experience and knowledge, including counter-evidence. (3) Compare it with other schemas the client holds. (4) Help the client draw new conclusions (accommodation). You may now offer content proposals; the client evaluates them.
• Example language (illustrative): "Your assumption is: 'If I show weakness, people leave.' What have you actually experienced when you showed weakness to your friend?"
• Watch for: Intellectual agreement without affective shift; then go to D3 or back to clarification. Do not argue (rule 2.4.12).

D2. Developing alternatives and linking with resources

• Purpose / when: Phase 4, alongside D1. [source: r-sachse-kop.pdf; rules 2.5.3.2; folienhandout KGI 2025]
• Steps: (1) Invite the client to formulate a more functional alternative assumption. (2) Link it to positive self-aspects and resources already shown. (3) Integrate it with other schemas. (4) Consolidate with cognitive or behavioural restructuring (e.g. trying it in situations; the specific behavioural techniques are not detailed in the sources). [uncertain]
• Example language (illustrative): "What would be a more accurate sentence about you, one you can actually believe?"
• Watch for: Alternative must be the client's, plausible to them, and tested in experience.

D3. One-person role play (Ein-Personen-Rollenspiel, EPR)

• Purpose / when: Main framework for working through cognitive and affective schemas, combining cognitive, affective and motivational techniques; client learns to act as their own therapist and distance from the schema. [source: r-sachse-kop.pdf; Grundlagen 2016 extract §1.1.2; Thieme abstract; kop_alle3foliensatze.pdf]
• Steps: The sources name the roles (client as client, client as therapist, therapist as coach) and the aims, but not a full protocol. The following sequence is my reconstruction from those elements. [synthesis] (1) Choose one clarified schema. (2) Seat the client in the "client" role and have them voice the schema and its feeling in first person. (3) Move the client into the "therapist" role (another chair or perspective) and ask them to respond to the "client" as a good therapist would: question the assumption, bring in counter-experience and resources, voice the alternative. (4) You act as coach at the side: suggest arguments or tones, encourage, ask the client to say it more convincingly, never take over. (5) Alternate roles until the "client" side can hear and partly accept the alternative; bring negative schema and positive schemas/resources into dialogue. (6) Debrief: what changed in thinking and feeling. (7) Repeat across sessions. Sachse et al. (2014) illustrate EPR in detail for avoidant PD with transcripts (not drawn on). [uncertain]
• Example language (illustrative): Coach to client-as-therapist: "Tell her what you know about her that she forgets." "Say it again, so she can really hear it."
• Watch for: The "therapist" voice becoming more confident and the "client" voice softening; if the client cannot leave the schema voice, return to clarification or resource activation.

D4. Chair work (empty chair, two-chair dialogue) as taught in KOP training

• Purpose / when: The KGI KOP course teaches chair dialogues alongside KOP: two-chair for inner conflicts (self-evaluative split: inner critic vs experiencing self, aim integration; self-interruptive split, aim expressing blocked feelings and needs) and empty chair for unfinished business with a significant other (aim self-affirmation and letting go). These procedures come from emotion-focused therapy rather than being specific KOP techniques. [source: folienhandout KGI 2025]
• Steps: (1) Identify the marker (internal conflict, self-interruption, or lingering feelings towards a person). (2) Set up two chairs; client speaks from one part, then switches. (3) Heighten what each part says and wants. (4) Follow until needs are voiced and the parts soften or the client affirms themselves. Follow an EFT source for full procedure. [synthesis]
• Example language: Slide form of a conflict split: "ich möchte zwar… aber traue es mir nicht zu" (I'd like to… but don't trust myself). [source: folienhandout KGI 2025]
• Watch for: Same as in EFT: affect arousal, softening of the critic, assertion of need.

E. Transfer (phase 5)

E1. Transfer and alternative interaction behaviour

• Purpose / when: Final phase in the personality-disorder model; whenever new schemas and behaviour need to reach everyday relationships. [source: Sachse 2020 sample; folienhandout KGI 2025; Hogrefe page for the avoidant PD volume (motivating concrete behaviour)]
• Steps (partly synthesis): (1) Identify relevant everyday situations. (2) Develop with the client more favourable interaction behaviour that serves the motive transparently, building on resources. (3) Motivate concrete steps; client chooses them. (4) Review outcomes next session; clarify any re-activated schema.
• Example language (illustrative): "Where this week could you ask for attention directly, instead of waiting to be noticed?"
• Watch for: Reports of new experiences that disconfirm old schemas. [uncertain: phase-5 details]

5. Handling problems

Items tagged with a source are KOP guidance; items tagged [synthesis] are my own, consistent with KOP rules.

Stuck clarification (vague, rambling, intellectualising, reporting without feeling)

• Locate the processing mode and make an offer one step higher (C1); concretise one situation (B9); intervene early and often rather than waiting (rule 2.4.11), to avoid therapist paralysis. [source: rules; folienhandout KGI 2025]
• Check for a level error: if the client is avoiding, more content questions won't help; switch to processing the processing (C5). If a game is running, switch to the relationship level (C11). [source: kop_alle3foliensatze.pdf]
• Check your interventions: too long, several instructions, "why" questions, yes/no or multiple-choice questions (which let the client stay passive). Shorten to one task, instruction last. [source: rules 2.7, 2.5.2.4]
• Check for plausibility traps: you accepted an explanation as obvious and stopped clarifying. Ask what exactly about it matters to the client. [source: rule 2.4.13]

Avoidance and "resistance"

• KOP treats avoidance as content to clarify, not opposition: make it transparent, clarify what is feared, name the ambivalence, turn it into a working task (C5). Use yes-but (C6) for trivialising, "on the contrary" (C7) for fleeing the unclear. [source: kop_alle3foliensatze.pdf; folienhandout KGI 2025]
• Don't argue content: client arguments serve to avoid change; address their function. [source: rule 2.4.12]
• "I don't know" used as a stop: acknowledge they don't have a perfect answer yet and invite another try at what they feel (slide form: "Es ist klar, dass Sie noch keine perfekte Antwort haben"). [source: folienhandout KGI 2025]

Control attempts, threats, symptom-based control, criticism of the therapist

• Don't be bluffed or controlled; respond constructively and stay with the process goal. [source: folienhandout KGI 2025]
• Take criticism seriously (check your part) and also hold the client accountable for theirs. [source: folienhandout KGI 2025; rule 2.4.3]
• If the client persistently refuses the KOP frame, make that transparent; you need not invent a new therapy and may end or refer. [source: rule 2.4.14]

Ruptures after confrontation

• Prevent: only confront with credit; add relationship messages; avoid tempo errors. [source: kop_alle3foliensatze.pdf; rules 2.3.9]
• Repair [synthesis]: (1) name what you noticed ("You've gone quiet since I said that"). (2) Ask how it landed. (3) Acknowledge your part (timing, wording) without retracting the content if it was accurate. (4) Return to complementary, motive-oriented responses (A2) to rebuild credit before re-confronting.

Relationship tests and games that stall therapy

• Pass tests reliably, do not reward the game, satisfy the motive, then make the game and its costs transparent (C11). Respect phase order: no schema clarification while games dominate. [source: folienhandout KGI 2025; Sachse 2020 sample]
• Watch your own pull [synthesis]: rising irritation (negative strategies) or flattery and over-involvement (positive strategies) are diagnostic signals of the game type.

Overwhelm and affective flooding

• Use low-load interventions; take out tempo (B10). [source: rule 2.7.2; kop_alle3foliensatze.pdf]
• Work at the edge of the possible, not beyond it; avoid over-challenge; this rule is explicitly not applied with schizophrenia or borderline presentations. [source: rule 2.4.9; folienhandout KGI 2025]
• [synthesis] When arousal exceeds what the client can process: shift down one processing step (from felt meaning back to concrete report), ground in the here-and-now, agree a stopping point, and make the limit transparent as the client's choice (C12). Revisit in the next session.

Crises and suicide risk

• Sachse states KOP is not crisis intervention and the therapist should not become a stabiliser of the client's system. [source: rule 2.3.8]
• [synthesis] That does not remove safety duties: if suicidal ideation or self-harm emerges, pause clarification work and carry out standard risk assessment (ideation, intent, plans, history, protective factors), collaborative safety planning, lethal-means counselling (safe storage or removal), and involve crisis services as needed. Resume KOP once acute risk is managed. Treat crisis talk used as appeal or control (C11) only after risk has been properly assessed, never instead of it.

Non-adherence to out-of-session tasks (transfer phase)

• [synthesis] The sources say little about homework. Treat non-completion as material: clarify (without blame) what happened in the client when the moment came (B9, B5); look for a re-activated schema or a hidden appeal ("I'm too weak, you do it"); have the client choose a smaller step; keep responsibility for doing it with the client (rule 2.4.3).

Practical problems dominating sessions

• Address only the psychological part; reframe or set aside job, money and legal issues. [source: rule 2.4.6] [synthesis] Where practical crises are urgent (housing, debts), refer to appropriate services before or alongside KOP.

Client wants solutions now

• Hold "clarify before solving": explain that solutions built on unclarified schemas don't hold, since the old schema stays active. [source: rule 2.5.2.3; r-sachse-kop.pdf] [synthesis] Offer a brief, explicit rationale once, then return to clarification; if the client still insists, consider whether a solution-oriented approach (e.g. CBT) suits their current motivational phase better (Sachse's slides use the Rubicon model to separate clarifying from solution-oriented therapies).

Therapist-side errors (KOP-specific)

• Working for the client (supplying content, answering your own questions) → give tasks back. [source: rule 2.5.2.4]
• Content-giving in clarification → stay content-abstinent until phase 4. [source: rule 2.5.2.2]
• Consoling instead of clarifying → acknowledge briefly, then return to clarification. [source: folienhandout KGI 2025]
• Siding with the client's view → keep working distance and neutrality. [source: rule 2.3.8]
• Over-detailed client model → filter for central schemas. [source: rule 2.6.8]

Contraindications and fit [uncertain: indication chapter of Grundlagen 2016]

• The "edge of the possible" and confrontational strategies are not used with schizophrenia or borderline presentations (rule 2.4.9). [synthesis] With acute psychosis, active substance dependence or acute suicidality, stabilise first or refer.

Sources

Sources

• Therapeutische Regeln in der Klärungsorientierten Psychotherapie (Sachse, Fasbender & Sachse; Klaus-Grawe-Institut PDF)
• Klärungsorientierte Psychotherapie, Folienssätze 1–3 (P. Schlebusch, IPP Bochum; Klaus-Grawe-Institut PDF)
• Rainer Sachse: Klärungsorientierte Psychotherapie (book chapter PDF, Klaus-Grawe-Institut)
• Klärungsorientierte Psychotherapie V, Folienhandout (B. Heiniger Haldimann, Klaus-Grawe-Institut, May 2025)
• Sachse: Klärungsprozesse in der Klärungsorientierten Psychotherapie, extract (front matter, TOC)
• Sachse, Sachse & Fasbender: Grundlagen Klärungsorientierter Psychotherapie, extract (front matter, TOC)
• Hogrefe: Personality Disorders: A Clarification-Oriented Psychotherapy Treatment Model (product page)
• Hogrefe sample PDF, Sachse 2020 (TOC, dual action regulation model, five-phase model)
• Hogrefe: Klärungsorientierte Psychotherapie der selbstunsicheren Persönlichkeitsstörung (product page)
• Thieme: article on the one-person role play (abstract only)

Books cited (full texts not drawn on unless listed above)

• Sachse, R. (2003). Klärungsorientierte Psychotherapie. Göttingen: Hogrefe.
• Sachse, R. (2016). Klärungsprozesse in der Klärungsorientierten Psychotherapie. Göttingen: Hogrefe.
• Sachse, R., Sachse, M. & Fasbender, J. (2016). Grundlagen Klärungsorientierter Psychotherapie. Göttingen: Hogrefe.
• Sachse, R. (2020). Personality Disorders: A Clarification-Oriented Psychotherapy Treatment Model. Boston/Göttingen: Hogrefe.
• Sachse, R., Fasbender, J. & Sachse, M. (2014). Klärungsorientierte Psychotherapie der selbstunsicheren Persönlichkeitsstörung. Göttingen: Hogrefe.
• Sachse, R. & Schlebusch, P. (2006); Sachse et al. (2008), Klärungsorientierte Schemabearbeitung; as cited on the IPP slides (not drawn on). [uncertain: exact titles]

Further reading (not drawn on): the Hogrefe "look inside" previews on pubengine2, so the detailed EPR protocol, disorder-specific strategies and session counts remain [uncertain].