Atlas›Domain VII · Transpersonal, psychedelic & altered states›Guide 011
Guide VII-011

Core Process Psychotherapy

Maura Sills, Franklyn Sills1982Devon, UK
A 31 · L 22 · M 4722 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: Core Process Psychotherapy (CPP) as taught at the Karuna Institute, Devon, UK, founded by Maura Sills with Franklyn Sills. It is now trained as "Mindfulness-Based Core Process Psychotherapy" (MA routes validated by Middlesex University). No public treatment manual exists. This guide rebuilds practice from Maura Sills' own account (1995 interview, reprinted 1996), two practitioner accounts of Karuna training (van Ooijen 1999; Talbot 2015, on the pre- and perinatal strand), and the descriptions published by the Accrediting Association of Core Process Psychotherapists (ACPP). Franklyn Sills' theory book Being and Becoming is drawn on only as publisher and bookseller descriptions. [source: Sills in Oliver 1996; van Ooijen 1999; Talbot 2015; ACPP via UKCP; Wikipedia/LiquiSearch]

What was verified. Confirmed from sources: the publication details of Being and Becoming (North Atlantic Books, 23 September 2008); that Karuna's MA training includes experiential pre- and perinatal (womb and birth) work (Talbot 2015); the current MA routes. Still not verified after a further search: any staged phase model or session count; a CPP procedure for shock or birth work with individual clients; any breathwork; any CPP touch or consent policy. These remain marked [uncertain]. The Karuna Institute site could not be used (it redirects to a casino) and no archived copy turned up in search. [source: Penguin Random House and Karnac book pages; Talbot 2015; GoodTherapy]

Dates and status. The ACPP says CPP has been taught at Karuna since 1982. Wikipedia and GoodTherapy give 1984 as the Institute's founding date, and GoodTherapy says Maura Sills developed the approach from 1982 with Franklyn Sills. Being and Becoming: Psychodynamics, Buddhism, and the Origins of Selfhood was published by North Atlantic Books on 23 September 2008 (Penguin Random House lists 328 pages, Karnac 352). It has a foreword by Maura Sills and two chapters ("The Perinatal Paradigm" and "Attachment") by Cherionna Menzam. GoodTherapy's 1998 date for an earlier edition could not be confirmed. [source: ACPP via UKCP; GoodTherapy; Penguin Random House; Karnac] [uncertain: 1982 vs 1984; the 1998 edition]

Warning about the Institute's website. As of October 2026, pages on karuna-institute.co.uk redirected to an unrelated casino subdomain. Don't rely on links to that domain. Check current training details through the ACPP or UKCP. [source: ACPP via UKCP]

What it is. The ACPP calls CPP a synthesis of Buddhist psychology and mindfulness practice with Western psychotherapeutic techniques. Sills calls it a "dharmic psychotherapy" rather than a Buddhist one. It is a whole psycho-spiritual psychotherapy (transpersonal, relational, body-aware), not a protocol. Its Western roots are depth psychology, with transference and countertransference used as tools. It also draws on object relations (Fairbairn, Winnicott), gestalt and awareness work (Dick Price, Esalen), Reichian body work, Gendlin's focusing, and pre- and perinatal psychology (Frank Lake, William Emerson). Its Buddhist roots are Ch'an, Theravada insight meditation and Tibetan Kum Nye. [source: ACPP via UKCP; Sills in Oliver 1996; van Ooijen 1999; Wikipedia/LiquiSearch]

How change happens, according to the tradition.

  • The "core" is each person's innate health and "all-rightness". The tradition equates it with Buddha-nature. Habit and defence obscure it, but it is never lost. This is the tradition's own theory, not established fact. [source: van Ooijen 1999; Sage encyclopedia excerpt]
  • "Core process" is the organism's inherent movement towards health. The therapy aims to catalyse it. [source: Wikipedia/LiquiSearch]
  • Sills locates suffering in how a person creates and keeps up their problem through the five skandhas (form, sensation, perception, mental formations, consciousness), and especially in mistaken perceptions. The work examines that process rather than tracing cause and effect. [source: Sills in Oliver 1996]
  • Awareness held jointly in relationship is considered healing in itself: "awareness is of itself curative". The past is reached through the present. Sills: "The door to the past is contact with the present." [source: Wikipedia/LiquiSearch; Sills in Oliver 1996]

2. Framework

No staged protocol is published. None of the sources describe formal phases, session counts or criteria for moving between phases. A further search (Oct 2026) of publisher pages, a 2015 Karuna trainee account and GoodTherapy found none either. Sills describes the method as "a following of process" rather than applying techniques. What follows is (a) the session arc the sources describe and (b) a course arc that is my own synthesis. [source: Sills in Oliver 1996; van Ooijen 1999; checked against Talbot 2015 and GoodTherapy]

Format and length. Individual, open-ended psychotherapy. GoodTherapy, a secondary source, calls it medium- to long-term, possibly "a year or more", and not suited to acute crisis needing quick symptom relief. It gives no session length or frequency. Weekly sessions are assumed. [source: GoodTherapy; weekly frequency is synthesis] [uncertain: no primary source gives session counts or frequency]

Session arc [source: van Ooijen 1999 (training framework); GoodTherapy for silence and closing]:

  1. Therapist settles first. The therapist checks their own breath, heartbeat, tension and self-image before the client arrives, and lets them settle.
  2. Slowing down and arriving. Client and therapist slow down and attend to the body, breath and whatever is emerging.
  3. Present-moment enquiry. Open questions about what is happening now, then widening the field ("And what else is there?").
  4. Following process. The work follows what arises: felt sense, images, memories, voices, body sensations, the relationship itself. Verbal exploration alternates with periods of silent mindfulness.
  5. Approach and withdrawal. Client and therapist go "to the edge" of difficult material, touch a small part, go further only if the client is ready, then step back.
  6. Expression, if it arises naturally. Any emotional expression is followed by a return to awareness of how it feels.
  7. Integration and grounding. Acknowledge what has emerged, including disowned parts, without judgement. Help the client return to their ordinary everyday "periphery" before they leave.

Course arc (my synthesis, not a published model) [synthesis]:

  • Early: build safety and the shared awareness field. Learn the client's ways of slowing down. Map their "periphery" (habitual armouring in posture and manner) and the perceptions that keep their suffering going. Agree how touch, silence and expressive work will be handled.
  • Middle: deepen into felt sense, persona and shadow, and accumulated emotionally charged experience. Use approach and withdrawal around trauma and shock. Work with the transference field. Where it arises and the therapist is trained, touch on early (including birth-related) experience.
  • Later: consolidate contact with the client's own health ("all-rightness") and equanimity. Carry awareness into daily life. Prepare the ending.
  • Criteria for deepening [synthesis, extending van Ooijen's client-led readiness]: the client can stay present at the edge without flooding or dissociating, can return to body and breath when asked, and can reflect afterwards on how it felt. If these fail, step back.

Training context. Sills says the original training grew from weekends into a nine-month course and is "nearly one hundred per cent" about cultivating the psychotherapist. Current routes (per GoodTherapy) are a four-year MA in Mindfulness-Based Core Process Psychotherapy and a three-year post-qualification MA, both with Middlesex University, plus short foundation courses (van Ooijen did six months). Practitioner pages confirm the Karuna/Middlesex MA (e.g. 2015–2019) and ACPP CPD courses in 2021–2023. A 2014 graduate describes the MA as including regular Kum Nye, close staff "holding" and an experiential pre- and perinatal strand on Dartmoor. Accreditation is through UKCP, BACP or the ACPP. [source: Sills in Oliver 1996; van Ooijen 1999; Talbot 2015; Beacon House practitioner page; GoodTherapy; Wikipedia/LiquiSearch]

3. Guiding principles

[source for all: Sills in Oliver 1996 unless marked otherwise]

  • Follow process; don't apply techniques. In practice: let the next step come from what is happening now. Any method serves the process.
  • Attention, awareness, intention. The therapist's main tools, taken from Dick Price's gestalt. In practice: keep these three steady, and the rest follows.
  • Psychotherapy as "a post-meditative practice". In practice: the therapist needs a disciplined meditation practice and must be able to place attention at will.
  • The therapist limits the depth. The client can only move as deeply as the therapist can be present. In practice: your own practice and therapy are part of the treatment. Van Ooijen: the therapist can only take clients where they have been themselves. [source: also van Ooijen 1999]
  • Joint enquiry and mystery. In practice: don't claim to know or control what is happening. Investigate alongside the client.
  • Transference as a shared field. Sills: "you will never know who started it". In practice: explore what is happening between you as co-created. Don't assume it is only the client's material.
  • "Vulnerability of the warrior". In practice: let the client affect you, taking things personally and not personally at once, while you keep observing.
  • Wisdom and clarity with heart. Skill without unconditional warmth is "an empty practice". Positive regard without discernment misses the "sharpening". In practice: be warm and precise.
  • Ascertain, don't diagnose. The skandha map is used "not to diagnose but to ascertain", without judgement. In practice: find exactly where in experience the difficulty sits.
  • Perception is often the crux. In practice: treat beliefs like "I'm a bad person" as mistaken perceptions to examine together.
  • Present contact opens the past. In practice: reach history through what is alive now, not through reconstruction first.
  • Expression must serve awareness and relationship. "Emotional expression is neither good nor bad." In practice: support expression that comes naturally out of the contact. Be wary of repeated discharge that digs deeper into the same pattern.
  • Emptiness, space, equanimity. In practice: keep space inside yourself so all experience can be met equally. Screen nothing out. [also van Ooijen 1999]
  • Wider conditioning. In practice: include cultural, social, political, economic and ecological conditions in your understanding of the person.
  • Interconnectedness and responsibility. In practice: work that leads away from relationship and real responsibility is going in the wrong direction.
  • Respect defences. Don't attack them. Enquire gently. In practice: some protective periphery is necessary. [source: van Ooijen 1999]
  • The client is "in the driving seat". In practice: the client sets the pace and decides how much to do. [source: van Ooijen 1999]
  • Non-interpretative, non-pathologising. In practice: the client discovers what they need to know within the relationship. Offer observations, not interpretations. [source: Wikipedia/LiquiSearch; GoodTherapy]
  • Being affected, involved, engaged and available. The stance named "licking honey from the razor's edge" (Sills and Lown article, not drawn on). In practice: stay personally engaged at the edge of intensity. [source: Wikipedia/LiquiSearch] [uncertain: primary article]
  • The body expresses consciousness. In practice: invite attention to sensation as a direct route into experience. [source: Wikipedia/LiquiSearch; Sills in Oliver 1996]

4. Intervention inventory

Scope note: CPP is taught experientially and has no public manual. This inventory lists every practice named in the sources. Step-by-step detail beyond what those sources describe is marked [synthesis]. Example wording is illustrative unless quoted with a citation. Quotes from van Ooijen 1999 are what her trainers or therapist said, as she reports it. They are not Maura Sills' words.

4.1 Therapist's pre-session settling (equanimous self-enquiry)

  • Purpose / when: Before every session, so you arrive present rather than driven by anxiety or a need to prove yourself. Sills treats therapy as "a post-meditative practice". [source: Sills in Oliver 1996; van Ooijen 1999]
  • Steps: (1) A few minutes before the client arrives, sit and notice your breath, heartbeat and areas of tension. (2) Notice any picture of yourself as "the therapist" and any pull to perform. (3) Name it silently and let it go, slowing the breath, until the mind feels more spacious. (4) Set an intention to attend to the client, their process, your own process and the space between. [source: van Ooijen 1999; step 4 phrasing synthesis]
  • Example language (inner, illustrative): "Breath, heartbeat, shoulders... there's the wish to be helpful. Let that be here. Just arriving."
  • Watch for: You still feel braced or rehearsing when the client arrives. Take one more conscious breath in the room. It is working when you can listen without pre-forming responses. [synthesis]

4.2 Slowing down and arriving (opening the session)

  • Purpose / when: At the start of each session, and whenever the pace speeds up, to move from narrative into direct present experience. "Core process therapy is about slowing things down, about being in our body" (as van Ooijen reports her training). [source: van Ooijen 1999; GoodTherapy]
  • Steps: (1) After greeting, invite a pause. (2) Suggest the client notices contact with the chair and floor, and the breath, without changing it. (3) Ask what they notice now. (4) Let the session's theme come out of this rather than from an agenda. [steps 2–4 synthesis consistent with sources]
  • Example language (illustrative): "Before we start, let's take a moment just to arrive. Notice how you're sitting... the breath... and whatever is here as you come in."
  • Watch for: Some clients find inward attention frightening (trauma, dissociation). Offer eyes open, an external focus, or a shorter pause. It is working when the client's speech slows and they report sensations or feelings rather than only events. [synthesis]

4.3 Present-moment enquiry questions

  • Purpose / when: The basic move throughout a session: keep attention on what is happening now and widen it. [source: van Ooijen 1999]
  • Steps: (1) Ask "What is happening?" or "How is that?" (as reported from training) when the client pauses, shifts or touches something. (2) Wait, allowing silence. (3) To open the field, ask "And what else is there?" (4) Repeat gently and follow what emerges. Don't steer towards a conclusion.
  • Example language: Quoted training questions: "What is happening?" / "How is that?" / "And what else is there?" [van Ooijen 1999]. Illustrative: "As you say that, what's happening right now?"
  • Watch for: Questions asked too fast become interrogation. Leave long pauses. It is working when answers become fresher and more detailed and less rehearsed. [synthesis]

4.4 Following process / joint enquiry

  • Purpose / when: The stance behind every session. You follow the client's moment-to-moment process as a shared investigation, without a plan. [source: Sills in Oliver 1996]
  • Steps: (1) Track the client's words, body, voice and energy, and your own responses at the same time. (2) Keep in mind the client, the client's process, your own process and the space between (as van Ooijen reports from training). (3) Offer what you notice as a shared observation, not an interpretation. (4) Let the client's response decide the next step. [source: Sills in Oliver 1996; van Ooijen 1999; step 3 phrasing synthesis]
  • Example language (illustrative): "I'm noticing something go quieter in me as you talk about her. I don't know what it is. What's it like on your side?"
  • Watch for: Slipping into advice or theory. It is working when the client starts to notice their own process unprompted. [synthesis]

4.5 Verbalising and tracking the moment (noticing closing down)

  • Purpose / when: When the client shuts down, deflects or changes state, help them notice the shift and stay with it rather than override it. [source: van Ooijen 1999]
  • Steps: (1) Notice the shift: a drop in voice, a glance away, a topic change. (2) Name it simply and invite the client to notice it. (3) Invite them to stay with it ("be there with it") without trying to push through. (4) Accept however far it opens. Don't force the door.
  • Example language: Reported from van Ooijen's therapist: "Just notice that, that you go down and then something closes". Illustrative follow-up: "Can you be with that closing for a moment, without needing it to open?"
  • Watch for: The client feeling caught out or criticised. Name the shift with warmth. It is working when the client can describe the closing from the inside. In van Ooijen's account, the "door" opened slightly even though she could not go further. [source: van Ooijen 1999]

4.6 Naming repeated patterns

  • Purpose / when: When the session returns to a familiar impasse, bring the repetition itself into awareness. [source: van Ooijen 1999]
  • Steps: (1) Recognise that you've been at this place before. (2) Say so, and enquire with curiosity rather than as a confrontation. (3) Explore how the pattern is kept going now. This matches Sills' focus on how people "re-embody" the past. [source: van Ooijen 1999; Sills in Oliver 1996]
  • Example language: Reported: "I am aware that we have been at this place before and I am wondering how is that?" [van Ooijen 1999]
  • Watch for: Shame at "failing" again. It is working when the client becomes curious about the pattern rather than ashamed of it. [synthesis]

4.7 Body awareness (attending to sensation)

  • Purpose / when: Throughout. In this tradition the body is "the vehicle" and an expression of consciousness. Attention to sensation separates raw sensation from emotional reaction and opens unprocessed material. [source: Sills in Oliver 1996; Wikipedia/LiquiSearch; GoodTherapy]
  • Steps: (1) When a theme carries charge, ask where it's felt in the body. (2) Invite description of quality (temperature, pressure, movement, size) rather than explanation. (3) Hold the attention there with the client for a while. (4) Ask what happens as they keep attending. [steps synthesis consistent with sources]
  • Example language (illustrative): "Where do you notice that in your body right now? ... What's it like, if you just describe it?"
  • Watch for: Rising arousal, numbing or dissociation. Widen attention to the room or to a neutral part of the body. It is working when sensations change or soften, or link to feelings or images. [synthesis]

4.8 Felt-sense focusing

  • Purpose / when: To contact the fluid, bodily "felt sense" of an issue or relationship. The felt sense lies near the core and changes more readily than fixed patterns. Van Ooijen attributes the method to Gendlin's focusing. [source: van Ooijen 1999]
  • Steps: (1) Ask about the whole of an issue (e.g. "How is the relationship?"). (2) Invite the client to give it bodily attention and wait for its "all about" feel to form. (3) Ask "And what else is there?" (4) Invite a word, image, sound or movement that fits it. (5) Allow plenty of time and stay with it until it shifts.
  • Example language: Reported question: "How is the relationship?" [van Ooijen 1999]. Illustrative: "Let the whole of this come into your body... no need to find words yet... see if an image or word comes that fits."
  • Watch for: Intellectualising instead of sensing. Slow down and come back to the body. It is working when there is a felt shift. In her example, an image of her womb expanding to hold her son led to a new understanding of letting go. [source: van Ooijen 1999]

4.9 Approach and withdrawal ("to the edge")

  • Purpose / when: For painful or traumatic material, so the client can contact it without flooding or being retraumatised. [source: van Ooijen 1999]
  • Steps: (1) Agree to move towards the material together. (2) Go "to the edge" and look at only a small part of what is there. (3) Move in further only if the client is ready. The client decides how much to do. (4) Step back to safety and present awareness, then approach again. This is the "gentle in-out movement". (5) With clients who rush towards pain (van Ooijen names people who were abused), actively hold them at the edge.
  • Example language (illustrative): "We don't need to go into all of it. Just stand at the edge and look at a corner of it... and now let's come back to your feet on the floor."
  • Watch for: Signs of flooding (rapid breathing, collapse, disorientation) or of the therapist being overwhelmed. Both are signals to withdraw. It is working when each approach can be tolerated a little longer and the client recovers more quickly. [source: van Ooijen 1999; signs synthesis]

4.10 Skandha discernment (locating the difficulty)

  • Purpose / when: When a problem is diffuse, find precisely where in experience it sits and how it is maintained. Sills uses the five skandhas (form, sensation, perception, mental formations, consciousness) "not to diagnose but to ascertain". This is a Buddhist model used as a map, attributed to the tradition. [source: Sills in Oliver 1996]
  • Steps: (1) Listen for where the suffering is concentrated: the body (form), raw pleasant or unpleasant tone (sensation), how things are recognised and labelled (perception), reactive habits and emotions (mental formations), or awareness itself. (2) With discernment, bring attention to that aggregate. (3) Explore how the client relates to it and what keeps it going, rather than why it began. (4) Notice where craving or clinging attaches. [source: Sills in Oliver 1996; the step order is synthesis]
  • Example language (illustrative): "Let's slow this down. There's the tightness in your chest, then the thought 'they're judging me', then the urge to leave. Which part has the most grip right now?"
  • Watch for: Turning the map into a lecture or a label. It is working when the client can tell sensation, perception and reaction apart in their own experience. [synthesis] Note: Sills says the therapist must be able to "direct the mind to the different skandhas", which needs the therapist's own meditation training. [source: Sills in Oliver 1996]

4.11 Working with mistaken perceptions and beliefs

  • Purpose / when: When a fixed self-view (e.g. "I'm a bad person") organises the suffering. [source: Sills in Oliver 1996]
  • Steps: (1) Hear the belief as a perception rather than a fact. (2) Make the perceptual framework visible to both of you. (3) Work with it together: notice when it arises, what it feels like in the body, and what it does. (4) As needed, explore it through dialogue or gestalt (4.12) or historically (4.13). [source: Sills in Oliver 1996; step 3 detail synthesis]
  • Example language (illustrative): "'I'm a bad person', that's a strong perception. Can we look at it together, as something that shows up, rather than arguing with it or agreeing with it?"
  • Watch for: Arguing the belief away (that is not this method). It is working when the client says "there's that thought again" rather than "I am bad". Van Ooijen adds that the work includes owning one's goodness, and that believing one is "not all right" can paradoxically excuse a person from responsibility. [source: van Ooijen 1999; first sentence synthesis]

4.12 Dialogue and gestalt with inner voices

  • Purpose / when: When critical or conflicting inner voices are active. Sills says the therapist could "dialogue with them, do gestalt with them". [source: Sills in Oliver 1996]
  • Steps: (1) Name the voice and invite the client to let it speak. (2) Use standard gestalt forms: speaking as the voice, answering it, or changing position or cushion. (3) After each exchange, return to present awareness of what is felt now. [steps 2–3 synthesis; specific gestalt forms are not detailed in CPP sources]
  • Example language (illustrative): "Let that voice say what it says to you, out loud. ... And now, hearing it, what happens in you?"
  • Watch for: The exercise becoming a performance. It is working when the client's relationship to the voice changes (more space, less fusion). [synthesis]

4.13 Historical exploration through present contact

  • Purpose / when: When a present pattern or voice clearly has a history. Sills: you could "look at that historically", but "the door to the past is contact with the present". [source: Sills in Oliver 1996]
  • Steps: (1) Stay with the present experience until it is vivid. (2) Ask whether it is familiar or when it was first known. (3) Let memory arise from the felt experience rather than from reconstruction. (4) Return to the present and look at how the past is "re-embodied" now. [source: Sills in Oliver 1996; sequence synthesis]
  • Example language (illustrative): "Staying with this feeling... is it familiar? Does anything come, from when you were younger?"
  • Watch for: Storytelling that loses contact with the present. It is working when insight about the past changes something in the present. [synthesis]

4.14 Expressive work, followed by return to awareness

  • Purpose / when: When strong emotion arises naturally out of the contact. Van Ooijen describes physical expression (hitting cushions, crying, shouting) linked to gestalt. Sills: "Emotional expression is neither good nor bad." Its value depends on the purpose it serves. [source: van Ooijen 1999; Sills in Oliver 1996]
  • Steps: (1) Let expression come out of the relationship rather than inducing it. (2) If physical expression is used, agree on safety first (cushions, space, stopping). [synthesis] (3) Afterwards, always return to the felt sense: "How is that, to have expressed that?" (as reported from training). (4) Give time and support for integration.
  • Example language: Reported: "How is that, to have expressed that?" [van Ooijen 1999]. Illustrative: "Let it come if it wants to... and now just feel what's here."
  • Watch for: Sills warns "most of what looks like catharsis is actually re-traumatisation". Repeated discharge may just be "digging into the pattern". Van Ooijen: expression without then becoming aware of how it feels can be destructive. It is working when release is followed by more space, calm or new understanding, not by depletion or a repeat of the same state. [source: Sills in Oliver 1996; van Ooijen 1999]

4.15 Working with shock and the trauma cycle

  • Purpose / when: When the client shows freezing or a stuck traumatic state. Sills says the basic freezing and shock "will not change" unless the work reaches the shock underneath. She describes real catharsis as when "something bursts open and cleans out". A 2015 Karuna graduate writes of the "locked in" effects of birth trauma and of her body processing material that had been consciously forgotten, but she describes outcomes, not method. [source: Sills in Oliver 1996; Talbot 2015]
  • Steps: No CPP-specific procedure was found, including after a further search (Oct 2026). Use 4.9 (approach and withdrawal), 4.7 (body awareness) and 4.14 (expression with awareness), and track for freeze responses. [uncertain: technique detail] [synthesis]
  • Example language (illustrative): "Something seems to go still in you. Let's not push. Can you feel your hands... your breath... and just notice the stillness from here?"
  • Watch for: Shutting down, dissociation or terror. Stabilise before going further. [synthesis]

4.16 Pre- and perinatal (birth and pre-birth) work

  • Purpose / when: The tradition holds that the earliest experience (in the womb, at birth, in the infant–mother holding environment) shapes later patterning. This is its own theory, not established fact. Sills says the training goes "back to birth and pre-birth experience". A 2014 MA graduate confirms that Karuna's training includes embodied exercises on the somatic memory of life in the womb, then an intensive few days on very early womb experience before students turn to their own birth process. She cites a 2007 Karuna paper by Franklyn Sills on stages of pre- and perinatal experience (not drawn on) and Grof's distinction between undisturbed ("good womb") and disturbed life in the womb. These were experiential exercises for trainees, not a described client procedure. Named influences: Grof, Laing, Lake, Fairbairn, Emerson. Being and Becoming reads Lake's perinatal psychology alongside Fairbairn, Winnicott and Stern and includes a chapter, "The Perinatal Paradigm", by Cherionna Menzam. [source: Sills in Oliver 1996; Talbot 2015; Wikipedia/LiquiSearch; Penguin Random House and Karnac descriptions]
  • Steps: No source drawn on describes how birth or prenatal work is done with an individual client. Talbot 2015 does not say how the training exercises were set up (group or individual, guided or not, posture, timing). [uncertain] Don't attempt structured birth or regression work without specific training. In ordinary practice: (1) be curious when the client spontaneously brings early, preverbal-feeling material (body states, images of being held, enclosed or born). (2) Attend to it with body awareness and the felt sense (4.7, 4.8). (3) Hold it as experience, not as verified memory. [synthesis]
  • Example language (illustrative): "This feels very early, maybe before words. We don't need to know what it is. Can you just let yourself feel held here, right now?"
  • Watch for: Treating images as literal memories. Overwhelm: Talbot reports a fellow student overwhelmed during an early womb exercise and credits the staff's "holding" for the work's safety, without saying how staff responded. [source: Talbot 2015] It is working when the client feels more settled and held. [synthesis]
  • Note on breathwork: Wikipedia says Grof's breathwork is "also involved" in CPP. No primary or practitioner source (Sills 1996, van Ooijen 1999, Talbot 2015, GoodTherapy, publisher pages) describes breathwork as a CPP intervention. Talbot names Grof only as an influence on the perinatal model. [uncertain] If any breathwork is used, screen as for holotropic-type work. Common contraindications include cardiovascular disease, high blood pressure, epilepsy, glaucoma, pregnancy, recent surgery or injury, psychosis or bipolar history, and severe trauma without stabilisation. No source naming these for CPP is drawn on. [synthesis]

4.17 Gentle touch to a defended area

  • Purpose / when: Van Ooijen reports that a hand placed softly on a defended area can bring a strong response, which then needs care and time. [source: van Ooijen 1999]
  • Steps: No CPP source drawn on describes a touch or consent procedure; GoodTherapy does not address touch. [uncertain] Minimum safeguards [synthesis]: (1) Discuss touch at contracting, and check your registration body's rules and your own training. (2) Ask explicitly in the moment, saying where and how. Make it easy to say no. (3) Use light, still contact on non-intimate areas only (e.g. upper back, shoulder). (4) Ask what the client notices. Remove your hand at once if asked or if they freeze. (5) Afterwards, discuss how it was, and record it in your notes.
  • Example language (illustrative): "Would it be all right if I rested my hand lightly on your shoulder blade while you stay with that? You can say no, or stop me at any time."
  • Watch for: Compliance rather than real consent, freezing, sexualised or abuse-related transference. Don't touch clients with abuse histories without very careful prior work. [synthesis]

4.18 Working with the transference field

  • Purpose / when: Throughout. Transference and countertransference are used as tools (Wikipedia). Sills treats them as a shared field in joint practice. [source: Wikipedia/LiquiSearch; Sills in Oliver 1996]
  • Steps: (1) Notice what arises in you (feelings, images, impulses) as information about the field. (2) Hold the possibility that it began on either side. (3) Where useful, disclose it tentatively as a shared observation. (4) Explore together what is happening between you and how it echoes the client's patterns. [steps synthesis]
  • Example language (illustrative): "I'm aware I've started to feel I need to get this right for you. I wonder if something like that is happening between us. How is it for you?"
  • Watch for: Overburdening the client with your material. Supervision is essential. [synthesis]

4.19 Silence and periods of shared mindfulness

  • Purpose / when: To let experience deepen and to rest in a shared awareness field. GoodTherapy, a secondary source, describes verbal exploration alternating with silent mindfulness. Wikipedia describes therapist and client creating an awareness field together. [source: GoodTherapy; Wikipedia/LiquiSearch]
  • Steps: (1) Offer silence explicitly when something important is present. (2) Stay present and embodied yourself. (3) Come back with a gentle enquiry (4.3). [synthesis]
  • Example language (illustrative): "Let's just be quiet with this for a little while."
  • Watch for: Silence felt as abandonment or as a test. Explain it and check how it was. [synthesis]

4.20 Integration and grounding (closing)

  • Purpose / when: End of each session and after intense work. Acknowledge what has emerged, including disowned parts, without judgement. Help the client re-establish the protective "periphery" they need for ordinary life, since people may feel "weird" or misunderstood after deep work. [source: van Ooijen 1999; GoodTherapy]
  • Steps: (1) Leave enough time. (2) Name together what emerged. (3) Return attention to the body, the room and the time of day. (4) Ask how the client will get home and what they will do next. [steps 3–4 synthesis]
  • Example language (illustrative): "A lot opened today. Let's take a few minutes to land. Feel the chair, look around the room. What do you want to take with you, and what can stay here?"
  • Watch for: The client leaving spacey or raw. Extend grounding. Consider a brief check-in contact if your service allows it. [synthesis]

4.21 Using the core-to-periphery map

  • Purpose / when: A working map (as van Ooijen learned it in training) for orienting where the client is. From the outside in: periphery (rigid armouring shown in posture and movement; partly necessary), persona and shadow (parts disowned as unacceptable, e.g. anger, sadness), a "co-ex matrix" (accumulated, emotionally charged experience that colours perception), the felt sense (fluid, open to change), and tendencies (subtle preferences nearest the core). At the centre is the "no-thing" core. [source: van Ooijen 1999] "Co-ex" echoes Grof's COEX concept. [synthesis] [uncertain: whether Karuna still teaches this exact five-layer form]
  • Steps: (1) Notice which layer the client is speaking from (defensive periphery, disowned material, old charged patterns, felt sense). (2) Don't attack the periphery. Enquire into it gently. (3) Invite movement towards the felt sense as safety allows. [source: van Ooijen 1999; steps synthesis]
  • Example language (illustrative): "You've been very composed telling me this. I'm curious what's underneath the composure, if anything wants to be felt."
  • Watch for: Using the map to label clients. It is working when the client can recognise their own layers. [synthesis]

4.22 Therapist's formative practices (not client interventions)

  • Purpose: In CPP the therapist's development is the main instrument. Sills names: meditation that builds equanimity and endurance; Kum Nye (Tibetan Buddhist yoga, which she says builds endurance to different mental states and eventually opens into emptiness); devotional practice for the heart quality; and the therapist's own ongoing therapy (van Ooijen: it "never stops"). [source: Sills in Oliver 1996; van Ooijen 1999]
  • Steps: Take part in regular personal meditation, a Kum Nye course if trained through Karuna, personal therapy, and supervision with a CPP practitioner. Don't teach Kum Nye or meditation to clients without appropriate training. [synthesis]
  • Watch for: Your own spiritual practice becoming a way to avoid being present. Sills cautions that "transcendent" practices can make avoidance easier. [source: Sills in Oliver 1996]

5. Handling problems

The CPP sources address only a few difficulties directly: resistance, overwhelm and re-traumatisation, catharsis that repeats a pattern, transcendent avoidance, and returning to everyday life. Everything else below is my synthesis and is marked as such.

Resistance / closing down [source: van Ooijen 1999; Sills in Oliver 1996]

  • Don't attack defences. Invite the client to notice the closing and "be there with it" (4.5). Accept however far it opens.
  • Treat repeated stuckness as a pattern to enquire into (4.6). Also ask yourself whether your own limits are setting the depth. Sills holds that the client can only go as deep as the therapist can be present. Take it to supervision and your own therapy.

Stuck clients / going round in circles [synthesis, building on sources]

  • Check where in the skandhas the process loops (4.10). Clients often stay stuck at perception ("I'm bad") or at reactive formations.
  • Shift channel: from story to body (4.7), from body to felt-sense imagery (4.8), or to the relationship in the room (4.18).
  • Review the contract and goals openly. Open-ended process work can drift, so agree periodic reviews (e.g. every 3 months).

Overwhelm, flooding, re-traumatisation [source: van Ooijen 1999; Sills in Oliver 1996]

  • Hold clients at the edge, especially those who rush towards pain (4.9). Withdraw to present safety and the body. Don't encourage catharsis that repeats the stuck state. Sills: "most of what looks like catharsis is actually re-traumatisation".
  • [synthesis] Ground with eyes open, orientation to the room, feet on the floor, slow exhale and naming five things seen. Shorten inward-focused periods. Put trauma stabilisation first (phased, trauma-informed work) before deeper process work.

Dissociation, depersonalisation, adverse effects of mindfulness and meditation [synthesis] [uncertain: the CPP sources don't discuss these; No meditation adverse-effects literature is drawn on in this guide]

  • Inward contemplative attention can, in some people, bring increased anxiety, panic, depersonalisation or derealisation, re-experiencing of trauma, and rarely psychotic or manic states. Screen at intake for trauma, dissociation, psychosis and bipolar history, and current intensive meditation retreats.
  • Respond by moving attention outward, shortening silences, using eyes-open practices and slowing the pace. Refer for psychiatric assessment if perceptual disturbance, mania or psychosis appears.

Psychosis and "mad" states [source: Sills in Oliver 1996; synthesis]

  • Sills sees Buddha-nature even in "mad" states. That is her tradition's view, not a clinical guideline, and she gives no practical guidance on psychosis. [synthesis] In acute psychosis or mania, suspend deep-process and body-focused work. Coordinate with psychiatric care. Use supportive, grounding contact only.

Spiritual bypassing / transcendent avoidance [source: Sills in Oliver 1996]

  • Sills cautions that some "transcendent" practices make it easier to avoid presence, and that work moving away from interconnectedness and real responsibility is going the wrong way. When a client uses spiritual language to skip anger, grief or relational responsibility, gently name it and return to embodied, relational experience. [example phrasing synthesis] (illustrative) "I notice we move quickly to letting it go. I wonder what's here before letting go."

Clients uneasy with Buddhist or spiritual framing [synthesis; GoodTherapy notes this concern]

  • Explain that you work with awareness, the body and the relationship. No belief or practice is required. Use plain language ("noticing", "what's happening") rather than Buddhist terms. Never impose spiritual interpretations. Ask about and respect the client's own faith or secular worldview.

Non-adherence [synthesis]

  • The sources describe no homework, so there is little to "comply" with. If you suggest between-session noticing, make it optional and small. Explore missed sessions or reluctance as process rather than defiance.

Ruptures [synthesis, consistent with Sills' shared-field view]

  • When the client withdraws, gets angry or feels misunderstood, treat it as something co-created in the field (4.18). Name it, own your part and enquire how it was for them. Slow down. Go back to whatever level of contact feels safe.
  • Ruptures around touch, silence or pushing too far: stop the technique, apologise where appropriate and re-contract explicitly.

Idealisation and power [synthesis]

  • A spiritually framed therapy can invite idealising the therapist as teacher or guru. Name the dynamic, return authority to the client ("in the driving seat"), and keep firm boundaries. Never combine roles (e.g. client and meditation student) without careful thought and supervision.

Touch-related problems [synthesis]

  • If the client froze, complied or later felt uncomfortable: acknowledge it, stop touch, discuss and document. Seek supervision. Follow your registration body's guidance. With an abuse history, the default is no touch.

After-effects outside sessions [source: van Ooijen 1999]

  • After intense work, people may feel "weird" or misunderstood in daily life. Spend time grounding (4.20) and discuss how to protect themselves (their "periphery") at work and home. [synthesis] Avoid deep openings close to holidays, breaks or the end of therapy.

Risk, crisis and suicidality [synthesis]

  • CPP is not a crisis intervention (GoodTherapy). If suicidal ideation or self-harm emerges, step out of open process work into standard structured risk assessment: ideation, intent, plan, history, protective factors. Make a collaborative safety plan, including lethal-means counselling (safe storage or removal). Liaise with GP or crisis services as needed. Resume process work only once safety is established.

Therapist overwhelm [source: van Ooijen 1999; Sills in Oliver 1996]

  • The therapist must not be overwhelmed either. Rely on your own practice (equanimity, Kum Nye if trained), personal therapy and supervision. Withdraw from the edge with the client if you can't stay present.

Scope of practice [synthesis]

  • Practising as a Core Process Psychotherapist requires the Karuna training and ACPP or UKCP accreditation. Clinicians without it can use the stance and attention-based enquiries (4.1–4.9, 4.19–4.20) inside their own modality. They should not describe their work as CPP or attempt birth, perinatal, breathwork or touch work without training.

Sources

Sources:

Further reading (not drawn on) [uncertain]: the Karuna Institute website; the ACPP website ambcpp.com; the full SAGE entry; the text of Being and Becoming; Sills' 2007 Karuna paper and his pre- and perinatal booklet (sales description only).

Books and articles (further reading, not drawn on):

  • Sills, F. (2008). Being and Becoming: Psychodynamics, Buddhism, and the Origins of Selfhood. Berkeley: North Atlantic Books (foreword by Maura Sills; chapters by Cherionna Menzam). An earlier 1998 edition (J. Garfield Press) is listed only by GoodTherapy. Publisher descriptions only.
  • Sills, M., & Lown, J. "Licking Honey from the Razor's Edge" (article; publication details not verified).
  • Sills, F. (2007). Karuna Institute paper on the stages and psychological correlates of pre- and perinatal experience (cited by Talbot 2015; not drawn on).
  • ACPP (2023). Core Process Psychotherapy: Standards and Guidelines for Practice (cited by GoodTherapy; not verified).
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