“It is about knowing when to do what, how to do it, and how much.”

When I heard one of my supervisees say this in their reflection, I was very pleased.

Because that is exactly what CPR is for—and what I hope to help my supervisees learn.

In my own clinical development, I was taught that case conceptualisation is the map of therapy. It tells us what we are working with, where we might need to go, and what interventions may help us get there.

I still find this profoundly true.

I spend a considerable amount of time with supervisees developing and refining case conceptualizations, trying to make them more precise.

And yet, over the years, I have also come to feel that conceptualization alone is not enough.

Schema Therapy, like many experiential therapy models, is concerned with moment-by-moment experience. The map may tell us where we are going, but it does not always tell us:

When?

How?

And how much?

The big picture does not necessarily tell us the right dosage in this particular moment, with this particular person.

And this is where I increasingly realize that my mindfulness training has been filling an important gap.

What Mindfulness Taught Me About “Doing”

I have trained in mindfulness and Buddhist meditation with many different teachers over the years—East and West, secular and religious.

Two teachers in particular have stayed very strongly with me.

One is Dr Helen Ma, who shaped much of my early development as a mindfulness teacher.

She showed me something close to: Less is more. 無為 (non-doing).

Much of what I learned from her teaching, guidance and supervision came not from what she did, but from what she deliberately restrained herself from doing.

She created space.

She noticed, and then she gave the other person space to notice.

So the other person had space to inquire.

It was a space for practitioners to learn directly from their own experience rather than being told too quickly what their experience meant.

This is much harder than it sounds.

Another teacher who has deeply influenced me is Pema Chödrön.

Although I do not consider myself a Buddhist, I have repeatedly found myself learning from the way she responds to people’s questions.

There is an art in how much she says.

Clear and direct enough to be useful, but not so much that her words fill the whole space.

Something remains open for the person who has just shared their experience.

If you are also a mindfulness teacher, you may recognize the fine balance I am trying to describe.

Spirituality can sometimes be a double-edged sword. The more we try to make something explicit, solid and grounded, the more the limitations of language can bind us. In trying to explain too much, we may lose our ability to point towards something deeper.

只能意會，不能言傳。

Some things can be understood through experience more readily than they can be fully captured in words.

Making the Implicit Explicit

Recently, one of my supervisees asked me:

“How can you be aware of so many layers simultaneously?”

I paused.

And in that pause, I realised something about what I have been trying to do in supervision—and perhaps also about why I developed the CPR framework.

I am not only trying to teach psychotherapy using the therapy models I know or the clinical knowledge I have accumulated over the years.

I am also trying to teach something I have learned through mindfulness practice and mindfulness teaching.

And I am trying to translate something that has often been implicit into something that can become more explicit, teachable and usable in clinical work.

That may also be why the CPR framework itself is not inherently bounded by collectivistic cultures. As one journal editor pointed out to me, the framework may have much wider applicability.

Collectivistic cultural contexts were the lens through which I chose to develop and present it.

Perhaps because that is closer to my heart.

CPR as Relational Mindfulness

I have said before that CPR is, essentially, relational mindfulness.

Increasingly, I understand more clearly what I mean by that.

My experience with Insight Dialogue has informed how I sit within a relationship with another person—how I notice not only what is happening in me or in them, but what is happening between us.

My years of teaching MBCT have informed how I guide someone towards greater curiosity about their own process.

In another language, this means helping someone notice their relationship with their own experience.

My Mindful Parenting training has shaped how I understand rupture and repair—with clients as much as with my own children.

My Mindfulness for Cancer training taught me that sometimes a very short and simple practice can bring someone back to one single moment.

And sometimes that is enough.

In the face of chronic illness, disability or suffering, we do not always need to do more.

Sometimes our task is to recognise when enough has already happened.

My learning in trauma-informed mindfulness has given me a much wider repertoire of how to remain mindful—how to adapt, offer choice, change the doorway into experience, and remain flexible without losing the essential qualities of 靜 (Stillness) and 定 (Stability).

Only then do we have observations.

And many retreat experiences continue to accompany me.

The 10-day silent Vipassana retreats (while I was 7 months pregnant!), and particularly a retreat with Bob Stahl (in Taiwan) that remains vivid in my memory, helped me experience that something of our connection with other beings in this world is inseparable—and that is closely linked to equanimity.

Not detachment or indifference, but the capacity to remain present without needing immediately to grasp, reject, rescue or control.

All of This Walks Into the Therapy Room With Me

All these experiences have accompanied me whenever I walk into the therapy room.

For years, much of this was simply there. Implicit. Embodied.

Something influencing how I listened, how long I waited, when I interrupted, when I asked another question, when I stayed silent, when I moved towards emotion, and when I decided that the moment needed no more intervention.

Now I find myself trying to verbalize it in teaching. Therefore, I tend to make a lot of video when I teach. ‘Show but not tell’ rule is still deep inside me. We want people to learn from their own experience, not from their head or what they were told.

How to make the implicit more explicit with another clinician, putting words around things that I previously knew largely through experience, without destroying or simplifying the learnings?

That feeling is closely linked to my cultural experience — a lot of deep love and care are delivered in silence. There are no words.

Today, I told my supervisee that being able to stay purely curious and neutral with a client at a particularly meaningful moment itself is not only a ‘corrective emotional experience’, but also ‘where our self-compassion begins’.

I am not sure he understood what I really meant, given that I am doing it with words this time. However, that’s exactly what many of my old classmates and I have experienced in the MBCT teacher training journey.

Compassion can be something very quiet. It’s already there, if we can slow down and listen.

Perhaps this is one reason supervision has become so interesting to me.

It asks me not only:

What did you notice?

but:

How did you know to notice it?

Not only:

What intervention did you use?

but:

Why then? Why in that way? Why that much?

And sometimes:

Why did you decide not to do anything more?

That last question may be just as important as all the others.

When to Do What, How, and How Much

We often talk about psychotherapy competence in terms of knowing techniques.

But perhaps expertise also involves developing sensitivity to timing, form and dosage.

A technically appropriate intervention can still be mistimed.

A useful question can become intrusive if we ask at a bad timing.

An experiential exercise can become overwhelming if we push past the person’s capacity to remain present.

An interpretation can be accurate and yet still be unhelpful if the relationship cannot hold it at that moment.

And sometimes a very small intervention can be enough.

This is where the map of case conceptualisation meets the immediacy of clinical presence.

We need both.

The conceptualisation tells us the direction, but moment-to-moment awareness helps us sense how to travel there with this particular person.

Perhaps this is one of the places where psychotherapy and mindfulness have become inseparable for me.

Returning

Silently, somewhere inside me, I also hope that this work remains rewarding and nourishing enough to keep me in this space.

Over the years, the quiet voice pulling me back towards mindfulness teaching has become louder and louder.

Tonight, I have the good fortune to join an online practice with one of my favourite mindfulness and Dhamma teacher, who is also a woman of colour.

One sentence stayed with me:

“If we can see our preciousness, we will live our lives in a very different way.”

I will be sitting with that as I return to my regular practice.

And perhaps, for now, that is enough.

In this short role-play, I initially notice what could easily be understood as emotional avoidance.

But Crystal, playing a client with a Mistrust/Abuse schema, experiences something quite different:

She thinks I am the one avoiding her question.
Same interaction.
Two very different experiences of what is happening.
This is where formulation becomes interesting.

When we identify a client as avoiding, detached, resistant, or not engaging, how often do we stop to consider how they are experiencing us at that very moment?

This is one of the reasons I find ‘process’ and ‘relationship’ so important clinically. Sometimes the difficulty is not in the question we asked, but in the meaning that question acquired between two people. In this situation, I find it particularly important for the therapist to be able to land on the ‘process’ level with the client, without going too quickly into the ‘content’. Because ‘relational safety’ should come first.

The video below is a clinical demonstration for learning purposes. Crystal is role-playing the client; it does not depict an actual client or therapy session.

Acknowledgment: Crystal Lee, Accredited Advanced Schema Therapist.

🔒 Full clinical demonstration for paid subscribers below.

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很多學過 Schema Therapy 的治療師都會說，Chairwork 和 Imagery Rescripting 是最有力量的介入方法之一。

然而，當個案的困難牽涉到父母時，我們卻常常開始猶豫。

「如果我鼓勵個案設立界線，是否等於鼓勵他反抗父母？」

「如果個案來自重視孝道和家庭責任的文化，我是否正在挑戰他的價值觀？」

「究竟我應該處理的是內化父母模式（Internalised Parent Mode），還是真實父母之間的互動？」

「什麼時候應該支持個案接受限制？什麼時候又應該推動改變？」

我發現，真正困難的，從來都不是 Chairwork 或 Imagery Rescripting 本身。

真正困難的是，治療師如何在自主（autonomy）與忠誠（loyalty）之間取得平衡。

不少個案並不是單純害怕父母。

他們同時愛父母、感激父母、心疼父母，希望父母幸福；同時又感到委屈、憤怒、失望，甚至窒息。

如果治療師未能通透地看見, 眼前的個案這兩面的模樣，治療便很容易觸礁。

Schema Therapy 的目的，不是說服個案離開父母，也不是要求個案一味接納父母，而是協助他們逐漸建立一個更成熟、更有自主能力的 Healthy Adult，讓他們能夠自由地決定，自己希望如何與父母相處。

從 Content-Process-Relationship 的角度，我愈來愈少問：

「治療應不應該鼓勵個案原諒父母？」

反而更常問自己：

「究竟是什麼 relational process，正在組織（organising）個案此刻的情緒經驗？」

很多時候，當這個 relational process 改變了，個案自然便知道自己最希望如何回應父母，而答案不需要由治療師替他決定。

Many Schema Therapists learn chairwork and imagery rescripting as powerful techniques for working with unmet childhood needs.

Yet something often changes when the client’s difficulties centre on their relationship with their parents.

Therapists begin to hesitate.

“Am I encouraging the client to distance themselves from their parents?”

“Am I challenging cultural values such as filial piety?”

“Should I work with the internalised parent, or the real parent?”

“How do I know when to validate loyalty, and when to support differentiation?”

These are not simply technical questions.

They reflect one of the central tensions in psychotherapy:

How do we facilitate psychological growth without positioning therapy against the client’s family?

Over the past few years, this has become one of the central questions in my clinical work, supervision, and research.

Many clients do not simply carry punitive or demanding parent modes. They also carry love, gratitude, responsibility, loyalty, and hope. These often coexist with resentment, fear, grief, and a longing for greater autonomy.

When therapists cannot see both sides of the same coin, interventions can unintentionally become polarising.

The goal of Schema Therapy is not to persuade clients to reject their parents, nor to encourage unquestioning acceptance. Rather, it is to help clients develop sufficient emotional freedom to relate to their parents from a healthier Adult mode.

From a (CPR) perspective, I have become less interested in asking,

“Should the therapy encourage the client forgive their parent?”

and more interested in asking,

“What relational process is organising the client’s emotional experience at THIS moment?”

The answer to that question often determines whether chairwork or imagery rescripting deepens emotional integration—or inadvertently reinforces guilt, compliance, or emotional distance.

一個由這些臨床問題衍生出來的工作坊

A workshop that grew out of these questions

這些問題，促成了我今年十一月在香港舉辦的一天工作坊。

除了介紹 Chairwork 和 Imagery Rescripting 的技巧外，我更希望和大家一起探討治療背後的臨床思考，包括：

• 如何處理內化父母模式（Internalised Parent Modes）

• 如何在複雜家庭關係中運用 Chairwork 與 Imagery Rescripting

• 如何支持自主，而不把個案推向與家庭對立: 再撫育個案的父母 (Reparenting the client’s parents)

• 如何在孝道與家庭排序下進行體驗式治療

• 如何避免過度順從或過早對抗

• 如何提升體驗式治療中的即時臨床判斷能力

These questions have shaped a new one-day Cantonese workshop that I will be teaching in Hong Kong.

Rather than focusing only on techniques, we will explore the clinical reasoning behind experiential work with complex family relationships.

Topics include:

• Working with Internalised Parent Modes

• Chairwork and Imagery Rescripting in complex family dynamics

• Supporting autonomy without positioning clients against their families

• Working with filial piety and family hierarchy

• Avoiding both over-compliance and premature confrontation

• Developing moment-to-moment clinical decision-making during experiential work

I will also provide an English version of this workshop in some in-house training in Hong Kong, UK and Singapore. Interested parties, please email: info@chinese-schema-therapy.com

Workshop Details | 工作坊資訊

Parental Relationship in Schema Therapy: Using Chairwork and Imagery Rescripting in Complex Family Dynamics

Schema Therapy 中的親子關係：在複雜家庭關係中運用 Chairwork 與 Imagery Rescripting

📅 22 November 2026 (Sunday)｜2026 年 11 月 22 日（星期日）

📍 Causeway Bay, Hong Kong｜香港銅鑼灣

🗣 Language｜語言：廣東話

👥 For clinicians who have completed Schema Therapy Level I (or equivalent basic training).

適合已完成 Schema Therapy Level I（或具備基本 Schema Therapy 訓練）的臨床工作者。

I would be delighted to meet colleagues who are interested in exploring one of the most nuanced areas of Schema Therapy practice.

Application Link: Parental relationship in Schema Therapy:Using Chairwork and Imagery Rescripting in Complex Family Dynamics | Chinese Schema Therapy Academy

期待在香港與大家一起深入探討 Schema Therapy 中最細緻、也最富挑戰性的臨床工作。

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In my previous post, I argued that when the content does not match—that is, when our client does not seem to be answering our questions—we need to look beyond the content itself and examine the Process and the Relationship.

In this post, I would like to take the discussion one step further.

What if the relationship we need to examine is not only the one unfolding between therapist and client, but also the relationship within the therapist?

Just as our clients’ interpretations are shaped by their upbringing, cultural context, and previous relational experiences, so are ours.

How we make sense of what happens in the therapy room is also bounded by our own history, experiences, and predictive infrastructure. Equally important is the relationship we have with our own inner experiences.

What does this mean in practice?

If you did not read Part I yet, here you go:

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One of the central ideas of the Content–Process–Relationship (CPR) Framework is deceptively simple:

When the content does not make sense, look at the process and the relationship.

In Schema Therapy, therapists may infer that when a client repeatedly struggles to answer well-framed experiential questions, they are operating from a Detached Protector mode. The client appears emotionally inaccessible. They may intellectualise, change the subject, or respond with, “I don’t know.”

Sometimes this formulation is accurate. But sometimes it is not.

The same observable behaviour can arise from a very different process.

Imagine working with a client from a strongly collectivistic culture characterised by pronounced hierarchical norms.

You ask thoughtful, carefully constructed questions. You slow the pace. You genuinely want to understand her experience.

Yet she still struggles to answer.

A content-focused interpretation might conclude:

“She is detached.”

A process-oriented therapist asks a different question:

“What is happening inside her right now?”

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The client’s difficulty may not reflect emotional avoidance at all.

Instead, she may be encountering a relational experience that is almost entirely unfamiliar.

Perhaps very few people have ever shown a genuine interest in understanding her inner world.

Perhaps no one has ever stayed with her experience without quickly advising, evaluating, correcting, or telling her what she should do.

Perhaps she has never imagined that someone might spend time before the session thinking carefully about how to help her, or discuss her case in supervision because they genuinely want to understand her more fully.

For therapists, supervision is simply part of good clinical practice.

For some clients, however, the idea that another professional has been consulted—not because they are “difficult,” but because their therapist is investing additional time, thought, and effort in understanding how best to help them—may be almost unimaginable.

That level of attention and care introduces something entirely new into the client’s interpersonal world.

The process may be unfamiliar

The client’s difficulty in responding does not necessarily mean that the therapist has encountered a Detached Protector.

It may instead reflect the fact that this particular interpersonal process has never existed in the client’s experience.

When the therapist asks a question with genuine curiosity—literally meaning what they say and genuinely wanting to understand the client’s inner experience—the client may not hear the question in the way it is intended.

Instead, she hears it through the relational process she has always known.

She hears criticism where the therapist offers curiosity.

She hears evaluation where the therapist offers understanding.

She hears expectation where the therapist offers genuine interest.

In other words, the client is not responding only to the therapist’s words.

She hears what she has learned to hear.

This is part of what I refer to in my earlier publication, Culture as Predictive Infrastructure.

Her response is therefore not necessarily a deliberate defence. It may reflect an automatic interpersonal process shaped by years of previous relational experience.

This invites the therapist to think one step further.

After asking,

“What is happening inside her right now?”

we also ask,

“What is happening between us right now?”

Importantly, this second question does not assume that the therapist has done something wrong.

It is not necessarily the case that the therapist has moved too quickly, asked the question too directly, or failed to establish sufficient safety.

Instead, what is unfolding between therapist and client may reflect the kinds of relationships the client has repeatedly experienced throughout her life.

The therapist is offering one kind of relationship, while the client is automatically responding as though she were in another.

From a CPR perspective, the apparent mismatch between the therapist’s intention and the client’s response is itself clinically meaningful.

The therapist may genuinely be communicating:

“I want to understand you.”

The client may automatically receive:

“There must be a right answer.”

Or:

“If I say the wrong thing, I will disappoint you.”

Or:

“You are testing me.”

The client’s response does not fully reflect what is happening in the room because it is being organised by an earlier relational process—the interpersonal environment in which the client developed.

The therapist’s task is therefore not simply to ask a better question, nor to conclude too quickly that the client is avoiding emotion.

Instead, the task is to recognise the interpersonal process that has emerged and gently help the client experience a different way of relating.

Sometimes, what appears to be emotional inaccessibility is not the absence of emotion at all.

It is the presence of an old relational process meeting an entirely new relationship.

To me, that’s the heart of limited reparenting. It looks very quiet on the outside. The therapy sessions can sometimes even look stuck, but the work could be in the relationship and process level.

If this process is partly organized by the client’s previous relational experiences, what role does the therapist’s own relational process play? That will be the focus of Part II. Stay tuned!

https://open.substack.com/pub/beatricengkessler/p/when-the-content-doesnt-match-looking-fa5?r=a3k7r&utm_medium=ios

兩個基模治療師的討論, 關於一套網絡影片如何反影兒童的基本需求、以及相關基模。

版權關係, 本片只剪出一小段分享, 全片請用以下連結觀看。

在這段影片中，我們討論了「親職化」（parentification）現象、它對成年後生活可能帶來的影響、當中哪些核心情緒需求可能未被滿足，以及親職化如何在某些文化中被強化。我們亦分享了與此相關的模式（modes）和基模(Schema)，以及一些基模可能如何形成與發展。

留言分享你的想法吧!

A discussion between two Schema Therapists exploring how a viral video reflects children’s core emotional needs and the schemas that may develop as a result.

In this clip, we discuss parentification, its potential impact on adult life, the emotional needs that may go unmet, and how parentification is reinforced in some cultures. We also shared the related modes and the potential development of some schema.

For copyright reasons, only a short excerpt of the original video is included here. To watch the full video, please use the link below.

Leave your thoughts in the comments please!

Source video: TVBS News
Original report: Facebook

At first glance, these clients often appear ambivalent. They say they want to protect themselves, yet repeatedly move back towards caregiving, accommodation or self-sacrifice.

It is tempting to interpret this as resistance, avoidance, or an inability to let go.

I have increasingly wondered whether something else is happening.

From a Content–Process–Relationship (CPR) perspective, what appears to be ambivalence may instead reflect two equally legitimate relational needs operating simultaneously.

One part longs for safety, autonomy and psychological space.

Another part longs to remain a loving son or daughter.

The therapeutic task is therefore not to persuade clients towards one side, but to understand what relational process is organising the guilt.

In this supervision demonstration, I apply Schema Therapy Imagery Rescripting to work with this dilemma.

Rather than challenging guilt directly, the imagery gradually transforms the relational meaning beneath it, allowing differentiation to emerge without requiring the client to reject filial love.

What you’ll see in this video

In this recording, I work with a supervisee who was struggling with guilt while supporting a client to establish boundaries with a parent.

The demonstration illustrates:

• applying Schema Therapy Imagery Rescripting in supervision;

• recognising guilt as a relational process rather than simply a cognitive belief;

• learning what is ‘reparenting the client’s parents’ means in Schema Therapy;

• helping differentiation emerge without invalidating attachment.

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The truth is, almost all relationships involve risk.

Because every relationship inevitably carries the risk of not being understood, not being valued, not being cared for, or even being abandoned. Even the relationship between children and their parents.

Although the world celebrates the greatness of maternal love, there are all kinds of mothers. They, too, were once daughters who needed to be loved and cared for. If they themselves grew up in environments marked by deprivation, then even with their best efforts, they may not be able to offer what we call “unconditional” love. Perhaps religion or spiritual growth allows some people to experience unconditional love. Otherwise, almost all human relationships involve risk.

For some people, that risk feels so immense that they must armour themselves into someone formidable. They may even need to diminish the worth of others in order to maintain their own self-esteem. Only then can they feel safe.

The way T arranged our first appointment was already unusual.

He first asked his secretary to call my office. Unfortunately, the only time he wanted happened to be on my day off, so the secretary left it there.

Later, T called personally. When my assistant explained that I never see clients on Mondays, he became somewhat irritated.

After he booked a Tuesday appointment, his secretary called again and asked my assistant,

“Are you sure the psychologist really can’t do Mondays?”

T came because his wife insisted.

She had already moved out of their mansion and wanted a divorce.

After much deliberation, he reluctantly agreed to therapy.

“I don’t want her to be so upset. She won’t have a good life without me either. I’ll see whether our marriage can still be saved.”

That was how he introduced himself.

T grew up in a wealthy family.

He never had to worry about money and had become accustomed to people serving him.

After graduating from university and working for two years, he joined the investment bank in which his father had an ownership stake. He had spent his entire career in investment.

He genuinely could not understand why, despite his wealth and status, his wife still wanted to leave him.

“I don’t know what she wants.”

He said this with obvious anger.

It took several sessions before I finally understood why she wanted a divorce.

T had numerous extramarital affairs.

At the same time, he tightly controlled his wife’s social life while freely pursuing other women himself.

Naturally, he saw nothing wrong with this.

Men and women, in his view, were never equal.

He had countless justifications for maintaining his lifestyle.

When I asked how he and his wife had first met, he relaxed for the first time.

“I liked taking care of her. She used to be very obedient. When we were dating, I took her to Paris to meet my friends. I bought her lots of designer clothes. She felt proud to be with me. She loved dressing up beautifully every day...”

As he recalled those early days, a rare sense of calmness and security appeared on his face.

“So,” I asked directly,

“Did your wife know, while you were dating, that you were sleeping with other women?”

He immediately straightened his back and answered loudly.

“Of course she didn’t know then. But after we got married, she started noticing clues. At first she pretended not to see them. Then one of my girlfriends called her. That’s when everything exploded.”

Whenever I tried to understand how they argued, T would quickly avoid the conversation.

He disliked describing what happened when his wife confronted him.

To T, having multiple partners simply felt necessary.

Yet when I asked what emotional needs those relationships fulfilled, he could not answer.

Instead, he began boasting about his sexual performance.

When I told him that such explicit descriptions felt intrusive and that I neither wanted nor needed to hear them, he suddenly looked pleased.

“Aren’t psychologists supposed to understand their patients? I’m your patient.”

Throughout therapy, T often adopted an intimidating stance.

He became angry whenever small things did not go his way.

One day his chauffeur happened to be ill, so he had to drive himself to my clinic.

Unable to find parking, he sat down and immediately started shouting at me, demanding to know why my clinic did not provide private parking spaces.

Whenever I asked about his feelings—especially regarding the divorce—he would avoid the topic.

He fiercely resisted experiencing any sense of vulnerability, let alone talking about it.

As a result, our sessions repeatedly revolved around the things that made him angry.

Only when I came to understand how deeply he missed being his wife’s hero—providing her with material comfort and protecting her from being mistreated by her own family—did he slowly begin expressing his hurt through anger.

“How could she do this to me? I’ve been so good to her. After we got married, I bought her a flat and a car. What more did she want?”

His eyes became red as he spoke.

I replied,

“You feel that you’ve done everything you possibly could to love her, yet she still wants to leave.”

I continued,

“When you were in primary school, you had no friends. It didn’t seem to bother you because you convinced yourself those children were idiots. Later, when you started working and still had no friends, you complained to your father. He told you not to waste your time on those people. He knew important people—who were they compared to him? Throughout your life, you’ve protected yourself from being hurt by believing you were superior to others. But that strategy doesn’t work in marriage. The more you relate to your wife from that position, the more she wants to leave.”

For the first time, T’s eyes filled with tears.

Narcissistic Personality Disorder causes tremendous suffering for the people around them.

At the same time, it is often difficult for those living with narcissism to recognise that they, too, are suffering.

Editor's note: This article was originally published in Chinese in the Hong Kong Economic Journal on 14 February 2023. The version below is a literal English translation.

不安全的人際關係 (上)

When people first hear about the CPR Framework—Content, Process, and Relationship—they often assume it is simply a way of organising clinical observations.

It is.

But that is not its essence.

At its heart, CPR is about relational mindfulness.

Mindfulness is often described as paying attention to present-moment experience with openness and curiosity. In psychotherapy, we usually think of this as something we invite clients to develop within themselves.

CPR extends this same attitude into the therapeutic relationship.

Rather than becoming absorbed in what the client is saying, the therapist learns to notice how the conversation is unfolding and what is happening between us in this very moment. Relational mindfulness also invites us to become aware of the assumptions we hold about the client’s inner world, while cultivating a deep understanding of our own relationship with our emotional experience. In doing so, we become more able to distinguish between what is unfolding in the client, what is arising within ourselves, and what is being co-created in the therapeutic relationship.

The shift is subtle but profound.

Instead of asking only,

“What is the client’s problem?”

we also ask:

• What is happening in the client’s experience right now?

• What process is unfolding for the client now?

• How am I responding to it internally?

• What is happening in our relationship at this moment?

This is relational mindfulness.

Following our symposium on the CPR Framework at the ISST Conference, one of the senior Schema Therapy trainers came up to me and asked,

“How do you hold so much information in mind?”

It was a thoughtful question.

I don’t consciously try to hold everything in mind at once.

The CPR Framework is not a checklist that I mentally work through during a session. Rather, it reflects a way of paying attention. Over years of clinical practice and mindfulness practice, the distinction between content, process, and relationship has gradually become an embodied way of observing what is happening in the room.

Much like mindfulness, it is less about remembering more and more about noticing differently.

This reminds me of Dr. Daniel Siegel’s view that well-being emerges through the integration of mind, brain, and relationships. Mindfulness is not simply an individual exercise occurring inside one person’s mind. Our minds are continually shaped through our relationships, and therapeutic presence is therefore inherently relational.

The CPR Framework is my attempt to bring this relational perspective into everyday clinical practice. It is a way of helping therapists remain aware not only of the client’s narrative, but also of the emotional process unfolding and the relationship that carries that process.

When our attention is anchored in the therapeutic relationship, we are no longer trying to analyse every detail. Instead, we become more sensitive to shifts in the client’s experience, our own responses, and the interaction unfolding between us.

The therapist’s mindfulness creates space for the client’s experience to unfold.

Seeing More Than the Story

Clients naturally bring us stories. Stories are important—they provide context, meaning, and history.

But therapy does not happen in the story alone.

It happens in the pauses.

The moments when someone suddenly shift topic after describing abuse.

The way a client’s eyes move away just before talking about grief.

The instant a therapist feels an urge to reassure, rescue, challenge, or withdraw, and sometimes, to prove themselves helpful.

These moments are easy to miss if our attention remains fixed on content.

Relational mindfulness asks us to widen our awareness.

Content is one layer.

Process is another.

Relationship is the field in which both unfold.

A Different Kind of Presence

Relational mindfulness does not mean becoming passive or detached.

It means remaining awake to multiple layers of experience simultaneously.

Listening to the narrative while noticing emotion.

Following emotion while observing interpersonal patterns.

Tracking interpersonal patterns while remaining aware of one’s own responses.

This is not divided attention.

It is expanded attention.

In the Mindfulness-Based Cognitive Therapy teaching module, the practice named ‘Choiceless awareness’ cultivates such expanded attention. The practice called ‘breathing with difficulty’ is, in fact, practicing a new way to ‘relate’ to our painful experience.

With the expanded attention, the therapist is no longer simply listening to the client.

The therapist is participating with the client while remaining aware of the relationship itself.

CPR as a Practice

For me, CPR has never been merely a framework for formulation. It is a way of cultivating therapeutic presence, which informs my clinical decisions.

The most meaningful clinical decisions often emerge not from analyzing harder, but from observing more carefully, connecting more deeply.

Relational mindfulness slows us down.

It invites us to notice before we interpret.

To understand before we intervene.

Today, my client, who has been struggling with death anxiety for years, told me, ‘I have come to realize that knowing is different from understanding.’

The warmth immediately comes up from my heart. At that very moment, I am sure he does practice the 5-minutes mindfulness at home.

To me, therapy is not only about changing people—it is about paying close attention to what is happening between two people, moment by moment. The connection itself is healing.

Perhaps that is what CPR is really trying to teach us.

Not simply to observe content, process, and relationship.

But to become more mindful of the relationship in which healing becomes possible.

When clients struggle to access emotions, our default explanation is often avoidance.

Certainly, avoidance exists. At times, people actively push feelings away because they are overwhelming, painful, or frightening.

However, I have increasingly wondered whether “avoidance” has become an umbrella explanation for many different clinical phenomena.

A recent paper by Andy Fung and colleagues particularly caught my attention. Rather than conceptualising experiential avoidance purely as avoidance behaviours, they distinguish between behavioural avoidance and a more fundamental Preference to Avoid Self-Experiences (PASE)—defined as “a preference to avoid engaging with one’s own internal experiences.” This shifts our attention from what clients do to how they have learned to relate to their own inner world.

I find this distinction clinically valuable.

Some clients genuinely want to engage in therapy. They attend sessions consistently, complete homework, and express a sincere desire to understand themselves. Yet approaching certain emotions, memories, or self-states still feels profoundly difficult—not necessarily because they are resisting therapy, but because engaging with these internal experiences has long been experienced as unsafe, overwhelming, or psychologically costly.

This distinction enriches our understanding of emotional accessibility.

Yet I also wonder whether it is still only part of the picture.

Even when clients demonstrate little evidence of a preference to avoid their inner experiences, emotional access may remain surprisingly elusive.

The problem is not always willingness. It is not always experiential avoidance.

Sometimes, the conditions necessary for emotional experience have simply not yet emerged.

Emotions Do Not Appear in a Vacuum

Recent developments in affective neuroscience suggest that emotions are not simply hidden entities waiting to be discovered.

Instead, emotional experiences are actively constructed through ongoing interactions between the brain, the body, prior experiences, language, and social context.

This means that emotions do not arise solely from what is happening inside us.

They are also shaped by how we have learned to interpret, organise, and make meaning of our experiences.

Consequently, emotional accessibility depends on more than willingness alone. It also depends on whether emotions feel psychologically safe to approach, whether they have become conceptually meaningful, and whether the relational context permits those emotions to emerge.

For example, imagine a child who grows up in an environment where emotional restraint is valued, conflict is discouraged, and maintaining harmony is considered important.

That child may become highly skilled at monitoring relationships, anticipating others’ reactions, and regulating emotional expression.

As an adult, emotional awareness may not be absent.

Rather, emotional access may occur through pathways that differ from what therapists—or even the client themselves—have come to expect.

A Different Question

Perhaps the most helpful shift is moving away from asking:

“Why can’t my client access their emotions?”

or immediately concluding,

“They are emotionally avoidant.”

Instead, we might ask a series of different questions.

• Has this person learned that certain emotions are unsafe to experience?

• Have they developed a preference to avoid particular internal experiences because these have historically been associated with pain, shame, or psychological threat?

• Do they yet have the language and conceptual framework to make sense of what they are feeling?

• Does the current therapeutic relationship provide sufficient safety for these emotions to emerge?

These questions invite curiosity rather than premature formulation.

Rather than treating emotional inaccessibility as a unitary phenomenon, they encourage us to consider multiple pathways through which emotions may become inaccessible.

For me, this is precisely where the CPR framework becomes clinically useful.

Rather than assuming that emotional inaccessibility necessarily reflects avoidance, CPR invites therapists to ask a different question:

Where is emotional accessibility currently constrained?

Is it primarily a matter of :

Content—the client’s meaning-making and conceptual understanding?

Process—the dynamic relationship between the client and their own internal experiences, including experiential avoidance, emotional tolerance, and the capacity to remain present with emerging emotions?

Relationship—whether the interpersonal context is sufficiently safe for emotions to emerge?

The answer may differ from one client to another, even when their outward behaviour appears remarkably similar.

References for Clinicians:

Barrett, L. F. (2017). The theory of constructed emotion: an active inference account of interoception and categorization. Social cognitive and affective neuroscience, 12(1), 1-23.

Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., ... & Devins, G. (2004). Mindfulness: A proposed operational definition. Clinical psychology: Science and practice, 11(3), 230.

Fung, H. W., Wong, M. Y. C., Chau, A. K. C., Lay, C. M., Huang, S. Y., & Wong, J. Y. H. (2026). The preference to avoid self-experiences scale: Validation and association with complex PTSD and dissociation. Research on Social Work Practice, 36(3), 313-321.

Ng-Kessler, B. (2026). Culture as predictive infrastructure: A constructionist account of emotional access in schema therapy. Journal of Contemporary Psychotherapy, 1-7.

Ng-Kessler, B. (2026). The content–process–relationship framework: A culturally responsive process model for working with emotional inhibition in collectivistic contexts. Practice Innovations.

Teasdale, J. D., Moore, R. G., Hayhurst, H., Pope, M., Williams, S., & Segal, Z. V. (2002). Metacognitive awareness and prevention of relapse in depression: empirical evidence. Journal of consulting and clinical psychology, 70(2), 275.

Today I’m delighted to share that my second journal paper has finally been published.

Many of you have followed my recent writing on emotional access, culture, and psychotherapy. In my previous paper, Culture as Predictive Infrastructure: A Constructionist Account of Emotional Access in Schema Therapy, I introduced the idea of delayed labelling.

The idea is simple, but I believe it has important implications for psychotherapy.

Sometimes the emotions we observe at the beginning of a session are not the emotions that are actually driving a person’s experience. This is particularly true when culture influences not only how emotions are expressed, but also which emotions become accessible to awareness in the first place.

If emotional access is shaped by culture, immediately naming what appears on the surface may lead us to mistake the client’s initial emotional presentation for their deeper emotional experience.

That led me to a practical question:

If we delay labelling, what should therapists do instead?

This new paper is my attempt to answer that question.

The Content–Process–Relationship (CPR) Framework is not another therapeutic technique. Rather, it is a process-oriented framework that helps therapists understand when deeper emotional experience is becoming accessible.

Instead of asking only “What emotion is this?”, the framework encourages us to ask three questions:

• Content: What is the client telling me?

• Process: How are they emotionally engaging with (this/that) experience?

• Relationship: How is (our/their) relationship influencing what becomes emotionally possible in (this/that) moment?

Only after understanding these three layers do we begin to make sense of emotional meaning.

For me, this framework is not about making therapy slower for its own sake. It is about making our understanding more accurate—particularly when working across cultures, where emotional accessibility is shaped by relational, developmental, and cultural contexts.

I’m grateful to everyone who has been part of this journey. I hope this paper contributes something useful to the ongoing dialogue about culture, psychotherapy, and emotional processing.

📖 Read the paper here: APA PsycNet FullTextHTML page

For readers who would like a short plain-language explanation of the research paper, see the Kudos summary.

As always, I’d love to hear your reflections.

As someone who now spends much of my time between private practice, training, supervision, writing, and research, it is easy to forget how much dedication is required to continue doing thoughtful clinical work within a large public healthcare system. Heavy caseloads, long waiting lists, administrative demands, service pressures, and limited resources are realities that many clinicians face every day.

Yet what struck me most was not the workload.

It was the heart.

Throughout the supervision, I heard clinicians speaking about their clients with genuine care, curiosity, and commitment. Behind every case discussion was a therapist trying to understand a person’s suffering more deeply and wondering how to help a little more effectively.

Perhaps this is one of the reasons I continue to enjoy supervision so much.

Supervision is often described as a space for developing skills, strengthening formulation, or refining interventions. While all of those are important, I increasingly see supervision as something else: a place where we help each other protect the parts of ourselves that first brought us into this profession.

The longer we work in mental health, the easier it is to become preoccupied with outcomes, protocols, service targets, risk management, and efficiency. These things matter. But underneath them sits something more fundamental: the human relationship.

When I listen to colleagues wrestling with complex cases, feeling moved by their clients’ stories, and continuing to show up despite the challenges of the system, I am reminded that good therapy has never been solely about techniques.

It is about people trying to help people.

Days like yesterday leave me feeling grateful. They remind me that amidst all the pressures facing our profession, there remains an extraordinary amount of compassion, integrity, and wisdom in the room.

And that gives me hope.

I arrived in Greece thinking I was presenting a framework that holds 2 clients’ stories in the collectivistic culture.

I left realizing something else.

When we screened therapy demonstrations involving Chinese clients, I expected colleagues to notice cultural differences. What surprised me was how many people from entirely different backgrounds described seeing their own stories reflected in the room.

A Vietnamese schema therapist shared that she became emotional during the video. A Greek therapist spoke about similar experiences of family expectations and emotional restraint. Others reflected on hierarchy, loyalty, guilt, and the difficulty of expressing vulnerability within close relationships.

It left me wondering:

If culture matters so much, why were people from such different cultures relating to the same material?

One possibility is that culture shapes not only what we feel, but also how we are allowed to feel.

The content may differ, but the emotional process may be more similar than we imagine. The relational dilemmas may be more universal than they first appear.

A Chinese daughter fearing she will burden her parents.

A Greek son struggling with family obligation.

A Dutch son wrestling with autonomy, loyalty, and belonging within a more rigid religious value system.

Different stories. Similar tensions.

Psychotherapy often encourages people to become more expressive. Yet one question that continues to interest me is whether emotional restraint is always a problem to be solved.

What if emotional restraint is not simply avoidance, but also loyalty?

What if silence sometimes represents love?

What if self-sacrifice sometimes protects attachment?

These questions sit at the heart of my work and the development of the CPR (Content–Process–Relationship) framework.

The conference strengthened my conviction that culturally responsive psychotherapy requires more than translating techniques across cultures.

It requires understanding the relational logic that gives emotional behavior its meaning.

The task is not choosing between culture and emotional needs, but helping clients hold both: expanding that safe space to allow more emotional and relational possibility within it.

Perhaps the most meaningful part of the conference was not presenting at all.

It was witnessing therapists from different parts of the world recognize themselves and their clients’ stories as culturally specific.

Perhaps we are more different than we think. And perhaps we are also more alike.

One idea I left the conference with is a growing curiosity about whether the CPR framework can be developed beyond collectivistic contexts. While the framework emerged from working with Chinese clients and relational-cultural themes, responses from colleagues from more diverse cultural backgrounds suggest that the underlying emotional and relational processes may have broader relevance. I would love to continue developing CPR into a clinical protocol that helps therapists understand emotional experience across different cultural contexts while remaining sensitive to the unique meanings that culture brings.

As I return home, I find myself carrying less certainty and more curiosity—and that feels like a good place to continue the conversation.

But in clinical work, guilt is not always simply cognitive distortion.

Sometimes, guilt reflects something relational.

In this video, I explore how guilt-inducing parental dynamics can become emotionally powerful not only because of fear or criticism, but because love, loyalty, responsibility, and relational identity are often intertwined together.

From a CPR perspective (Content–Process–Relationship), what becomes important is not only what the client feels guilty about, but how the guilt is unfolding relationally in the therapeutic moment.

A client may intellectually recognise a parent’s behaviour as harmful, while simultaneously feeling emotionally responsible for the parent’s wellbeing.

This creates a complex internal negotiation:
between self-protection and loyalty,
between anger and care,
between emotional honesty and relational belonging.

When therapists move too quickly toward confrontation or individuation, clients may feel misunderstood rather than liberated.

Sometimes the therapeutic task is helping them develop greater emotional differentiation while remaining connected to what matters to them relationally.

This is part of the broader CPR series exploring emotional experience within relational and cultural contexts.

Read more

Across earlier reflections, I explored how emotional restraint, ambivalence, shame, and even limited emotional access may reflect relational processes rather than individual deficits.

This brings us to another familiar clinical moment.

A client speaks about their family with a strong sense of connection.

They remain involved in family decisions.

They feel responsible for their parents’ wellbeing.

They may adjust their own choices in consideration of family needs.

From a certain therapeutic perspective, this can raise concern.

Is the client overly dependent? Are boundaries unclear? Is this enmeshment?

The language of individuation and separation is often used to make sense of these patterns. But what if this way of understanding is incomplete?

Read more

In many families, especially within collectivistic cultures, parental sacrifice is deeply valued. It signals love, responsibility, and commitment. Parents give their time, energy, and often their own needs for the sake of their children.

But there is a side of sacrifice that is rarely talked about within our culture: sometimes, it can cause harm.

In my work with therapists, I’ve noticed how difficult it can be to see this clearly—particularly within cultures we ourselves belong to. When sacrifice is normalised, even idealised, it becomes harder to question. This is especially true when parents are both highly devoted and highly demanding.

So how do we begin to understand when care supports development—and when it begins to constrain it?

Looking Beyond Good Intentions

A starting point is to look at intention. Many parents are genuinely caring, attentive, and deeply invested in their children’s well-being.

But intention alone is not enough.

We also need to ask: Who is this care really serving?

Is it primarily for the child’s safety and development?
Or is it, at least in part, regulating the parent’s own anxiety?

In reality, both can coexist. But the more care is driven—often unconsciously—by a parent’s need to manage their own fear, uncertainty, or distress, the more likely it is to become constraining for the child.

When Care Oversteps Development

Another important factor is the child’s developmental stage.

The way a parent relates to a 10-year-old is naturally different from how they relate to a 20-year-old. But when that difference becomes blurred—when the same level of involvement, control, or decision-making persists—care and overindulgence begin to merge.

At that point, the relationship can become enmeshed.

Boundaries are no longer clear. The child’s autonomy does not have space to develop.

When Expectations Become Emotional Pressure

In enmeshed relationships, something else often happens.

Parents may express expectations in ways that feel emotionally loaded:

• “If you don’t do well, I lose face.”

• “If you struggle, it means I have failed.”

• “If you are unhappy, I suffer too.”

These messages may not be intended as pressure—but they are experienced as such.

Over time, they can create a sense that: the child’s life carries the emotional burden of the parent.

When this dynamic continues into adulthood, even well-meaning expressions of hope or expectation can feel like emotional coercion, especially if the relationship has long been shaped by guilt and blurred boundaries.

Why Communication Alone Is Not Enough

It is tempting to think the solution lies in better communication.

But with some parents—particularly those who carry high levels of anxiety—communication skills alone are not enough.

The difficulty often runs deeper:

• unresolved grief

• unprocessed trauma

• a long-standing sense of insecurity

Without addressing these, attempts to “communicate better” may have limited impact.

Working With Adult Children

When working with adult children, one stance the therapist may take is, ‘Helping parents see the experience from the child’s perspective.’ (Yes, I may still see the adult children’s parents in front of them for a session or two.)

Often, simply helping parents see the experience from the child’s perspective already reduces some of the emotional burden the adult child carries.

From there, the therapeutic work focuses on something that takes time: we may call that individualisation if we use psychology term (which is essentially individualistic) to describe—the gradual development of a sense of self that is not defined by parental expectations.

Working With Parents

When working with parents, the direction is often different.

Simply telling parents to “let go” rarely works.

Because the issue is not a lack of love. It is that their way of loving may be too narrow, too rigid, or too tied to their own unmet needs.

In these cases, an important shift is helping parents reflect on what it means to care for themselves. Not as a separate task—but as part of caring for their family. Because many parents who struggle to let go were never fully cared for themselves.

A Different Way of Seeing

Parental sacrifice is not the problem in itself. But when care becomes the only way to love—and when it is shaped by anxiety, guilt, or unresolved history—it can limit rather than support development. Sometimes, the work is not about reducing care.

Sometimes, healing is not about loving less. It is about creating enough space within love for another person to become fully themselves.

In schema therapy, we are taught that both the Detached Protector and the Avoidant Protector serve the same function: to avoid vulnerability.

• The Detached Protector withdraws internally.

• The Avoidant Protector moves away behaviourally—through distraction, action, or disengagement.

But in practice, especially in collectivistic cultural contexts, this distinction becomes far less straightforward.

Because sometimes, avoidance does not look like moving away. It looks like staying exactly where you are.

When Dependence Is Not Just a Schema

In many Asian families, dependence is not simply tolerated—it is relationally meaningful.

Care is often expressed through concrete involvement in daily life, such as providing practical support and ongoing parental presence in decision-making.

What might be conceptualized clinically as “overprotection” or “control” is often interwoven with love, responsibility, and moral commitment.

This creates a particular therapeutic difficulty.

For clients with a strong Dependence schema, their main theme is “I am incapable. I must rely on others.”

This belief is not experienced as purely dysfunctional. It is partially validated by the relational environment.

If a Failure schema is also present, the system tightens even more. Because comparison becomes constant, the helplessness deepens and avoidance becomes structurally reinforced.

Not simply as defense, but as a coherent way of organizing life within that cultural field.

The Clinical Shift: When Avoidance Protector mode Evolves

What becomes clinically challenging is not when avoidance is obvious. It is when the client begins to improve. When a client starts to explore possibilities, reduces overt avoidance, and moves toward autonomy. Sometimes, the Avoidant Protector does not disappear, but transforms.

A Clinical Moment

Shi had made significant progress.

Her depressive and anorexic symptoms had eased. She was engaging more actively in life and moving toward her academic goals. Strengthening her Healthy Adult mode was central to this phase of therapy.

But in-session, her position remained fluid. She can easily slips into Helpless Surrenderer mode or Detached Protector mode.

At this stage, staying in ‘Content’ becomes misleading. (CPR framework, Ng-Kessler, in press)

The key question requires us to shifts to ‘Process’ so that we can identify:

Who is speaking right now?

The Shift That Wasn’t Obvious

In a chairwork, Shi spoke from the Helpless Surrenderer mode to her Vulnerable Child mode: “You will never have friends. You will never find a meaningful relationship.”

But something was different.

No tears.
No visible distress.
Just a calm, almost neutral tone.

So I moved to ‘Process’: “What do you notice in your body as you say this?”

She paused.

“I don’t want to move to the other chairs. It feels comfortable here.”

Then she added with a slight smile: “I don’t want to go over there and think about becoming independent, building relationships, or what I’ll do after graduation. It’s enough to stay here and admit I’m helpless.”

Explanation:

If we take it on the ‘Content’ Level, we may move to challenge its belief and strengthen problem-solving as a way to enhance the Healthy Adult mode. But if we attend to the ‘Process’ level, we open a more complex picture.

This is the clinical pivot.

Because this is no longer simply Helpless Surrenderer.

This is Avoidant Protector—reconfigured.

When Avoidance Takes the Form of “Comfort”

The Avoidant Protector here is not withdrawing. It is doing something far more subtle. It is using “staying in helplessness” as a way to avoid life transition.

And importantly, this form of avoidance is culturally coherent.

Remaining dependent in this cultural context will also mean delays separation from her parents, postpones autonomy, and preserves relational proximity, which her parents also prefer.

In a collectivistic context, it is not only safer psychologically—it is often more relationally acceptable.

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Naming the Mode Changes the Work

Once named, the shift becomes visible.

I invited her to speak again, now recognizing this part as Avoidant Protector.

She did and became more firmly this time. “I don’t want to think about what comes after my PhD.”

Clear. Direct. No collapse.

Explanation:

Moving to the ‘Process’ reveals:

the emotional system is not in collapse, but organised around avoidance.

The key shift:

This is not Helpless Surrenderer.
This is Avoidant Protector, using helplessness as a strategy.

And more specifically:

Avoidance here is not moving away. It is remaining in a position that suspends demand.

This is why process tracking overrides content interpretation.

Moving to the ‘Relational’ Layer

We paused the chairwork and mapped the modes together. Then I shifted the work to ‘relationship’

“What does it mean for you to explore these modes with me?”

She hesitated.

“I don’t want to think.”

So, I made the relational hypothesis explicit:

“I wonder if this Avoidant Protector not only helps you avoid the pressure of your future, but also helps maintain our therapeutic relationship. We’re already meeting less frequently. If you become more independent, it might also mean we move toward ending therapy.”

She immediately teared up.
And nodded.

Clinical Implication

The Avoidant Protector here is doing two things at once:

1. Avoiding developmental tasks (independence, future planning)

2. Preserving a meaningful attachment (the therapy relationship, likely also parental relationship in its old form)

And within a cultural context where:

• separation is complex

• dependence carries relational meaning

• autonomy can imply loss

This organisation is not simply defensive. It is also relationally intelligent.

The CPR Framework in Practice: Seeing What Content Hide

Read more

In earlier reflections, I explored how emotional restraint, ambivalence, shame, and even limited emotional access may reflect relational processes rather than individual deficits.

This leads to another clinical moment that can be difficult to interpret.

A client appears polite, agreeable, respond thoughtfully, often acknowledging the therapist’s perspective.

When the therapist offers an interpretation, the client nods: “Yes, that makes sense.”

When asked if something feels accurate: “I think so.”

There is little disagreement. Little challenge.

And over time, the therapist may begin to wonder:

Is the client engaging fully in the work?

Or are they holding something back?

Read more

Jenny carries many wounds that even she herself does not fully understand.

From a young age, she was cared for by a domestic helper, while her parents were constantly travelling for business and only saw her about once a week. The helper was, in many ways, like Jenny’s mother—raising her single-handedly from infancy, feeding her, changing her diapers, caring for her through her earliest years, teaching her to speak, and tending to her daily routines. For a period of time, Jenny could even speak a little Tagalog. This helper cared for her until she was eight years old.

Then one day, the helper returned to her home country—and never came back.

Jenny remembers that day vividly. She cried and begged her not to leave, trying to push her luggage back into the house, clinging to her legs and screaming in distress. The helper left, heartbroken.

Later, her parents told Jenny that the helper had disappeared. She had debts and used her return home as a way to leave for good. Jenny would never be able to contact her again.

The first time Jenny experienced heartbreak was when she learned, through her parents, that the helper would not be coming back. She only knew that something inside her was missing, that her heart ached deeply, and that she would break down crying again and again.
“At that time, she was my mother,” Jenny says, still in tears when she recalls it.

She did not know that this was what it meant to feel abandoned.

“I thought she would come back…” Jenny said. For a period of time, whenever the door opened, she would think the helper had returned—only to be disappointed again and again.
“Then I realised… she had really just disappeared.”

A lack of safety

There was emotional distance between Jenny and her parents. On one hand, she knew they loved her—they would buy her anything she wanted. On the other hand, she could not connect with them emotionally. They did not have enough time for her, nor the sensitivity to understand her inner world.

After the helper left, Jenny not only cried but also had frequent nightmares and remained in a persistently low mood. With no adult guiding her, she never spoke about this experience to anyone.

Jenny developed a deep sense of insecurity. She often felt that others would leave her. She kept her distance from people and became accustomed to handling everything on her own. When she faced difficulties, felt wronged, or was hurt, she would not speak about it.

She never had the opportunity to learn how to recognise or express her emotions—to articulate her feelings, or to explain what had happened when she felt wronged.

By the time her parents stopped employing a helper, Jenny was already 12, entering adolescence. Her relationship with her parents had become that of familiar strangers.

On one hand, she knew they were her support. But she was not used to opening up to them. She often said,
“I’m afraid they wouldn’t be able to handle it. I don’t want them to worry.”

So when she was repeatedly sexually harassed by her physical education teacher in secondary school, she told no one at home.

Hallucinations and voices

For a 12-year-old to believe that her parents “couldn’t handle it” reflects a deeper fear of revealing her own vulnerability—especially feelings of shame.

“I had never seen anyone in my family express these kinds of emotions, nor had anyone ever asked me or guided me to talk about my inner experiences.”

A child in such an environment may come to feel that vulnerability is something that must not be touched, cannot be brought into the open, and is something frightening and unbearable.

At 14, Jenny became unwell. It began as depression, and at its worst, she experienced hallucinations and auditory disturbances. She was prescribed increasing amounts of medication.

When their only daughter fell ill, the family underwent a significant shift. Her parents became united in supporting and caring for her. They sought help from one private doctor and psychologist after another until they found someone suitable. She was transferred to an international school to avoid the stigma she had experienced after becoming unwell in a traditional school setting.

I met Jenny when she was 18. Reflecting on the years between 14 and 16, she described them as chaotic and extremely difficult.
“People often say I’m lucky—my parents are so supportive. But I couldn’t feel it.”

For a long time, I was the only person who knew she was gay.

The ‘earned secure attachment’ is possible

Yet, over time, things began to shift.

Her parents’ love was consistently present, even as her mental health fluctuated alongside her romantic relationships. We worked through many ups and downs together.

When she revisited those earlier years—when her parents were often absent—she was able to begin healing the wound of feeling “my parents didn’t really value me.” At the same time, she could also see that, despite their limitations, they were there. When she became ill, they immediately put aside their work without hesitation.

Holding onto these experiences of being cared for, she once said to me:
“My parents have changed so much for me. I’ve made things very hard for them. I need to get better.”

From that point on, Jenny gradually learned to care for herself more. For example, she no longer over-compromised in relationships out of fear of losing her partner. Her sense of self-worth began to grow.

As trust and intimacy developed in her relationships, Jenny eventually found the courage to come out to her parents.

Disclaimer: This story does not reflect any individual’s personal experience. It is a composite created by combining elements from multiple client cases.

Why I’m Sharing These Stories

These moments in therapy are so common — yet rarely written about in psychotherapy literature.

They’re the reason I started collecting and writing schema stories across cultures.

If this resonates with your clinical experience, I hope you’ll stay connected here as we continue exploring schemas, emotions, and cultural meaning-making together.

To help readers better understand how the CPR framework can be applied in session, a demonstration video is provided below, followed by an analysis.

The following provides a CPR-informed analysis of the chairwork demonstration above.

The client’s experience is organised within a cultural system structured by filial piety, which carries implications for face, hierarchical relational expectations, and emotional restraint. Within this context, the observed emotional process unfolds in a patterned manner: anger is rapidly reorganised into self-blame; hurt is minimised or rendered inaccessible, including associated unmet developmental needs; and shame emerges as a regulatory mechanism that stabilises the system by preserving beliefs consistent with filial expectations.

From a CPR perspective, therapeutic work does not proceed by directly challenging these beliefs at the level of content. Rather, moment-to-moment clinical judgement is guided by tracking how experience is being organised, with interventions aimed at shifting relational positioning and expanding the range of emotional experience that can become available within the therapeutic context, as elaborated below.

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