Free Therapist Training›Psychodynamic Therapy Toolkit›Cyclical Maladaptive Pattern Worksheet
Last updated: November 11, 2026
A cyclical maladaptive pattern (CMP) is a short description of the relational cycle a client keeps repeating: what the client does with other people, what the client expects them to do, what they actually do, and how the client treats the self afterward. Mapping it gives psychodynamic treatment a focus that can be tracked in the client's week and in the room. The worksheet below walks through one relational episode, the four parts of the pattern, your own side of it, and the goals it points to. A completed example for an invented client follows.
The worksheet is part of the Sentio MFT program's free psychodynamic therapy toolkit. The CMP itself comes from time-limited dynamic psychotherapy (TLDP); for the full method, see the books by Strupp and Binder (1984) and Levenson (2026) in the references.
This is an optional aid from the Sentio MFT program's psychodynamic therapy toolkit. It is not an official form of any agency or payer.
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Part 1. One relational episode
| Question | What the client describes |
|---|---|
| When, where and with whom | |
| What the client wanted | |
| What the client did or said | |
| What the client expected the other person to do | |
| What the other person did | |
| How the client felt, and what the client said to the self, afterward |
Part 2. The four parts of the pattern
| Part | Questions to ask yourself | What you are hearing |
|---|---|---|
| Acts of the self | What does the client do, say, feel, wish and fear with other people? What does the client hold back? | |
| Expectations of others' reactions | How does the client imagine others will respond? What is the feared reaction, and the hoped-for one? | |
| Acts of others toward the self | What do other people do, as the client tells it? Do their responses seem to confirm the expectation? | |
| Acts of the self toward the self | How does the client treat the self afterward: with criticism, neglect, dismissal or care? Whose voice does it echo? |
Part 3. Your side of the pattern
- What role do you feel pulled into with this client?
- What have you found yourself doing, or wanting to do, that fits the pattern?
Part 4. The cycle in one paragraph
When [situation], the client [acts of the self], expecting that [expectation]. Others [acts of others], which seems to confirm it, and the client [acts of the self toward the self], which leads back to [acts of the self].
Part 5. Goals
- New experience: what would it look like for the client to live the pattern differently with you, and then with others?
- New understanding: what does the client need to recognize about the pattern, its origins and its costs?
Part 6. Revisions
| Date | What changed | What prompted it |
|---|---|---|
Part 7. A plain-language version to share with the client (optional)
- When I want ...
- I usually ...
- I expect that other people will ...
- What often happens is ...
- Afterward I tell myself ...
- What I would like to try instead is ...
What Does a Completed CMP Worksheet Look Like?
The example maps the pattern of Elena, an invented client seen weekly for depression. The episode comes from session 6, and the worksheet was revised in session 8. The same case runs through the toolkit's case formulation, treatment plan and progress note.
Part 1. One relational episode (session 6)
| Question | What the client describes |
|---|---|
| When, where and with whom | Monday's department meeting, with the new chair and six colleagues. |
| What the client wanted | To say she had no room for another committee and to be asked how she was managing. |
| What the client did or said | Said "Sure, I can take it," and offered to write the minutes as well. |
| What the client expected the other person to do | "If I said no she'd think I wasn't a team player, and everyone would look at me." |
| What the other person did | Thanked her quickly and moved on to the next item. |
| How the client felt, and what the client said to the self, afterward | Cried in the car. "You're being ridiculous. It's one committee. Other people have real problems." |
Part 2. The four parts of the pattern
| Part | What you are hearing |
|---|---|
| Acts of the self | Takes on tasks before anyone asks, keeps her preferences to herself, apologizes for "taking up time." Wishes to be noticed and looked after; fears being seen as demanding. In session, tells painful events evenly and checks whether she is "doing it right." |
| Expectations of others' reactions | If she asks for something or says no, people will be annoyed or let down and will pull away. Expects the therapist to tire of "small problems." |
| Acts of others toward the self | Colleagues and the chair hand her more work; she was passed over for chair; her husband leaves household decisions to her and then questions them; her mother still calls her for errands. She experiences others as taking her for granted. |
| Acts of the self toward the self | Harsh and dismissive. Calls herself greedy for wanting the chair position, overrides her fatigue, and blames herself when she is overlooked. |
Part 3. Your side of the pattern
The therapist feels pulled to reassure her, to fill silences with suggestions and to work harder than she does in the session. At moments the therapist's attention drifts while she recounts painful events in an even voice, which may echo how her feelings were set aside at home.
Part 4. The cycle in one paragraph
When Elena wants recognition or help, she hides the wish and gives more, expecting that asking would make people annoyed and withdraw. Others take what she offers and turn to her for more, which seems to confirm that only her usefulness counts, and she then turns on herself for wanting anything at all. The self-criticism deepens her low mood and leads her to give still more.
Part 5. Goals
- New experience: Elena states a preference, a disagreement or a wish in session and finds the therapist interested rather than burdened, then tries the same with her husband and at work.
- New understanding: Elena recognizes the cycle while it is happening, links it to looking after her mother as a girl, and sees how her self-criticism keeps it going.
Part 6. Revisions
| Date | What changed | What prompted it |
|---|---|---|
| Session 8 | Added anger to her acts of the self: she feels it, then quickly calls it "petty" and turns it on herself. | She described snapping at her husband over a dinner plan and feeling "shaky but relieved." |
Part 7. Elena's plain-language version (written with her in session 7)
- When I want help or credit,
- I usually say yes and do more,
- because I expect people will be annoyed if I ask.
- What often happens is that they give me more and I feel invisible,
- and afterward I tell myself I'm being greedy.
- What I would like to try instead is saying "I don't have room" once a week and seeing what happens.
What Is a Cyclical Maladaptive Pattern?
The cyclical maladaptive pattern comes from time-limited dynamic psychotherapy (TLDP), a relational approach to brief psychodynamic work developed by Hans Strupp and Jeffrey Binder at Vanderbilt University and later extended by Hanna Levenson. Thomas Schacht, Jeffrey Binder and Hans Strupp first set out the CMP in a chapter of Strupp and Binder's Psychotherapy in a New Key (1984), as a way to give each treatment an interpersonal focus and to train therapists in the Vanderbilt research. TLDP treats a client's problems as arising from a dysfunctional relational pattern that was learned in earlier relationships, is kept alive in current ones, and will sooner or later be enacted with the therapist. The CMP is the tool for describing that pattern in a way a clinician can use session by session.
The pattern has four parts. Acts of the self are what the client does, thinks, feels, wishes and fears in relation to others. Expectations of others' reactions are how the client imagines others will respond. Acts of others toward the self are what others actually do, as the client experiences it. Acts of the self toward the self, sometimes called the introject, are how the client treats the self, which often mirrors how important people once treated the client. The pattern is cyclical because each part feeds the next: expecting rejection, a client may hold back, others respond to the holding back, and their response seems to prove the expectation right.
Why Does the Worksheet Ask About You?
Alongside the four categories, TLDP asks the therapist to consider their own reactions to the client. Because the client's pattern invites particular responses, the therapist will feel pulled to play the complementary role, for example to reassure a client who expects to be a burden or to take charge of one who defers. Levenson calls this interactive countertransference. Noticing the pull, rather than acting on it unthinkingly, is often the first sign of what the pattern is, and stepping out of it is how the client gets a new experience. Part 3 of the worksheet gives that observation a place. Our interventions list has note-ready wording for countertransference work, and the free Countertransference webinar demonstrates it.
How Do You Turn the CMP Into Treatment Goals?
TLDP names two goals. The first is a new experience: the client relates in a way that breaks the pattern and finds a different response, first with the therapist and then with others. The second is a new understanding: the client comes to recognize the pattern, where it came from and what it costs. Levenson gives the new experience particular weight, because a client who has lived something different in the room has more to build on than an insight alone.
Write each goal in terms you could observe. "Elena voices a disagreement with the therapist" can be seen in a session; "Elena feels more confident" cannot. The psychodynamic treatment plan examples show both goals written as measurable objectives, for depression and for anxiety.
How Does the CMP Compare With the CCRT?
The Core Conflictual Relationship Theme (CCRT), developed by Lester Luborsky, is another way of formulating a client's central relationship pattern from the stories the client tells. It has three components: the client's wish, the response from the other person and the response of the self (Luborsky & Crits-Christoph, 1998). The CMP covers similar ground in four categories. It separates what the client expects others to do from what they actually do, and it gives a category of its own to how the client treats the self afterward; TLDP then adds the therapist's own reactions. If you trained in the CCRT, the relational episode questions in Part 1 of the worksheet gather the same material.
How Do You Fill In the Worksheet?
- Start with one episode. Ask for a specific recent moment with a specific person, and slow the story down until you know what the client wanted, did, expected and felt.
- Collect several episodes before you sort. A pattern shows up across relationships: at work, at home, with family and with you.
- Use the client's words. "I'm being greedy" says more than "harsh introject."
- Write the cycle as one paragraph. If you cannot, the parts are not yet connected, and more inquiry is needed.
- Share it when it helps. Part 7 offers a plain-language version you can write with the client.
- Revise it. Record each change and what prompted it. A CMP that never changes after session 3 has stopped being used.
Keep reading
Psychodynamic Case Formulation Template, the full formulation the CMP sits inside, with a completed example
Psychodynamic Treatment Plan Examples, new experience and new understanding written as measurable objectives
Practice Statements for Psychodynamic Skills, client statements in the toolkit for rehearsing therapeutic inquiry, process comments and transference interpretations
Deliberate Practice in Psychodynamic Psychotherapy, free webinars and skill videos that pair with the APA book by Levenson, Gay and Binder
Frequently Asked Questions
What are the four parts of the cyclical maladaptive pattern?
Acts of the self (what the client does, feels, wishes and fears with others), expectations of others' reactions, acts of others toward the self, and acts of the self toward the self, sometimes called the introject.
Who developed the cyclical maladaptive pattern?
Thomas Schacht, Jeffrey Binder and Hans Strupp first described it in 1984, within the time-limited dynamic psychotherapy that Strupp and Binder developed at Vanderbilt University. Hanna Levenson later extended the approach and emphasizes the therapist's own reactions, which she calls interactive countertransference, as part of the formulation.
Can I use the CMP outside time-limited dynamic psychotherapy?
Yes. The worksheet organizes relational information in a way any psychodynamic or integrative clinician can use, in brief or open-ended treatment. The structure of the pattern does not depend on the number of sessions.
Should I share the cyclical maladaptive pattern with my client?
Often it helps, in plain language and as a working idea the client can correct. Part 7 of the worksheet offers wording you can fill in together. Timing matters: a pattern offered before the client has seen it in action can feel like a verdict.
References
Binder, J. L. (2004). Key competencies in brief dynamic psychotherapy: Clinical practice beyond the manual. Guilford Press. ISBN 978-1-59385-058-6. https://www.guilford.com/books/Key-Competencies-in-Brief-Dynamic-Psychotherapy/Jeffrey-Binder/9781609181680
Levenson, H. (1995). Time-limited dynamic psychotherapy: A guide to clinical practice. Basic Books. ISBN 978-0-465-08651-1. https://www.hachettebookgroup.com/titles/hanna-levenson/time-limited-dynamic-psychotherapy/9780465086511/
Levenson, H. (2003). Time-limited dynamic psychotherapy: An integrationist perspective. Journal of Psychotherapy Integration, 13(3-4), 300-333. https://doi.org/10.1037/1053-0479.13.3-4.300
Levenson, H. (2026). Brief dynamic therapy (3rd ed.). American Psychological Association. ISBN 978-1-4338-4478-2. https://www.apa.org/pubs/books/brief-dynamic-therapy-third-edition
Levenson, H., Gay, V., & Binder, J. L. (2023). Deliberate practice in psychodynamic psychotherapy. American Psychological Association. ISBN 978-1-4338-3673-2. https://doi.org/10.1037/0000351-000
Luborsky, L., & Crits-Christoph, P. (1998). Understanding transference: The core conflictual relationship theme method (2nd ed.). American Psychological Association. ISBN 978-1-55798-453-1. https://doi.org/10.1037/10250-000
Strupp, H. H., & Binder, J. L. (1984). Psychotherapy in a new key: A guide to time-limited dynamic psychotherapy. Basic Books. ISBN 978-0-465-06747-3. https://www.hachettebookgroup.com/titles/hans-h-strupp/psychotherapy-in-a-new-key/9780465067473
