Book Review—Acceptance and Commitment Therapy for Couples: A Clinician’s Guide to Using Mindfulness, Values & Schema Awareness to Rebuild Relationships

by Avigail Lev and Matthew McKay

 

Acceptance and Commitment Therapy for Couples: A Clinician’s Guide to Using Mindfulness, Values & Schema Awareness to Rebuild Relationships by Avigail Lev and Matthew McKay offer novice and seasoned clinicians alike a well-rounded discussion of acceptance and commitment therapy (ACT) when integrated with schema-focused work for couples. The text presents a sequenced discussion beginning first with an explanation of how schemas—or core beliefs that we create about ourselves and our relationships based on early and lifespan experiences with others—are an integral part of couples counseling (according to several theoretical approaches including Imago relationship therapy, emotion-focused couples therapy, enhanced cognitive behavioral couples therapy, and Gottman Method couples therapy). Given that schemas are internal products of the mind, they become an accessible pathway to understand barriers to intrapersonal and interpersonal connection (also known as schema activations or schema triggers, by the authors). The authors note that the 10 primary schema triggers impacting couples are abandonment/instability, mistrust/abuse, emotional deprivation, defectiveness/shame, social isolation/alienation, dependence, failure, entitlement/grandiosity, self-sacrifice/subjugation, and unrelenting standards. Each of these schemas can consequently lead to unhelpful and potentially harmful schema coping behaviors (SCBs), a form of experiential avoidance according to ACT.

With these fundamental understandings in mind, the authors thread a discussion of schemas as the basis for enacting the principles of ACT therapy (values, committed action, cognitive defusion, self-as-context, contact with the present moment, and acceptance). Core to this approach is first fully identifying schema triggers; connecting with values (both as an individual and as a couple); understanding cognitive, emotional, and skill barriers to values-based action; and recognizing the moments of choice when an individual can enact their valued-action over the automatic schema-trigger response. For readers to fully understand the utility of this theory and approach, they must first appreciate the essence of ACT, which is that the schema itself is not the problem; our response to the schema trigger or activation is what leads to disconnect and challenges in partnerships. Simply put, the “negative schemas are ubiquitous—everyone has them to some degree. . . . The object of couples therapy is not to stop schemas from being triggered or even to reduce schema pain, but rather to change how partners respond to schema pain” (p. 6). Thus, the ACT approach helps clients imbue acceptance, mindfulness, compassion, and empathy to the therapeutic process as they open their heart and mind to learn about the schema activation, SCBs, and ways to align with values to choose differently in triggered moments.

The strength of this book is the abundance of resources that are provided within the text. Included are example transcripts of ACT in action for couples counseling, an entire chapter on the 8-step protocol for implementation, and an extensive appendix section replete with printable documents such as the couples schema questionnaire (to identify schema activations), thoughts journals, a schema triggers log, a values in relationship worksheet, a values monitoring log, a values alignment worksheet for partners, and a shared interest worksheet, among other relevant handouts for cognitive, emotional, and skill development. For counselors who are new to ACT, the step-by-step approach with printable worksheets and examples will be of great benefit.

The limitation to this book is not in the presentation of the materials, but rather the “clunky” or “awkward” language that accompanies these approaches. Readers may find themselves reading and rereading passages to retain the content within the chapters. Words that are specific to ACT (such as self-as-context) as well as acronyms that are used to integrate schemas into ACT (such as schema coping behaviors—SCBs) may interrupt the natural flow or rhythm of reading when using this text. With those points in mind, this book remains a valuable resource for counselors who promote ACT in couples work. The detailed theoretical discussion positioned alongside approachable examples, metaphors, and handouts creates a great balance to this text.

 

 

Lev, A., & McKay, M. (2017). Acceptance and commitment therapy for couples: A clinician’s guide to using mindfulness, values & schema awareness to rebuild relationships. Oakland, CA: Context Press.

Reviewed by: Elizabeth A. Keller-Dupree, NCC, Northeastern State University

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Book Review—CBT Made Simple: A Clinician’s Guide to Practicing Cognitive Behavioral Therapy

by Nina Josefowitz and David Myran

 

The first and most important challenge that any author who wishes to write a book about cognitive behavioral therapy (CBT) must face is the fact that the market is swamped with texts on CBT. These range from single chapters in theory textbooks to entire books devoted to the philosophical underpinnings of the theory. These also include a great number of manual-type books that are designed to provide step-by-step instructions in how to apply this theory to a clinical setting. CBT Made Simple, by Josefowitz and Myran, falls into this category. Broadly, it is a text designed to translate somewhat ambiguous theoretical concepts into practical, replicable steps that can be followed to produce a therapeutically beneficial result. Fortunately, this text presents CBT in splendid fashion and stands as a wonderful option for counselors who wish to incorporate this theory into their practices.

The text is broken down into three parts, which are further divided into individual chapters. The flow of the book makes logical sense, especially from the viewpoint of the practicing clinician, which this book is aimed toward. There is clear and intentional movement from the foundation of the theory, to basic CBT work, to more advanced interventions. The book concludes with a review of two clients that were consistently discussed throughout previous parts of the book.

The strongest element of this text is its intentional organization. Throughout the book, the authors reference the fact that CBT takes practice and that counselors who are new to CBT should not expect to be experts immediately. Knowing this, the authors provide consistent “practice” information in the core elements of the theory at the beginning of each chapter. They create a parallel process in which each chapter begins by setting an agenda, then working through it, and concluding with assigned homework. This allows the reader to become familiar with how to organize and conduct initial counseling sessions using this CBT method and then reinforces that knowledge throughout the text.

Additionally, the text encourages the reader to try the techniques on themselves or apply the principles to their own lives. This makes the book feel much more approachable. Also, the book does well in its use of concrete problems and solutions. The two recurring client cases present difficulties that most counselors will see in their clients at one time or another. The problems are addressed through the book in a way that seems doable and easy to follow. For example, when describing work with a client suffering from depression, some authors will say: “assist the client in understanding the nature of their thoughts, feelings, behaviors, and how those are related.” That’s a great goal, but difficult for some counselors to grasp. Alternatively, Josefowitz and Myran give step-by-step instructions for dealing with issues similar to this: (1) Identify the client’s thoughts; (2) Judge whether the thought is irrational; (3) Help the client to dispute the thought; and (4) Create a more effective action plan. This way is not strictly better, but is very congruent with the way this text approaches CBT.

This text will find its greatest application with professional counselors currently working in the field who are wanting to incorporate CBT into their practice and are in need of an excellent guide. Overall this book seeks to do one thing: educate practicing counselors in an effective way to practice CBT, and it does just that.

 

Josefowitz, N., & Myran, D. (2017). CBT made simple: A clinician’s guide to practicing cognitive behavioral therapy. Oakland, CA: New Harbinger.

Reviewed by: Wes Allen, NCC, University of Tennessee

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Book Review—Mindfulness and Acceptance for Treating Eating Disorders and Weight Concerns: Evidence-Based Interventions

by Ann F. Haynos, Evan M. Forman, Meghan L. Butryn, and Jason Lillis

 

In Ann Haynos, Evan Forman, Meghan Butryn, and Jason Lillis’ most recent publication, Mindfulness and Acceptance for Treating Eating Disorders and Weight Concerns, the authors provide a comprehensive, practical, insightful, informative, and organized resource for graduate students, practitioners, researchers, educators, and related professionals working in the field of mental health—specifically within the specialty of eating disorders. Additionally, the title of this book accurately describes its purpose, contents, and overall themes.

The current publication is divided into two parts; mindfulness interventions directed toward individuals presenting with eating disorders (Chapters 1–5) while the second part focuses more on interventions related to weight concerns (Chapters 6–9). Chapter topics include using dialectical behavior therapy and emotional acceptance to strengthen appetite awareness, improving body image, and using mindfulness-based tactics for individuals who have recently experienced bariatric surgery. The authors were also intentional in enlisting over 20 expert contributing authors who are pioneers in the field.

The book is filled with excellent case conceptualization tools and treatment applications for the various eating disorder diagnoses. Likewise, the book demonstrates how to translate theory and research into clinical practice with its mindfulness-based framework and by integrating evidence-based components into innovative techniques. Each chapter provides specific instruction, examples, and explanations for applying this approach when working with individuals presenting with body image and/or food concerns.

While eating disorders are challenging to treat, this book and ultimate resource provides hope for the entire eating disorder community. For example, the book includes strategies for helping clients understand connections between thoughts and urges, tools for separating facts from feelings, hands-on tips for reducing experiential avoidance and practicing mindfulness, and insight for viewing “self-as-context” rather than attaching to their suffering. By using this empirically supported approach, clients will be more able to stay connected with recovery and live a life consistent with their values.

While this resource does an exceptional job of incorporating acceptance and mindfulness-based approaches (ACT, DBT, MBCT) to the treatment of eating disorders and includes numerous strengths, this publication is not without potential growth areas. One area for improvement would be to consider more cultural barriers and language skills for better connecting with clients of diversity. This would also strengthen the social justice, access, and equity of service components. Additionally, it may be helpful to add a “quiz” section at the end of each chapter or section so that readers can check their comprehension. The authors may consider adding a helpful resource or quick reference section before the index, possibly listing websites, YouTube videos, sample worksheets, or in-session activities.

In summary, Mindfulness and Acceptance for Treating Eating Disorders and Weight Concerns: Evidence-Based Interventions demonstrates how theory can be translated into practice. It represents a comprehensive and valuable resource that significantly contributes to the mental health and related counseling fields, and includes research from a variety of experts in the eating disorder and mindfulness niche. Whether for graduate students or advanced professionals in the field, this book will serve as a beneficial resource that can be used across eating disorder presentations and concerns.

 

Haynos, A. F., Forman, E. M., Butryn, M. L., & Lillis, J. (2016). Mindfulness and acceptance for treating eating disorders and weight concerns: Evidence-based interventions. Oakland, CA: Context Press.

Reviewed by: Mary-Catherine McClain Riner, NCC, Riner Counseling, LLC

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Book Review—Career Development and Planning: A Comprehensive Approach (5th ed.)

by Robert C. Reardon, Janet G. Lenz, Gary W. Peterson, and James P. Sampson, Jr.

The latest edition of Career Development and Planning, written and updated by giants in the field of career counseling, is a valuable resource for both career counseling practitioners and their clients. The book’s primary audience is college students and instructors, making it an especially apt tool for counselors working in university settings. I will provide a brief overview of the book, its strengths and limitations, and its applicability for counseling professionals.

The authors begin by considering the basic concept of a career—and how it has evolved throughout history—and emphasizes the importance of knowing oneself before beginning career planning. Next, the authors take a holistic look at factors affecting one’s career choices, including the global economy, alternative ways to work (e.g., job-sharing, telecommuting), and family roles. The book’s third section contains practical information on necessary professional skills such as communicating and negotiating. Numerous appendices present resources such as the RIASEC hexagon and guides to academic planning and career-related self-examination. Thus, the authors provide a comprehensive look at the theoretical basis of career counseling, the realities of our economy and job market, and concrete steps for students to take.

Practitioners will find this book helpful for a number of reasons. One major strength is that the authors aptly balance factual information with an emphasis on self-discovery. Career counselors know that students often focus on careers that involve prestige, large salaries, and other advantages, and may not consider how well they are actually suited to these careers. The resources in Career Development and Planning can help students assess their values, interests, personality traits, and skills. In addition, contemporary college students often operate with outdated knowledge of higher education and the job market, relying on their parents’ and professors’ experiences and opinions, which may not accurately reflect the present. Unfortunately, the amount of occupational data easily accessible via the Internet is daunting for many students, but a resource like this book can make the career search less intimidating and empower students to stay up-to-date on professions that interest them.

However, counselors should be aware that simply handing this book to a student could be overwhelming as well. Because of the dualistic thinking that represents a developmental norm for beginning college students (and the secondary education system’s focus on test scores), contemporary students are trained to look for the “right” answer and may be ill-equipped for the critical thinking that career planning necessitates. It would be best for counseling practitioners to use the book as a guide and work through relevant sections with the student, providing support while empowering the student to ultimately work through the career planning process.

Career Development and Planning is a worthwhile addition to any counselor’s bookshelf, especially one who works with college students or members of other populations involved in career planning. The process of developing one’s career necessitates a combination of self-awareness and research into the larger world, and this book provides a comprehensive framework for both.

Reardon, R. C., Lenz, J. G., Peterson, G. W., & Sampson, J. P., Jr. (2017). Career Development and Planning: A Comprehensive Approach (5th ed.). Dubuque, IA: Kendall Hunt.

Reviewed by: Carie M. Kempton, NCC, The University of North Carolina, Wilmington

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Book Review—Spiritual and Religious Competencies in Clinical Practice

by Cassandra Vieten and Shelley Scammell

The authors of this text have given mental health professionals a useful guide to navigate the coming of age of spirituality in clinical practice. While not the first of such books, the authors are in good company with other healing professionals (Council for Accreditation of Counseling & Related Educational Programs, 2009; Wiggins Frame, 2003; Young, Cashwell, Wiggins Frame, & Belaire, 2002) who have already developed competencies for addressing spiritual and religious issues in counseling. What sets this volume apart as an excellent addition to the literature is the research-based competencies upon which the book is structured.

The book is organized in three parts: Attitudes (three competencies), Knowledge (seven competencies), and Skills (six competencies), under which each chapter elucidates the 16 spiritual and religious competencies the authors purport. Through a rigorous quantitative and qualitative analysis, the authors identify “the basic attitudes, knowledge, and skills that all psychologists and other mental health professionals should possess to be able to work at a baseline level of competence with their clients’ religious and spiritual diversity issues” (p. XIII).

While noting that extant research recognizes the importance of religion and spirituality as aspects of human diversity and multicultural competencies, their inclusion into the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994, 2013) established that religious and spiritual issues are worth paying attention to in clinical practice.

The book’s strengths are many in that the text focuses on the clinical acumen and competency of mental health professionals. By delving deeper into each competency (one per chapter), the authors provide exercises for practice and an inclusive appendix of resources, including books, websites, articles, videos, and training guidelines. All of these can supplement a practitioner’s professional and personal development or be used as an adjunct for teaching and curriculum in counselor education. Each competency and its activities are geared toward challenging the practitioner to become more aware of his or her own biases and assumptions as they relate to these issues; achieve greater tolerance for other religious and spiritual systems without judgment; and implement relevant and sensitive interventions strategies.

Though not a comprehensive text on religion and spirituality, the authors’ focus is on delineating between competency and proficiency, and the book deals with developing the practitioner’s ability to do certain tasks in an appropriate and effective manner as qualified by his or her training. From an ethical perspective, the distinction is helpful, as counselors are not to practice outside of their area of competence. At the same time, this distinction can be debilitating, excluding a counselor (especially a new counselor) from working with any client, and confusing, unless the difference between competence and proficiency is clearly defined. In this book, the authors have engaged in this important dialogue as it applies to the context of religious and spiritual issues.

The applications for counseling professionals are replete and the competencies explained in the book complement the values and standards espoused in the American Counseling Association Code of Ethics (2014), the Association for Spiritual, Ethical, and Religious Values in Counseling competencies (2009), and the Association for Multicultural Counseling and Development competencies (Arredondo et al., 1996), making this an excellent resource for professional counselors who want to gain greater competency to work with clients’ religious and spiritual issues.

 

Vieten, C., & Scammell, S. (2015). Spiritual and religious competencies in clinical practice: Guidelines for psychotherapists and mental health professionals. Oakland, CA: New Harbinger.

Reviewed by: Miles Matise, NCC, Troy University

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References

American Counseling Association. (2014). Code of ethics. Retrieved from https://www.counseling.org/Resources/aca-code-of-ethics.pdf

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental

            disorders (4th ed.). Washington, DC: Author.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental

            disorders (5th ed.). Washington, DC: Author.

Arredondo, P., Toporek, M. Brown, S., Jones, J., Locke, D., Sanchez, J. and Stadler, H. (1996). Operationalization of the Multicultural Counseling Competencies. AMCD: Alexandria, VA.

Association for Spiritual, Ethical, and Religious Values in Counseling. (2009).

Competencies for addressing spiritual and religious issues in counseling.

Retrieved from https://www.counseling.org/docs/default-source/competencies/competencies-for-addressing-spiritual-and-religious-issues-in-counseling.pdf?sfvrsn=8

Council for Accreditation of Counseling & Related Educational Programs. (2009). 2009 standards. Retrieved from http://www.cacrep.org/wp-content/uploads/2017/07/2009-Standards.pdf

Wiggins Frame, M. (2003). Integrating religion and spirituality into counseling. Belmont, CA: Brooks/Cole.

Young, J., Cashwell, C., Wiggins Frame, M., & Belaire, C. (2002). Spiritual and religious competencies: A national survey of CACREP-accredited programs. Counseling and Values, 47(1), 22–33.

Book Review—Metaphor in Practice: A Professional’s Guide to Using the Science of Language in Psychotherapy

Niklas Törneke, in his book, Metaphor in Practice, provides a very helpful guide to understanding and using metaphors in mental health counseling. The book is divided into two primary sections. The first section reviews research on metaphors and establishes support for metaphors being appropriate for counseling. The second section describes how metaphors are structured and can be used to support the counseling goals of acceptance and commitment therapy (ACT). For those only interested in the practical use of metaphors, it is possible to skip section one. However, both sections contain valuable information.

In part one of the book, Törneke delves into linguistic and psychological research into metaphors, connecting those findings to the theory underlying ACT, namely, relational frame theory (RFT). RFT puts forward the view that the process of developing language and the ability to function in the world involves perceiving and internalizing relationships. ACT was developed from RFT and contains a foundational belief that the internalized, maladaptive relating of thoughts, emotions, behaviors, and events is the basis for most mental illness. The therapeutic approach in ACT is to change those internalized and maladaptive relationships. Metaphors are highlighted as a particularly helpful way of shifting those relationships because the function of metaphors is to expand understanding by relating something that needs to be better understood, the target, to something else more easily understood, the source. Metaphors are presented as a tool to guide the transformation of maladaptive relationships into adaptive ones. This first section, in addition to expanding understanding of metaphors, provides an informative introduction to RFT and the therapeutic approach that grew out of it, ACT.

In part two of Metaphor in Practice, the book shifts from theoretical to practical. It highlights three stages in the behavioral change process of ACT: establishing the relationship between behaviors (with thoughts and emotions understood as behaviors) and their problematic consequences; developing an internal ability to observe one’s own internal processes (e.g., thoughts, emotions, physical sensations); and helping the client clarify what is important in life and making steps toward what is important. For each of those stages, examples are given of how metaphors can support the goals of the stage. In each of the examples, the structure of the metaphor is dissected to reinforce an understanding of its constituent parts along with its purpose. In addition to verbal metaphors, experiential metaphors, metaphors in which the source is demonstrated through physical exercises, are described with examples, further expanding the reader’s understanding of what may be possible with metaphoric interventions. The organization of metaphor structure and the connection of metaphors to ACT stages and creative interventions provide a clear guide to using metaphors in practice, especially as presented through many well-written and detailed examples.

Metaphor in Practice is a book that is approachable and user-friendly. It provides excellent examples of metaphor usage that may be easily incorporated into readers’ professional practice. It also provides a foundational understanding of metaphors that will allow readers to adaptively use metaphors for specific therapeutic purposes. From a critical lens, the review of literature support for metaphors in section one is helpful, though simplistic. It creates an awareness of research support but does not deeply explore the breadth of literature or address some research findings, such as those of Bohrn, Altmann, and Jacobs (2012), Citron and Goldberg (2014), Citron, Güsten, Michaelis, and Goldberg (2016), and Fetterman, Bair, Werth, Landkammer, and Robinson (2016), that connect metaphor usage to increased emotional processing and emotional experiencing. The connection to emotion has a direct relevance to metaphors in counseling practice and may have strengthened and expanded the foundation for using metaphors in counseling. Though the research review could be strengthened, it does accomplish its goal of being informative and extracting core information that is beneficial for counselors to know. There is also a strong agenda within the book to connect metaphor findings to RFT and ACT, which may not be of interest to those with different theoretical orientations. The practice portion of the book is well-developed and explained, but it must be noted again that the descriptions of metaphor use are all related to stages in ACT. For those not interested in ACT, this may be a barrier. However, even for those not interested in ACT, the clear descriptions of metaphors make their use adaptable to other theoretical purposes. Therefore, and in summation, I recommend this book for counselors and believe the information contained will be interesting and clinically valuable.

 

 

References

Bohrn, I. C., Altmann, U., & Jacobs, A. M. (2012). Looking at the brains behind figurative language—A quantitative meta-analysis of neuroimaging studies on metaphor, idiom, and irony processing. Neuropsychologia, 50, 2669–2683. doi:10.1016/j.neuropsychologia.2012.07.021

Citron, F. M. M., Güsten, J., Michaelis, N., & Goldberg, A. E. (2016). Conventional metaphors in longer passages evoke affective brain response. NeuroImage, 139, 218–230. doi:10.1016/j.neuroimage.2016.06.020

Citron, F. M. M., & Goldberg, A. E. (2014). Metaphorical sentences are more emotionally engaging than their literal counterparts. Journal of Cognitive Neuroscience, 26, 2585–2595. doi:10.1162/jocn

Fetterman, A. K., Bair, J. L., Werth, M., Landkammer, F., & Robinson, M. D. (2016). The scope and consequences of metaphoric thinking: Using individual differences in metaphor usage to understand how metaphor functions. Journal of Personality and Social Psychology, 110, 458–476. doi:10.1037/pspp0000067

 

 

 

Törneke, N. (2017). Metaphor in practice: A professional’s guide to using the science of language in psychotherapy. Oakland, CA: Context Press.

 

Reviewed by: Alwin Wagener, NCC, The University of North Carolina at Greensboro

 

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