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

Apr 1, 2018 | Book Reviews

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

The Professional Counselor

tpcjournal.nbcc.org

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

Apr 1, 2018 | Book Reviews

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

The Professional Counselor

http://tpcjournal.nbcc.org

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

Apr 1, 2018 | Book Reviews

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

The Professional Counselor

http://tpcjournal.nbcc.org