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