This is the first book of which I’m aware that combines ideas from schema-focused therapy with methods from acceptance and commitment therapy (ACT). These two treatment approaches come from different wings of the cognitive behavioral community, which could suggest that they will be in conflict. In the hands of these authors, that never happens.
This book approaches schemas simply as well-ingrained patterns of thought. There is nothing in this idea that violates ACT. Schemas imply a kind of functional theme, and the authors focus on ten patterns of particular importance to interpersonal problems: abandonment, mistrust, deprivation, defectiveness, alienation, incompetence, failure, entitlement, subjugation, and hypercriticalness. Chunking patterns of thinking into larger units and themes in this way can make it somewhat easier for the clinician to detect larger patterns and see the possible functions for more fine-grained thoughts. It can help the client and clinician alike see the forest and not just the individual trees.
Building on the identification of schemas, the tested protocol presented here brings ACT sensibilities to how schemas can be addressed effectively. That is, schemas, once identified, are addressed largely through ACT methods. The authors make that task easy by thinking about schemas in a functional sense. Just as in traditional ACT, which holds that fusion with thoughts leads fairly directly to avoidant forms of adjustment. The functions of schema coping behaviors are to escape from or avoid the emotional pain that is connected to a particular pattern of thinking. That helps turn schemas into themes to be used to detect unhelpful patterns of avoidance and their history. It’s a useful idea that is put to good use in this book.
One reason to take a more schema-focused approach in the domain of interpersonal problems is that such problems present themselves in a bewildering variety of forms. It is very easy to get caught up in content—in the details of the interpersonal stories and difficulties that make up the psychological aspect of the social world. Everyone has relationship difficulties from time to time, but this book is focused on recurring difficulties in relationships based on chronically dysfunctional styles of interacting. When dealing with problems of that kind, the larger patterns are more important than the details of a given instance.
Many years ago, language researchers determined that human language has a limited set of analytic dimensions; you could summarize the myriad evaluative themes into just three polar dimensions (good/bad, strong/weak, and fast/slow). Schemas can help in much the same way. If you can avoid reifying them, or turning them into causes, schemas can help focus clients and clinicians alike on a small set of themes to apply to the many details. The act of looking for larger patterns helps clients take a more defused and mindful look at their own behavior, and it can empower the search for ways to create new forms of adjustment. It helps clients step back and ask “What am I up to here?” and “What are the larger patterns of relationship that I am building in this moment?” That step—of backing up and looking for larger patterns—is a powerful ally of change. It is not by accident that this book uses ACT methods in service of this process, because the process is entirely ACT consistent.
The protocol in this book constantly directs the clinician’s attention toward the function of thought and emotion, and the construction of more effective behavioral patterns. It is very much to the credit of the authors that the protocol itself has been tested so we can say with some confidence that it can be of help in working with interpersonal problems. Detailed descriptions of interventions are provided, and scripts help readers envision when they might be used.
There are a limited number of approaches available for interpersonal problems. It is still early, but I believe this book adds another method to that list of approaches. Given how pervasive and destructive interpersonal problems can be, it has not arrived a moment too soon.
–Steven C. Hayes
Foundation Professor, University of Nevada