Psychoanalysis, Behavior Therapy, and the Relational World
Dowd, E. Thomas, Journal of Cognitive Psychotherapy
Psychoanalysis, Behavior Therapy, and the Relational World Paul Wachtel. American Psychological Association, 1997. 484 pp., $49.95 (39.95 to APA members) (hardcover).
The history of our field illustrates two oscillating dynamics; separation and integration. While earlier eras, which saw the emergence of the great theories (Freudian, Adlerian Behavioral) were separative in nature, the recent period has been characterized by integration. It's as though one extreme breeds another, only to be gradually replaced by fewer extreme views as the older protagonists are replaced by second generation theorists who more clearly recognize the complexity of the human condition and are less wedded to their own creation.
Paul Wachtel's latest book is clearly integrative and follows logically from his 1977 book Psychoanalysis and Behavior Therapy. This book has been widely cited as a classic and indeed maybe said to have begun the integration movement. However, it's not really a new book at all, since the first part is simply a reprint of that earlier work. This is followed by seven additional chapters focussing on the further integration of both psychoanalysis end behavior therapy with more contextual and systemic therapies. In addition) this second part addresses the integration since 1977 that has occurred as a result of the schema-focussed and constructivistic movements within cognitive behavior therapy and object relations, self-psychology, and the new relational emphasis within psychoanalysis. The book was constructed in this manner, Wachtel says, because the original book was written in such a seamless fashion that new concepts could not be inserted without appeal to be awkward add-ons.
The original 1977 book was an excellent exploration of points of contact and divergence between psychoanalysis and behavior therapy, both theoretical and clinical, and remains so to this day. Indeed, I was struck with how contemporary it still seems. What's dated is some of the large, because the male pronoun was and is here consistently used. Wachtel has an interesting solution to that problem which I'll mention later. Because the original book is widely known I'll restrict this review to the second section.
The second part consists of seven new chapters. The notion of cyclical dynamics pervades this section. Cyclical dynamics refers to an examination of the contextual nature of human psychological processes and the ways in which people mutually shape each other's experiences end behaviors. It also deals with the repetitive intrapersonal patterns of behavior, often self-defeating, which pervades human activity. It essentially ties together the constructivistic movement in cognitive behavior therapy to the relational element in a modern psychoanalysis.
The first chapter in the second section discusses the evolution of the psychotherapy integration movement, from the point of view of an insider who helped create it. This chapter is an excellent historical summary and bogs down only when Wachtel describes and critiques in some detail the integration efforts of some psychoanalytic thinkers. One has to be a student of their works to follow the discussion well.
The next chapter is an excellent discussion of recent changes in psychoanalytic thinking which was fascinating to an outsider like me. Essentially, it describes a movement away from an intrapsychic, drive reduction, hydraulic model of human development to owe based on analyses of relationships. The therapist is, within this new paradigm, not just a passive "blank screen" but an active participant in a "twoperson" model of the world. Also, discussed are the changed viewpoints within psychoanalysis toward the analysis of the transference and the use of action techniques. …