Dr. Wachtel's approach to therapy is an integrative one. Centered in the relational version of psychoanalytic thought and practice, it includes elements of behavioral, family systems, and experiential approaches as well. The rooting in relational psychoanalysis leads to a strong concern with the therapeutic relationship and an understanding of that relationship that leaves room for a much wider range of possible interactions and interventions than traditional psychoanalytic approaches.
It includes such traditional psychoanalytic concerns as transference and countertransference, unconscious motives, fears, and conflicts, defensive processes, and attention to the subtleties of subjective experience. But it also includes a variety of considerations, derived in part from Dr. Wachtel's efforts to integrate ideas and methods from other approaches, which are not typically part of the thinking or the practice of psychoanalytically oriented therapists.
Among these additional concerns and perspectives is an emphasis on exposure as a process at least as important as insight. That is, overcoming problematic anxieties and conflicts is achieved not so much by knowing about them as it is by experiencing them. Because, from a psychoanalytic vantage point, the most relevant anxieties are often associated with one's own thoughts and feelings, the approach here brings together the skills of the psychoanalytic therapist in identifying and uncovering those feelings and the methods of behavioral and experiential therapists in actually bringing the person into contact with what he or she has avoided.
Especially pertinent to this approach, which Dr. Wachtel has described as based on cyclical psychodynamics, is attention to the ways in which people's difficulties are typically a reflection of vicious circles. These vicious circles include both the repetitive patterns that go on between people (here he draws particularly on interpersonal psychoanalysis, family systems approaches, and social psychology) and the ways in which the pattern of thoughts, feelings, and overt behaviors that characterizes each individual is organized circularly. One's internal state (including assumptions, expectations, predominant wishes, needs, and fears—both conscious and unconscious) leads the person to act in the world; and those actions have consequences—for example, leading others to respond in particular ways. The circle is completed when those consequences, as happens so often, serve to maintain or reproduce the same internal state, starting the cycle all over again.
The starting point for this analysis is arbitrary. What is crucial is to mobilize as many forms of intervention as possible that are at once sensitive to the patient's experience, vulnerabilities, and strengths, and capable of breaking the vicious circle and promoting a process of change. The DVD will illustrate the ways in which this point of view is put into action.
Work using this approach has primarily been directed toward individuals who suffer from anxiety or depression; who have difficulties in relationships; who feel constricted in their affective life; who experience a lack of vitality or meaning in their lives (with or without identifiable depression per se); who are thwarted in their careers or in other pursuits that are meaningful to them.
The approach has not been used very much with schizophrenia, bipolar disorder, or sociopathic disorders, and Dr. Wachtel is not sure how much it would have to be reworked and adapted for these populations.
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