Psychoanalytic Therapy And Behavior Therapy

This book has a question mark in its title because it aims to invite inquiry. The possibility of integrating psychoanalytic and behavior therapies has been controversial since it was first proposed about 50 years ago, and this has elicited a wide range of reactions from both psychologists and psy chiatrists. It was with the hope of fostering constructive interchange that this book was conceived. We wanted to spark further thinking about the question in the title in a way that could lead either to conceptual and clinical progress toward an integrated approach or to a clearer sense of the obstacles involved. In either case, we hoped that it would present a healthy challenge to current forms of psychoanalytic and behavior therapies. The present volume was stimulated by the appearance in 1977 of Paul Wachtel's book Psychoanalysis and Behavior Therapy: Toward an Integration. Al though many reviewers did not necessarily agree with Wachtel's proposals for integration, they (and we) were highly laudatory of his attempt. After reading the book, Hal Arkowitz organized a symposium on integration that took place in Chicago at the November 1978 meeting of the Association for the Advancement of Behavior Therapy. The symposium included Cyril Franks, Merton Gill, Hans Strupp, Paul Wachtel, and Michael Merbaum as moderator. Arkowitz subsequently proposed to edit a book on integra tion and invited Messer to be coeditor.

In this update of Dr. Wachtel's seminal work, Psychoanalysis and Behavior Therapy, the author has developed a new integrative theory, cyclical psychodynamics, that has reworked traditional psychoanalytic concepts and proved capable of addressing observations and clinical experiences on which both psychoanalytic and behavioral theories are based. Psychoanalysis, Behavior Therapy, and the Relational World carefully examines the implications of new developments in both psychoanalytic and behavioral approaches and significantly extends the cyclical psychodynamic model clinically and theoretically. The book addresses the increasingly powerful influence of cognitive perspectives in the thinking of behavior therapists and the emergence of a distinctive and integrative "relational" point of view in psychoanalysis. Both developments have been incorporated into the evolving cyclical psychodynamic model, as has increasing attention to the systemic point of view that guides the work of family therapists. In addition, this book introduces the reader to an innovative approach to the therapist's use of language. Dr. Wachtel considers in detail what the therapist says and how his or her choice of words can enhance or impede the therapeutic process. (PsycINFO Database Record (c) 2004 APA, all rights reserved)

TABLE OF CONTENTS: 1. Introduction 2. Psychoanalysis: from medicine to psychology 3. the historical and the intrapsychic 4. an interpersonal alternative 5. some therapeutic implications of the interpersonal view 6. Anxiety, conflict, and learning in neurosis 7. Psychoanalysis and behavioral analysis 8. The reduction of fears: Foundations of systematic desensitization and related methods 9. Anxiety reduction through exposure: clinical issues 10. Facilitating action in the real world: Assertive training and related approaches 11. Reinforcement and interpretation 12. Some questions of ethics and the image of man.

Defending theoretical areas may be one way to cope with external impingments on clinical practice, but advancements are needed to enhance and improve the work. This text explores an approach based on applying cognitive-behaviour techniques in psychodynamic clinical practice. It aims to help understand, theoretical and practical, of the strengths and limitations of the approach, as well as how to determine when to combine approaches when treating couples, children, adolescents, older adults, even cases of abuse and chemical dependency.

It is sobering to reflect that it has been nearly fifty years since Thomas French's article on the "Interrelations between Psychoanalysis and the Experimental Work of Pavlov," representing the first psychoanalyst to bridge the gap between the theories of conditioning, was published. In hjs paper French clearly delineated the manner and directions in which these two points of view might enrich each other. Regrettably, his open ness to new ideas has not been characteristic of most "schools" of psychiatry thought, which have tended instead to develop an unfortu nate degree of insularity. This has occurred despite the obvious reality that the bio-social-psychological nature of man is such that no one theory or discipline is likely, in the foreseeable future, to explain, much less predict, all of the complexities of human behavior. All too often disputing theoreticians, like the fabled blind men describing the elephant, assume that the whole is just a gigantic magnification of the parts with which they are in contact. When treatment strategies are extrapolated from such narrow views, more often than not they fail to achieve the parsimony of effort, the breadth of application, and the maximum of efficiency that one would hope for. In our opinion, it is impossible adequately to conceptualize person ality development, symptom formation, or responses to psychotherapy, without taking into consideration theories of conflict as well as those of learning.

RESISTANCE AND THE PROCESS OF THERAPEUTIC CHANGE Paul L. Wachtel Psychotherapy, whether practiced from a psychodynamic or a behavioral point of view,! is rarely as straightforward as textbooks and case reports usually seem to imply. More often the work proceeds in fits and starts (and often does not seem to be proceeding at all, but rather unraveling or moving backward). The "typical" case is in fact quite atypical. Almost all cases present substantial difficulties for which the therapist feels, at least some of the time, quite unprepared. Practicing psychotherapy is a difficult-if also rewarding-way to earn a living. It is no profession for the individual who likes certainty, predictability, or a fairly constant sense that one knows what one is doing. There are few professions in which feeling stupid or stymied is as likely to be a part of one's ordinary professional day, even for those at the pinnacle of the field. Indeed, I would be loath to refer a patient to any therapist who declared that he almost always felt effective and clear about what was going on. Such a feeling can be maintained, I believe, only by an inordinate amount of bravado and lack of critical self-reflection. But the therapist trying to get some ideas about how to work with 1 These are, of course, not the only two points of view in psychotherapy; nor do I believe they are the only two of value.

In Psychoanalytic Participation: Action, Interaction, and Integration, Kenneth Frank argues that the gulf between analysis and what he terms "action-oriented" or cognitive-behavioral techniques is anachronistic and has unnecessarily limited the repertoire of analytically oriented clinicians. In point of fact, action-oriented and even cognitive-behavioral techniques may be employed in ways that are consistent with the analytic goal of promoting profound personality change, and so may be profitably incorporated into analytic treatments. Anchoring his discussion in a contemporary two-person model of psychoanalysis, Frank clarifies and extends the shift toward analyst participation that has developed within recent relational theorizing. On the basis of this orientation, which calls attention to the therapeutic importance of the real qualities of the analyst and of the analytic relationship, Frank sets forth a pragmatic analytic approach that balances traditional "process" elements with patients' problem-solving and outside progress in realizing life goals. By letting themselves be known by their patients and by participating intensively and actively in their treatment, analysts as analysts can help patients shape new and adaptive behaviors in their daily lives. It is the participatory possibilities growing out of a contemporary relational perspective that provide the ground for a rapprochement between psychoanalysis and cognitive-behavior therapy. To this end, Frank presents numerous examples of how action-oriented, cognitive-behavioral principles and techniques can be used to potentiate and accelerate the analytic process. At once scholarly and exploratory, pragmatic and visionary, Psychoanalytic Participation helps shepherd psychoanalysis into the 21st century while making psychoanalytic wisdom - both traditional and contemporary - available to the broad community of psychotherapists appreciative of the usefulness of cognitive-behavioral treatment strategies.

Relational Psychoanalysis and Psychotherapy Integration traces the history of efforts to integrate psychoanalysis with other psychotherapeutic modalities, beginning with the early analysts, including Ferenczi and Rank, and continuing on to the present day. It explores the potential for integration made possible by contemporary developments in theory and technique that are fundamental to a relational psychoanalytic approach. Editors Jill Bresler and Karen Starr bring together an array of valuable theoretical and clinical contributions by relationally oriented psychoanalysts who identify their work as integrative. The book is organized in four segments: theoretical frameworks of psychotherapy integration; integrating multiple models of psychotherapy into a psychoanalytically informed treatment; working with specific populations; the future of integration, exploring the issues involved in educating clinicians in integrative practice. The contributions in this volume demonstrate that integrating techniques from a variety of psychotherapies outside of psychoanalysis can enrich and enhance psychoanalytic practice. It will be an invaluable resource for all practicing psychoanalysts, psychotherapists, and psychoanalysts and psychotherapists in training, particularly those with an interest in relational psychoanalysis and psychotherapy integration.