Therapeutic Communications: Principles and Effective Practice by Paul Wachtel,  The Guilford Press, 1993,  307 pp.

This simply written, well-illustrated book is aimed at the issue of effective therapeutic communications. The author feels that as therapists we are often unaware of the meta-messages behind our communications to our patients. These meta-messages are extremely important in determining how our interpretations are received, regardless of the correctness of the interpretation. Our choice of language, and the ways in which we frame our comments and questions, can either facilitate change or can further resistance. An interpretation that describes a patient's behavior as infantile or narcissistic, even if correct, can be easily experienced by the patient as critical, and can cause an increase in anxiety, defensiveness, and resistance. Thus, the author is primarily concerned with how we communicate.

As with all good attempts to address or improve technique, this book is grounded in a theory that attempts to explain how our communications to our patients can function as either a corrective emotional experience or as an anxiety-producing threat. Paul Wachtel suggests that this can be understood in terms of what he calls cyclical psychodynamics. While he does not deny (or explain) the importance of childhood experience in the creation of neurosis, he feels that neurotic difficulties are maintained not by repetition compulsion but rather by the ways in which the neurotic becomes involved in vicious cycles. Any reader of Karen Horney will be familiar with the idea of vicious cycles, and the author borrows extensively from her theory in this book.

Thus, partially in an attempt to defend against certain interpersonal or intrapsychic experiences, the neurotic behaves in ways that ironically make these experiences more likely to occur. Other people, who Wachtel calls “accomplices,” can be induced through actions to behave in ways that reinforce the vicious cycle. The author feels that these cycles can be broken through the use of judicious interpretation, which can point out the cyc