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Paul L. Wachtel, Distinguished Professor at The City College and at the Graduate Center of The City University of New York, is prominent among today's “integrationists”—clinician/theoreticians who are attempting to bridge the formidable chasm that lies between psychoanalytic principles and the more pragmatic goals and techniques of behavioral and family systems orientations. In Therapeutic Communication: Principles and Effective Practice, Wachtel's most recent publication in an oeuvre that spans more than 15 years, he turns his attention to the ticklish problem of how to talk “therapeutically” to patients. In this original and valuable book, he depicts in minute detail the sorts of things that fall under Freud's recommendation for sympathetic understanding and psychological tact. These qualities, obviously indispensable to any effective psychotherapy, are often lost, Wachtel argues, because of pervading attitudes that are a carryover from certain inherently adversarial aspects of classical theory and technique.
It is a central argument of this book that the therapist's every communication to the patient carries with it, in addition to its intended point, a “metamessage”—an all-too-often unexamined expression of theoretical bias—that has, for better or worse, power to influence the therapeutic process. Wachtel perceives the significance of these nuances according to his own conceptual model, a transactional/interpersonal theory of complex feedback loops that shape and maintain intrapsychic processes, subjective experience and overt behavior. The first several chapters of Therapeutic Communication develop this model, which he calls “cyclical psychodynamics,” and commence a thoroughgoing reexamination and reevaluation of older psychodynamic concepts in the light of today's wider perspectives on the therapeutic relationship and on theories of therapeutic action.