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Paul Wachtel's interview with Louise, who is in an ongoing therapy with someone else, is very moving. At the end she is effusive in describing her feeling that she has achieved great insight and thanks him profusely.
Watching this video has stimulated my own thinking in the direction of considering the impact of the choices we make from moment to moment as we engage with our patients, not only in a consultation such as this but in long-term work as well. I will try to spell out some thoughts about this here. First, however, I will focus on some questions of definition raised for me by Paul's comments about how he works.
Paul gives a brief outline of his clinical perspective, which he calls “integrative relational psychotherapy,” and which he describes as involving the integration of behavioral approaches, psychoanalysis, family therapy approaches, and cyclical psychodynamic systems theory. [Editors' note: The video referred to here includes an interview with Paul, in addition to the clinical session with Louise. In this section, Ehrenberg refers primarily to the content of the former.] He tells us that he sees himself as grounded in a relational analytic approach, but that he sees the strength of behavioral therapy in the attention it pays to what we do with other people. He suggests that this is the opposite of the focus on the here-and-now of relational approaches.
It is not clear how Paul is defining “relational” approaches, since “relational” includes diverse perspectives ranging from interpersonal, object relations, self-psychology, gender theory, and other points of view (Ehrenberg, 2006). These are not only diverse
but also sometimes incompatible perspectives. Furthermore, there are also major differences among those within the same relational tradition.
Paul tells us that behavior therapy helps people become less afraid of external things through the opportunity for exposure without anticipated consequences. He seems to believe this does not occur in