Therapeutic Communication: Knowing What to Say When / Edition 2

by Paul L. Wachtel PhD

Overview

A uniquely practical guide and widely adopted text, this book shows precisely what therapists can say at key moments to enhance the process of healing and change. Paul Wachtel explains why some communications in therapy are particularly effective, while others that address essentially the same content may actually be countertherapeutic. He offers clear and specific guidelines for how to ask questions and make comments in ways that facilitate collaborative exploration and promote change. Illustrated with vivid case examples, the book is grounded in an integrative theory that draws from features of psychodynamic, cognitive-behavioral, systemic, and experiential approaches.

New to This Edition
* Reflects nearly 20 years of advances in the field and refinements of the author's approach.
*Broader audience: in addition to psychodynamic therapists, cognitive-behavioral therapists and others will find specific, user-friendly recommendations.
*Chapter on key developments and convergences across different psychotherapeutic approaches.
*Chapter on the therapeutic implications of attachment theory and research.

See also Wachtel's Relational Theory and the Practice of Psychotherapy, which explores a new direction in psychoanalytic thought that can expand and deepen clinical practice.

Product Details

ISBN-13:	9781609181710
Publisher:	Guilford Publications, Inc.
Publication date:	04/11/2011
Edition description:	2nd ed.
Pages:	398
Product dimensions:	6.30(w) x 9.00(h) x 1.50(d)

About the Author

Paul L. Wachtel, PhD, is Distinguished Professor in the Clinical Psychology Doctoral Program at The City College of New York. Dr. Wachtel has been a leading voice for integrative thinking in the human sciences and is a cofounder and past president of the Society for the Exploration of Psychotherapy Integration. He is a recipient of the Hans H. Strupp Memorial Award; the Distinguished Psychologist Award from Division 29 (Psychotherapy) of the American Psychological Association (APA); the Scholarship and Research Award from Division 39 (Psychoanalysis) of APA; and the Sidney J. Blatt Award for Outstanding Contributions to Psychotherapy, Scholarship, Education and Practice

Table of Contents

Introduction
1. Rethinking the Talking Cure: The Therapist Speaks Too
I. Theoretical and Empirical Foundations
2. The Continuing Evolution of Psychotherapy: New and Converging Developments in Psychoanalytic, Cognitive-Behavioral, Systemic, and Experiential Approaches
3. Attending to Attachment: Accelerating Interest in the Therapeutic Implications of Attachment Theory and Research
4. Cyclical Psychodynamics I: Vicious and Virtuous Circles
5. Cyclical Psychodynamics II: Anxiety, Exposure, and Interpretation
6. Cyclical Psychodynamics III: Insight, the Therapeutic Relationship, and the World Outside
II. Clinical Applications and Guidelines
7. Accusatory and Facilitative Comments: Criticism and Permission in the Therapeutic Dialogue
8. Exploration, Not Interrogation
9. Building on the Patient’s Strengths
10. Affirmation and Change
11. Attribution and Suggestion
12. Reframing, Relabeling, and Paradox
13. Therapist Self-Disclosure: Prospects and Pitfalls
14. Achieving Resolution of the Patient's Difficulties: Resistance, Working Through, and Following Through
III. Postscript
15. Therapeutic Communication with Couples, Ellen F. Wachtel

Interviews

Clinical psychologists, psychiatrists, social workers, psychiatric nurses, and counselors; psychotherapy students and trainees. Serves as a text in graduate-level psychotherapy courses.

Editorial Reviews

"This is the best book on how to talk to one's patients I have ever read, and it is the book I most frequently recommend to my trainees....The lessons on language embodied in this book are experience-near and clinically useful for anyone who talks with patients, regardless of theoretical orientation....Wachtel addresses with tremendous sophistication a number of thorny issues that are seldom addressed in such a clear, clinically genuine (as opposed to theoretically driven) way, such as the uses and limits of therapeutic self-disclosure and suggestion....A profound and important book."

Journal of Psychotherapy Integration

"A comprehensive and provocative examination of the uses of language by therapists in clinical practice....Paul L. Wachtel, a noted expert, clinician, and theorist of psychotherapy...generously shares his extensive professional experience throughout the text....This book will be very helpful to clinicians in guiding their decisions about the best uses of language in clinical practice. Wachtel generously interweaves relevant theory and clinical experiences in the clearly written and informative chapters....It is up to date, comprehensive, well referenced, and strongly grounded in relevant theory and practice....Wachtel's book provides a strong impetus for examining the nature of therapeutic communication and encourages careful thought about the strategic exchange of messages to achieve therapeutic outcomes."

PsycCRITIQUES

"Quite simply, an excellent book. It is comprehensively researched; it takes an inclusive and integrative theoretical and practical approach; it engages deeply and with precision on tendentious issues and difficult concepts; and it renders explicit what a seasoned and experienced therapist may be doing intuitively....My copy is now well scribbled and earmarked, and I can imagine coming back to it again and again, not only to refine my own understanding of the difficult nettles grasped therein, but to simply begin to do all the secondary reading that Wachtel so expertly integrated into this formidable and profitable piece of work. This is a text that one would profit from greatly by reading straight through like any book; but my sense is that it will be ultimately more valuable as a reference and teaching guide."

Psychodynamic Practice

"Should be of significant help to students and to practitioners of psychotherapy....Nuances of communication style are treated comparatively and persuasively rather than pejoratively....Wachtel's material is fecund with an admixture of theoretical knowledge, experience, and universally applicable clinical vignettes. The chapter on achieving resolution of the patient's difficulties is particularly germane....Overall, this book would be very useful and productive in training programs for all those engaging in forms of psychotherapy."

Journal of Behavior Therapy and Experimental Psychiatry

"Therapeutic Communication, Second Edition, builds on the foundation of Wachtel's original book, but it very substantially updates and revises it, reflecting many exciting advances that have occurred in our field. Wachtel presents theoretical and clinical material that will sharpen any psychotherapist's understanding of how to communicate with patients."—Leslie S. Greenberg, PhD, Distinguished Research Professor Emeritus of Psychology, York University, Canada

"Paul Wachtel is among the very few teachers and theorists of psychotherapy whose writing has an immediate, direct, and powerful impact on my clinical practice. I have long used and recommended this excellent text and am delighted to see the revised second edition, which incorporates recent developments across the range of therapeutic approaches. Wachtel does not speak in generalities or abstractions; rather, he moves easily among theoretical formulations, research findings, and their practical application, illustrating his principles with numerous recognizable examples. He examines in great detail the nuances and subtleties of what you say to patients, how you say it, and the relational context within which you convey your therapeutic messages. This book is essential reading for practicing therapists of all persuasions. I can't wait to start reading it with my students."—Lewis Aron, PhD, Director, Postdoctoral Program in Psychotherapy and Psychoanalysis, New York University
 
"The wisdom and experience of a creative therapist are reflected in every chapter. As the subtitle indicates, it's what you say and when you say it that determines what a patient hears. Novice and experienced therapists of any theoretical orientation will find this book to be of significant value. It is clear that therapy is not simply about techniques—it's about relations that work. This book shows you how and why that is true."—Robert L. Leahy, PhD, Director, American Institute for Cognitive Therapy; Department of Psychiatry, Weill Cornell Medical College

"I have used Therapeutic Communication in my graduate seminars, and students have been consistently appreciative of its combination of theoretical rationale and detailed examples (the 'why' and the 'how-to'). This combination has made it possible for students from all therapeutic orientations to apply the book's insights to their clinical thinking and practice. Wachtel's formulation of 'cyclical psychodynamics' is consistent with perpetuating factors, awareness of which is critically important for effective psychotherapy of any school."—Steven A. Kvaal, PhD, Department of Psychology, Roosevelt University

"Students in my master's-level class in Interpersonal Communication have consistently found Therapeutic Communication to be the best text to help them understand how change and growth take place through dialogue and disclosure. Wachtel seamlessly interweaves theory and skills, explicating not just one theory but several, in some of the clearest writing in the field. The chapters on building on patients' strengths and therapeutic communication with couples are a 'must' for practitioners. The focused session transcripts are a valuable teaching tool; the extensive references and detailed index are also significant assets of the book."—Delores Friesen, PhD, LMFT, Professor Emerita of Pastoral Counseling, Fresno Pacific Biblical Seminary

From the Publisher

Reviewer: Christopher J Graver, PhD, ABPP-CN(Madigan Healthcare System)
Description: As a complement to the many resources on manualized treatments, this book examines the general aspects of communication that occur in therapy and how students and clinicians can improve not only what they say, but how they say it.
Purpose: This second edition is aimed at updating theories, science, and therapeutic approaches.
Audience: It is appropriate for anyone working clinically with psychological patients, ranging from clinicians to students. This book has been used as an introductory textbook in graduate clinical courses and practica. The author is experienced in this area and is a natural choice to write this type of resource.
Features: An overview of theories of communication in therapy begins the book. Several approaches are considered and the overlap between therapy types is explored in some detail. This is followed by a review of attachment theories as they relate to emotional factors between the therapist and patient. The author strongly encourages attention to this dynamic attachment process as a core to therapy and a primer to the rest of the book. The next few chapters turn to a psychodynamic perspective, but that should not deter behaviorists because the discussions of cyclical patterns of interpersonal interactions are applicable to a wide variety of approaches and orientations. Later chapters focus on the subtle distinctions between exploration and interrogation by carefully scrutinizing the way in which interactions occur between the therapist and patient. Examples illustrate "what no to do," and provide guidance about beneficial communication methods. It presents a nice balance between encouragement and focusing on strengths and being forthright when unpleasant truths need to be faced. There are a few downsides to the book, one being the organization and writing style that lacks excitement or inspiration, partly due to the lack of a single figure, illustration, or table in the entire book. The other downside is lack of specific examples or dialogues to illustrate how the author would handle certain situations, although some may find this too directive and detracting from the general theory of therapeutic communication.
Assessment: This book provides a reasonable introduction to therapeutic communication. The information is solid and useful, but the writing style and delivery may become somewhat tedious for readers, and the lack of specific examples may engender some frustration in budding student therapists. I read the first edition in graduate school, and the changes in this second edition do not immediately stoke my desire to update my library.

Doody's Review Service

A uniquely practical guide and widely adopted text, this book shows precisely what therapists can say at key moments to enhance the process of healing and change….The book offers clear and specific guidelines for how to ask questions and make comments in ways that facilitate collaborative exploration and promote change. Illustrated with vivid case examples, the book is grounded in an integrative theory that draws from features of psychodynamic, cognitive behavioral, systemic and experiential approaches.”

Counseling Today

"Therapeutic Communication, Second Edition, builds on the foundation of Wachtel's original book, but it very substantially updates and revises it, reflecting many exciting advances that have occurred in our field. Wachtel presents theoretical and clinical material that will sharpen any psychotherapist's understanding of how to communicate with patients."--Leslie S. Greenberg, PhD, Distinguished Research Professor, Department of Psychology, York University, Canada

"Paul Wachtel is among the very few teachers and theorists of psychotherapy whose writing has an immediate, direct, and powerful impact on my clinical practice. I have long used and recommended this excellent text and am delighted to see the revised second edition, which incorporates recent developments across the range of therapeutic approaches. Wachtel does not speak in generalities or abstractions; rather, he moves easily among theoretical formulations, research findings, and their practical application, illustrating his principles with numerous recognizable examples. He examines in great detail the nuances and subtleties of what you say to patients, how you say it, and the relational context within which you convey your therapeutic messages. This book is essential reading for practicing therapists of all persuasions. I can't wait to start reading it with my students."--Lewis Aron, PhD, Director, Postdoctoral Program in Psychotherapy and Psychoanalysis, New York University
 
"The wisdom and experience of a creative therapist are reflected in every chapter. As the subtitle indicates, it's what you say and when you say it that determines what a patient hears. Novice and experienced therapists of any theoretical orientation will find this book to be of significant value. It is clear that therapy is not simply about techniques--it's about relations that work. This book shows you how and why that is true."--Robert L. Leahy, PhD, Director, American Institute for Cognitive Therapy; Department of Psychiatry, Weill Cornell Medical College

This book notes the importance of therapist communication within the therapy context and makes recommendations for optimal therapeutic interventions. The purpose of the book is to demonstrate how best to convey understanding of a patient to that patient for maximal therapeutic benefit, an often overlooked but extremely important issue in the therapeutic process. The author also presents his theory of psychological disorder and change called "cyclical psychodynamics.' The book went to great lengths in meeting this objective and pointing out the importance of all language in the therapy process. The book is written primarily for clinical psychologists. In addition, graduate students will also benefit from reading the book. The book is written at an appropriate level for this primary audience but will appeal more to students of psychoanalytic theory than students with other orientations. The author is well-known in his field and has lectured extensively on his theories. He is a credible authority in the subject matter. The book contains no illustrations, figures, or tables. It deviates from a straight prose style only in the later chapters when therapy transcripts are introduced. The book may lose some audience because little mention is made of other work, especially in the cognitive behavioral area where there is considerable overlap with the issues presented. A big advantage of this book is its easy-to-read language. The book covers an important topic in a very attractive writing style. It is a subject that the author has spent a great amount of time researching. I had two overall problems with the book, though. First, the author displays a bias toward the psychoanalytic literature.Second, I would have liked to see more research cited and discussed. Perhaps the author made a decision to focus only on the clinical applications of his theory but research on related topics would have made his points that much stronger.

Tamara Goldman Sher

Dr. Wachtel explores the largely unmapped territory of what the therapist says in the therapeutic setting, demonstrating a use of language that shows understanding, avoids inducing resistance, and yet does not sidestep the confrontation of painful realities. Extensive annotated transcripts of therapy sessions give insights into the principles discussed. Annotation c. Book News, Inc., Portland, OR (booknews.com)

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