An integrative relational point of view.

This article, part of a special section on the Relational Foundations of Psychotherapy, describes a particular relational approach called cyclical psychodynamics. Cyclical psychodynamics is rooted both in the relational perspective in psychoanalysis and in an integrative melding of psychodynamic, cognitive-behavioral, systemic, and experiential points of view. Central to its theoretical structure is a focus on the vicious and virtuous circles that perpetuate (or contribute to changing) personality patterns that may have originated in childhood but that persist because they often generate the very feedback from others that is necessary to keep them going. As a consequence of this latter focus, the relational foundation of cyclical psychodynamic therapy addresses in equal and dynamically reciprocal fashion both the therapeutic relationship in the consulting room and the key relationships outside the consulting room that play an essential role in the maintenance or change of the problematic patterns the person has come to therapy to work on. I work from a point of view (which I call cyclical psychody- namics) that is grounded both in the relational version of psycho- analytic thought (Wachtel, 2008) and in long-standing efforts to integrate psychodynamic thought and practice with the contributions of cognitive behavioral, systemic, and humanistic-experiential thera- pists (Wachtel & Wachtel, 1986; Wachtel, 1977a, 1987, 1997, 2011). This simultaneous participation in both the relational move- ment and the psychotherapy integration movement probably ac- counts for one of the major ways in which I differ from many other relational thinkers, not only within the psychoanalytic world but in the broader field of psychotherapy and psychotherapy research. While, like other relationalists, I see the therapeutic relationship as an extremely important element in the process of therapeutic change, and draw on both clinical observations and systematic research (Norcross, 2002, 2010) pointing to its importance, I am nonetheless of the view that therapy can be harmed as much by paying too much attention to the relationship between therapist and patient as too little. As I will elaborate below, my work is as concerned with the relationships outside the consulting room as it is with those inside. Most of all, perhaps, I am concerned with how attention to each helps illuminate the other. The transference-countertransference enactments that are so central in the thinking of most contemporary relational analysts are indeed important, both as sources of understanding the patient's difficulties and way of life and as a medium for therapeutic reworking of problematic patterns. But in my experience, it is often only with the additional perspective of viewing and experi- encing the interaction through the prism of what one has learned about the patient's daily interactions with others that what is happening in the room really becomes clear. Conversely, it is often only with the understanding and experience of what is happening in the room that one fully understands what is happening with the patient's wife, daughter, father, boss, friend, and so forth. As I shall elaborate below, the cyclical psychodynamic point of view, and the integrative relational therapy which derives from it, aims both to achieve corrective emotional experiences via the therapeutic relationship and to foster new ways of interacting with others outside the consulting room that permit the patient's ongo- ing life experiences to themselves be a key therapeutic agent. In this sense, the importance of the relationship is not only as a therapeutic agent in its own right but also as a means of gaining the patient's cooperation and active participation in experiences out- side the session, where, after all, most of the patient's life is lived. It is only in the context of a relationship of trust and confidence that the patient can dare to engage in the kinds of new (and therefore likely frightening or intimidating) experiences outside the room that are perhaps the most powerful therapeutic experi- ence of all.