Cyclical psychodynamics

Domain I · Psychodynamic & depth psychology · Paul L. Wachtel · 1977

What it is

Cyclical psychodynamics (CP) is an integrative, relational psychodynamic therapy. It joins psychoanalytic attention to wishes, fears, fantasies and warded-off feelings with behavioural, systemic and experiential methods. It is a theory and clinical framework, not a manualised treatment. There is no…

Format

• Status. Wachtel gives no formal phases, session counts or criteria for moving between phases. Everything in this section beyond the format notes is, built from the emphases in the 2011 table of contents and the 2014 article.
• Format. Individual psychotherapy, usually weekly and face to face, conversational rather than couch-based. Length is open-ended and set by the problem, from brief focal work to long-term therapy. No standard count is given. Conjoint couple or family sessions, or family-systemic thinking within…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• burdening the patient, or self-focus. It’s working when the disclosure opens exploration rather than closing it.
• any use that relies on deception or one-upmanship; avoid it. It’s working when a power struggle over change eases.
• your own frustration turning into accusatory comments. It’s working when the fear behind the resistance becomes speakable.
• the stance turning into “more of the same” (2014 p. 345). It’s working when the patient takes more risks with you and then outside.
• a map that reads as blaming, or one that leaves out what others really do. It’s working when the patient says “I could feel the loop starting.”

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.