Episode 222: Paul Wachtel's Approach to Integrative Psychotherapy: Exploring Attachment, Anxiety, and the Disavowed Self
James Swanson, Liam Browning, David Puder, M.D.
None of the presenters have any conflicts of interest to report.
Peer reviewers: Dr. Erica Vega, Dr. Jeremiah Stokes
Integrative Psychotherapy: Dr. Paul L. Wachtel’s Pioneering Approach to Blending Therapeutic Models
Dr. Paul L. Wachtel is a distinguished psychologist, psychoanalyst, and professor known for his integrative approach to psychotherapy. His work blends concepts from cognitive-behavioral, psychodynamic, humanistic-experiential, psychoanalytic, behavioral, and systemic therapies. A central theme in Dr. Wachtel’s work is his rejection of rigid adherence to any single therapeutic model. Instead, he advocates for a comprehensive framework that incorporates insights from various approaches to best serve patients’ needs. In this episode, we explore his idea of “making room for the disavowed” and other significant topics in psychotherapy.
Dr. Wachtel’s psychotherapy practice is shaped by his extensive study across multiple therapeutic domains. Initially trained in psychoanalytic ego psychology at Yale’s clinical psychology doctoral program, his approach later expanded to include relational psychoanalysis, behavioral therapy, family therapy, and more. This broad exploration led to his integrative view of psychotherapy. As a pioneer in integration, Dr. Wachtel has significantly contributed to the field by founding the Society for the Exploration of Psychotherapy Integration and authoring numerous influential articles and books. One of his notable works, Making Room for the Disavowed: Reclaiming the Self in Psychotherapy, will be the focus here, highlighting key topics from the podcast discussion.
Reintegrating The Disavowed Self In Therapy: A Path To Holistic Healing
Dr. Wachtel introduces the term “disavowed self” to describe aspects of an individual’s identity, emotions, or experiences that they have unconsciously rejected or denied. Grasping this concept is crucial for a comprehensive understanding of the therapeutic process. Wachtel highlights a “dialectical tension” that characterizes all well-practiced therapy, regardless of nominal orientation. The therapist must simultaneously manifest a genuinely empathic and validating stance with the patient while being clear-eyed about the ways of thinking and behaving that contribute to the patient’s problems. Ultimately, the therapist’s focus must be more on making room for the thoughts, feelings, desires, and potentials that have been squeezed out or cast aside in the course of development than on interpreting or correcting errors or distortions. Many patients come to therapy already demoralized, and it is essential to maintain an environment that allows them to reclaim their capacity to experience the full spectrum of emotions, even the ability to simultaneously feel seemingly contradictory emotions (such as sorrow and joy), and to develop a full range of adaptive and problem-solving capacities.
Wachtel’s book is filled with practical clinical examples and recommendations that complement his theoretical clarifications. Below, we offer a hypothetical scenario of a client and therapist that illustrates what it means to make room for the disavowed, not just to interpret it.
Case Study: Addressing Anxiety and Assertiveness in Therapy Using Disavowed Self Concept
In therapy, a client sought help for anxiety and difficulties in his professional relationships. The therapist observed that the client had trouble asserting himself at work, generally going out of his way to avoid conflict and, in the process, frequently suppressed his own needs. Growing up in an environment where his opinions were often dismissed, the client had learned to disavow assertiveness or desire for recognition and to view them as unacceptable. This led him, with little conscious awareness, to consistently downplay his contributions and avoid taking credit for his successes. As a result, he often felt unappreciated and overlooked and, in ways he was not very aware of, to overcompensate for this frustration and deprivation by subtly undermining colleagues’ ideas, creating tension in his workplace relationships that left him puzzled about why his interactions at work were so fraught with difficulty.
Some therapists would focus on pointing out and correcting these problematic behaviors and beliefs in the patient. However, the client’s self-esteem was already fragile, and many ways of pointing out the pattern – even if accurate – could simply add to his experience of incompetence or of being misunderstood or not appreciated. To address this, the therapist needs to help the client accept the legitimacy of the feelings and desires he has long deemed unacceptable. By helping him to reclaim his assertiveness and wish for recognition, and to reintegrate those elements of behavior and experience into his adaptive repertoire, the patient can begin to modify the more abrasive elements of his interactions that had unwittingly arisen as a reaction to his blocked access to more adaptive self-enhancing behavior.
Benefits Of An Integrative Approach In Psychotherapy: A Comprehensive Perspective
The integrationist perspective is crucial in psychotherapy because no single orientation in the field has an exclusive hold on truth. As Dr. Wachtel notes, psychotherapy consists of “evolving and open-ended systems of thought and practice whose boundaries with the other major approaches are often, on close inspection, rather porous.” Despite these porous boundaries, each approach maintains a distinct identity, style, and contribution to the therapeutic process.
This perspective challenges the “silo problem,” where practitioners believe that one domain has nothing to offer another, thus limiting the potential for richer, more effective therapeutic outcomes. Embracing an integrationist approach allows for the blending of different perspectives and therapeutic modalities, such as attachment theory and third-wave cognitive behavioral therapy, critical elements in the further evolution of Dr. Wachtel’s integrative approach in his latest book. By combining these diverse approaches, therapists can create a more nuanced and flexible framework that better meets the complex needs of their patients.
How Integrative Psychotherapy Treats Anxiety: Combining Cognitive-Behavioral and Psychodynamic Techniques
Dr. Wachtel’s emphasis on making room for what has been repressed, cast aside, or disavowed (rather than on interpreting what the patient has been hiding from himself), is rooted in a key revision of psychoanalytic thought that should have created more fundamental change in therapeutic practice than it did. As Dr. Wachtel points out, Freud essentially “shifted the cornerstone” of psychoanalysis in 1926, when he clarified that it was anxiety that was the fundamental cause of repression rather than vice versa. (Dr. Wachtel also discusses the important ways in which the causal arrows go in both directions.) Attention to this fundamental role of anxiety highlights that, most of all, helping the patient overcome the anxiety that underlies his self-disavowals is what enables both insight and behavior change. This, in the current era, when exposure has become such a prominent element in the treatment of anxiety, opens a crucial path toward combining the strengths of the psychodynamic and cognitive-behavioral approaches.
Dr. Wachtel argues that some of the key anxieties that underlie psychological difficulties are anxieties associated with the person’s own thoughts, feelings, and behaviors. Psychodynamic interpretations, from this view, are not simply clarifications or generators of insight but, when effective, are to a great extent promoters of exposure. When the therapist’s comments bring the patient into closer contact with experiences he has previously avoided, the effect is very similar to what happens when a cognitive-behavioral therapist promotes exposure to the experiences that that approach tends to place in its theoretical foreground. His work illuminates a range of ways in which the perspectives and the strengths of each approach can be brought together when this critical role of anxiety and of exposure is understood. The two approaches still differ in many ways, but that is a strength rather than a problem. When cognitive-behavioral therapists understand the ways in which psychodynamic approaches are grounded in foundations that significantly overlap with theirs, and psychodynamic therapists understand the powerful ways in which methods central to cognitive-behavior therapy overlap and can contribute to their own work, the possibilities of synergies that benefit patients are greatly enhanced.
Treating Phobias in Therapy: Uncovering Disavowed Emotions for Better Outcomes
An example of how this combined approach can work is seen in the treatment of a patient with a debilitating fear of pigeons that severely limited both her social life and her work life. The patient lived in New York City, where avoiding pigeons to the extent she did meant curtailing much of normal living. The patient viewed the origins of her phobia as lying in a childhood incident where she was bitten by a parakeet, but in the course of the therapy it became clear that a powerful contributor was an extended experience, around the time the phobia began, during which her father was frequently hospitalized due to both cancer and heart disease. Her family, attempting to shield her from this disturbing reality, provided misleading explanations for his prolonged absences and very obvious poor health when he was home (business trips, a bad cold, etc.), but these reassurances failed to reassure. The patient had sensed something was terribly wrong, but she was left with only a vague, persistent feeling of unease and, in essence, the message that there was no room for her to express her worry (because “nothing was wrong”).
The pigeon phobia offered a focus and an explanation for her anxiety, and also some sense of control, since she could diminish her anxiety by avoiding pigeons. Had her parents shared with her, in a developmentally appropriate way, something of the reality the family was facing, it would have been difficult and painful, but she also would have learned ways to cope with (if not totally erase) anxiety through communication and connection. Instead, she learned only avoidant strategies, and because those avoidances ended up also leading to avoidance of the sometimes uncomfortable, but also essential experiences of learning to cope with social and work challenges, her skills in those areas remained undeveloped, adding further fuel to the maintenance of an avoidant and restrictive way of life.
At the time the therapy began, there were many indications that she felt quite angry at her mother and other family members for not having been honest with her or giving her any opportunity to talk about her anxieties and worries, but it was difficult for her to let herself experience that anger. She was also impeded by a clear and understandable mistrust of the honesty or sincerity of others in her life. This mistrust, like the anger, was largely obscured to her by a manifest indifference. She did not let anyone get close enough to her for these uncomfortable feelings to surface, but, of course, that also meant healing experiences and countervailing gratifying experiences were also limited. She viewed herself as interested only in overcoming the pigeon phobia.
Both an exclusively interpretive or insight-oriented approach and an exclusively exposure-focused approach are limited in their ability to address the needs of a patient like this. One element of the treatment did include both imaginal and in vivo exposure to pigeons, but as she began to move through the exposure experiences and made some progress, she began to “forget” to practice between sessions and increasingly disparaged the value of such a “limited” approach. In this, she called upon her increasing interest in the larger dynamics that contributed to the phobia, which made addressing her original presenting complaint seem trivial to her. But in working more directly on the complex of feelings and inhibitions that contributed to her difficulties, she would checkmate those explorations when we got too close to uncomfortable feelings by stating things like “I’d like to see my friends more and pursue more interesting and rewarding work options, but I can’t because of my pigeon phobia.” In her effort to maintain what felt like a fragile equilibrium, psychodynamic exploration could become a source of resistance to exposure therapy and vice versa. Any therapeutic approach that risked disturbing the delicate balance between her sense of safety and underlying dissatisfaction was met with resistance, causing her to retreat from whichever aspect of the therapy—whether psychodynamic exploration or exposure work—felt most threatening at the time.
Ultimately, what she needed was a complex mix of multiple therapeutic methods, deriving from different theoretical rationales, in order to address the complex lattice of anxieties and inhibitions that maintained her unsatisfying stasis. She could not commit herself to wholeheartedly participating in a regimen of exposure until she had worked through the many layers of mistrust that were the heritage of her childhood experience and that, hardly surprisingly, extended (often without much acknowledgement) to the therapist and the therapy. She could not carry through on her increasing insight about the complex feelings generated by those childhood experiences without attention to the ways in which her avoidances had affected her social and occupational skills in the present, an insight that, to be a genuine source of change, required behavioral skill training exercises, as well as other interventions. Each element of the work was supported by and required for the fully effective implementation of other elements from other perspectives, that, in turn, required the support of the first.
Breaking Vicious Cycles in Therapy: The Role of Cyclical Psychodynamics and Disavowed Emotions
This patient’s pigeon phobia and the limitations it placed on the rest of her life represents an example of “cyclical psychodynamics,” where negative early experiences disrupt the development of crucial skills necessary to connect with others in age-appropriate ways and to express and regulate emotions. This then leads to patterns of avoidance and problematic interactions that further impede the development of those skills, and so further maintain the pattern of internal states and external behavior in a way that locks it in through its own consequences.
In this and many other examples, the inhibitions, avoidances, and truncated expressions of emotion create consequences that perpetuate those very inhibitions, avoidances, and emotional restrictions. The result is a vicious cycle, and effective treatment must address multiple facets of the pattern in order to break that vicious cycle. An understanding of what is being impeded or left out (on the part of both the therapist and the patient) is essential, but understanding alone is insufficient. Multiple interventions contribute by making room for the feelings and behaviors that have been restricted. These interventions address anxiety through verbal clarifications and examinations, promote exposure to the avoided experience, and create opportunities for skill development, practice, and greater comfort and familiarity. The mix of interventions can include explicit formal exercises, as in some therapeutic approaches, and more informal interactional and relational experiences in the therapy room. Often best is a mix of these, with the therapist learning a wide range of skills to help the patient in both the therapy room and in his daily life.
Role Play Case Study: Applying Integrative Therapy Techniques For Complex Phobias
Dr. Puder presented the case of a patient who presented with a phobia of elevators at work that caused him intense anxiety, panic attacks, and insomnia (days before riding the elevator). This patient had developed the phobia when he found out he was promoted.
In role playing how he would work with this patient, and in discussing what he did in the role play, Dr. Wachtel explored the possible meaning of the elevator phobia in relation to a fear of “moving up in the world,” symbolized by the movement of the elevator from the lobby to the office high above. He explored the ways in which receiving the promotion and raise was related to engaging in competition or defeating rivals and also to having more and more to lose.
In doing so, he did not “interpret” the meaning to the patient, but invited him to feel certain feelings, to “sit in” the feelings, and, in other ways, combined a more insight-focused approach with an approach in which exposure and actually experiencing the feelings that have been hard to experience was central.
Interpreting Dreams in Psychotherapy: Understanding Unconscious Patterns and Meanings
The patient had a dream in which he was unable to use the elevator and was fired. Then, because he was fired and lost his income, he defaulted on his house payments and was thrown in jail, losing his family and everything important to him.
In discussing how he would approach this dream, Dr. Wachtel pointed out that in traditional psychoanalytic theory, dreams are understood to have both manifest content (the literal storyline of the dream) and latent content (the hidden, symbolic meaning).
The manifest content of a dream is what the dreamer remembers and describes, like the patient’s dream of being unable to use an elevator, getting fired, and subsequently losing everything.
The latent content, according to this theory, represents the unconscious wishes, fears, and conflicts that the manifest content disguises.
Traditionally, the focus was on the latent content, on figuring out what the dream “really” means. Dr. Wachtel argues that instead of identifying a single latent content of a patient’s dream, a single “correct” interpretation, it is useful to view the dream as a sample of mental activity in a state of mind in which the defenses were half asleep, providing a window onto many features of the patient’s psychological makeup that are disavowed in the waking state.
Within the role play, Dr. Wachtel picked up on a further elaboration on the dream that the patient reported the following week – he was now in the jail cell, playing chess with a lion, and although he has now lost everything, he is calm and peaceful playing chess with the lion. Dr. Wachtel initially responded to chess as a game that is competitive, that has a winner and a loser. However, the patient stated that when his father taught him to play chess it was not about winning and losing—his father would not let him lose. Instead, the father would turn the board around to himself if his son was losing, giving the son the stronger position. Dr. Wachtel picked up on how the father protected his son from the experience of losing, and wondered about an implicit message that losing was very bad and to be avoided at all costs.
The patient objected to this framing, saying his parents did not care about winning or losing, and even went to his high school athletic events only to hear the band. Dr. Wachel utilizes this information to further highlight the family’s disavowal of competition, commenting that going to sporting events only to hear the band conveys, “I’m not going to look at what’s aggressive and competitive, only what is harmonious.”
Dr. Wachtel acknowledges there is an element of that attitude that could be supportive or reassuring, but states, “That’s only part of life, and you’re trying to figure out, how do I include in myself that part of me that wants to knock heads and clash and engage in rough and tumble competition?” Again aiming for a more experiential and exposure-centered alternative to a purely interpretive approach, he asks the patient, “What does it feel like when you picture yourself really engaging competitively?”
He also explores other issues suggested by the dream, such as feeling safer taking on a lion—a strong, worthy adversary—than a competitor who is vulnerable and afraid of aggression, as perhaps his father was.
How Attachment Theory Shapes Modern Psychotherapy: Key Insights And Applications
Categorical Views on Attachment
Our earliest interpersonal relationships play a pivotal role in shaping how we experience ourselves and others and behave throughout life. In one sense, a child is entirely vulnerable, relying on their caregiver to meet their most basic needs. To manage feelings of safety and cope with anxiety, children often adjust their thoughts, emotions, and behaviors to preserve their bond with the caregiver. These adaptations help reduce anxiety and strengthen the relationship, but they can also be a source of maladaptation in the person’s life going forward.
Attachment theory was largely developed by John Bowlby and Mary Ainsworth. Initially, while researching precursors of delinquency, Bowlby (1944) found that emotional regulation and behavior could be explained by experiences of attachment between a caregiver and child. Mary Ainsworth later published additional research backing this idea and clearly categorized the different styles of attachment (Ainsworth et al., 1978). In the literature, attachment styles are broadly categorized as seen below:
Secure/Autonomous Attachment - Child expects that their emotional needs will be met by their caregiver.
Insecure Attachment - This form of attachment is driven by the expectation that the caregiver will not attend to the child’s needs.
Avoidant/Dismissive - Child will try to avoid the feeling of neglect and vulnerability by withdrawing from caregiver.
Ambivalent/Anxious-Preoccupied - Attempts are made to get the attention of the caregiver, but the child will likely not be consoled when attention and care is given.
Disorganized/Unresolved - Child does not have a clear idea of what they need to accomplish/their emotional needs and they will oscillate from clinginess and distancing themselves.
There is substantial evidence supporting the enduring nature of attachment styles throughout life. Several factors contribute to the strength and persistence of these attachment styles. Wachtel approaches these continuities by examining the feedback loops that develop that maintain patterns.
For example, someone with an anxious attachment style may be looking for constant reassurance from a loved one, which can lead to anxiety, frustration, or withdrawal on the part of the caretaker, thereby further perpetuating the child’s anxiety. On the other hand, a child who is avoidantly attached may show signs of emotional detachment from their caregiver, which in turn may cause the caregiver to feel incompetent, unloved, or unneeded, ultimately leading them to feel less emotionally engaged with their infant, contributing to a vicious cycle that further perpetuates the child’s defensive withdrawal.
Attachment dynamics play a crucial role in psychotherapy, as they shape how we express or suppress our thoughts, feelings, and behaviors. For better or for worse, the patterns we develop in our earliest relationships often influence how we navigate interpersonal interactions throughout life, including therapeutic settings. From these foundational relationships, we gain a sense of which of our thoughts, feelings, and inclinations are accepted and enable us to engage safely and effectively with others and which aspects of our psychological makeup disrupt the sense of mutuality and
resonance that is critical to healthy psychological development (Wachtel, 2023, p. 191). Understanding these dynamics allows therapists to work with clients to explore how early attachment experiences may affect their current emotional responses and relationships.
Reevaluating Attachment Theory in Therapy: Dynamic Interpersonal Processes Explained
While Dr. Wachtel recognizes that the categorical view of attachment can be clinically useful, citing David Wallin’s book, Attachment in Psychotherapy, as an example, he focuses more on the idea of attachment as an evolving interpersonal process. He encourages clinicians to focus on attachment dynamics—specifically, how “attachment experiences contribute to shaping which of their thoughts, feelings, or ways of interacting with the world the developing child accepts and integrates into their sense-of-self… and which get shunted aside… and impeded in their capacity for elaboration, refinement, and further development” (Wachtel, 2023, p. 182).
Parents are the source of safety, but they also provide safety, comfort and security in an inevitably selective manner. They do not accept all experiences, and do not respond in a genuinely comforting way to all feelings, behaviors or desires. So even as the child learns that the parents are a source of safety, it also learns that the parents are a source of contingent safety, that they are safe and secure if they act and feel within certain parameters. What doesn’t fit in those parameters is at least somewhat banished from the evolving personality’s behavioral and experiential repertoire.
Practical Applications of Attachment Theory in Therapy: Techniques and Tips for Clinicians
So the question remains: how exactly do clinicians, armed with the knowledge of attachment theory, help their patients grow and meet their goals? Below are helpful tips that Dr. Wachtel highlights in his book.
The work of the therapist can be thought of from the vantage point of the metaphor of search and rescue. The searching aspect refers to finding “the thoughts, feelings, and behavioral inclinations that have been obscured or impeded or rendered difficult to acknowledge” (Wachtel, 2023, p. 225). Rescuing, on the other hand, involves helping the patient become able to incorporate their disavowed thoughts, feelings, and behaviors.
Help the client understand how their attachment style directly impacts their current experiences. It is not enough to focus solely on analyzing their past upbringing to understand attachment style. The client should also recognize how their attachment patterns perpetuate adaptive or maladaptive ways of being in the present day.
Attachment styles, particularly insecure ones, can reinforce the anxieties and inhibitions developed in early life. The therapist’s job is to help break the cycle that maintains these feelings and inclinations being disavowed by fostering a safe environment for the client to express them. This process can be facilitated through role plays, modeling, rehearsals, or planning graduated goals for the patient to achieve, enabling them to incorporate their disavowed thoughts and feelings into everyday life.
A patient's experience of whether a therapist is helpful or unhelpful may be influenced by the impact of earlier significant relationships. For example, if a patient has come, in the course of development, to readily feel invaded or that their boundaries are violated, the therapist must be cautious in making suggestions or interventions. Conversely, a patient who has experienced abandonment or insufficiently active and structured parenting may find a more active approach more helpful.
Understanding Attunement and Emotional Disavowal in Therapy: Effective Approaches
Being unseen, unheard, or unrelated to by the attachment figure is one of the most difficult experiences. For example, the Still Face Experiment, conducted by Dr. Edward Tronick, involves a mother interacting with her infant, initially engaging in normal, responsive play. Then, the mother is instructed to suddenly adopt a neutral, unresponsive expression—referred to as the “still face.” The infant, who had been happily interacting, quickly becomes distressed, trying various behaviors to re-engage the mother, such as smiling, cooing, or reaching out. When these efforts fail, the infant often becomes increasingly upset, showing signs of confusion and distress. The experiment demonstrated the critical importance of attunement.
The behaviors and expressions that are not met with responsiveness tend to be the ones that are disavowed. This need not imply overt disapproval or harshness. The mere absence of responsiveness can be powerfully motivating.
For example, Dr. Wachtel describes a patient who (clearly categorized as securely attached) entered therapy because, despite a warm and loving, and even physically affectionate, relationship with her husband, she was unable to experience pleasure or arousal when they had intercourse.
At one point, in a conversation with her older brother, he mentioned something he had noticed when she was about a year old and just learning to speak. Her mother was teaching her the names for the parts of the body, as so many mothers do, naming each and pointing to it. Her brother, who was a teenager then, noticed that their mother went from head to toe rather thoroughly, but when she arrived at the belly, she paused for a long time and then skipped down to the knees, anxiously omitting the genitals. As they spoke further, they both recalled many instances of their mother leaving the room during sexual scenes in movies “to fix everyone a snack,” and in many other ways manifesting discomfort with the sexual and sensual side of life, even while being a generally very affectionate and engaged mother.
This discussion with her brother stirred a host of recollections that surprised the patient because they had been both obvious and, nonetheless, largely overlooked by her. She suspected that her mother was not even aware of this avoidance, that it happened automatically and in a way such that both the elements of sexuality, and the avoidance of discussing or acknowledging them, were rendered invisible. “‘Boy, she’s good at that,’ the patient said. ‘It happens so quickly and so smoothly that no one notices. Or at least, I never noticed.’”
Her mother never expressed overt prohibitions regarding sexuality. It was the absence of her response to this side of life, her rendering it invisible, that had the more powerful impact. This kind of parental discomfort can, even in the absence of overt criticism or prohibition, impact the full spectrum of human emotions and experiences. In understanding our patients’ histories, we must of course be alert to instances of trauma, harshness, rage, and so forth. But we must also be attuned to invisibility, both to what the patient has rendered invisible in him/herself and how their key attachment figures were unable to be attuned to or to subjectively tolerate one or another dimension of human experience.
Expert Tips From Dr. Wachtel On Becoming A More Effective Therapist
Ask yourself, “What am I not picking up on?” Just as a parent cannot be equally attentive to or love equally every facet of a child, we cannot respond to every aspect of a patient’s experience that needs attention.
Consult other professionals, as they are likely to notice what we do not.
Consider what personalities or types of patients with whom you connect best. Do not feel bad about referring a patient to another provider if you feel a sense of stagnation or if you feel they would be a better fit.
Avoid theoretical silos and make use of an approach that draws on multiple viewpoints.
Continue learning about yourself and be honest with yourself about the fact that you are human and will continue to make mistakes.
“My analysis expanded my empathetic capacities in other ways. I became slowly, painfully familiar with my blind spots, and with my vanity, greed, envy, sadism…which were only possible to admit and explore because of my analyst’s matter-of-fact acceptance.” -Nancy McWilliams
Resources:
Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Erlbaum.
Bowlby J. (1944). Forty-four juvenile thieves: Their character and home-life. International Journal of Psychoanalysis. 25:19–52. DOI:10.4324/9780203779958-9
Freud, S. (1926). Inhibitions, symptoms, and anxiety. Standard Edition, Vol. 20 (pp. 87-172). London: Hogarth Press, 1959.
Wachtel, P. L. (1977). Psychoanalysis and behavior therapy: Toward an integration. Basic Books.
Wachtel, P. L. (1987). Action and insight: Psychoanalysis and the active patient. Guilford Press
Wachtel, P. L. (1997). Psychoanalysis, behavior therapy, and the relational world. American Psychological Association.
Wachtel, P. L. (2007). Relational theory and the practice of psychotherapy. The Guilford Press.
Wachtel, P. L. (2013). Therapeutic communication: Knowing what to say when (2nd ed.). The Guilford Press.
Wachtel, P. L. (2014). Cyclical psychodynamics and the contextual self. Routledge.
Wachtel, P. L. (2023). Making room for the disavowed: Making room for the self in therapy. The Guilford Press.
Wallin, D. J. (2007). Attachment in psychotherapy. The Guilford Press.