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Australian and New Zealand Association of Psychotherapists

ANZAP 2013

Dancing in the dark, moving towards the light: complex patterns of dyadic interaction in psychotherapy sessions

Cry and response

We announce our arrival in the world as separate individuals with the cry. The cry, and the environmental response to the cry, determines the initial atmosphere in the consciousness of the neonate.

Boundaries, caring and the Conversational Model: What can we do about complex trauma?

In therapy we are constantly struggling with the paradox and tension between firmness/rigidity and flexibility. The first provides the requisite clarity and stability that generates safety, the second provides for the possibility of change. Boundaries are important in a variety of ways in all therapies. Within the Conversational Model boundaries are seen as central to the notion of self and its development. Without developing the capacity to distinguish between inner and outer there can be no self and thus there can be no distinction between self and other.

Integration in the Psychotherapy of Borderline Personality.

The relationship between borderline personality disorder (BPD) and traumatic attachment and abuse in childhood is documented in numerous studies around the world. Over seventy per cent of these patients reported a childhood history of emotional abuse – that is frequent experiences of being shamed or humiliated, being frustrated by being given mixed messages, being put in impossible situations, having their thoughts and feelings denied. 

Marquis d'Hervey De Saint-Denys : Pioneer of Dream Studies

We tend to think that dream theories started with Freud and Jung. In fact a number of dream pioneers had published on the topic in the late 1800s’ Europe. I spent the last months reading one of

What do we do with dreams?

This talk puts forward some ideas towards an answer to this question. The discussion involves observations from two pioneers of dream research, Maury and Hervey de Saint-Denis; a dream of Jung, commented

Emeritus Professor Russell Meares interviewed by Dr Kamal Touma

Working at the interface of education and trauma in an Indigenous pre-school - the importance of deep soul listening

This seminar creates discussion around one of the most important problems facing any health professional working at the coalface. How do we recognise trauma in the infant, the toddler, the Pre-school child? How are an infant or preschool child’s physical, psychological and mental faculties affected by early trauma? How does the child respond to it in their body and in their psyche? How do we respond as professionals to help the parent, the teacher, the friend, the partner to intervene in a way that will prevent or undo harm? Trauma interferes with a child’s capacity to learn from experiences, trauma creates a vacuum where imagination could be, where play could enact his inner world, where learning as a pleasurable part of living could occur.

Toward Cohesion – A Phasic Approach to Dissociation and Dissociative Disorders

This paper attempts to offer a clinical perspective of certain parts of Russell Meares’ most recent book “A Dissociative Model of Borderline Personality Disorder’’ and illustrate with case examples some of the important insights he provides us. In this excellent book, Russell describes to us a way of approaching dissociation and the dissociative disorders in a scientific manner – based on years of clinical experience and of research; as he concludes that ‘the central disturbance of BPD is disconnectedness among the elements of neural function necessary to higher- order consciousness, or self.

Self-cohesion and the Poetic Experience

In his book, Poetries and Sciences, written in 1926, I.A. Richards’s describes the poetic experience in terms that seem to echo strongly the Jamesian idea that ‘Thoughts connected as we feel them to be connected are what we mean by personal selves.’ The interconnectedness between the two streams of intellect and emotion, according to Richards, allows us to appreciate the poem’s meaning in its entirety and therefore feel its restorative effect. This has contemporary meaning in that what he describes as the poem’s power to rebalance a frequently destabilised ‘assemblage of interests’ we might think of today in terms of affect regulation and the tendency towards a dynamic state of equilibrium or psychophysiological homeostasis.

ANZAP 2014

Does the form of abuse matter? The experience of physical pain and injury within developmental trauma.

Awareness of trauma to children was first codified as the “battered baby syndrome” by Henry Kempe in 1962. While Accident & Emergency Departments, paediatricians and social workers remain alert to these presentations, it seems that child sexual abuse and the range of emotional abuse particularly in disorders of Attachment, have come to the fore in psychotherapy. The sequelae of physical abuse are not always highlighted in the discussions of Complex Trauma but occur, as expected, often in association with other forms of abuse. 

What else works: evidence for psychotherapy models for treating borderline personality disorder

Vicarious traumatization: A necessary therapeutic tool

The renewal of the natural order through meaning: The evolutionary spiral of ‘self’ realisation

Evolutionary change can now be studied at extraordinary scales; and these scales involve increasing evidence of semiotic (or sign based) expansion in telodynamic systems – systems which appear oriented to goals and even to self-correction (Shapiro 2011; Deacon 2012). Here I wish to explore how the emergence of the human self can be understood as an expansion of meaning potential, in particular, as a product of a ‘strategy’ of doubling and differentiation. My argument reviews the role of semiotic behaviour from bacteria to the collective consciousness that underpins human language. I further argue that the ‘stages’ of differentiation – e.g.. head to tail; top vs. underneath; right to left symmetry; hemispheric brains – all employ a double with differentiated function.

The Musicality of Therapeutic Conversations

Therapy requires the patient and therapist to be in a mutually aware relationship. An underlying characteristic of this relationship is that both parties aim towards ‘feeling felt’. The human necessity for ‘feeling felt’ is at the very beginning of the human journey. In a sensitive caregiver-infant relationship the infant and caregiver ‘take in’ the other’s inner state through giving their awareness purposefully to the other’s communicative gestures. This ‘taking in’ is confirmed moment-by-moment through the ‘giving back’ (mirroring) of these gestures. But for the relationship to be alive, in the giving back there must also be the addition of the other person’s inner state. In adulthood this intersubjectively shaped storytelling, created through gestures and words, characterises the space where trauma can be healed in relationship.

Cultural Clues: Meaning making about suicide in Australia

Suicide is a major risk in Australia. In 2007, 1,881 people died by suicide. People bereaved by suicide must construct personal meaning about the death, decode the intentions of the deceased and receive and process a range of attitudes and beliefs about suicide from their social networks, from the supportive to the stigmatising.

Psychotherapy, Spiritual Development and Relatedness: three sides of the same coin.

In our work as therapists we constantly seek to develop our patients’ capacity for relatedness. Spiritual seeking in its purest forms is the pursuit of levels of development beyond the aims of most psychotherapy patients, but is understandable as a profound extension of this capacity in relation to both humanity and the divine.

Embodied mutual meaning unfolding through time as substrate of clinical complexity

The aims and objectives of this paper are to demonstrate the underlying ‘musical thematic’ structure of embodied meaning between psychotherapist and patient and to discuss how this gives insight into the interpersonal dynamics of psychotherapeutic healing. The model of Communicative Musicality (Malloch, 1999; Malloch & Trevarthen, 2009), like that of the Conversational Model (Meares, 2004), has its origins in the investigation of mutuality in the infant-caregiver relationship. We observe in this relationship an exquisite mutually regulated interchange of embodied narratives of affect which enable caregiver and infant to spend meaningful time together.

Pride and shame in adventures of companionship: Primary aesthetic and moral values for human meaning and their importance in early development

Acoustic resonance: Musical and acoustic elements of the therapeutic conversation

Anna sits on the edge of her chair, smiling up at me under a tussle of unruly curls, relating a joyful experience in a sing-song lilting voice. Intuitively I vocalize a series of 'mmmms' matching the acoustic intonation of her narration. If I do not respond immediately with concordant vocalisations indicating I am on her wave-length, she subsides into a flat, dead, monotone, muttering under her breath, ‘What’s the point. No one ever listens. So ‘depressed’. There was no musicality to her speech, it had suddenly become disjointed, unrhythmical, harsh-toned. She had been triggered into a traumatic memory system. Vocal attunement as well as facial mirroring are vital aspects of the intersubjective encounter between patient and therapist. Through implicit empathic recognition, an attuned therapist will acoustically resonate with the overtone series of the patient’s material: as well as matching the tone, rhythm, melodic contour and timbre of the patient’s narration in vocal responsiveness.

ANZAP 2015

Youth Interrupted - Confusion, Diffusion and Belief Systems in Anorexia Nervosa

Levinas’ ethics of alterity as a means to transcend psychoanalytic fundamentalism

A Linguistic Approach to Poetics and Cohesion of Self in Therapeutic Conversation

In therapeutic conversation there is a co-construction of text by therapist and patient. The language of this therapeutic conversation is crucial: it is both the mode and evidence of intervention. This paper explores the language of the poetic in this context, which is associated with the non-linear, analogical, right-hemispheric form of language outlined in the Conversational Model (cf. Meares et al, 2012:27). This style of conversation is associated with a change in the form of consciousness and cohesion of self (Meares, 2012; Meares et al, 2012).

Affect, Authenticity and Analogical Relatedness: exploring Heidegger’s Eigentlichkeit and the Conversational Model

This paper examines a clinical case in which Heidegger’s work took a central role, where a confluence of Conversational Model and Heideggarian ideas assisted in a current engagement in psychotherapy. In this case, Heidegger’s work functioned in two modes. Firstly, as a shared play-space between my patient and I where analogical relatedness could develop. Secondly, Heidegger’s work also functioned as a literal model for being-in-the-world that over time became integrated into the conversation. This is an example of fit, intersubjectivity and fellow-feeling. Heidegger’s concept of existential authenticity (Eigentlichkeit) derives from that which is owned. If affect is innate, then it is arguable that this is the essence of that which is owned. By engaging with the affect of our patients we are engaging on a fundamentally authentic level.

Verbal arts, poetics and the silent legislation of thought

While verbal art has been regarded as the quintessential expression of what a community shares in a “collective consciousness”, equally it has been studied as the harbinger of experiential innovation. Language affords the chief source of interpersonal solidarity AND a semantic laboratory for what is incipient or even weird (outside the ken of ‘normal folk’).  This polarisation of functions can in some cases be explained by changes of artistic taste – mediaeval poetry in Europe was appreciated in terms of its ensemble of standard cultural motifs – e.g. roses, blood, courtesy… Other eras, like our own (in English, at least), have given value to novelty and invention, as well as to highly marked linguistic constructions. 

Utopia/Dystopia: the inner world of DID

Narcissism and the Borderline Condition

Narcissism - Alone, Alongside and Within the Borderline Condition

Why don't we worship Mickey Mouse? Reflections on cognition, the unconscious, collective processes and religious fundamentalism

In the preface to his Pulitzer Prize winning play, Doubt, John Patrick Stanley (2005) wrote: "It is doubt that changes things, doubt is nothing less than an opportunity to re-enter the present. The beginning of change is the moment of doubt. It is the crucial moment when I renew my humanity or become a lie (p. 6-7). Fundamentalism is the antithesis of doubt; it is literalism [and certainty] in interpreting scriptures as history rather than as mythology and metaphor expressing universal or archetypal themes of timeless significance for humankind’s understanding of its origins, future destiny and significance in cosmology" (Todd, 2012, p. 3). Radical fundamentalism constitutes an extreme form of religious certainty that arises from a primitive narcissistic fantasy of merger with an ideal object.

Dreaming and Democracy: maintaining the conversation in the face of those who seek to create enemies in order to render them speechless

The 2015 attack on Charlie Hebdo in Paris was widely interpreted as an attack on free speech, one of the latest in a series of such attacks that appear to be intended to intimidate journalists in relation to criticisms, or humour, in relation to specific religions. “Je suis Charlie” became a rallying call for worldwide protest. Over the ages, political and scientific discussion has often taken the form of argument. This can be healthy provided individuals are allowed to have a voice. However, humans are passionate creatures and argument is often associated with conflict, where individual voices may be derailed. In considering the conflict between the materialist and the idealist philosopher in the 19th Century, Hegel came to the conclusion that these two positions were both “moments” in a larger conversation. When one position is silenced, this becomes a lop-sided affair with a cost to the potential for development of self.

ANZAP 2016

Society, Catholicism and the human person as complex systems and sub-systems

Complexity theory is recognised as the New Science that conceptualises the universe as a system of communicating systems. As such, everything in the universe is better understood by exploring the dynamic, nonlinear relationships between the parts that make up the whole. Psychoanalytic Complexity Theory provides a new, but familiar contribution to contemporary psychoanalytic theory and practice.

Poiesis in verbal art, in verbal science and in nature: Creativity and the Conversational Model

Therapists working in the Conversational Model draw from a number of sources of experience and creative endeavour. The use of such sources suggests that therapists recognise some form of crossover between the goals of therapeutic, dyadic sharing and the value bestowed on aspects of subjectivity by creative engagements. In this talk, we offer analyses related to three aspects of such a crossover: a) what reasons have been proposed by practitioners (i.e.. Meares and his colleagues) for the efficacy of artistic values in therapeutic method and in a therapeutic relationship? b) what role do analogical ‘leaps’ have in the discourse between therapists and patients with Borderline Personality Disorder (BPD)? c) what do current theories of art and science suggest about a resonance between mental health and ‘poiesis’ – or inspired making and accomplishment?

Depressive realism, angst and creativity - What can the work of Michel Houellebecq tell us about the art and science of psychotherapy?

This paper will explore this question and present the work of Michel Houellebecq who has now published six novels, all of them bitter and miserable. Their pessimism isn't the only or necessarily their most important element, but it's probably the first thing that everybody notices. They are callow, cynical, sex obsessed, openly racist and misogynistic in turn, rife with B-grade porn, contradictory, full of contempt for art and intellectuals and operate on a low level of masculine anger at the indignities of not being an alpha male. They are none-the-less serious works, and their increasing reputation has more to do with their artistic achievement than the strong reactions they elicit.

Society, Catholicism and the human person as complex systems and sub-systems

Complexity theory is recognised as the New Science that conceptualises the universe as a system of communicating systems. As such, everything in the universe is better understood by exploring the dynamic, nonlinear relationships between the parts that make up the whole. Psychoanalytic Complexity Theory provides a new, but familiar contribution to contemporary psychoanalytic theory and practice.

Spoiled identities and community resilience

Using the work of Goffman and other social psychologists, this presentation looks at the ways in which the identities of perpetrators of sexual abuse are constructed in a monolinear fashion creating `spoiled identities’. This is a social construction which the community actively participates in for necessary reasons but which after time affects levels of community healing and resilience through embedded and habitual processes of othering.

Trauma and Lateral dissociation: The spoken and the unspoken stories

Joseph Conrad, master of ships and master of affect: His gift to Robert Hobson and the Conversational Model

He who would do good to another must do it in Minute Particulars: General Good is the plea of the scoundrel, hypocrite, & flatterer. For Art & Science cannot exist but in minutely organised particulars.’ William Blake, apart from Wordsworth, Coleridge and Shakespeare, Robert Hobson declared his indebtedness to the Polish/English novelist, Joseph Conrad (1857-1924). But what in particular did Conrad give to Hobson? His Darwinian biological conceptions? His Jamesian (Henry, if not William) psychological concept of an unconscious? His awareness of Newtonian Physics? (O’Hanlon), Maybe? 

Making sense: The intersection of the actual and the symbolic

To be a person is to have a place within a relational network. Simply occupying such a space carries significance, although often a significance that is only vaguely sensed, as if “through a glass darkly”. We exist within a reality that is simultaneously actual and symbolic. To have a developed mind is to be able to negotiate one’s place within this duality; to be a self-organising system not solely contingent upon the exigencies of physical space and time. Like language, which only has meaning through contrast within a network of linguistic relations, self; person; and mind exist as unique realisations within a relational network that has symbolic as well as practical significance. The area of significance, with multiple resonances and symbolic, non-literal dimensions can be seen as the zone of self, developing in complexity over time in the manner of Saussure’s “axis of simultaneities”, while the area of specific meaning, in the sense of “dictionary definition” is more defined and fixed and applicable to the “axis of successions”.

Development of the CMAS - Conversational Model Adherence Scale

Meares et al. (2012) outlined within the clinician’s manual for Conversational Model Therapy (CMT), the basis for a scale that would measure adherence to CMT within any given therapy session. Our aim was to further develop the Conversational Model Adherence Scale (CMAS) through multiple workshops with senior clinicians within the Westmead Psychotherapy Program and through consultations with Russell Meares, the co-founder of the Conversational Model. Measuring adherence to a given psychotherapeutic approach has numerous benefits, such as the verification of therapist expertise, ensuring therapy fidelity in the reporting of patient outcomes, and facilitating the training of new CMT psychotherapists by minimising the cognitive load within a complex skillset.

The persecutory therapist re-visited: The damage done by trauma to a patient's sense of agency and the implications for psychotherapy practice