Westmead Meetings 2012

Essentials of the Conversational Model

The essentials of the Conversational Model (CM) are briefly presented. The focus is upon the  two main forces in the therapeutic field. One of these is towards a better  state of well being

Introduction to Psychotherapy with the Conversational Model

Therapy with the Conversational Model is based upon an understanding of the development of self. William James' understanding of the stream of consciousness as providing a basis for an experience of

The Conversational Model in context.

Psychoanalysis and therefore Psychotherapy does not have an integrated homogenous point of view. But all contemporary theories and clinicians subscribe to the complexity of the mind, the importance

Boundaries in the therapeutic relationship.

 "This could never happen to me." Beware, it happens to many. Psychotherapy involves patient and therapist in intimate exchange for extended periods of time. Few friendships

Couple Therapy: An Overview

Relationship issues are a common presenting problem for psychotherapists. Some therapists work with the individual, while others work primarily with the couple. Such practices occur in a context in which formal training in couple therapy is difficult to access. This presentation is concerned with providing an overview of practical and theoretical considerations in the practice of couple therapy with both parties present. It will draw on a range of perspectives including family life stage development, systems and psychodynamic theories to conceptualise relationship issues.

Psychosis - An exploration of traumatic origins.

Psychosis is a breakdown of the establishment of the unitary self – defenses that have been in place to maintain stability and self- organization when environmental failure threatens or is a reality and a reversal of maturational processes of emotional growth results – in fact psychosis is itself another defense; a defense upon a defense. Winnicott D. W. (1974) There is a connection between mental functioning and relatedness. When relatedness is threatened by a significant other, one of the results is fragmentation and incoherence, as a result of changes in cognition and emotions – this pathological process is unconscious, provoking guilt and anxiety which leads to primitive functioning –regression, intrusion of misperceptions and hallucinations. Cameron J. (1965)

Westmead Meetings 2014

Changing minds - changing bodies: Using attachment as a secure base for biopsychosocial research.

Attachment theory is a robust biopsychosocial model that is developmental and evolutionary based, proposing that human beings develop in relationship. It speaks to both the development of self and self-regulation and the mal/adaptations and disruptions due to stress or trauma that often underlie health presentations as well as the ongoing power of relationships to promote resilience and to heal. It powerfully predicts the stress responses and the coping strategies that arise if a person is not safely and comfortably supported, including both the conscious strategies and unconscious strategies. It then offers a guide to different recovery pathways and strategies and is a model that can apply to systems and cultures as well as the individual and is conducive to integrated care. An overview of a body of collaborative biopsychosocial research (including work by McLean, Kozlowska and Proctor) will be presented, using the unifying model of Attachment theory for research and integrated care.

Research in the Conversational Model (CM).

This paper will give an overview of the research efforts conducted by the Westmead Psychotherapy Research Program over the last 25 years. Examples are given of research that relates to outcome, phenomenology and process in the treatment of Borderline Personality Disorder. The basis of research in psychotherapy is also discussed with reference to the need to continue questioning our philosophical assumptions.

Doing Short Term Intensive Psychodynamic Psychotherapy (STIPP) - An Introduction

STIPP has a history that goes back to the 1950’s – pioneers were Luborsky, Malan, Basch, Abbass and others. I will give a brief overview of a model of STIPP which was the outcome of my attendance at short term therapy training workshops overseas and the use of important principles of the Conversational Model derived from my training. I developed this way of working over many years in my private practice with adolescents and adults. It is being taught as a 28 week part time short course at the psychotherapy training unit since 2011. STIPP is recommended for a wide variety of patients seen in day to day clinical work, so long as they meet the assessment criteria which I will outline. A history of trauma is not an exclusion factor.

EEG for Multimodal Therapy

Severe trauma in both children and adults leads to a disintegration of the core aspects of self-organisation and experience. In treating clients who are survivors of loss, trauma and torture, we need to optimize their assessment, case formulation and treatment plan to promote biopsychosocial recovery.

Traumatic experiences of the Lord’s Resistance Army victims: a proposal for healing

Assessment and Formulation

Ethical Maturity and Advancing Practice Wisdom

When we think about “ethics” or “ethical practice” our minds can move in two main directions: that this relates to serious transgressions (which does not involve us) or that this is something to do with our professional codes (which we will read if and when required). In fact, our need to respond ethically occurs in a myriad of small ways that make up the moment to moment relational transactions through which we deliver our services. This should mean that discussions about ethics are commonplace with colleagues, and yet they are often not. 

Similar to telepathy, non-verbal affective indicators tell a story in the process of psychotherapy

Power - 'The Power Dynamics in Psychotherapy'

In virtually all theoretical concepts in psychoanalysis and psychotherapy, from id, ego and superego, to trauma system, self and intersubjectivity, notions of their clinical usefulness imply the general term ‘power.’ While less commonly considered, it may be that this power operates, not only in the therapy room, but within layers of contexts. These might include the reputations of the actual college or association, of the institute, clinic or hospital, of the modality of the therapy, of charismatic figures and their literature, of the life histories of patient and therapist and supervisor, and of all of the above forces internalised and transformed in patient and therapist.

Love, Wiring and Relationships: The Impact of Interpersonal Neurobiology on Couple Therapy

Westmead Meetings 2015

Ethics: Confidentiality, Privacy, and what constitutes a medical record

Finding Common Ground: a proposed clinical and research collaboration between clinical psychology and psychiatry in WSLHD

Behind closed doors: what is going on? Somatic Countertransference and the Conversational Model of Psychotherapy

This presentation draws upon Karen’s treatise in the Master of Science in Medicine (Psychotherapy) degree at the University of Sydney. The heart of this presentation is a clinical vignette involving a patient with borderline personality disorder who was treated by the Conversational Model of psychotherapy (CM) in the Westmead Psychotherapy Program for Complex Traumatic Disorders. An excerpt from a clinical transcript, and patient drawings, will be examined in light of the common ground between patient and therapist. Specifically, shared unconscious traumatic memories will be discussed through the lenses of somatic countertransference (SCT) and clinical material.

Network Based Therapy approach to promoting coping

Couples Therapy - Finding Common Ground

The Conversational Model with its focus on affect, trauma and the minute particulars is well-suited to bridging the communications gap between people that find themselves alienated and at odds with each other. This paper will give a brief overview of the conversational model and offer a perspective on couples therapy from this vantage point. It suggests that subtle misinterpretations and misunderstandings of the other's communications are rooted in each owns traumatic past that may be preverbal and inaccessible to reflective awareness.

The Spiralling Self: growth in conversation

"It is language which created humans, rather than human’s language.” While self is first experienced in relation to another, the emergence of a mature self occurs in relation to a multiplicity of others in embodied communicative relationships to an individual. While "free association" is often thought of as psychoanalytic technique, it is argued that the primary form of free association is relational, and inter-subjective. In modern democratic societies the range of associative possibilities for the investment of individual lives leads to an enormous range of "forms of life". The developmental form involves a spiral of growth embedded in communicative exchange, and person-environment interaction. In humans, physiological homeostasis is a dynamic process that includes, at its highest level, shared understanding, contributing to the embedding of self in the physicality of the body. Such growth is impeded by traumatic experience that has its basis in the inter-subjective field.

The Spiralling Self: growth in conversation

"It is language which created humans, rather than human’s language.” While self is first experienced in relation to another, the emergence of a mature self occurs in relation to a multiplicity of others in embodied communicative relationships to an individual. While "free association" is often thought of as psychoanalytic technique, it is argued that the primary form of free association is relational, and inter-subjective. In modern democratic societies the range of associative possibilities for the investment of individual lives leads to an enormous range of "forms of life". The developmental form involves a spiral of growth embedded in communicative exchange, and person-environment interaction. In humans, physiological homeostasis is a dynamic process that includes, at its highest level, shared understanding, contributing to the embedding of self in the physicality of the body. Such growth is impeded by traumatic experience that has its basis in the inter-subjective field.

The Human Nature of Culture and Education, and its Expression in the Aesthetic and Moral Emotions of Relationships

Psychosis, depression, personality and the mother-infant relationship

The quality of the mother infant relationship is of critical importance in perinatal psychiatry. We aim to ensure that the infant has a good attachment relationship with the mother, but this can be interfered with by the mother’s mental illness. Working in perinatal psychiatry allows one to see the mother and infant interaction across a broad range of psychiatric disorders. Our observations of what is going on, allow us to make some hypothesis about how a mother interacts with her baby.

The Conversational Model: an Outline

The Conversational Model is the first psychotherapy which was specifically developed to treat a condition which in the 1960s was still believed to be untreatable, later termed Borderline Personality Disorder. This new form of psychotherapy was a joint creation of Robert Hobson and Russell Meares. It aimed to treat a disabling condition gradually understood to arise from severe developmental stresses in parent-child relationships.

Westmead Meetings 2016

Attachment, the Therapeutic Dyad and the CM Perspective: tracking self-development and (re)integration

Human beings develop in connected relationships, commencing with the touch, gaze, voice and affective tone of the proto-conversation and the sequencing of activities that tend to care, safety, comfort and play, extending to the therapeutic context where psychotherapy is the base for a healing relationship that fosters post-traumatic transformation, often mutual. Connectivity is constructed at every level of the individual and interpersonal systems: neurons fire and wire together, autonomic nervous systems are in conversation and the “soft wiring” and intrapersonal connections slowly unfold.

The Bare Essentials of the Conversational Model

The Bare Essentials of the Conversational Model By Tony Korner Selves in Conversation Humans live in a language environment as much as they live in a physical one. Throughout life we are faced with decisions (or ‘motivated selections’) about whether to associate through language or to dissociate through non-communication. Each person’s life gets shaped by these decisions, many of which occur unconsciously under the influence of traumatic experience. Each self has the form of a story, an incomplete one. Dissociation, relating to trauma, is an important reason for this incompleteness.

Trauma in the Workplace: Safework Australia and the Bullying Epidemic

Language and the self

The sense of self is inextricably connected to language, itself an intrinsically collective phenomenon with a life independent of individuals. If feeling provides an internal value system for self, then language can be thought of as providing an external value system, variably appropriated by individuals. Language consists of a network of differences; of relations within its own network; of shades of meaning. Its living qualities provide a gateway to “forms of life”. Communicative exchanges begin within a largely affective, indexical context: the proto-conversation.

Brain Plasticity, Psychotherapy and the Conversational Model

The emergence and development of The Conversational Model of Psychotherapy over the last 35 or so years arose out of a belief that models of psychotherapy ought to have a scientific basis. The key elements of the conversational model are dependent upon some key assumptions. These are that normal development is dependent upon our early infant and childhood relationships being able to meet our age appropriate needs. In time these relational experiences allow us to generate particularly integrated, reflective states of mind that we can call self and identify as health. Disruptions to that development (trauma) prevent the normal development of our cohesive, integrated and reflective sense of self. As a result we and others experience ourselves/us as living in a variety of fragmented, dissociative states that generate symptom clusters that are identified as pathology.

Traumatic Narcissism

To the layperson, narcissism is most often associated with arrogant, conceited, entitled behaviours which are captured by the term narcissistic grandiosity. This is consistent with common expressions of maladaptive behaviour such as self-enhancement and lack of empathy characterised by pathological narcissism. There is an emerging contemporary clinical model of pathological narcissism that combines grandiosity with clinically important regulatory impairment that leads to self, emotional and behavioural dysregulation in response to threats to self or failures of self-enhancement.

No-Self, Self, Not-Self

Lateral dissociation. When each brain hemisphere tells a different story.

Turbulence’ and Text: What a Linguist Learned About Language from the Psychotherapist's 'Grammar of Empathy

In over 10 years of collaboration between psychotherapists working with the 'Conversational Model' (CM: Meares 2005) and Systemic Functional linguists (Webster 2015), the central purpose of our research (including an NHMRC project) was to make explicit the modes of talk which brought about change between traumatised patients (BPD) and their therapists. From the point of view of the linguists, the core language principles that emerged aligned in name and function with clinical ideas which themselves have drawn increasing emphasis from practitioners in the CM (Meares 2012; and Meares et al. 2012). These principles might be referred to as 'cohesion' and 'construal in context'. These terms, as findings, are outlined in this talk. The methods of analysis in the research included the detailed comparison of critical transitions in patient and therapist interactions, using transcripts marked by therapists for clinical significance (although with the potential to be construed in different ways). Details of this method are illustrated through examples (Butt, Moore, and Henderson-Brooks 2012). What concerns me most in this talk, however, is the degree to which the linguist's view of language was itself renewed within a biological and pragmatist framework of the "self" (Meares 2012).

A clinical discussion of the case ‘Forget me not – My journey through Jungian analysis – A case presentation’ by Toni Woodward from the book Psychotherapy and Counselling: reflections on Practice. Oxford University Press.

In the contemporary world where short-term psychotherapeutic interventions are privileged, it is encouraging to see a consumer’s account of long-term work, in Toni’s case, spanning now over 15 years (though with different degrees of intensity). It is rare in the field of psychotherapy for a client to be so open about their experience, therapy being such a personal and intimate encounter and Toni’s account covers both the positive personal growth she experienced as well as those things she did not like. In this presentation, the reasons Toni sought therapy will be outlined followed by descriptions of the unfolding process and the way her transference projections brought into the ‘here-and-now’ unresolved issues arising from her relationship(s) with early caregivers from the ‘there-and-then’ of her earliest developmental experiences.

Westmead Meetings 2017

The Consolations of Anger

Testimony and Transformation

The Goodbye Letter

The Bare Essentials of the Conversational Model

The Bare Essentials of the Conversational Model By Tony Korner Selves in Conversation Humans live in a language environment as much as they live in a physical one. Throughout life we are faced with decisions (or ‘motivated selections’) about whether to associate through language or to dissociate through non-communication. Each person’s life gets shaped by these decisions, many of which occur unconsciously under the influence of traumatic experience. Each self has the form of a story, an incomplete one. Dissociation, relating to trauma, is an important reason for this incompleteness.

Complex Trauma, and the Dynamics of Shame, Dissociation and Dissociative Processes

The term Complex trauma captures the sequelae of early attachment trauma accompanied by cumulative other trauma i.e. emotional, physical and/or sexual abuse and neglect. The central disturbance in complex trauma is dissociation which causes disconnectedness among the elements of neural function i.e. parts of the brain, such as the hippocampus, prefrontal regions, anterior cingulate, corpus callosum and cerebellum, necessary for the brain’s capacity to create stable, flexible and adaptive states of mind. Dissociation must be understood to exist on a continuum, and understood to occur in a relational context.

An Introduction to Short Term Dynamic Interpersonal Psychotherapy (STDIP)

The model I am presenting is an integrated, trauma-informed, contemporary, relational and dynamic way of working with adolescents and adults. Conducted in 10 to 20 weekly sessions, it is phase oriented, structured, flexible, focussed, active and time-limited. Its purpose is to change the patient's way of behaving, thinking and feeling, by beginning to work on a specific focus which is collaboratively decided upon by patient and therapist. It derives theoretically from the Conversational Model, Attachment Theory, Interpersonal Theory and a long history of short term dynamic therapies.