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Case Study ‘T’: Play in the ED, emergency psychotherapy and other contradictions in terms

Case Study ‘T’: Play in the ED, emergency psychotherapy and other contradictions in terms

This paper examines a clinical case that demonstrates the utility of the Conversational Model of psychodynamic psychotherapy in the most acute settings. This is a discussion of ‘T’, a 10 year-old girl who attended an Emergency Department in acute mental health crisis. ‘T’ arrived to the ED highly traumatised, distressed and dissociated; unable to talk or tolerate any form of direct interview. She was able to offer valuable insights into her internal world through drawings, jokes and poetry. In this way, the engagement thickened, transforming what might have been a formulaic process into something genuinely therapeutic. The Conversational Model’s emphasis on working with that which is offered: the valuing of metaphor, analogical relatedness, empathic attunement and inter-subjectivity, was crucial to the success of this engagement.

Current practice in NSW dictates that almost all persons attending Emergency Departments be seen and treated within 4 hours. At a time when acute mental health services are increasingly pressured to ‘flow’ clients through their systems, the emphasis on genuine therapeutic engagement can suffer. The example in this paper demonstrates a brief engagement that has authentic clinical import and resonance, even in these difficult circumstances; albeit with a note of caution.

This paper aims to examine the utility of the Conversational Model within an acute, public mental health system setting. It also aims to offer an orientation to the Conversational Model’s key theoretical concepts and clinical practices, particularly the clinical engagement as a form of play or reverie.

Speakers: Duncan Loasby
Areas of Interest / Categories: ANZAP 2016

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?