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.
Languages of words and music and gesture develop and weave through our relational life, becoming connected with our inner voice and musings, tracking the trajectory of our development: the joy of companionship, the pride of achievement and the vicissitudes of trauma and loss. Parent-infant and attachment research has something to offer in operationalizing the individual and dyadic state and their change over time in our psychotherapeutic conversations.
This talk aims to illustrate the utility of the CARE-Index, examining the music and dance of dyads, and the Adult Attachment Interview, scored via linguistic markers to reveal attachment states of mind and markers of reflective functioning, in assessing the therapeutic interchange and the resolution of trauma in our ongoing process of formulation, reformulation and reformation. These approaches will be outlined and then applied to an adult psychotherapy context, taking examples from earlier and later sessional material (used with permission) to demonstrate change. These ways of evaluating the music and the dance of self and dyad are helpful to the therapist seeking to reflectively track process and change and foster transformation.
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.
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.
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.
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.
Over the last century there have been significant changes in understanding the mind and brain: both in psychiatric practice; and in psychotherapeutic practice. In psychodynamic thought the central change is a theoretical shift away from drive theory, with its intra-psychic focus, towards relational theory, with an intersubjective focus. The recognition of the role of relational trauma as a common basis for mental suffering confronts us with a communal responsibility to provide adequate therapeutic responses. In this talk some of the key points in the evolution of psychodynamic theory are highlighted, particularly seeking to identify points of practical application to current psychotherapeutic practice. In addition some of the research by the Westmead Psychotherapy Program is highlighted with respect to contributions to outcome, phenomenological, and process research.