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.
Communicative play, analogous to the proto-conversation, is a model for therapeutic interaction that facilitates association and integrates trauma. The core of the therapeutic process is development of a feeling language that focuses on the experience of feeling in the ‘here and now’ of each session in the context of a trusting therapeutic relationship leading to shared understanding.
1) Be able to articulate a normative model of self and mental life
2) Identify conversational processes of growth and differentiation in self
3) Identify basic moves in facilitating the patient’s capacity to express
experience (find his or her voice)
4) Be able to explain the model of therapy to a patient
An Introduction to the spectrum of short term approaches in the Conversational model
By Dr Loyola McLean
Although the Conversational Model began as an approach to seeing difficult patients, often on the wards as well as outpatients and of varying length, it became more associated in Australia with intensive long term therapy for complex trauma. This talk will instead outline some of the various shorter term applications of the CM including: 1) ultra- brief work in the ED, clinic, wards or general practice; 2) Formal Psychodynamic Interpersonal Therapy (PIT) of 4-8 sessions and its evidence base; 3) the CM as a model of trauma-informed care for individual clinicians and team, including acute care teams and their supervision.
A later talk will focus on the STDIP. This talk will outline the common framework of fostering the bond with the patient, developing a shared understanding of the problem (the formulation) to inform an agreement on treatment and the way real experience and feeling language are used to help the healing process.
By the end of this lecture the student will be able to:
1) Describe several shorter term applications of the Conversational Model
2) Outline the evidence base for Psychodynamic Interpersonal Therapy (PIT)
3) Take a framework of the process common to shorter term work in the CM to
their clinical encounters: fostering the bond; developing a share
understanding (formulation) and using feeling and feeling language in the
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.
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.