The psychotherapy of commonly occurring personality disorders – borderline, narcissistic, dependent, avoidant and obsessive compulsive – presents the therapist with a unique therapeutic challenge, as each of these personality disorders rarely occur alone. The therapist is required to have a basic understanding of personality and psychopathology; to be empathically attuned to the patient’s complaints, problems, symptoms and respond to the subtle nuances of the patient’s communication, both verbal and non-verbal; to be aware of the patient’s relational functioning, and have a flexible theoretical framework from which to proceed. This paper will describe such a theory i.e. the Conversational Model and its approach to traumatised individuals who present for psychotherapeutic help.
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 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 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.
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.
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.