Professor Else Guthrie has applied the Conversational Model, with its understanding of relational trauma, to a range of acute and somatic presentations. Her employment of a written goodbye letter provides a focus for integration as patients move beyond therapy.
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 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.