Conversational model

Last updated

The conversational model of psychotherapy was devised by the English psychiatrist Robert Hobson, and developed by the Australian psychiatrist Russell Meares. Hobson listened to recordings of his own psychotherapeutic practice with more disturbed clients, and became aware of the ways in which a patient's self—their unique sense of personal being—can come alive and develop, or be destroyed, in the flux of the conversation in the consulting room.

Contents

The conversational model views the aim of therapy as allowing the growth of the patient's self through encouraging a form of conversational relating called 'aloneness-togetherness'. This phrase is reminiscent of Winnicott's idea of the importance of being able to be 'alone in the presence of another'. The client comes to eventually feel recognised, accepted and understood as who they are; their sense of personal being, or self, is fostered; and they can start to drop the destructive defenses which disrupt their sense of personal being.

The development of the self implies a capacity to embody and span the dialectic of 'aloneness-togetherness'—rather than being disposed toward either schizoid isolation (aloneness) or merging identification with the other (togetherness). Although the therapy is described as psychodynamic, and is accordingly concerned to identify activity and personal meaning in the midst of apparent passivity, it relies more on careful empathic listening and the development of a common 'feeling language' than it does on psychoanalytic interpretation.

Psychodynamic Interpersonal Therapy (PIT)

In its manualised form ('PIT'), the conversational model is presented as having seven interconnected components. [1] These are:

Research

The conversational model, which has been manualised as Psychodynamic-Interpersonal Therapy, [1] [2] has been subject to outcome research, and has demonstrated effectiveness in the treatment of depression, [3] psychosomatic disorders, [4] self-harm, and borderline personality disorder. [5] [6]

Notes and references

  1. 1 2 Guthrie, E. (1999) Psychodynamic interpersonal therapy, Advances in Psychiatric Treatment, 5: 135-145.
  2. Shapiro, D. A. & Firth, J. A. (1985). Exploratory Therapy Manual for the Sheffield Psychotherapy Project. (Memo 733) Psyschological Therapies Research Centre, University of Leeds, England.
  3. Shapiro, D. A., Barkham, M., Rees, A., Hardy, G. E., Reynolds, S., Startup, M. (1996). Effects of treatment duration and severity of depression on the effectiveness of cognitive-behavioral and psychodynamic-interpersonal psychotherapy. Journal of Consulting and Clinical Psychology, 64, 1079-85.
  4. Guthrie, E., Creed, F., Dawson, D. & Tomenson, B. (1991). A controlled trial of psychological treatment for the irritable bowel syndrome, Gastroenterology, 100, 450-457.
  5. Korner, A., Gerull, F., Meares, R., & Stevenson, J. (2006). Borderline personality disorder treated with the conversational model: a replication study. Comprehensive Psychiatry, 47, 406-411
  6. Stevenson, J. & Meares, R. (1992). An outcome study of psychotherapy for patients with borderline personality disorder. American Journal of Psychiatry, 149, 358-62

Further reading

Related Research Articles

<span class="mw-page-title-main">Psychotherapy</span> Clinically applied psychology for desired behavior change

Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome problems. Psychotherapy aims to improve an individual's well-being and mental health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills. Numerous types of psychotherapy have been designed either for individual adults, families, or children and adolescents. Certain types of psychotherapy are considered evidence-based for treating some diagnosed mental disorders; other types have been criticized as pseudoscience.

Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group. The term can legitimately refer to any form of psychotherapy when delivered in a group format, including art therapy, cognitive behavioral therapy or interpersonal therapy, but it is usually applied to psychodynamic group therapy where the group context and group process is explicitly utilized as a mechanism of change by developing, exploring and examining interpersonal relationships within the group.

<span class="mw-page-title-main">Borderline personality disorder</span> Personality disorder with strong emotions

Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a personality disorder characterized by a long-term pattern of unstable interpersonal relationships, distorted sense of self, and strong emotional reactions.

<span class="mw-page-title-main">Dialectical behavior therapy</span> Psychotherapy for emotional dysregulation

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat personality disorders and interpersonal conflicts. Evidence suggests that DBT can be useful in treating mood disorders and suicidal ideation, as well as for changing behavioral patterns such as self-harm and substance use. DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies, and ultimately balance and synthesize them—comparable to the philosophical dialectical process of thesis and antithesis followed by synthesis.

<span class="mw-page-title-main">Otto F. Kernberg</span>

Otto Friedmann Kernberg is an Austrian-born American psychoanalyst and professor of psychiatry at Weill Cornell Medicine. He is most widely known for his psychoanalytic theories on borderline personality organization and narcissistic pathology. In addition, his work has been central in integrating postwar ego psychology with Kleinian and other object relations perspectives. His integrative writings were central to the development of modern object relations, a theory of mind that is perhaps the theory most widely accepted among modern psychoanalysts.

Countertransference is defined as redirection of a psychotherapist's feelings toward a client – or, more generally, as a therapist's emotional entanglement with a client.

Transference is a phenomenon within psychotherapy in which repetitions of old feelings, old attitudes, old desires, and/or old fantasies that someone displaces, are subconsciously projected onto a here-and-now person. Traditionally, it had solely concerned feelings from a primary relationship during childhood.

<span class="mw-page-title-main">Cognitive analytic therapy</span> Form of psychological therapy

Cognitive analytic therapy (CAT) is a form of psychological therapy initially developed in the United Kingdom by Anthony Ryle. This time-limited therapy was developed in the context of the UK's National Health Service with the aim of providing effective and affordable psychological treatment which could be realistically provided in a resource constrained public health system. It is distinctive due to its intensive use of reformulation, its integration of cognitive and analytic practice and its collaborative nature, involving the patient very actively in their treatment.

<span class="mw-page-title-main">Psychodynamic psychotherapy</span> Form of psychoanalysis and/or depth psychology

Psychodynamic psychotherapy and psychoanalytic psychotherapy are tow categories of psychological therapies. Their main purpose is revealing the unconscious content of a client's psyche in an effort to alleviate psychic tension, which is inner conflict within the mind that was created in a situation of extreme stress or emotional hardship, often in the state of distress. The terms "psychoanalytic psychotherapy" and "psychodynamic psychotherapy" are often used interchangeably, but a distinction can be made in practice: though psychodynamic psychotherapy largely relies on psychoanalytical theory, it employs substantially shorter treatment periods than traditional psychoanalytical therapies.

Multimodal therapy (MMT) is an approach to psychotherapy devised by psychologist Arnold Lazarus, who originated the term behavior therapy in psychotherapy. It is based on the idea that humans are biological beings that think, feel, act, sense, imagine, and interact—and that psychological treatment should address each of these modalities. Multimodal assessment and treatment follows seven reciprocally influential dimensions of personality known by their acronym BASIC I.D.: behavior, affect, sensation, imagery, cognition, interpersonal relationships, and drugs/biology.

Intensive short-term dynamic psychotherapy (ISTDP) is a form of short-term psychotherapy developed through empirical, video-recorded research by Habib Davanloo.

The integrative milieu model, developed by Kevin F. McCready, is an alternative treatment regime to the medical model of psychiatry for treating people suffering from psychological distress.

Interpersonal psychotherapy (IPT) is a brief, attachment-focused psychotherapy that centers on resolving interpersonal problems and symptomatic recovery. It is an empirically supported treatment (EST) that follows a highly structured and time-limited approach and is intended to be completed within 12–16 weeks. IPT is based on the principle that relationships and life events impact mood and that the reverse is also true. It was developed by Gerald Klerman and Myrna Weissman for major depression in the 1970s and has since been adapted for other mental disorders. IPT is an empirically validated intervention for depressive disorders, and is more effective when used in combination with psychiatric medications. Along with cognitive behavioral therapy (CBT), IPT is recommended in treatment guidelines as a psychosocial treatment of choice for depression.

Mentalization-based treatment (MBT) is an integrative form of psychotherapy, bringing together aspects of psychodynamic, cognitive-behavioral, systemic and ecological approaches. MBT was developed and manualised by Peter Fonagy and Anthony Bateman, designed for individuals with borderline personality disorder (BPD). Some of these individuals suffer from disorganized attachment and failed to develop a robust mentalization capacity. Fonagy and Bateman define mentalization as the process by which we implicitly and explicitly interpret the actions of oneself and others as meaningful on the basis of intentional mental states. The object of treatment is that patients with BPD increase their mentalization capacity, which should improve affect regulation, thereby reducing suicidality and self-harm, as well as strengthening interpersonal relationships.

Transference focused psychotherapy (TFP) is a highly structured, twice-weekly modified psychodynamic treatment based on Otto F. Kernberg's object relations model of borderline personality disorder. It views the individual with borderline personality organization (BPO) as holding unreconciled and contradictory internalized representations of self and significant others that are affectively charged. The defense against these contradictory internalized object relations leads to disturbed relationships with others and with self. The distorted perceptions of self, others, and associated affects are the focus of treatment as they emerge in the relationship with the therapist (transference). The treatment focuses on the integration of split off parts of self and object representations, and the consistent interpretation of these distorted perceptions is considered the mechanism of change.

<span class="mw-page-title-main">Peter Fonagy</span>

Peter Fonagy, is a Hungarian-born British psychoanalyst and clinical psychologist. He studied clinical psychology at University College London. He is a Professor of Contemporary Psychoanalysis and Developmental Science Head of the Division of Psychology and Language Sciences at University College London, Chief Executive of the Anna Freud Centre, and a training and supervising analyst in the British Psycho-Analytical Society in child and adult analysis. His clinical interests center on issues of borderline psychopathology, violence, and early attachment relationships. His work attempts to integrate empirical research with psychoanalytic theory. He has published over 500 papers, and 270 chapters and has authored 19 and edited 17 books.

Eating recovery refers to the full spectrum of care that acknowledges and treats the multiple etiologies of anorexia nervosa and bulimia, including the biological, psychological, social and emotional causes of the disorder, through a comprehensive, integrated treatment regimen. When successful, this regimen restores the individual to a healthy weight and arms them with the skills and resources needed to maintain a sustainable recovery. Although there are a variety of treatment options available to the eating disorders patient, the intensive and multi-faceted program followed in eating recovery is the appropriate option for individuals who require intensive support and are able to commit to treatment in an inpatient, residential or full-day hospital setting.

Supportive psychotherapy is a psychotherapeutic approach that integrates various therapeutic schools such as psychodynamic and cognitive-behavioral, as well as interpersonal conceptual models and techniques.

The mainstay of management of borderline personality disorder is various forms of psychotherapy with medications being found to be of little use.

Dynamic deconstructive psychotherapy (DDP) is a manual-based treatment for borderline personality disorder.