Being in therapy

What is it like to experience the Conversational Model of Psychodynamic Psychotherapy?

What will my therapist expect from me?

It is important to get into a pattern of attending therapy regularly and to let your therapist know if you cannot attend. There will be times when you don’t feel like coming or when you think that you don’t have anything worthwhile or significant to talk about. It is important to come at these times anyway as often the very thing that is getting in the way of coming is an important thing to talk about in therapy.

What difficulties might arise in therapy?

Sometimes you might feel like nothing has changed or you may worry that you are not making changes fast enough. It is important to hold in mind that there is no expectation that you should be able to make major changes in your life quickly or easily. This approach recognises that change takes time because it is a complex process. Usually changes occur on the inside first and it can be difficult to see these changes happening when you live with yourself all the time. Your therapist will help you to notice changes, no matter how small they seem.

Sometimes you may find that some of the people closest to you, who have encouraged you to get help, may change their mind and decide that therapy is not helping you. This may be an indication that you are changing and that these changes are puzzling and troublesome to someone close to you. Sometimes the people around you will be convinced that you are getting worse, often just at the time when you feel you are starting to improve.

Sometimes you might also feel worse and discouraged at some stages of therapy. It is important to try and keep going during these times. These uncomfortable feelings are often a good indications that you're working on difficult problems. Let your therapist know your concerns. If you can stick with it, things are likely to improve over time.

What should I do if I feel like I want to stop therapy?

Therapy can be very hard work and it’s natural to feel like stopping when it’s hard. Although it may be painful or even scary at times, the pace of the therapy is always guided by you. You won’t be asked or expected to talk about anything you don’t want to.

If you find that you wish to leave therapy earlier than the agreed time, naturally this is your decision and your right to do so. However, we would encourage you to discuss your reasons for leaving with your therapist first, in case some obstacles can be overcome together. If you have already decided to leave, please return for one last session so that you have an opportunity to share any unresolved concerns and both you and your therapist have a chance to say goodbye.

More questions?

We encourage you to discuss any issues or further questions with your therapist.

What is the Conversational Model?

It was developed by Robert Hobson and Russell Meares in the 1960s. It stems from psychodynamic theories, developmental theories on early childhood attachment and recent memory research. It was initially developed specifically to help people with borderline personality disorder. It is now being used more broadly with other clinical disorders.

What evidence is there that it works?

Research studies have described very successful outcomes for the majority of a group of 30 patients with borderline personality disorder after one year of twice a week therapy. The patients in this study were followed up after five years and the researchers found that they had maintained the progress they had made in therapy (Stevenson & Meares, 1992 & 1999). Later research found the model is effective for day-to-day psychotherapeutic practice.

How does it work?

Research with babies and toddlers shows us that children need a supportive environment in order to feel safe enough to play so that they can explore the world and experiment with what they like and dislike. They also need to be listened to and understood in a supportive relationship so that they can learn that it is okay to be themselves, to feel valued and to develop a continued sense of wellbeing. Some people miss out on these early experiences. This therapy offers a space for you to be yourself and to be fully listened to in a way that may be different from what you have experienced before. By having the space to talk about confusing thoughts and feelings it will eventually allow you to understand yourself better.

The quality of the relationship is considered a very important aspect of the therapy. The therapist aims to be supportive, trustworthy, reliable and predictable. We believe that it’s important that we create a space where it is safe for you to express yourself. The therapist will treat what you say with respect and will ensure confidentiality.

What actually happens in therapy?

The therapist tries to listen carefully to how you feel and to pay attention to particularly very small emotional changes. The therapist then feeds back with you about what he or she has heard and checks with you to see if this fits with your experience. So in some ways it is different than a normal conversation in that this will be your space where the priority is on the therapist really listening to your experience.

Your therapist will encourage you to talk about anything that comes to your mind. At first it may be difficult to figure out what to talk about and you may find yourself ‘editing out’ things that seem trivial or unimportant. You may also worry that something is too inappropriate to say. In life we often ‘edit’ what we’re really thinking because we can get ourselves into trouble with others if we say everything we think! In psychotherapy it is helpful to say what ever comes to mind. Often what you think is trivial and unimportant is actually the key to something very important. It takes a while to get used to this approach before you can truly believe that what you have to say will be accepted.

Your therapist won’t tell you what to talk about or give you advice. Sometimes this can be frustrating, but there are important reasons for this. Most people have not had many opportunities of talking things over with someone who does not try to make the decisions for them. Your therapist does not think that he or she knows the answers, or knows what is best for you. Instead you will be supported to explore and figure out what is best for you.

Often people try to think their way through issues and they might expect themselves to have it all sorted out in their heads before saying it out aloud. This therapy is more about feeling and noticing instead of needing to be logical, so you will be encouraged to express things even if they don’t make sense to you yet.

The therapy may also help you to explore your general patterns of relating to people. Over time, you may notice that the way you relate to your therapist may be similar to how you relate to other people in your life. For example, if you have difficulty trusting people, you may have difficulty trusting your therapist. Noticing these patterns can help you to understand yourself and your needs in your relationships.

Why is it called the Conversational Model?

Quite simply it’s because the therapy happens through a conversation between you and your therapist. Through having a place where someone listens closely to you and reflects back to you what they have heard, you can come to develop a different understanding of yourself.