Dr. Robert Hobson (my father, known to colleagues, students and almost eve- ryone else as Bob Hobson) developed what he called the Conversational Model of psychotherapy. Tis was in the context his experience as a Jungian analyst as well as a psychotherapist within the UK National Health Service, where for a long time he was responsible for an in-patient ward run on therapeutic com- munity lines. In his book, Forms of Feeling (R.F. Hobson 1985, from which all subsequent page-numbered quotations are taken), Bob Hobson lays out the theoretical basis for his approach in chapters with headings such as Persons, Symbols, and Seeing. Te theoretical orientation he adopts is strongly influ- enced by writings in philosophy and literature, perhaps most notably those of Buber, Wittgenstein, and Coleridge.
About half way through his book, Bob Hobson summarizes the thinking behind and procedures of the Conversational Model. In part from a wish to provide explicit guidance for would-be psychotherapists at the very begin- ning of their training, and in part because he believed there are some sim- ple but valuable ways to foster engagement with someone at an emotionally deep level, Bob Hobson listed certain principles that might shape a therapist’s interventions. His further aim was to specify the approach so that it could be subject to scientific evaluation. He wrote (p. 182): “We cannot begin to study the results of such a nebulous process as ‘psychotherapy’ in any meaning- ful way unless we can first state unambiguously what is done and for what reasons.”
Te Conversational Model is designed for treating patients whose prob- lems arise from defects or disturbances in significant relationships. Hobson described how it “aims at the promotion of unlearning and of new learning in a dialogue between persons. A situation is created in which problems are disclosed, explored, understood, and modified within a therapeutic conversa- tion” (p. 182). In essence, the therapist is trying to reach understanding of a patient, especially the patient’s current feelings in therapy; to articulate, share, and modify such understanding through a “mutual feeling language”; and to promote insight and explore the meanings of the person’s experience and conduct. Bob Hobson was especially concerned to foster the “development of the dynamic relationship of aloneness-togetherness” (p 183). He wrote:
explanatory interpretations are not the goal of therapy, nor are they essential for “insight.” Tey are useful in organizing, in ma king sense of, immediate experiences and helping the acknowledgement of disclaimed actions; but these formulations are
THE CONVERSATIONAL MODEL (PSYCHODYNAMIC INTERPERSONAL THERAPY, PIT) 27
important only in so far as they promote on-going, understanding conversations in a language of feeling which is developing now. (p. 198)
A formal version of the approach became known as Psychodynamic Interpersonal Terapy, admirably summarized and discussed by Guthrie (1999).
Therapeutic approach
As in each of the examples of brief psychotherapy given here, the principles outlined should not be viewed as the be all and end all of treatment. In the case of the Conversational Model, for example, Bob Hobson stressed that the prime task of a psychotherapist is “to go on learning more about how to listen” (italics in the original, p. 208).
Psychotherapy needs to take place within an agreed timeframe, and the number of sessions and date of ending are made clear at the outset. Within this structure, the therapist embarks on the task of understanding the patient’s emotional experience, through tentative exploration. Te therapist tends: • to focus on the here and now relation between patient and therapist, and be
prepared to address hidden feelings that are either evident but unavailable to the patient, or missing when they would be appropriate to what is being recounted or relived
• to make statements (rather than asking questions) to express the thera- pist’s understanding of a patient’s experience
• to employ metaphors and other “living symbols” to capture and explore a patient’s emotional states
• to employ first person words “I” and “we,” the use of which “affirms the aim of a conversation between two separate and yet related responsible persons who, alone and together, claim their actions” (p. 196).
• in due course, to offer “understanding hypotheses” about reasons that might underlie the patient’s difficulties
• to point out recurring themes in the patient’s different relationships, both past and present, including links with the patient–therapist relationship; and to indicate connections with the patient’s symptoms or other present- ing complaints
• to aim at the “reduction of fear associated with separation, loss, and aban- donment” (p. 196), and to draw attention to moments in psychotherapy when the patient does or feels something new.
Te therapist needs to set interventions in a meaningful sequence, so that for instance, staying with feelings comes first and articulating explanatory
THEMES AND VARIATIONS IN BRIEF PSYCHODYNAMIC PSYCHOTHERAPY 28
hypotheses only later. Serious thought is given to the ending of treatment, both for its personal significance to the patient and because of the need to review the value and limitations of what has occurred in the course of psychotherapy.
Here is a brief sequence of edited dialogue (omitting most of the commen- tary that appears in the original text, as well as some of the verbal exchanges) between Bob Hobson and a patient Freda, distilled from Chapter 2 of Forms of Feeling (R.F. Hobson 1985, pp. 22–24: I adopt “RFH” and “Freda” from the original):
�����: It just seems to be bottled up. And I feel guilty over that, as though there’s something wrong with me—that I should be crying and yet I just can’t cry.
���: Well, I think you are feeling a lot inside.
[from text, p. 22: “As I say these words, I move toward her speaking with my hands. My fingers move back and forwards between my tummy and hers. I then point to the space between us.”]
GAP
�����: Tere’s … this terrible empty feeling I’ve got inside.
��� [from text p. 23: “I speak with my hands, gently moving them up and down with palms towards her.”]: Sort of … empty.
�� ���: Empty. Just empty.
��� (discovering his right hand is over his heart): You put your hand about here.
����� (repeating RFH’s movement): Just about here. Emptiness. ���: Mm.
�����: Just empty.
���: Just as if there is nothing there at all … Let me make a guess … er … I think that there are times … when you feel bad … that you can’t love people enough.
�����: Tat’s just it.
Freda then elaborates on her lack of love for her husband and mother, and her guilt about this.
Overall, then, the Conversational Model encourages mutual exploration between patient and therapist. Te tone is collaborative, and the primary aim is to achieve, express, and share interpersonal understanding, both verbally and nonverbally, especially in relation to what is happening in the present interaction between patient and therapist. It is this process that affords the patient new ways of seeing (insights) and provides the basis for change.