Conversational model

1. Introduction

Version followed: the Conversational Model (CM) as Robert Hobson set it out in Forms of Feeling (1985), together with Russell Meares's development of it for borderline and trauma-related disorders: Intimacy and Alienation (2000), A Dissociation Model of Borderline Personality Disorder (2012), and the Norton clinician's manual (Meares, Bendit, Haliburn, Korner, D. Meares & Butt, 2012). Psychodynamic Interpersonal Therapy (PIT), the brief manualised UK sister variant from Sheffield and Manchester (Shapiro & Firth 1985; Guthrie 1999), is named here only. Where this guide uses PIT's component labels (cues, statements, hypotheses), they are Hobson's ideas in PIT's wording.

Source caveat. The primary books are not drawn on here. Their tables of contents, abstracts, chapter structure and key terms are taken from catalogue pages, abstracts and reviews (see Sources). The detailed account of Meares's response forms (coupling, amplification, representation), of script, chronicle and narrative, and of disruption–repair comes from the published literature. These items are tagged [uncertain] wherever the exact detail matters. All therapist wording in this guide is illustrative unless it is quoted and cited.

What it is. CM is a psychodynamic, relational therapy. Hobson devised it from recordings of his own sessions with severely disturbed patients, and Meares extended it in London and then Sydney (Westmead). It treats the patient's self (William James's reflective "I–me" consciousness, Meares's "personal being") as the thing that is damaged and the thing to be grown. [source: Wikipedia, Conversational model; Meares 2004 abstract; GoodTherapy AU]

How change happens. The self is not a fixed structure. It emerges, and it emerges only within a particular form of relatedness and conversation, much as a child's self emerges in play in the presence of an attuned caregiver. Hobson called that form "aloneness-togetherness". Developmental trauma disrupts the self's emergence and leaves an unconscious traumatic memory system that keeps intruding on it. The therapist creates a conversation whose form (attuned, analogical, feeling-based) lets the self come alive, and repairs the inevitable disruptions. Over time the patient's mental life shifts from stereotyped, stimulus-bound talk (script and chronicle) towards reflective, personal narrative. The self becomes more integrated, which in Meares's 2012 dissociation model means less disconnected. [source: Meares 2004 abstract; Wikipedia; NWAPS; metapsychology review of Meares et al. 2012] [uncertain: the fine detail of the 2012 dissociation model]

2. Framework

Status. CM is not organised into formal, manualised phases. Meares's manual gives a long case story (a two-year treatment) and chapters on the "therapeutic field", therapist language and attitude, the care network, and an adherence scale (CoMTAS), but it does not set out a stage protocol. PIT, the brief variant, has an implicit early, middle and late structure. The phases below are therefore a working synthesis. They combine Hobson's account of negotiating a conversation, Meares's account of the emergence of self, and the PIT sequence of moving from feeling to explanation. [synthesis] [source: metapsychology review; Halovic et al. 2018 CoMTAS citation; Wikipedia]

Format and dose.

Individual, face to face, in a stable frame: same room, same time, regular breaks announced in advance.
CM for borderline personality disorder: about twice weekly for one to two years. The Westmead outcome studies (Stevenson & Meares 1992; Korner et al. 2006) used roughly one year of twice-weekly therapy. [uncertain: the exact frequency in each study was not verified here]
The manual's case: two years. [source: metapsychology review]
PIT, brief form: commonly 8–16 weekly sessions in the Sheffield trials, and shorter adaptations exist, e.g. a four-session home-based version for self-harm. [uncertain: dose taken from the trial literature]
Coordination with the wider care network (GP, psychiatrist, crisis services) is part of treatment for severe cases. [source: metapsychology review, manual ch. 5]

Phase A: Establishing the therapeutic field and a shared conversation (early sessions; in brief PIT, sessions 1–3)

Goals: agree the frame. Negotiate a shared, exploratory understanding that links the patient's symptoms to relational difficulties (PIT's "exploratory rationale"). Begin a language of mutual feeling. Map the patient's characteristic conversational forms (chronicle, script, moments of narrative) and the triggers of traumatic states. [source: Wikipedia (PIT components); manual ch. 6 per review]
Move on when: the patient comes back regularly. There are moments of felt contact (the voice softens, the patient pauses and reflects, images appear). You have an emerging shared sense of the main relational pain. [synthesis]

Phase B: Fostering the emergence of self, and disruption–repair (the bulk of therapy)

Goals: sustain analogical relatedness through coupling, amplification and representation. Stay with feeling in the here and now. Recognise disruptions and shifts into the traumatic memory system, and repair them. Gradually make the script visible and give it words. [source: Meares 2000, 2012; Hobson 1985] [uncertain: the detail]
Move on when: disruptions are noticed and repaired faster, often by the patient. Chronicle and script give way to longer stretches of reflective narrative. The patient can talk about inner states as their own ("I felt…" rather than "it happens"). There is less acting out, such as self-harm or crisis presentations. [synthesis, drawing on the Butt/Meares discourse-correlates work]

Phase C: Explanatory linking, integration and ending (final months; in brief PIT, the last third)

Goals: offer explanatory hypotheses that link the here-and-now relationship, current relationships and the past (sequenced only after a base of shared understanding exists). Acknowledge change. Work through the ending as a relational event that may itself trigger the script. [source: Wikipedia (PIT: sequencing, insight, acknowledging change)]
End when: the patient can hold a coherent personal narrative of their difficulties. Gains survive breaks. The ending can be talked about with feeling rather than enacted. [synthesis]

3. Guiding principles

Each principle is followed by what it means in practice.

The self is the target. Track whether the patient is "alive" (reflective, imaginative, feeling) or not, minute by minute, and treat that as the main outcome. [source: Meares 2004 abstract]
The form of the conversation constitutes the self. How you talk (rhythm, tone, tentativeness, mutuality) matters more than what you explain. [source: Meares 2004 abstract]
Aloneness-togetherness (Hobson). Be present but not intrusive, so that the patient can be "alone" with their own inner life in your company. Don't fill silences. [source: Wikipedia; Hobson 1985]
Analogical relatedness is the principal therapeutic agent (Meares). Respond with something that has the same shape as the patient's experience before you respond with anything about it. [source: metapsychology review]
Language of mutual feeling (Hobson). Build a shared, personal vocabulary out of the patient's own words and images, not jargon. [source: Wikipedia; Hobson 1985]
Understanding before explaining. Put empathic understanding first. Use explanatory interpretation sparingly, later, and only on that ground. [source: Wikipedia (sequencing)]
Statements, not questions. Offer tentative statements that the patient can correct. Questions push the patient into fact-giving, which is chronicle. [source: Wikipedia; Guthrie et al. 2018 abstract]
Hypotheses, held lightly. Everything you offer is a conditional hypothesis to be negotiated. Use "perhaps", "I wonder", "it sounds as if". [source: Wikipedia]
Minute particulars and cues (Hobson, after Blake). Pick up the small, live details: a word, a sigh, a change of tone. That is where the self shows itself. [source: Hobson 1985; Guthrie et al. 2018 abstract ("picking up cues")]
Here and now. Prefer feelings present in the room to abstract talk about feelings. [source: Wikipedia]
Trauma is understood as an intrusive memory system, not a story. Expect sudden state shifts and stereotyped scripts, and read them as triggered memory rather than as "resistance". [source: metapsychology review; Meares 2000] [uncertain: detail]
Disruption is inevitable, and repair is therapeutic. Your own misattunements will happen. Notice them and own them aloud. [source: Meares 2000/2012] [uncertain: detail]
Mutuality and "I"/"we". Speak as a person ("I find myself…", "we seem to…"), not from behind a role. [source: Wikipedia]
Value the positive force. Two forces shape the conversation, one towards selfhood and one traumatic. Feed the first rather than chasing the second. [source: metapsychology review]
Pacing and tolerable doses. Slow down, and let feeling come in amounts the patient can bear. [source: Mental Health Academy (secondary)]
The therapist's feelings are information. Your boredom, deadness, urge to rescue or flash of irritation tells you about the conversation's form. Reflect on it before you voice it. [source: Mental Health Academy (secondary); Hobson 1985, Book III] [uncertain: the Book III attribution is based on the chapter title only]

4. Intervention inventory

The model is mainly a way of conversing, not a toolkit of exercises. The interventions below are response forms and conversational moves its authors describe, and none of them are worksheets or homework. Items 4.1–4.10 come from Hobson's model, using the component names PIT later gave them. Items 4.11–4.20 are Meares's developments. [source: Wikipedia; Guthrie et al. 2018 abstract; metapsychology review]

4.1 Negotiating the therapeutic field and an exploratory rationale

Purpose / when: First sessions, and again after any break or crisis. It sets a safe, predictable frame (the manual's "therapeutic field") and a shared working idea that the patient's symptoms are bound up with how they relate to people, including you. [source: Wikipedia (exploratory rationale); manual ch. 6 per review]
Steps:
1. Agree the practicalities: time, frequency, length, breaks, how contact between sessions works, and the crisis plan and care network.
2. Invite the patient to talk in their own way, and listen for where the pain is relational.
3. Offer a tentative link between symptom and relationship, and invite correction.
4. Explain briefly that you will mostly talk with them about what happens between you, rather than give advice.
5. Return to the frame whenever it is tested (lateness, between-session contact) and treat it as meaningful, without punishing.
Example language (illustrative): "It sounds as if the panic comes most when someone close seems to pull away. I might be wrong. Perhaps that's something we could look at together here." / "We'll meet Tuesdays and Fridays. I'll let you know about my breaks well ahead, because I imagine gaps might matter."
Watch for: compliant agreement with no feeling behind it (chronicle-style yes). It is working when the patient adds to or corrects your link with their own example.

4.2 Picking up cues (minute particulars)

Purpose / when: Throughout. It catches the small, live signs of feeling or self (a sigh, an image, a shift of word, a laugh, a change of pace) that would otherwise pass by. [source: Hobson 1985 (minute particulars); Guthrie et al. 2018 abstract]
Steps:
1. Listen to the music as well as the content: tone, tempo, pauses, body, and the odd or vivid word.
2. Choose the one cue that seems most alive or most avoided. Don't pick up everything.
3. Return it gently, close to the patient's own words.
4. Then wait, and let the patient take it further or leave it.
Example language (illustrative): "You said 'just' a hospital visit. There was a little catch in your voice on 'just'." / "You smiled as you said that."
Watch for: turning a cue into an interrogation, or picking up a cue that shames the patient. It is working when the patient elaborates spontaneously, slows down, or brings an image.

4.3 Statements rather than questions

Purpose / when: Default stance, especially when the patient is giving a factual chronicle. Questions demand information and keep the patient outward-facing. Statements offer an understanding the patient can check against their inner experience. [source: Wikipedia; Guthrie et al. 2018 abstract; Hobson 1985]
Steps:
1. Notice the urge to ask ("How did you feel?", "Why?").
2. Turn it into a tentative statement about what it might be like.
3. Leave space after it. The patient can confirm, amend or reject.
4. Keep factual questions for necessary practical and risk matters.
Example language (illustrative): Instead of "How did you feel when he left?", say "I imagine the room felt very empty after he went."
Watch for: statements that are really disguised interpretations, or that are too certain. It is working when the patient shifts from reporting events to describing experience.

4.4 Understanding hypotheses (tentative, conditional language)

Purpose / when: Whenever you offer a sense of what the patient is feeling or experiencing. It conveys that you are trying to understand, not to diagnose, and leaves the patient as the authority on their own experience. [source: Wikipedia (conditional statements, tentative hypotheses); Guthrie et al. 2018 abstract]
Steps:
1. Keep it short, in the present tense, and about feeling.
2. Frame it conditionally: "perhaps", "I wonder", "it sounds as if", "I may be wrong".
3. Base it on something the patient actually said or showed.
4. If the patient corrects you, take up their version warmly and build on it.
Example language (illustrative): "Perhaps part of you was furious, and another part felt you had no right to be."
Watch for: over-hedging that sounds vague or anxious. It is working when the hypothesis is refined jointly and the patient's vocabulary for feeling grows.

4.5 Mutual "I" and "we" language (the language of mutual feeling)

Purpose / when: Throughout. It builds a shared, personal language and models two persons talking, as opposed to an expert and a case. [source: Wikipedia; Hobson 1985]
Steps:
1. Speak from your own experience of the moment ("I find myself…", "I'm struck by…").
2. Use "we" for the joint exploration ("we seem to keep coming back to…").
3. Adopt the patient's own words and images as the shared vocabulary, and keep reusing them across sessions.
4. Avoid technical terms.
Example language (illustrative): "I notice we both went quiet just then." / "That 'glass wall' you mentioned last week, it sounds as if we're on either side of it today."
Watch for: "we" that blurs boundaries or imposes closeness on a patient who fears merging. It is working when the patient starts using the shared images themselves.

4.6 Staying with feeling in the here and now

Purpose / when: When feeling appears in the room, or when the patient talks about feelings abstractly. Feelings that are actually present are where change happens. [source: Wikipedia (here and now; focus on feelings); Guthrie et al. 2018 abstract]
Steps:
1. When a feeling surfaces, slow down. Don't move to explanation or problem-solving.
2. Name it lightly, close to the patient's words, and keep the attention on it.
3. If the patient goes abstract or past-tense, gently bring it back to now.
4. Track tolerance, and back off if the patient begins to fragment (see 4.18 and 5).
Example language (illustrative): "Let's just stay with that for a moment. It sounds as if the sadness is here right now, as we talk."
Watch for: pushing feeling beyond tolerance (dissociation, shut-down). It is working when there is affect with coherence: the patient feels and can speak from it.

4.7 Working with metaphor and image (Hobson's "amplification" of images)

Purpose / when: When the patient offers an image or metaphor, or when feeling is hard to name directly. Metaphor carries feeling in analogical form and opens the inner life. [source: Wikipedia (metaphors unfold); Hobson 1971 "Imagination and amplification in psychotherapy" (cited in Equinox abstract)] [uncertain: Hobson's 1971 paper is not drawn on]
Steps:
1. Notice the image ("like a fog", "walking on glass").
2. Take it up in its own terms, not translated into plain language yet.
3. Let it develop: its texture, where it leads, what it is like inside it.
4. Keep the image available as shared language for later sessions.
Example language (illustrative): "A fog. So you can't see far, and perhaps nobody can see in either."
Watch for: imposing your own metaphors, or decoding them too quickly. It is working when the image becomes richer and more personal, and links to feeling.

4.8 Noting hidden or absent feelings

Purpose / when: When an expected feeling is missing (a loss told flatly), or a feeling is hinted at but disowned. [source: Wikipedia (difficult feelings)]
Steps:
1. Notice the gap between content and affect.
2. Name it gently as an observation, not a criticism.
3. Wonder about the absence rather than insisting on the feeling.
Example language (illustrative): "You've told me about the funeral very calmly. I wonder if the feelings have had to be put somewhere safe."
Watch for: shame ("I'm cold"). It is working when the patient becomes curious about the absence or a feeling arrives.

4.9 Explanatory hypotheses and linking (gaining insight), sequenced

Purpose / when: Later, and only after a base of shared understanding exists. Link what happens between you to the patient's current relationships and to the past. [source: Wikipedia (gaining insight; sequencing interpretations)]
Steps:
1. Wait until a pattern has appeared several times and has been felt, not just described.
2. Start with the here and now (between us), then current relationships, then the past.
3. Frame it as a hypothesis built from shared material, using the patient's words.
4. Check its fit, then return to feeling rather than staying intellectual.
Example language (illustrative): "When I mentioned the holiday you went very polite, rather like you said you'd go with your father when he was angry. Perhaps something of that comes in here between us."
Watch for: links given too early, which disrupt the conversation and feel like being "explained". It is working when the patient extends the link themselves with new material.

4.10 Acknowledging change

Purpose / when: When the patient does something new emotionally or relationally, in session or outside it. It reinforces the emergence of self. [source: Wikipedia (acknowledging change)]
Steps:
1. Notice the specific shift.
2. Name it briefly and warmly, without praise that sounds like grading.
3. Link it to the patient's own agency.
Example language (illustrative): "You told me you were annoyed with me, and we're both still here. That feels different."
Watch for: patients who fear that improvement means losing you. Pair the acknowledgement with reassurance about continuity. It is working when the patient can own the change.

4.11 Background presence (conditions for play and reverie)

Purpose / when: Throughout, and especially when the patient begins to muse, associate or drift reflectively. Meares models the self's emergence on a child's symbolic play in the presence of a quietly attentive caregiver. The therapist provides that background presence, so that non-linear, associative inner life can unfold. [source: metapsychology review (reverie and symbolic play as necessary for the self); NWAPS; Meares, The Metaphor of Play] [uncertain: detail]
Steps:
1. When the patient's talk becomes associative, loose and reflective, reduce your input.
2. Give minimal, rhythm-matched responses ("mm", repeating a word) that show you are there without steering.
3. Don't interrupt reverie with questions, clarifications or interpretations.
4. Protect the conditions: no note-taking flurries, interruptions or clock-watching.
Example language (illustrative): "Mm… the garden." Then silence.
Watch for: silence felt as abandonment by patients with trauma. Those patients need more audible presence. It is working when the patient's speech becomes non-linear and imaginative, with first-person reflection.

4.12 Analogical responsiveness: coupling

Purpose / when: The basic response form, and essential early on and after disruptions. The therapist's response matches the shape of the patient's expression (its feeling tone, intensity, rhythm and content) so that the patient feels met, as in the proto-conversation of mother and infant. The review calls analogical relatedness "the principal therapeutic agent". [source: metapsychology review] [uncertain: "coupling" is Meares's term for this form in his 2000/2012 books]
Steps:
1. Attend to the form of what the patient says (pace, pitch, energy, the image), not just its content.
2. Reply in a form that is analogous: matching tempo and intensity, echoing key words or images, mirroring the feeling level.
3. Keep it close. Add little or nothing new.
4. Check the effect. Does the patient continue, deepen, or relax?
Example language (illustrative): Patient, slowly and flatly: "Nobody… rang." Therapist, matching pace and tone: "Nobody rang… all day."
Watch for: mechanical parroting. Coupling is attunement, not repetition. It is working when there are moments of "fit": the patient visibly settles, says "yes, exactly", or goes further.

4.13 Analogical responsiveness: amplification

Purpose / when: Once coupling is established and there is a faint sign of feeling, vitality or self. The therapist takes up that sign and slightly enlarges it, as a parent enlarges an infant's gesture, so that it becomes more available to the patient. [source: Meares 2000/2012; Meares 2004 abstract refers to fostering the "amplification" of self-consciousness] [uncertain: the operational detail]
Steps:
1. Spot the small, positive or alive element: a flicker of interest, humour, preference, a memory with warmth.
2. Reflect it back with a little more emphasis or elaboration than the patient gave it.
3. Stay within what the patient can own. Don't inflate it into enthusiasm the patient doesn't share.
Example language (illustrative): "You lit up a bit just then, talking about the dog. Something in you really comes alive with her."
Watch for: amplifying something the patient isn't ready to own (they may feel exposed), or amplifying traumatic affect so it escalates. It is working when the patient expands the element, and it reappears in later sessions.

4.14 Analogical responsiveness: representation (representational responses)

Purpose / when: When the patient is in a state they cannot yet put into words. The therapist offers a picture, a word or an image that represents the inner experience, so it can be held, reflected on and become part of the self. [source: Meares 2000/2012] [uncertain: the operational detail]
Steps:
1. Draw on coupling: feel your way into what it might be like for the patient.
2. Offer a concise, concrete picture of the state, ideally built from the patient's own images.
3. Phrase it tentatively (4.4).
4. Let the patient correct and refine it, then use the refined version from then on.
Example language (illustrative): "It sounds a bit like being in a house where all the lights have gone off at once, and you don't know which room you're in."
Watch for: representations that are clever but not the patient's own. It is working when the patient adopts the representation, uses it reflectively ("I was in the dark house again"), and can then link it to triggers.

4.15 Recognising conversational forms: chronicle, script and narrative

Purpose / when: Continuous assessment. Meares distinguishes three forms of talk:
- Chronicle: linear, factual recounting of outer events. It is linked to "stimulus entrapment", in which the mind is captured by external stimuli and there is little inner life.
- Script: stereotyped, repeated, timeless expressions of traumatic memory.
- Narrative: personal, reflective, self-expressive talk in which inner and outer are joined.
The direction of therapy is towards narrative, and the patient's form tells you their state and what response is needed. [source: LINGUIST List thesis abstract (scripts, chronicles, narratives); ANZAP/PIT-UK seminar (chronicle, stimulus entrapment); Meares 1995] [uncertain: the precise definitions]
Steps:
1. Listen to the form, not only the content. Is it a list of events (chronicle)? A fixed, repeated, often harsh pattern (script)? Reflective and personal (narrative)?
2. Note shifts between forms within a session, and what came just before each shift.
3. Respond differently to each:
  - Chronicle: couple, then gently move inward (4.16).
  - Script: recognise the traumatic memory system (4.17).
  - Narrative: background presence (4.11) and amplification (4.13).
Example language (illustrative): This is mostly internal. When you share it: "I notice we've moved into the list of what happened. I wonder what it was like inside during all that."
Watch for: treating chronicle as resistance. It is a symptom of a self that is not yet available. It is working when sessions contain more and longer narrative stretches.

4.16 Moving from outer to inner (responding to chronicle and stimulus entrapment)

Purpose / when: When the patient is caught in factual, outer-world talk, or in reacting to stimuli. [source: ANZAP/PIT-UK seminar; Meares (chronicle)] [uncertain: technique detail]
Steps:
1. Don't interrupt the chronicle abruptly. Couple with it first (its pace and tone).
2. Find the smallest inner element in it: a word with feeling, a pause.
3. Offer a statement about inner experience attached to that element.
4. If the patient returns to chronicle, accept it and try again later. The shift is gradual.
Example language (illustrative): "Then the bus, then the shop, then the phone call… It sounds like a day you had to get through, one thing after another."
Watch for: the patient experiencing the inward turn as intrusive. It is working when brief reflective comments start appearing within the chronicle.

4.17 Identifying the traumatic memory system and its triggers

Purpose / when: When there is a sudden shift: the patient goes cold, self-attacking, panicky or blank, or the talk becomes stereotyped. Meares treats these as intrusions of an unconscious traumatic memory system, triggered by cues that resemble the original trauma, often something in the therapist's own response. [source: metapsychology review (traumatic memory systems overthrowing the self); Meares 2000] [uncertain: detail]
Steps:
1. Notice the shift: tone, syntax, eye contact, a sudden change of content or harshness.
2. Trace back to what happened just before it, particularly your own words, tone or movement.
3. Name the shift simply, without interpreting.
4. Together, identify the trigger and what the "old" state feels like.
5. Over many repetitions, build a shared map of triggers and the states they bring. That gives the patient a representation (4.14) of the trauma system.
Example language (illustrative): "Something changed just then. You'd been telling me about your sister, and then you went very far away. I wonder if it was when I looked at the clock."
Watch for: going straight to trauma content (detailed reliving), which can flood the patient. In this model the focus is on the shift and its trigger in the relationship. It is working when the patient starts to notice shifts themselves ("I just went into that place again").

4.18 Disruption–repair

Purpose / when: After any misattunement, such as a mistimed comment, a missed cue, a break, or lateness, that leads to withdrawal, anger or a traumatic state. Repair restores the analogical connection, and repeated repair is itself therapeutic. [source: Meares 2000/2012; NWAPS (disruption); Mental Health Academy (secondary, repair dialogue)] [uncertain: the step sequence is a synthesis of Meares's account]
Steps:
1. Notice the disruption (see 4.17).
2. Return to coupling. Slow down and match the patient's present state.
3. Acknowledge your part, specifically and without excessive apology.
4. Represent the disruption: what it might have felt like from the patient's side.
5. Let the patient correct you, and check whether connection has returned before going on.
6. Later, when the patient is settled, the disruption can be linked to the wider pattern (4.9).
Example language (illustrative): "I think I jumped in too quickly with my idea just then, and you lost the thread of what you were feeling. Perhaps it felt like I wasn't really listening."
Watch for: brushing off ("it's fine"), which shouldn't be accepted too quickly, and the therapist over-apologising, which burdens the patient. It is working when connection returns within the session, and when disruptions over time become shorter, more nameable, and raised by the patient.

4.19 Recognising script enactments in the relationship (including role reversal)

Purpose / when: When the traumatic script is lived out between you. For example, the patient treats you as the abuser, or takes the attacking role towards you or towards themselves, as if the old relationship were present. Meares describes the traumatic system bringing with it a fixed relational pattern, sometimes with roles reversed. [source: Meares 2000, Intimacy and Alienation] [uncertain: Meares's exact terms (e.g. "reversal") and procedure were not verified; the steps are synthesis]
Steps:
1. Don't counter-attack, defend at length or collapse. Keep a steady, analogical tone.
2. Name what is happening between you as a pattern, not as the patient's fault.
3. Represent both positions: the one who attacks or controls and the one who is hurt or diminished.
4. Wonder, tentatively, where this pattern was first known (4.9). Do this later, once the patient is calmer.
Example language (illustrative): "Right now it feels as if I'm someone who's going to humiliate you, and you have to get in first. That makes sense if that's what being close has meant."
Watch for: your own retaliatory or shamed feelings (4.20), and escalation that needs safety measures (see 5). It is working when the patient can step out of the script and comment on it.

4.20 Using the therapist's own experience as information

Purpose / when: When you feel bored, dead, confused, irritated, protective or drained. These feelings often reflect the form of the conversation, for example chronicle, script or dissociation. [source: Mental Health Academy (secondary); Hobson 1985 Book III "The Heart of a Psychotherapist"] [uncertain: the Hobson content is inferred from the chapter title]
Steps:
1. Notice the feeling, and pause before acting on it.
2. Ask yourself what in the conversation's form might be producing it.
3. Regulate yourself first.
4. If it helps the patient, voice a small piece of it as a here-and-now observation in "I" language.
5. Take the rest to supervision.
Example language (illustrative): "I'm noticing I've lost touch with you in the last few minutes. I wonder if something has gone a long way off."
Watch for: self-disclosure that serves your own relief. It is working when your observation re-opens contact.

4.21 Coordinating the care network

Purpose / when: With severely ill patients (frequent crises, self-harm, multiple services). Treatment is held together by a coherent network so that fragmentation in the system doesn't mirror fragmentation in the self. [source: metapsychology review, manual ch. 5]
Steps:
1. With consent, identify the other professionals involved: GP, psychiatrist, case manager, emergency department.
2. Agree roles, a shared crisis plan, and how information is passed on.
3. Keep the psychotherapy frame distinct from case management, while staying in contact.
4. Talk with the patient about network events as relational events too.
Example language (illustrative): "I'd like Dr X and I to be on the same page about what happens if things get very bad between our sessions. Can we work out together what you'd want us to share?"
Watch for: splitting between services. It is working when there are fewer unplanned crises and a consistent response across services.

4.22 Working with breaks and the ending

Purpose / when: Before and after holidays and cancellations, and in the final phase. For patients whose self depends on connection, absence is a prime trigger of the traumatic system. [synthesis, consistent with Hobson 1985 ("Love and Loss" chapter) and with Meares on disruption] [uncertain]
Steps:
1. Announce breaks early and return to them several times.
2. Couple with and represent the feelings about absence before they are acted out.
3. After a break, watch for disruption and repair it (4.18).
4. Set the end date well in advance. Expect old scripts to reappear, and treat that as a chance to work them through.
5. Acknowledge change (4.10) and what the relationship has meant.
Example language (illustrative): "We have eight sessions left. I wonder whether part of you is already starting to say goodbye, so it won't hurt so much."
Watch for: sudden 'flight into health' or crises near the end. It is working when the patient can feel and speak about the loss.

5. Handling problems

The sources say little that is explicit about troubleshooting. Most of what follows applies the model's principles and is marked [synthesis]. Where a source supports a point, it is cited.

Stuck in chronicle: session after session of factual reporting. Don't confront it. Couple with the chronicle (4.12), then look for the smallest inner element and make a statement about it (4.16). Reduce your questions, because questions feed chronicle (4.3). Listen for moments of interest or humour and amplify them (4.13). Expect slow change. Meares treats chronicle as a sign of a self that is not yet available, not as defiance. [source: ANZAP/PIT-UK seminar; principle 7] [synthesis]
Intellectualising or fluent, affect-free talk. Name, gently, the distance you feel between you (4.20). Slow the pace, and stay with the one live cue (4.2). Drop explanatory hypotheses for now, because they feed intellectualising. [source: Mental Health Academy (secondary)] [synthesis]
"Resistance": attacks, contempt, silence, refusal. Read these first as possible script enactments, or as a response to a disruption you caused (4.17–4.19), not as opposition. Trace what came just before. Repair before you explore. If the silence is reflective, let it be (4.11). If it is frozen or dissociated, couple audibly and orient the patient to the present. [synthesis]
Overwhelm, flooding or dissociation in session. Stop deepening. Return to simple, present-focused coupling: slow voice, short phrases, the patient's own words. Orient to the room and to you. Name the shift once the patient can hear it (4.17). Before the session ends, bring the patient back to a manageable state, and if needed agree what they will do in the next hours. Next time, go slower and give smaller doses (principle 15). [synthesis]
Self-harm, suicidality and crises between sessions. Use standard professional suicide and risk assessment and your service's protocols. Have a shared crisis plan and care network in place from the start (4.21). Within the therapy, also understand crises relationally: often a disruption, a break or a script enactment came first. Look for that and repair it, without letting relational understanding replace risk management. [source: metapsychology review (care network)] [synthesis]
Non-attendance, lateness, dropout risk. Treat these as communications, especially after a disruption or near a break. Reach out within the agreed frame (a letter or call) in a non-punitive tone. On the patient's return, wonder together about the absence, and own any part you may have played. Re-negotiate the frame if it was unrealistic. Guthrie et al. (2018) suggest that PIT-style empathic handling of difficult moments may reduce dropout. [source: Guthrie et al. 2018 abstract] [synthesis]
Ruptures with the therapist. Use disruption–repair (4.18). Be specific and own your part. Don't accept quick reassurance ("it's fine") too readily. Keep the link to history for later. [source: Meares 2000/2012] [uncertain: detail]
The patient wants advice, questions or "techniques" instead of conversation. Acknowledge the wish and what it says about their distress. Go back to the exploratory rationale (4.1). Give genuinely necessary practical information directly, then return to what it is like to need answers from you. [synthesis]
Too much closeness: dependency, idealisation, demands for contact. Keep the frame steady and predictable, and couple with the longing without gratifying it beyond the frame. "We" language (4.5) should not turn into merger. Hold Hobson's "aloneness-togetherness": being with someone without fusing. [source: Wikipedia (aloneness-togetherness, avoiding merger)] [synthesis]
Therapist pitfalls: over-questioning, premature interpretation, compulsive repairing, deadness or drain. Record and review sessions; the model was built from recorded sessions. Use the CoMTAS adherence scale, or supervision with a CM-trained colleague, to check your proportion of statements to questions, how tentative you are, and whether you are coupling. Treat your own drain as information (4.20). [source: Wikipedia (Hobson's recordings; CoMTAS); Halovic et al. 2018] [synthesis]
Modality-specific difficulty: concrete or cognitively limited patients who struggle with metaphor. Keep representations concrete and close to the body and to daily events. Reuse the patient's own images. Lean on coupling more than on symbolic work. [synthesis]
Modality-specific difficulty: mismatch of tone. Matching the pace and intensity of a highly aroused patient can escalate them. Couple with the feeling at a slightly lower intensity, then help them settle, rather than mirroring their arousal exactly. [synthesis] [uncertain: not addressed in the sources]
Cultural and linguistic difference. The model depends on the music and idiom of language. When working across languages or cultures, ask for and adopt the patient's own words, and be open about not knowing. [synthesis]
Brief settings (PIT-length work). Concentrate on 4.1–4.6 and 4.18. Pick one relational focus early, and make the ending a central topic from the middle sessions onward. [synthesis; PIT named only]

Sources

Sources:

Books and papers cited (full text not drawn on):

Hobson, R. F. (1971). Imagination and amplification in psychotherapy. Journal of Analytical Psychology.
Hobson, R. F. (1985). Forms of Feeling: The Heart of Psychotherapy. London: Tavistock.
Shapiro, D. A., & Firth, J. (1985). Exploratory Therapy Manual (Sheffield Psychotherapy Project).
Meares, R. (1995). Episodic memory, trauma, and the narrative of self. Contemporary Psychoanalysis, 31, 541.
Guthrie, E. (1999). Psychodynamic interpersonal therapy. Advances in Psychiatric Treatment, 5, 135–145.
Meares, R. (2000). Intimacy and Alienation: Memory, Trauma and Personal Being. London: Routledge.
Meares, R. (2004). The conversational model: an outline. American Journal of Psychotherapy, 58(1), 51–66.
Meares, R. (2005). The Metaphor of Play (3rd ed.). London: Routledge.
Meares, R. (2012). A Dissociation Model of Borderline Personality Disorder. New York: Norton.
Meares, R., Bendit, N., Haliburn, J., Korner, A., Meares, D., & Butt, D. (2012). Borderline Personality Disorder and the Conversational Model: A Clinician's Manual. New York: Norton.
Stevenson, J., & Meares, R. (1992). American Journal of Psychiatry, 149, 358–362.
Korner, A., et al. (2006). Comprehensive Psychiatry, 47, 406–411.

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