Joan Haliburn

The links between early childhood trauma and major mental illness: psychiatry's response?

Australian & New Zealand Journal of Psychiatry, 48(6) circumstances, there is nothing glamorous or idealistic about homicide. Clearly there is no simple answer to what has occurred increasingly over the last decades. However, by the use of the words ‘homicide bomber’ a gradual change in the worldwide interpretation and acceptability of these acts may occur. Representatives of the scientific community and the media are urged to consider this change.

Adolescent suicide and SSRI antidepressants

I agree with Dudley et al . that the controversy in recent years regarding the safety and effi cacy of SSRIs and related medications in children and adolescents has created considerable uncertainty for child and adolescent psychiatrists. With an estimated point prevalence of 4 – 6%, adolescent depression is a major public health concern and contributes to considerable morbidity in terms of pervasive and prolonged functional impairment, increasing the risk of suicidal behaviour and increasing the risk of psychopathology into the adult years.

What has happened to the practice of short term dynamic psychotherapy in Australia’s mental health services? A multidisciplinary training programme in Western Sydney

Objective: Short term psychodynamic psychotherapies have been markedly phased out of Australia’s mental health services. This paper aims to describe the successful introduction of a Conversational Model of Short Term Intensive Psychodynamic Psychotherapy into a public health service in an attempt to revive its practice. Method: A brief review of relevant papers in the Royal Australian & New Zealand College of Psychiatrists journals since 1980 gives a background to the decline of dynamic psychotherapy in Australia. The development of a Conversational Model of Short Term Intensive Psychodynamic Psychotherapy in the author’s private practice over 20 years, and its introduction into a hospital-based training programme are described. Results: A structured programme by scholarship has been offered yearly since 2011 to 10 multidisciplinary mental health clinicians of the Western Sydney Health District. Trainees see two patients from their own service. Over three years, 29 trainees have treated 57 patients with weekly supervision provided. Conclusions: The model has been easily learned. Trainees report a sense of re-invigoration, refinement of existing skills and acquisition of new skills. Resolution of problems in a significant number of patients is noted and improvement and satisfaction reported by others. A valuable service is provided and research is underway.

A University Psychotherapy Training Program in a Psychiatric Hospital: 25 Years of the Conversational Model in the Treatment of Patients with Borderline Personality Disorder

Objective: The aim of this paper is to describe the development, delivery and experience of a university psychotherapy training program for psychiatry trainees in a public psychiatric hospital, demonstrating that patients with severe borderline personality disorder can be treated successfully with psychodynamic psychotherapy and stressing the need for structured psychodynamic psychotherapy training in psychiatry. Method: Two of the authors (JH and JS) were part of the first group of eight trainees supervised by Professor Russell Meares and several other experienced psychiatrists. Results: Ninety trainees have successfully completed the course. Two hundred and forty patients have been treated by trainees in this program to date; 49 patients have dropped out. Conclusions: The training program provided a sound psychodynamic base and an improved capacity to relate with our patients, not only in the program but also in our routine work as psychiatrists. An important public health issue and community need was addressed, which also proved to make sound economic sense as the number of patients who were treated might not have otherwise received long-term psychotherapy. An integrated process model of psychoanalytic psychotherapy – the conversational model – has evolved and continues to be offered as a 3-year part-time clinically oriented course leading to a Masters in Medicine, Psychotherapy at the University of Sydney. Several outcome studies and papers have been published and workshops have been presented both in Australia and overseas. The patients improved considerably – their self harming behaviour stopped within 6 months and they were no longer clinically depressed at the end of 1 year.

Trauma, personality disorders and chronic depression – the role of the conversational model of psychodynamic psychotherapy in treatment resistant depression

Objective: To report preliminary data describing the interim treatment outcome of 44 patients referred with treatment-resistant depression (TRD), comorbid personality disorders and histories of early childhood trauma using the Conversational Model (CM) of psychodynamic psychotherapy. Method: Patients (N = 44), 13 males and 31 females with long histories of depression ranging from 2 to 30 years, resistant to multiple trials of treatment, were referred by mental health practitioners, including psychiatrists. They were treated with twice weekly CM psychotherapy by multidisciplinary trainees and supervised by experienced trained clinicians. Questionnaires were administered at assessment and at 12 months to assess symptoms, functioning, self-esteem, history of trauma, personality functioning and suicidality. In this preliminary study, there was no separate control group, and patients served as their own controls. Results: Patients with TRD were found to have comorbid severe personality disorders and histories of early childhood trauma. Significant improvement in symptoms, self-esteem, functioning and suicidality was noted after 12 months. Conclusion: Patients responded with symptomatic and functional improvement to twice weekly CM therapy.

Integration through relatedness in the conversational model: a case study.

Objective: The aim of this paper is to demonstrate the principles of the conversational model in two therapies with a patient, at 16 years of age and again 20 years later. Method: Described is the first therapy of L, which commenced in hospital and continued twice weekly after discharge. L was an acutely disturbed 16-year-old female admitted for 4 months to the psychiatry ward, a dynamically oriented milieu of a University teaching hospital where I was training. This is followed by a brief description of Ls second therapy. Supervision was through audiotape of sessions. Results: At the conclusion of the first therapy, L was functioning well. Five years later, she married and had a child. She was referred to me again after she attempted suicide following an acute stressful event which resulted in hospitalization. She is more aware and reflective at present but continues to be vulnerable. Conclusions: Attention to certain aspects of the psychotherapeutic relationship is important as demonstrated in the conversational model.

From traumatic attachment to somatization disorder.

Objective: This paper emphasizes attachment trauma as an important etiological factor in somatization disorder and psychoanalytic psychotherapy as an effective treatment. Method: Weekly psychotherapy with an 18 year old with somatization disorder, using the Conversational Model, is described. Conclusion: Early cumulative trauma has far-reaching health consequences. Brief psychotherapy produces symptom relief, and long-term analytic therapy is necessary for sustained improvement.

Integration in the Psychodynamic Psychotherapy of Severe Personality Disorders: The Conversational Model

The psychotherapy of commonly occurring severe personality disorders-borderline, narcissistic, avoidant, dependent, obsessive compulsive, and schizoid-presents the therapist with a unique therapeutic challenge, as each personality disorder rarely occurs alone. Integration of what is most useful and what works in each model is being proposed to enable a more successful approach to the diversity of presentations. We describe the conversational model, some outcome research, and descriptive studies to illustrate this. Based in psychoanalytic theory, the conversational model is integrated with trauma theory, findings in memory research, linguistics, neurophysiological data, and, above all, on the observations of clinical experiences. Our emphasis in this article is on the treatment principles, methods, and techniques, along with case examples to illustrate what we mean. Case material is taken from audio recordings for which written informed consent was obtained for presentations and journal articles. Some changes have been made to maintain confidentiality.

Paediatric bipolar disorder.

We thank Jairam for his thoughtful comment on our paper concerning the controversy surrounding the diagnosis of paediatric bipolar disorder (PBD) especially among pre-pubertal children. In response, we emphasize that the British National Institute for Health and Clinical Excellence (NICE) guidelines on bipolar disorder (BD) regard the bipolar spectrum in children as highly speculative and the case for inclusion in evidence-based practice remains unproven. They advocate caution until further research evidence becomes available.