Dr Jamie Rickcord

A conversation with Jamie Rickcord

• What led you to choose psychotherapy or counselling as a profession?

  I spent ten years as a GP before I made the switch, and the honest answer is that general practice showed me what medicine couldn't do. I kept seeing the same pattern: a patient would come in with pain that moved around the body, or a depression that had outlasted two rounds of CBT and three medications, or symptoms that kept returning with a normal result. I could refer them on, and sometimes it helped, and often it didn't. What struck me was how much of what they were carrying had nowhere else to go — it wasn't going to show up on a blood test, and a ten-minute consult wasn't built to hold it.
  
  I didn't leave medicine so much as follow that observation further. Training in the Conversational Model at the University of Sydney gave me a way of understanding what I'd been seeing for a decade: that a coherent sense of self is built between people, and that when it's been disrupted — by trauma, by chronic illness, by simply not being heard properly — it can be rebuilt the same way, through the texture of a real conversation rather than another set of instructions.

• Which philosophical approaches have influenced your professional development?

  The Conversational Model itself carries a philosophical lineage I've come to value more the longer I practise it — it draws on existential and phenomenological thinking, particularly the idea that a self isn't something fixed inside a person waiting to be uncovered, but something made and remade in dialogue with another. That's closer to Buber's sense of an "I" that only fully exists in relation to a "Thou" than it is to a diagnostic, symptom-focused view of the mind.
  
  My own contribution has been to push that further into the body. My Masters research proposed the endocannabinoid system as a biological substrate for the felt sense of intimacy — the idea that trauma doesn't just disrupt a person's narrative about themselves, it disrupts the physiological system that lets closeness register as safe in the first place. I think polyvagal theory, for all its popularity, tells only part of that story.
  
  So in practice I sit between two traditions that don't often talk to each other: a relational, dialogical view of what heals, inherited from my psychotherapy training, and a medical curiosity about the biology underneath it, inherited from ten years as a GP. Neither one on its own has ever felt like the whole picture to me.

• Which particular aspects of health or the human journey are you interested in?

  The place where body and relationship meet is what holds my attention most. Medically unexplained symptoms — pain that moves, systems that keep misfiring on a normal work-up — sit right at that junction, and ten years as a GP gave me a front-row seat to how much of that is the body carrying something the person hasn't yet been able to say. I'm interested in intimacy and its opposite: what allows a person to feel safe enough to be close to someone, and what trauma does to that capacity at a physiological level, not just a narrative one.
  
  I'm also drawn to the longer arc — how a life gets shaped, sometimes for decades, by disturbances to the sense of self that trauma leaves behind, and what it actually takes to rebuild that rather than just manage its symptoms. That includes grief, which I think is under-recognised as a driver of presentations that get labelled as something else entirely.
  
  Increasingly I'm curious about whether the connection between therapist and client — the thing the Conversational Model treats as the mechanism of change — can be observed directly, not just inferred. It's part of why I've started looking at ways of measuring synchrony between two people in a session, rather than taking it on faith.

• What methods do you use?

  Two, depending on what's needed. Psychodynamic Interpersonal Therapy (PIT) is the brief option — 8 to 16 sessions, time-limited and structured enough to have randomised trial evidence behind it in depression, self-harm, and physical symptoms with no physical explanation. It's often what I offer when CBT has already been tried and hasn't given lasting relief. It's still a conversation, not a set of exercises, but it has a defined shape and an endpoint.
  
  The Conversational Model is the longer-term work — weekly, open-ended, for trauma that has shaped how someone experiences themselves and other people. There's no manual to move through here. The method, if it can be called that, is close attention to the texture of what's actually happening between us in the room — the pauses, the shifts in tone, the moments a person's story about themselves doesn't quite hold together — rather than following a script or setting homework.
  
  Neither approach involves worksheets. If someone has tried therapy before and found it too brisk or too shallow, that's usually a sign one of these two will suit them better than what came before.

• When do you think the client will start to feel that progress is being made?

  It depends which of the two ways of working someone is in, and I'd rather be honest about that than promise a timeline that doesn't hold up. With brief therapy — PIT — the shape is defined enough that most people can feel something shifting by session six or eight, roughly the midpoint of the 8 to 16 sessions. That's partly the structure doing its job: a defined endpoint tends to concentrate the work.
  
  The longer-term Conversational Model is different, and I say this to people directly rather than let them find out the hard way: progress there often isn't linear, and it isn't always visible from the inside while it's happening. For trauma that has shaped how someone experiences themselves and other people, the early sessions are frequently about the relationship itself becoming a place that feels safe enough to be honest in — which doesn't feel like progress at the time, it just feels like talking. The shift usually gets noticed retrospectively, often by someone else in the person's life before the client names it themselves.
  
  What I tell people who've tried therapy before and found it too brisk or too shallow is that if this way of working suits them, the sign isn't a checklist of symptoms improving on schedule — it's that the conversations start to feel like they're going somewhere, even when neither of us could say exactly where.

• How has therapy made a difference in your life?

  Practising this work has changed how I understand connection itself, probably more than any single training did. Ten years as a GP taught me to notice illness; psychotherapy taught me to notice the relationship it was happening inside of. Sitting with people whose sense of self had been disrupted by trauma made it impossible to keep thinking of a "self" as something fixed and private — I now think of it as something built and rebuilt between people, which is as true for me as it is for anyone I see.
  
  That shift is part of why I ended up going further into the biology of it in my own research — proposing the endocannabinoid system as part of what makes closeness feel safe, and asking what breaks down when it doesn't. It's not a question I could have asked as a GP. It came directly out of paying close attention, session after session, to what actually seems to help people change, rather than what the textbooks say should.
  
  Supervising trainee therapists has done something similar in reverse — watching someone else learn to sit with that kind of difficulty keeps me honest about what I actually do in the room, as opposed to what I'd say I do if you asked me cold.

• What do you like most about being a therapist?

  The moment something that's been stuck for years finally moves — that's what I keep doing this for. In the longer-term work especially, you sit with someone through a great deal of repetition, the same painful shape recurring in slightly different clothes, and then one session the person says something about themselves or another person that they genuinely couldn't have said six months earlier. It's rarely dramatic. It's more that the texture of the conversation itself has changed, and you can feel it.
  
  After ten years as a GP, where most encounters were ten minutes and rarely followed a person's story past the presenting complaint, I find real satisfaction in being allowed to stay with someone long enough to watch that kind of change actually happen, rather than just referring it elsewhere and hoping.
  
  I also like that the work keeps me curious rather than settled. Supervising trainee therapists means I'm constantly re-examining what I actually do in the room, not just what I'd say I do. And having a foot in both the relational world of the Conversational Model and the biological questions I chase in my research — what closeness does to the body, what trauma does to that capacity — means I never quite arrive at a finished answer. I like that it stays open.

• What do you think is the most significant problem we face, in the world today?

  From where I sit, it's disconnection — and I don't just mean it as a general observation, I mean it in the fairly literal, physiological sense my own research has pushed me toward. I spent ten years as a GP watching people bring in bodies that were carrying something they had no relationship able to hold. Now I spend my time with people whose trauma has broken down their capacity to feel safe enough to be close to anyone at all. Those aren't two different problems to me anymore.
  
  I think a lot of what gets labelled individually — anxiety, medically unexplained pain, depression that won't shift — is downstream of something more structural: fewer and thinner relational containers for ordinary human distress than people had a few generations ago. My Masters research went looking for the biology of that, proposing the endocannabinoid system as part of what makes closeness register as safe, and what happens when trauma degrades it. I don't think a supplement or a policy fixes that. I think it gets addressed the slow way, one relationship at a time — which is, not coincidentally, the only tool I actually have.