Volume 10, Issue 2
  • ISSN 2210-4070
  • E-ISSN: 2210-4097
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Metaphors are common in psychotherapy. The last decade has seen increasing interest in the use of metaphor in cognitive behaviour therapy (CBT), with attention to client metaphors being asserted as a way of enhancing CBT. However, prior to this current research there was very little research on the use of metaphor in CBT sessions, and no studies have examined how to train therapists in this skill.

This article discusses four studies that provide a preliminary empirical basis for the exploration of metaphors in CBT. The first study evaluated the reliability and utility of an approach to metaphor identification. The second study explored how clients and therapists co-construct metaphors, contributing to development of a shared language in early therapy sessions and identified a range of responses to each other’s metaphors. The third study explored the effect of training CBT therapists to intentionally bring client metaphors into case conceptualisations in terms of building therapeutic alliance and collaboration, along with an exploration of preference for metaphoric language. The fourth study explored the impact of the metaphor training on therapist confidence, awareness and use of metaphors, based on therapist self-report ratings and reflections on their ongoing application of learning over a three month period. These findings suggest that it is possibly to conduct empirical research on metaphor in CBT, with metaphor having potential as an important therapy process1 variable.


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  1. Angus, L. , & Rennie, D.
    (1989) Envisioning the representational world: The client’s experience of metaphoric expression in psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 26(3), 372–379. 10.1037/h0085448
    https://doi.org/10.1037/h0085448 [Google Scholar]
  2. Beck, A.
    (1993) Cognitive therapy: past present and future. Journal of Consulting and Clinical Psychology, 61(2), 194–198. 10.1037/0022‑006X.61.2.194
    https://doi.org/10.1037/0022-006X.61.2.194 [Google Scholar]
  3. Bennett-Levy, J. , McManus, F. , Westling, B. , & Fennell, M.
    (2009) Acquiring and refining CBT skills and competencies: Which training methods are perceived to be most effective?Behavioural and Cognitive Psychotherapy, 37(5), 571–583. 10.1017/S1352465809990270
    https://doi.org/10.1017/S1352465809990270 [Google Scholar]
  4. Bennett-Levy, J. , & Padesky, C.
    (2014) Use it or lose it: Post-workshop reflection enhances learning and utilization of CBT skills. Cognitive and Behavioral Practice, 21(1), 12–19. 10.1016/j.cbpra.2013.05.001
    https://doi.org/10.1016/j.cbpra.2013.05.001 [Google Scholar]
  5. Blackburn, I. , James, I. A. , Milne, D. L. , Baker, C. , Standart, S. , Garland, A. , & Reichelt, F. K.
    (2001) The revised cognitive therapy scale (CTS-R): psychometric properties. Behavioural and Cognitive Psychotherapy, 29, 431–466. 10.1017/S1352465801004040
    https://doi.org/10.1017/S1352465801004040 [Google Scholar]
  6. Blenkiron, P.
    (2005) Stories and analogies in cognitive behaviour therapy: A clinical review. Behavioural and Cognitive Psychotherapy, 33(01), 45–59. 10.1017/S1352465804001766
    https://doi.org/10.1017/S1352465804001766 [Google Scholar]
  7. Butler, G. , Fennell, M. , & Hackmann, A.
    (2008) Cognitive behaviour therapy for anxiety disorders: Mastering clinical challenges. New York, NY: Guilford.
    [Google Scholar]
  8. Cameron, L.
    (1999) Identifying and describing metaphor in spoken discourse data. In L. Cameron & G. Low (eds.), Researching and applying metaphor (pp.105–132). Cambridge, United Kingdom: Cambridge University Press. 10.1017/CBO9781139524704.009
    https://doi.org/10.1017/CBO9781139524704.009 [Google Scholar]
  9. (2003) Metaphor in educational discourse. London, United Kingdom: Continuum.
    [Google Scholar]
  10. (2007) Patterns of metaphor use in reconciliation talk. Discourse & Society, 18(2), 197–222. 10.1177/0957926507073376
    https://doi.org/10.1177/0957926507073376 [Google Scholar]
  11. (2008) Metaphor shifting in the dynamics of talk. In M. Zanotto , L. Cameron , & M. Cavalcanti (eds.), Confronting metaphor in use: An applied linguistic approach (pp.45–62). Amsterdam, Netherlands: Benjamins. 10.1075/pbns.173.04cam
    https://doi.org/10.1075/pbns.173.04cam [Google Scholar]
  12. Cameron, L. , & Deignan, A.
    (2006) The Emergence of Metaphor in Discourse. Applied Linguistics, 27(4), 671–690. 10.1093/applin/aml032
    https://doi.org/10.1093/applin/aml032 [Google Scholar]
  13. Cameron, L. , & Maslen, R.
    (2010) Metaphor analysis: Research practice in applied linguistics, social sciences and the humanities. London, United Kingdom: Equinox.
    [Google Scholar]
  14. Citron, F. , Cacciari, C. , Funcke, J. M. , Hsu, C. T. , & Jacobs, A. M.
    (2019) Idiomatic expressions evoke stronger emotional responses in the brain than literal sentences. Neuropsychologia, 131, 233–248. 10.1016/j.neuropsychologia.2019.05.020
    https://doi.org/10.1016/j.neuropsychologia.2019.05.020 [Google Scholar]
  15. Citron, F. , & Goldberg, A.
    (2014) Metaphorical sentences are more emotionally engaging than their literal counterparts. Journal of Cognitive Neuroscience, 26(11), 2585–2595. 10.1162/jocn_a_00654
    https://doi.org/10.1162/jocn_a_00654 [Google Scholar]
  16. Cocklin, A. A. , Mansell, W. , Emsley, R. , McEvoy, P. , Preston, C. , Comiskey, J. , & Tai, S.
    (2017) Client perceptions of helpfulness in therapy: A novel video-rating methodology for examining process variables at brief intervals during a single session. Behavioural and Cognitive Psychotherapy, 45(6), 647–660. 10.1017/S1352465817000273
    https://doi.org/10.1017/S1352465817000273 [Google Scholar]
  17. Duncan, B. , Miller, S. , Sparks, J. , Claud, D. , Reynolds, L. , Brown, J. , & Johnson, L.
    (2003) The Session Rating Scale: Preliminary psychometric properties of a “working” alliance measure. Journal of Brief Therapy, 3(1), 3–12.
    [Google Scholar]
  18. Fluckiger, C. , Del Re, A. , Wampold, B. E. , Symonds, D. , & Horvath, A. O.
    (2012) How central is the alliance in psychotherapy? A multilevel longitudinal meta-analysis. Journal of Counseling Psychology, 59(1), 10–17. 10.1037/a0025749
    https://doi.org/10.1037/a0025749 [Google Scholar]
  19. Foster, N.
    (2011) An investigation of early sudden gains in cognitive-behavioural therapy for depression: Client and within-therapy predictors of change (PhD), Massey University, Auckland, New Zealand.
    [Google Scholar]
  20. Goncalves, O. F. , & Craine, M. H.
    (1990) The use of metaphors in cognitive therapy. Journal of Cognitive Psychotherapy, 4(2), 135–149. 10.1891/0889‑8391.4.2.135
    https://doi.org/10.1891/0889-8391.4.2.135 [Google Scholar]
  21. Hague, B. , Scott, S. , & Kellett, S.
    (2015) Transdiagnostic CBT Treatment of Co-morbid Anxiety and Depression in an Older Adult: Single Case Experimental Design. Behavioural and Cognitive Psychotherapy, 43, 119–124. doi:  10.1017/S1352465814000411
    https://doi.org/10.1017/S1352465814000411 [Google Scholar]
  22. Harnett, P. , O’Donovan, A. , & Lambert, M.
    (2010) The dose response relationship in psychotherapy: Implications for social policy. Clinical Psychologist, 14(2), 39–44. 10.1080/13284207.2010.500309
    https://doi.org/10.1080/13284207.2010.500309 [Google Scholar]
  23. Hatcher, R. L. , & Gillaspy, J.
    (2006) Development and validation of a revised short version of the Working Alliance Inventory. Psychotherapy Research, 16(1), 12–25. 10.1080/10503300500352500
    https://doi.org/10.1080/10503300500352500 [Google Scholar]
  24. Hayes, S. , & Hofmann, S.
    (2017) The third wave of cognitive behavioral therapy and the rise of process-based care. World Psychiatry, 16(3), 245–246. 10.1002/wps.20442
    https://doi.org/10.1002/wps.20442 [Google Scholar]
  25. Hill, C. , & Regan, A.
    (1991) The use of metaphors in one case of brief psychotherapy. Journal of Integrative and Eclectic Psychotherapy, 10, 56–57.
    [Google Scholar]
  26. Horvath, A. O. , Del Re, A. , Fluckiger, C. , & Symonds, D.
    (2011) Alliance in individual psychotherapy. In J. C. Norcross (ed.), Psychotherapy relationships that work: Evidence-based responsiveness, 2nd ed. (pp.25–69). New York, NY: Oxford University Press; US. 10.1093/acprof:oso/9780199737208.003.0002
    https://doi.org/10.1093/acprof:oso/9780199737208.003.0002 [Google Scholar]
  27. Horvath, A. O. , & Luborsky, L.
    (1993) The Role of the Therapeutic Alliance in Psychotherapy. Journal of Consulting and Clinical Psychology, 61(4), 561–573. 10.1037/0022‑006X.61.4.561
    https://doi.org/10.1037/0022-006X.61.4.561 [Google Scholar]
  28. Kahlon, S. , Neal, A. , & Patterson, T. G.
    (2014) Experiences of cognitive behavioural therapy formulation in clients with depression. the Cognitive Behaviour Therapist, 7, null-null. 10.1017/S1754470X14000075
    https://doi.org/10.1017/S1754470X14000075 [Google Scholar]
  29. Kazdin, A. E.
    (2011) Single-case research designs: Methods for clinical and applied settings (2nd ed.). New York, NY: Oxford University Press.
    [Google Scholar]
  30. Kuyken, W. , Padesky, C. , & Dudley, R.
    (2009) Collaborative case conceptualization: Working effectively with clients in cognitive-behavioral therapy. New York, NY: Guilford.
    [Google Scholar]
  31. Mathieson, F. , Jordan, J. , Bennett-Levy, J. , & Stubbe, M.
    (2018) Keeping metaphor in mind: Training therapists in metaphor-enhanced cognitive behaviour therapy. The Cognitive Behaviour Therapist, 11(E8).
    [Google Scholar]
  32. Mathieson, F. , Jordan, J. , Carter, J. D. , & Stubbe, M.
    (2016) Nailing down metaphors in CBT: Definition, identification and frequency. Behavioural and Cognitive Psychotherapy, 44(02), 236–248. 10.1017/S1352465815000156
    https://doi.org/10.1017/S1352465815000156 [Google Scholar]
  33. Mathieson, F. , Jordan, J. , Merrick, P. , & Stubbe, M.
    (2017) Juicy conceptualizations: Increasing alliance through attending to client metaphoric language. Behavioural and Cognitive Psychotherapy, 45(6), 577–589. 10.1017/S1352465817000339
    https://doi.org/10.1017/S1352465817000339 [Google Scholar]
  34. Mathieson, F. , Jordan, J. , & Stubbe, M.
    (2014) The metaphoric dance: Co-construction of metaphor in CBT. Paper presented at theAotearoa New Zealand Association for Cognitive Behavioural Therapy Conference, Christchurch, New Zealand.
    [Google Scholar]
  35. McMullen, L. M.
    (2008) Putting it in context: Metaphor and psychotherapy. In R. W. G. Jr. (ed.), The Cambridge handbook of metaphor and thought (pp.397–411). New York, NY: Cambridge University Press. 10.1017/CBO9780511816802.024
    https://doi.org/10.1017/CBO9780511816802.024 [Google Scholar]
  36. Otto, M.
    (2000) Stories and metaphors in cognitive-behavior therapy. Cognitive and Behavioral Practice, 7(2), 166–172. 10.1016/S1077‑7229(00)80027‑9
    https://doi.org/10.1016/S1077-7229(00)80027-9 [Google Scholar]
  37. Padesky, C.
    (1996) Developing cognitive therapist competency: Teaching and supervision models. In P. M. Salkovskis (ed.), Frontiers of cognitive therapy (pp.266–292). New York: Guilford Press.
    [Google Scholar]
  38. Padesky, C. , Kuyken, W. , & Dudley, W.
    (2011) Collaborative Case Conceptualization Rating Scale and coding manual, version5(Vol.19thJuly).
    [Google Scholar]
  39. Rogers, C. R.
    (1957) The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95–103. 10.1037/h0045357
    https://doi.org/10.1037/h0045357 [Google Scholar]
  40. Seiden, H. M.
    (2004) On Relying on Metaphor: What Psychoanalysts Might Learn From Wallace Stevens. Psychoanalytic Psychology, 21(3), 480–487. 10.1037/0736‑9735.21.3.480
    https://doi.org/10.1037/0736-9735.21.3.480 [Google Scholar]
  41. Stott, R. , Mansell, W. , Salkovskis, P. , Lavender, A. , & Cartwright-Hatton, S.
    (eds.) (2010) Oxford guide to metaphors in CBT: Building cognitive bridges. Oxford, United Kingdom: Oxford University Press. 10.1093/med:psych/9780199207497.001.0001
    https://doi.org/10.1093/med:psych/9780199207497.001.0001 [Google Scholar]
  42. Sudak, D. M. , Codd, R. T., III , Ludgate, J. , Sokol, L. , Fox, M. G. , Reiser, R. , & Milne, D. L.
    (2016) Teaching and supervising cognitive behavioral therapy. Hoboken, NJ: John Wiley & Sons.
    [Google Scholar]
  43. Tay, D.
    (2017) The Nuances of Metaphor Theory for Constructivist Psychotherapy. Journal of Constructivist Psychology, 30(2), 165–181. 10.1080/10720537.2016.1161571
    https://doi.org/10.1080/10720537.2016.1161571 [Google Scholar]
  44. Voutilainen, L. , & Perakyla, A.
    (2016) Interactional practices of psychotherapy. In M. O’Reilly & J. N. Lester (eds.), The Palgrave handbook of adult mental health: Discourse and conversation studies (pp.540–557). New York, NY: Palgrave Macmillan.
    [Google Scholar]
  45. Weiste, E. , Voutilainen, L. , & Perakyla, A.
    (2016) Epistemic asymmetries in psychotherapy interaction: Therapists’ practices for displaying access to clients’ inner experiences. Sociology of Health and Illness, 38(4), 645–661. 10.1111/1467‑9566.12384
    https://doi.org/10.1111/1467-9566.12384 [Google Scholar]
  46. Witztum, E. , van der Hart, O. , & Friedman, B.
    (1988) The use of metaphors in psychotherapy. Journal of Contemporary Psychotherapy, 18(4), 270–290. 10.1007/BF00946010
    https://doi.org/10.1007/BF00946010 [Google Scholar]
  47. Yarbrough, D. B.
    (1991) The reliability and validity of a measure of reported affinity for figurative language. Creativity Research Journal, 4(4), 317–335. 10.1080/10400419109534409
    https://doi.org/10.1080/10400419109534409 [Google Scholar]
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