Metaphor and the Social World - Volume 10, Issue 2, 2020

Abstract

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.

Abstract

In most models of psychotherapy metaphor is considered an important aspect of communication. At the same time there is a need for a rationale to tell the clinician with what purpose and how to use metaphor for the benefit of the client. The present article suggests such principles, specifically based on a behavioral approach to human language, relational frame theory (RFT). This approach has co-developed with a specific model of psychotherapy: acceptance and commitment therapy (ACT) and the conclusions in this article are very much in line with that model. Overlap between RFT and a recent linguistic theory of metaphor, the dynamic approach, is also discussed.

Abstract

In recent years, studies from social/cultural geography and social psychology have shown the importance of the subjective experience of space in anxiety disorders. This study investigates how lived space in anxiety is discursively negotiated in interactional narratives, with a focus on the co-construction of time, physical space and epistemic modality, and the ways in which metaphors contribute to the representation of spatial experience. The data are two case studies taken from television programmes in which a figure in the public eye is being interviewed about their experiences of anxiety. The analysis showcases two distinct kinds of lived space in anxiety, one in which the self is continually moving through a space experienced as too expansive, and another in which other people/entities are moving around the self in a space experienced as too small. Both experiences involve spatial responses that serve to bring some relief from anxiety. The analysis also has methodological implications by exemplifying how metaphors feed into spatial gestalts that are collaboratively constructed as narratives unfold in situated interaction.

Abstract

The importance of metaphor in psychotherapy and counseling has been shown by a growing number of studies. Image-schematic metaphors, which derive from experience of sensory processes and space, are potential resources for conceptualizing major themes like anger, anxiety, and depression in therapeutic discourse. To test the potential correlation between image-schematic metaphors and the themes of anger, anxiety, and depression, this study employs a mixed-method approach, integrating corpus linguistics techniques, discourse analysis, and statistical analysis, to examine a specialized corpus of therapeutic transcripts which contains approximately three million words. The findings show that containment, force, path, and vertical orientation are the most frequent types of image-schematic metaphors for describing the therapeutic themes of anger, anxiety, and depression in the corpus, and there is a significant correlation between the two variables (i.e., “types” and “themes”). This study has implications for how image-schematic metaphors can be used to facilitate the descriptions of anger, anxiety, and depression in therapeutic conversations.

Abstract

Five key therapeutic functions of metaphors are often discussed by psychotherapists. They (i) help clients express emotions and experiences, (ii) help therapists and clients explain difficult concepts, (iii) introduce new frames of reference, (iv) help work through client resistance, and (v) build a collaborative relationship between therapists and clients. Research on how these functions are enacted in psychotherapy talk tends to assume that they are indeed perceived as such by clients, and that metaphorical language is preferred to comparable literal language in performing them. This paper reports a survey study (N = 84) to critically interrogate these assumptions. Participants read two constructed therapy dialogues, controlled and counterbalanced for presentation sequence, where therapist and client discuss an issue using metaphorical and literal language respectively. Each dialogue is followed by a 15-item questionnaire to rate how well the presumed functions were performed (e.g. the therapist and client can work effectively together, the therapist is able to explain difficult concepts). A combined Confirmatory (CFA) and Exploratory Factor Analysis (EFA) suggests that, instead of the five distinct functions proposed in the literature, participants discerned three functions which reflect a more holistic view of what metaphors can do. A second EFA conducted on literal responses yielded only two factors. This contrast in factor structure further suggests that (i) literal language is less functionally nuanced, and (ii) metaphors are not simply perceived as an ‘add-on’ to literal language, but are evaluated across an extended narrative in fundamentally different ways. Within-subjects metaphor vs. literal ratings of the items under the emergent three-factor structure were then compared. Metaphor ratings were significantly higher in all factors (p < 0.01), suggesting that metaphorical language is indeed perceived as more effective than literal language when discussing clients’ issues. Implications, limitations, and future directions are discussed.

Abstract

Given the centrality of metaphor in the (re)structuring of experience (Burns, 2005; Loue, 2008; Roffman, 2008) and of bodily experience to the notion of conceptual metaphor in cognitive theory (Lakoff & Johnson, 2003 [1980]; Lakoff, 1993; Gibbs, 2006), this paper investigates the ‘transformative power’ of metaphor in ‘talking cure’ practices – Counselling and Psychotherapy – to implement its application potential. An experimental integrated “metaphor-based and -driven” model is presented by adapting textual identification procedures (Steen, 1999; Ferrari, 2007; Pragglejaz, 2007) to an integrated psychological approach (Rogers, 2003 [1951]; Perls, 1951) in order to further develop metaphor transformation guidelines. The ‘M’ psycho-test had been created to evaluate the power of metaphor in counselling sessions in a diachronic perspective, providing both qualitative and quantitative data. Some preliminary cases (e.g. ‘the frog’, ‘eating’, ‘the hare’, ‘the desolated land’) are presented, with relative Transformational score, as examples of test application and metaphor potential. Test evidence has allowed for quantitative and qualitative observations. The evidence gathered shows: (1) Applying a metaphor-based experimental integrated approach can offer alternative for action in the practice; (2) Measuring the transformational power of metaphor through ‘M’ psycho-test can offer further degree of awareness for both counsellor and client.

Abstract

Today’s healthcare professionals shoulder consequences of budget cuts, staff shortages, longer hours and a growing, aging patient population. To address support for both patients and staff in this challenging context, the kidney dialysis unit of a major Italian hospital was chosen for a three-phase pilot study of Metaphoric Affect Processing (MAP). MAP is a metaphor-based interview technique designed to enhance wellbeing in hospital settings by facilitating the identification, verbalization and regulation of affect as metaphor. The subject of this article is Phase 1 of the study, which focused on mitigation of burnout symptoms among peritoneal and hemodialysis nurses. In Phase 1, nurses were offered weekly group sessions of MAP training. All participants learned to use codified, “poetic” dialogue to explore, share and metaphorically “rewrite” present-moment feelings. By the end of training, a number of nurses also qualified as MAP facilitators themselves. Nurses’ pre-training burnout levels were measured in subcategories of depressive anxiety, loss of empathy, and reduced sense of personal achievement. Assessment after MAP training confirmed nurses’ self-reports of having engaged metaphor to address these aspects of burnout, reducing stress levels, increasing empathy among colleagues and expanding perspective. Phase 1 outcomes suggest that MAP may be an effective intervention to boost wellbeing for healthcare workers at high risk for burnout, and merits further study. This article also offers an overview of MAP’s early development with patient populations in cancer treatment and acute care psychiatric settings.

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