Metaphor in Therapeutic Conversation

Metaphor in therapeutic conversation can be studied as language produced by clients, language introduced by therapists, and a process developed between them. These are related subjects, but they call for different kinds of evidence. This article introduces research from the wider psychotherapy literature as background reading.

Listening to patients' descriptions

Malkomsen and colleagues interviewed 22 patients with major depressive disorder after cognitive behavioural or psychodynamic therapy. Their analysis grouped metaphors around the therapy process, the therapeutic relationship and improvement. Recurring imagery included depth and surface, openness and closure, chemistry, tools, movement from darkness towards light, and depression as disease or an opponent.

The study gives access to how these participants described their experience. It does not establish that every patient uses these images, or that a particular metaphor caused improvement. The authors also point to the possibility of misunderstanding: an expression that seems familiar can conceal differences in how participants understand the therapy.

For reading a transcript, it is useful to keep the speaker's words beside any proposed interpretation. A reference to depth can be recorded before deciding whether it concerns thoroughness, discovery, cause or something else in that conversation.

Therapists' perspectives

A related qualitative study interviewed ten therapists, five practising each of the two approaches. Most said they did not actively listen for metaphors, and many said they seldom introduced them deliberately. The researchers reported differences in how the therapists responded to patient-generated and therapist-generated imagery, including disagreement about tools, surface and depth, and depression as an opponent.

With five therapists in each group, these observations should remain descriptions of the interview sample. They are not a classification of all cognitive behavioural or psychodynamic therapists. Reading the patient and therapist papers together helps reveal that the same image can be valued differently by the people involved.

Metaphor as interaction

Zuzanna Rucińska and Thomas Fondelli offer a dialogical and enactive account of metaphor in systemic collaborative therapy. Their paper analyses two examples involving adolescents and attends to action words, agency and the shared development of meaning. “Enacting” in this account can occur within the dialogue; it need not mean physically acting out a metaphor.

This offers a different unit of analysis from a list of images. A conversation unfolds: one speaker's expression is taken up, questioned or changed by another. The two examples illustrate the authors' account; they do not constitute a controlled comparison of treatment outcomes.

What different sources can establish

Source type	What to look for	Limit of the claim
Patient interviews	How participants describe treatment, relationships and change	A retrospective account is not a direct record of everything that occurred in a session.
Therapist interviews	Stated habits, assumptions and reactions	What a therapist reports doing and what happens in an observed session are distinct evidence.
Analysis of dialogue	How wording changes and is taken up in an interaction	An illustrative exchange does not establish a general success rate.
An outcome study	Comparison groups, outcomes, follow-up and the intervention actually tested	Evidence for one intervention cannot automatically be transferred to another that also uses metaphor.

The table is a reading aid. The cited articles should be consulted for their particular methods and limitations. None of these three papers is a trial of Metaphors of Movement.

Comparison questions

When studying published material, ask:

1. Who introduced the image, and what happened immediately before it?
2. Does the other speaker retain the wording or substitute a different description?
3. What becomes possible or impossible within the image?
4. Is an interpretation supplied by the speaker, the therapist or the researcher?
5. Is the reported outcome understanding, a change in wording, satisfaction, or a measured clinical change?

These questions support the analysis of texts and conversations. They are not a protocol for practising a therapeutic method.

Further reading

The Metaphor Research Library brings together further papers, doctoral work and explicitly labelled book previews. For the imagery itself, compare Containers, Burdens and Paths and Trails.

Related pages

• Metaphors of Emotion
• Embodied Cognition
• Idiomatic, Literal and Figurative Communication
• About Metaphors of Movement
• Concepts and language