Hearing metaphor: an approach to working with family-generated metaphor

Metaphorical language and psychopathological symptoms: a case study of trauma victims' metaphor use

BACKGROUND

While clinical diagnosis of mental health issues focuses on factual details represented by literal language (e.g., the onset and process of the triggering event and duration of symptom), the relationship between metaphorical language and psychopathological experiences remains an intriguing question. Focusing on psychological trauma triggered by the 2019-2020 Hong Kong social unrest, this study explored the correlations between trauma victims' quantitative metaphor usage patterns and their experience of specific Acute Stress Disorder (ASD) symptoms.

METHODS

Forty-six individuals with trauma exposure within 28 days were recruited through convenience sampling. Each completed a 20- to 30-minute semi-structured interview and filled out the Chinese version of the Stanford Acute Stress Reaction Questionnaire (SASRQ; 1). Metaphors in the interviews were identified using the discourse dynamic approach (2), and clinically interesting categories related to trauma and emotion expression, as revealed by previous literature, were sorted out. Standardized frequencies of the categories were correlated with participants' SASRQ scores of five major ASD symptoms, and the correlational patterns were interpreted from a discourse analytic perspective.

RESULTS

The study reveals how metaphor usage patterns can reflect the speakers' differentiated experiences of psychopathological symptoms. Compared with individuals who experienced less trauma, those more disturbed by the re-experiencing symptom were more inclined to use emotion-related metaphors and to metaphorize about the self and the self-society relationship. Individuals who experienced more severe anxiety and hyperarousal showed a heightened awareness of self-related issues and diminished attention to others. Those who suffered from more severe impairment in functioning produced more metaphors in the negative valence. Dissociation and avoidance, which were less experientially salient and intense than the others, were not significantly correlated with metaphor usage patterns.

CONCLUSION

This study establishes symptom-level metaphor usage patterns as a previously overlooked but interesting avenue in trauma evaluation, treatment, and research. While the study is confined to a single context, it nevertheless reveals the potential for metaphor research findings to be incorporated as useful materials in psychology education and therapist training.

Keeping metaphor in mind: training therapists in metaphor-enhanced cognitive behaviour therapy

Over the last decade, there has been increasing interest in the use of metaphor in cognitive behaviour therapy. However, to date, there has been only very limited research on the use of metaphor in CBT sessions, and no studies which have examined how to train therapists in this skill. The present study is the first in the literature to explore how we might train therapists in metaphor-enhanced CBT. Twelve therapists attended two half-day training workshops, 2 weeks apart. Details of the content of the training workshop are provided. The therapists rated the workshop quality and provided structured self-report ratings and reflections on their ongoing application of learning over a 3-month period which were compared with pre-training ratings. Therapists reported significantly increased awareness of metaphors, with increased confidence in responding intentionally to client metaphors and bringing them into shared conceptualizations. In addition, there were significant increases in reported time spent elaborating on client metaphors, and use of metaphors when conceptualizing with clients. Barriers and solutions to application of learning are discussed.

Juicy Conceptualizations: Increasing Alliance Through Attending to Client Metaphoric Language

BACKGROUND

There is increasing interest in the use of metaphor in cognitive behaviour therapy. Experts advocate bringing client metaphors into case conceptualizations, but there is little empirical research to support this.

AIMS

This study evaluated the effect of training 12 therapists to attend to client metaphors and bring them into case conceptualizations.

METHOD

Pre- and post-training role-played therapy sessions were conducted and video-recorded. Alliance was rated by role play 'clients' and an external expert rated the quality of the sessions and of the shared conceptualizations.

RESULTS

There were significant increases in some ratings of alliance, based on role play 'client' ratings and external ratings of role plays of therapy sessions before and after training. The greater the difference between therapist and 'client' on a measure of preference for producing metaphor, the lower the rating of the session by the 'client' on the Bond factor score of an alliance measure, the Working Alliance Inventory. This result suggests that working metaphorically may be most effective when the therapist and client have a similar degree of preference for speaking metaphorically.

CONCLUSION

This study provides preliminary support for the idea that attending to client metaphors during conceptualization can be beneficial for alliance.

The metaphoric dance: co-construction of metaphor in cognitive behaviour therapy

Attention to client metaphors has been asserted as a way of enhancing cognitive behaviour therapy. Metaphors can be part of the shared language that is co-constructed between clients and therapists. Recent advances in cognitive linguistics have provided the most clearly operationalized method yet to identify metaphors in conversations, allowing analysis of how shared language develops. This study aims to explore how metaphoric shared language develops in early cognitive behaviour therapy sessions. Based on 12 transcripts of early cognitive behaviour therapy sessions, an iterative process led to the identification of a range of therapist and client responses to each other's metaphors, and identification of whether therapists or clients initiated metaphoric exchanges. Types of responses to therapist or client metaphors within three speaking turns were found to be: repetition, rephrasing, exploration, elaboration/extension, or agreement. Bursts of metaphoric exchange were initiated and taken up by therapists and clients at a similar rate. To conclude, therapists need to attend to the occurrence of metaphors and be aware of the range of potential responses that can engage the client in the ‘metaphoric dance’ (co-construction of shared metaphors). This has the potential to enhance engagement and outcomes though more salient reformulating of the problem for the client.

A conceptual framework for differential use of mediation and family therapy interventions with older adults and their families

The purpose of this article is to present a family-centered approach to working with older adults. This framework utilizes a differential use of family therapy and therapeutic mediation theoretical concepts and skills. This provides an effective approach to conceptualizing and intervening with these often complex situations regarding the decision-making processes related to care of older members. Family-centered mediators/clinicians must be skilled in both models to understand and intervene in the challenging issues presented by families. A case example is included in the article to illustrate the framework.

Homeopathic remedies as metaphors in family therapy. A narrative-based approach to homeopathy

OBJECTIVE

To examine a metaphorical, narrative model to explain the outcome of an homeopathic, encounter involving the patient, practitioner and the homeopathic medicine.

MATERIAL AND METHODS

The transcript of a videotaped doctor-patient interaction from a European doctor-patient communication study (EUROCOM) was analysed using qualitative methods.

RESULTS

Analysis demonstrates a narrative relationship between the protagonists in the therapeutic interaction, with the homeopathic medicine performing a metaphorical role.

DISCUSSION

The results justify further investigation of the narrative and metaphorical properties of the therapeutic encounter in homeopathy.