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 Metaphor in psychotherapy
Submitted By DavidvdW | Added on: 2010 September 02 | Total Visits: 15310 | Printable version

Metaphors in psychotherapy

Dr Aharon Segal
In this paper Johannesburg based Clinical Psychologist Dr Aharon Segal describes the therapeutic potential of metaphor in psychotherapy.

Dr Aharon Segal is a Clinical Psycologist in Craighall Park in Johannesburg. Click here to view his practice details.

Definition of metaphor

Metaphor is defined as the transference of the relation between one set of objects to another set for the purpose of brief explanation. For example, in the metaphorical clause 'the ship plows the sea', some of the meanings associated with plowing are transferred to the movement of the ship for purposes of explanation. In the famous line from Shakespeare, "All the world's a stage", the transient quality of a theatrical play is transferred to the world. Metaphor can thus be defined as a figure of speech in which an expression is used to refer to something that it does not literally denote in order to suggest a similarity (Webster's New Twentieth Century Dictionary, 1959).

The word 'metaphor' stems from the Greek meaning 'to carry across'. It is a word or phrase denoting one kind of idea or object in place of another word or phrase for the purpose of suggesting likeness between the two. Other definitions of metaphor describe it as proceeding from the known to the unknown and as a means of fusing two separate realms of experience into one enlightening, condensed sign (Nisbet, 1969). Beardsley (1967) describes metaphor as a linguistic phenomenon.

Metaphor is described by Turner (1974) as having transformative powers. There is also something of the transformative in Theilgaard's (1984) explanation of the metaphor when he looks at metaphors also from a neuropsychological perspective and refers to the dynamic synergism between the left and right hemispheres which integrates imagery, emotion and thinking. The metaphor builds a bridge between the iconic mode of the right and the linguistic mode of the left hemisphere, and this bridge enhances the exchange between conscious and unconscious realms, resulting in genuine insight. The carrying and bridging quality of metaphor is also implied by Lacan (1977)who refers to metaphor as the 'creative spark' that flashes between two signifiers that have changed places in the signifier chain.

Metaphor as indirect communication

Metaphor provides an avenue of indirect communication between patient and therapist, later to be exchanged for a more direct communication, and also provides the patient and therapist with a measure of relief not available with encounter of a more direct nature. Cox and Thielgaard (1987)state: We found that an image could safely hold experience which was too painful, too brittle, or too broken to be firm enough to tolerate analysis. Such patients enabled us to see that the image, activated by metaphor, could be the location of exploration of the fabric of support. (p.xiii)

Cox and Thielgaard (1987, p.xiii) use as a key to their book, the words of Bachelard: "But the image has touched the depths before it stirs the surface." They state that the depths of psychotherapy can be effectively touched not only by a precise technology of the use of words, but effectively also by the use of simpler words that speak a universal timeless language of imagery and metaphor, predating contemporary ideas.

Metaphors abound in language and are found in profusion in the revealing language of psychotherapy. Therapeutic application of the metaphor therefore has enormous scope owing to the vast number of possible referents. Cox and Theilgaard (1987) describe how the metaphor 'I wonder who would win the medal for skating on thin ice?', introduced into a group session, furthered a therapeutic process in both an exploratory and a supportive direction. Sometimes a fusion of inner and outer world phenomena is encouraged. For example, one patient in the group referred to the failure of his social supports while another referred to the 'thin ice' being inside him, implying threatening loss of internal control. They say: "each member proclaimed experience which would have remained concealed, had it not been for the skating on thin ice mutative metaphor." (Cox and Theilgaard, 1987, p.80).

In the course of psychotherapy, therefore, it is important todistinguish between the literal use of language and the metaphorical use of language as the latter may have some prognostic and diagnostic significance. Cox and Theilgaard (1987, p.92) describe a borderline arsonist patient who refers to himself as getting on with his neighbours 'like a house on fire'. Is the patient here referring to a secret desire to set light to his neighbour's house?

Metaphor as a therapeutic resource

Cox and Theilgaard (1987) refer to the clinical relevance of metaphor and provide numerous examples of how metaphors in psychotherapy can serve as a container for emotions that are too overwhelming to be tolerated. The authors remind us that metaphors can also be vehicles for carrying, mobilising, expressing and integrating affect and cognition in furthering the therapeutic effect. The metaphor energises alternative ways of viewing experience, bringing to the surface material that the patient has hitherto tried to suppress and placing that material in the "pending action file" (Cox and Theilgaard, 1987, p.99).

The metaphor permits the therapist to sail as close to the wind as possible in the face of the ever present risk of going too far too fast, which could block therapeutic movement and progress. Cox and Theilgaard (1987) refer to Kahn's (1979) statement that metaphors have the ability to intensify the patient's already deep initiative by taking the therapeutic process a step further. The example quoted is that of a patient who had killed a child. The patient embarked upon a generic discussion about nature versus nurture. The patient said: "For example, take two children, two babies. One of whom is destined to become a neurosurgeon and the other a drug addict", whereupon the therapist replied: "or take one baby?"

Here is an example where 'take' meaning 'consider' is mutated by metaphor into 'take' meaning 'remove'. Skilled discernment is required in order to detect whether this confrontation is too much for the patient. Metaphors appear to facilitate the communication of emotionally sensitive issues, the essences of which would remain unrevealed but for metaphor and therefore out of reach of therapeutic intervention. Another example of the use of metaphor, where correct pacing is required, is to be found in an unpublished paper by Van Vuuren (1997, p. 6) who describes his patient's stated reasons why she bought him back a gift of sea shells from her trip to the ocean. He quotes her as saying: I deferred and recoiled from the demands of life by withdrawing into my shell. My fear of 'breaking' and being hurt consumed my courage to risk. No wonder I was so depressed and anxious in my small 'caged-in' shelled existence. In therapy I began to reveal myself. I began emerging out of my shell and slowly learned to live beyond the narrow boundaries of my shell.

Arlow (1969) likens metaphor to a fragment of unconscious fantasy breaking through into conscious expression and Wright (1984, p.84) says the undoing of a symptom is partially the creation of a metaphor from the symptom. He refers to Freud's well known phrase "where id was there shall ego be" and creatively adds "where symptom was there metaphor shall be". According to Cox and Theilgaard (1987) metaphor is suitable in psychosomatic disturbances owing to its ability to change preconceptual and kinaesthetic experience into other representational complexes. Hobson (1985) refers to the ability of metaphors about the human body to convey the deepest levels of experience. For example, the patient who declares that he suffers from a 'broken heart'. Cox and Theilgaard (1987, p.9) refer to body, epic and primordial metaphors. They seem to prefer the latter which they say are "linked to primal chaos and our deepest fundament", having even greater potential for housing anguish or ecstasy. They write: "primordial metaphor of fire and ice takes us immediately into the preserve of the dawn of things." (Cox and Theilgaard, 1987, p.9). They refer to the "pull of the primordial" in describing a patient who was afraid of slipping off the world (Cox and Theilgaard, 1987, p.9). Use of body metaphor to depict the psychotherapy group and to guide the treatment process is the focus of a study by Laube & Wieland (1998). Chapter 1, section 1.5 lists some of the other studies that have used metaphor in the psychotherapeutic process.

Griffith and Griffith (1994) distinguish between exclusionary and inclusionary metaphors. Exclusionary metaphors, they say, describe patients' realities that leave no room for the clear implementation of either conversational or pharmacological interventions. An often used exclusionary metaphor, they say, is one used to describe the patient's symptoms as originating from a 'chemical imbalance'. Other exclusionary metaphors described by them include'misbehaviour metaphors', in which the patient's symptoms are referred to as 'irresponsible'; 'family-game metaphors', in which family rules are used to describe patients' symptoms; and 'addiction metaphors', by which patients are encouraged to admit to powerlessness in the face of their symptoms. Unlike exclusionary metaphors, inclusionary metaphors, or coupling metaphors, create "expansive realities in which physiological problem-solving with drugs and conversational problem solving with language can easily coexist" (Griffith and Griffith, 1994, p.195).

Examples of coupling metaphors that contain implicit assumptions validating both conversational and physiological solutions to a problem, are offered (Griffith and Griffith, 1994). These include 'stress-diathesis' metaphors, which assume an underlying physiological vulnerability for illness, 'psychophysiological' metaphors, which describe psychosomatic illness due to prolonged distress, 'physiological adaptation' metaphors, which describe a 'shutting down' mechanism and liken depression to the hibernation of bears, and 'domains-of-discourse' metaphors, which describe symptoms as arising out of the particular social and personal practices of those that accept and use a particular sociocultural language.

The power of metaphor

According to Cox (1978; 1982) metaphors have 'an invitational stretching quality' that assists the therapist to enter into the patient's perspectival world. When the patient senses that he is being understood by the therapist, the patient invites the therapist into his inner world. The graphic power of metaphor is illustrated by an extract from William Shakespeare's (1592) play Richard III (11.2,41) where there is puzzlement at the fact that the children survive even though their father has died. "Why grow the branches when the root is gone?" The metaphor has the ability to convey much meaning with few words. Another example is "the Sailor cannot see the North, but knows the needle can." Dickinson, (1970)

Apart from the positive aspects of metaphor, there are also binding, restricting qualities. Metaphor has the potential to trap both the therapist and the patient. It is therefore important to avoid being, as Wilshire (1982) advises, "in the grip of the metaphor." Cox and Theilgaard (1987, p.111) give, as an example of therapist entrapment by the metaphor, the hasty psycho- sexual interpretation by an analytically orientated therapist to the description of a patient's fantasy of having a long, thin key "which will not stay sufficiently stiff for him to insert into the lock to which it belongs". They write that it requires a shift in the therapist's thinking to see that the patient is planning to escape from a relatively secure institution and is describing an actual key that has been poorly manufactured for the purpose.

According to Cox and Theilgaard (1987), metaphor may sometimes be used by the patient to avoid saying how he really feels and although, in such instances, metaphors have a supportive and containing function, they may unfortunately encourage the patient to 'hide' in them. Metaphors, it may be concluded, have a transforming quality invariably accompanied by psychic tension resulting in the gaining of insight. The successfully applied metaphor, as with insight, is often pleasurably received. In the arena of transpersonal psychology, which aims to bridge the gap between traditional Western psychology and other systems of psychotherapy that recognize a divine presence, Metzner (1986) outlines various metaphors used in many traditions to describe this transformational process. He mentions metaphors such as changing from caterpillar to butterfly; awakening from the dream of 'reality'; uncovering the veils of illusion; emerging from captivity to liberation; purification by inner fire; moving from darkness to light; progressing from fragmentation to wholeness; journeying to a place of vision and power; returning to the source; dying and being reborn and unfolding the tree of one's life.

When judiciously exercised, the metaphor, it seems, can be a priceless instrument in the therapist's armoury. It becomes this by its ability to circumnavigate the patient's defences, thereby facilitating communication where it would otherwise probably be unforthcoming. By plowing through uncharted, choppy and dangerous seas, the metaphor reaches its destination on the far shores where the patient waits ready in anticipation to study its precious cargo.

List of References

Arlow, J. A. (1969). Unconscious fantasy and disturbances of conscious experience. Psychoanalytic Quarterly,    38,1-27

Webster's New Twentieth Century Dictionary (1959).    Cleveland: The World Publishing Company.

Bachelard, G. (1994). The poetics of space. U.S.A: Beacon    Press

Beardsley, M. C. (1967). Metaphors. In P. Edwards    (Ed.).The Encyclopaedia of Philosophy, Vol. 5. London: 

Collier Macmillan. Cox, M. (1978). Structuring the therapeutic process:    Compromise with chaos. Oxford: Pergamon Press.

Cox, M. (1982). 'I took a life because I needed one': Psychotherapeutic possibilities with the schizophrenic offender-patient. Psychotherapy and Pychosomatics, 37,    96-105.

Cox, M. & Thielgaard, A. (1987).    Mutative metaphors in    psychotherapy: The aeolian mode. London: Tavistock    Publications.

Dickinson, E. (1970). The complete poems. London: Faber &    Faber.

Griffith, J. L. & Griffith, M. E. (1994). The body Hobson – reference missing.

Kahn, L. (1979). Between silence and light.    Massachusetts: Shambhala Publications. Lacan, J. (1977).

Ecrits. Transl. A. Sheridan. London:    Tavistock Publications. Laube, J. J. & Wieland, V. (1998, July). Nourishing the    body through use of process prescriptions in group

Metzner, R. (1986). Opening to inner light: the transformation of human nature and consciousness. Los Angeles: Tarcher.

Nisbet, R. A. (1969). Social change and history: Aspectsof the western theory of developments. Oxford: Oxford University Press.

Shakespeare, W. (1592). Richard III. In The complete works of William Shakespeare. London: Spring Books.

Theilgaard, A. (1984). A psychological study of the personalities of XYY and XXY men. Acta Psychiatrica Scandinavica, Sup. 315. Copenhagen: Munksgaard.

Turner, V. (1974). Dramas, fields and metaphors: Symbolicaction in human society. London: Cornell University Press.

Van Vuuren, R. J. (1997, September). The paradigm of the shell. Upublished manuscript, University of Pretoria,    Pretoria.

Wright, E. (1984). Psychoanalytic criticism: Theory inpractice. London: Methuen. therapy. International Journal of Eating Disorders, 24    (1), 1-11.

Dr Aharon Segal is a Clinical Psycologist in Craighall Park in Johannesburg. Click here to view his practice details.


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