Therapy

Are Metaphors Your Secret Magic Wand in Therapy?

Why metaphors work and how they can be useful in therapy

Posted Jan 09, 2020

Image by Geralt from Pixabay
Source: Image by Geralt from Pixabay

If you have ever been in therapy, you probably know that moment when, all of a sudden, something clicks. A former patient of mine (who has generously given me permission to use their words in print) used to call it “the moment when something becomes part of my cells.” It is more than insight, which can be intellectualized. It is when something that is said becomes more than the sum total of words, and is experienced in the body.

Jane (not a real client) is sitting literally at the edge of her seat in my office. She is tense, as I observe how stiff and straight her back is, how her foot dances up and down to a rhythm audible only to her. Her words, accompanied by brisk hand gestures, describe how, in the past week, she has had to leave work early to drive her husband to the ER, babysit for her son’s twin infants, and communicate back and forth with her daughter’s AA sponsor. Her daughter had relapsed and needed help to get to her detox program. Jane, of course, picked her up and dropped her off.

Jane is exhausted, yet seemingly incongruously activated. Like she has just gotten off a roller coaster but her body is not yet registering that she is safe on the ground.

“It seems like at the moment, or perhaps for a while now, you have felt like one of those rescue trucks rushing around the city, all sirens and blinking lights, constantly responding to emergencies, constantly on high alert.”

Jane’s facial expression changes immediately and she tears up. Her posture softens, hands now limp in her lap, back resting against the chair. In that moment, she has seen herself in a light that allows her to both experience and observe herself. The metaphor of the rescue truck strikes such a chord because she realizes just how overwhelmed she has been feeling, responding to everyone’s emergencies while neglecting her own needs, how taxing this has been on her emotional and physical health, and just how ready she is to jump at the first sign of trouble. Simultaneously, she becomes cognizant of how depleted she feels, while at the same time feeling like she cannot take time to herself because another disaster might strike. Jane realizes how responsible she has been feeling for “rescuing” everyone in her family in a way that is so much more powerful than if I had simply said: “Sounds like you feel responsible for rescuing everyone in your family.”

Why Metaphors Work

In general, the first ones to systematically study the role of metaphors in organizing our experience was George Lakoff and his colleagues. They argued that much more than simply a linguistic structure, metaphors are the backbone of our conceptual world. In other words, we understand the world and concepts through other sets of concepts. One example from Metaphors We Live By is how we see disagreements as attacks/war. We do not simply disagree, we “arm ourselves,” “counter-strike,” “battle it out.” The concept of war organizes our perceptual understanding of a disagreement, which is why we so often find ourselves angry or defensive. Imagine how different the world would be if we saw disagreement as an opportunity for exchanging different ideas, to be approached with curiosity and interest!

My research on metaphors and why they are so impactful, which you can read in more detail in The Unconscious: Theory, Research, and Clinical Implications, led me to the concept of embodied cognition. Metaphors work because they are grounded (that’s a metaphor) in bodily experiences, and are therefore much more capable of evoking an experiential reaction than a conglomeration of descriptions or adjectives alone. Metaphors are touching! (Yes, that’s a metaphor too.) As the Asaro tribe of Papua New Guinea say: “Knowledge is only a rumor until it lives in the muscle.”

Think about how many concepts in life there are, that we understand through bodily metaphors: we categorize people as warm or cold or sweet or bitter, we think of our life/time as a journey in which we position ourselves, we feel weighed down by stress or problems, or lifted by supportive relationships. (A whole TED Talk by Nora McInerny is dedicated to the concept of “moving forward,” rather than “moving on,” after the death of a loved one. Another one, by Amy Cuddy, unpacks the “fake it till you make it” saying and suggests that “fake it till you become it” as a much more desired outcome. Both talks have garnered millions of views.)

Metaphors in Therapy

There is surprisingly little empirical research on the role of metaphors in psychotherapy, their effectiveness, or relationship to therapy outcomes. Anecdotally and theoretically, several books and articles have explored the use of metaphors in psychotherapy. Many are within the psychoanalytic/psychodynamic orientation, but metaphors are also emphasized by some evidence-based treatments like Prolonged Exposure therapy for Post-traumatic Stress.

Metaphors may help us understand complex and abstract concepts, but they are also central to our own personal stories. Do I see myself as a victim or a survivor of trauma/tragedy? Do I see a difficult task as a burden or a challenge? (There is evidence to suggest that people who have better stress regulatory skills read the nervous/stress reaction that their body experiences in challenging times as excitement rather than anxiety or panic. This, in turn, helps them gear up for facing and resolving the problem, rather than experience crumbling panic or a shutdown response.)

In therapy, metaphors can be crucial in assimilating new knowledge or resolving emotional conflicts, because of their unique capacity to evoke feelings, images, and experiences that were previously hidden from awareness. Thus, they can aid us in resolving what previously may have seemed as a paradox that fueled up internal struggles. In one study (Martin, Cummings, & Hallberg, 1992), patients remembered therapist-introduced metaphors about two-thirds of the time, and rated sessions with such metaphors significantly higher in helpfulness. Metaphors “enhanced emotional awareness and understanding” and provided “conceptual bridging.” In other words, this shows the unique role of metaphors in working simultaneously at the emotional, cognitive, and relational levels, thus ensuring new experiential learning.

The few qualitative studies of metaphors in therapy highlight the embodied nature of metaphors. For instance, in a successful therapy for depression, the metaphor of depression as a burden evolved into a metaphor of unloading, sharing, and shedding the burden (Levitt, Korman, & Angus, 2000). What is more, these authors also found that metaphors worked best when the client was in a heightened experiential/affective state. In other words, the client was fully emotionally engaged and invested in the transformation of their self-narrative.

Similarly, when tragedies and traumas occur, we find ourselves saying that we had “the ground pulled from beneath our feet,” we feel “in the dark” about the future, we “cannot get a hold” of ourselves, or feel “besides” ourselves (see Tay and Jordan, 2015). Exploring which metaphors construct the client’s narrative of the trauma and its impact can be essential in understanding their experience and reorganizing it. As one trauma survivor, after a year-long treatment for Post-traumatic Stress and depression, succinctly put it, “Now I finally can switch to neutral.” They were finally able to experience the calming of their nervous system, which had been taxed by the vigilance following the traumatic experiences. Switching to neutral represented an ability to feel carefree in the moment, mindful but unburdened.

References

Weinberger, J. & Stoycheva, V. (2019). The unconscious: Theory, research, and clinical implications. New York: The Guilford Press.

Levitt, H., Korman, Y., & Angus, L.  (2000).  A metaphor analysis in treatments of depression: Metaphor as a marker of change.  Counseling Psychology Quarterly, 13, 23-35.

Tay, D. & Jordan, J.  (2015).  Metaphor and the notion of control in trauma talk. Text & Talk, 35, 553-573.

Lakoff, G. & Johnson, M. (2003). Metaphors we live by. University of Chicago Press.

Martin, J., Cummings, A. L., & Hallberg, E. T.  (1992).  Therapists’ intentional use of metaphor: Memorability, clinical impact, and possible epistemic/motivational functions.  Journal of Consulting and Clinical Psychology, 60, 143-145.