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 process
variable.
Angus, L., & Rennie, D. (1989). Envisioning the representational world: The client’s experience of metaphoric expression in psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 26(3), 372–379.
Beck, A. (1993). Cognitive therapy: past present and future. Journal of Consulting and Clinical Psychology, 61(2), 194–198.
Bennett-Levy, J., McManus, F., Westling, B., & Fennell, M. (2009). Acquiring and refining CBT skills and competencies: Which training methods are perceived to be most effective?Behavioural and Cognitive Psychotherapy, 37(5), 571–583.
Bennett-Levy, J., & Padesky, C. (2014). Use it or lose it: Post-workshop reflection enhances learning and utilization of CBT skills. Cognitive and Behavioral Practice, 21(1), 12–19.
Blackburn, I., James, I. A., Milne, D. L., Baker, C., Standart, S., Garland, A., & Reichelt, F. K. (2001). The revised cognitive therapy scale (CTS-R): psychometric properties. Behavioural and Cognitive Psychotherapy, 291, 431–466.
Blenkiron, P. (2005). Stories and analogies in cognitive behaviour therapy: A clinical review. Behavioural and Cognitive Psychotherapy, 33(01), 45–59.
Butler, G., Fennell, M., & Hackmann, A. (2008). Cognitive behaviour therapy for anxiety disorders: Mastering clinical challenges. New York, NY: Guilford.
Cameron, L. (1999). Identifying and describing metaphor in spoken discourse data. In L. Cameron & G. Low (eds.), Researching and applying metaphor (pp. 105–132). Cambridge, United Kingdom: Cambridge University Press.
Cameron, L. (2003). Metaphor in educational discourse. London, United Kingdom: Continuum.
Cameron, L. (2007). Patterns of metaphor use in reconciliation talk. Discourse & Society, 18(2), 197–222.
Cameron, L. (2008). Metaphor shifting in the dynamics of talk. In M. Zanotto, L. Cameron, & M. Cavalcanti (eds.), Confronting metaphor in use: An applied linguistic approach (pp. 45–62). Amsterdam, Netherlands: Benjamins.
Cameron, L., & Deignan, A. (2006). The Emergence of Metaphor in Discourse. Applied Linguistics, 27(4), 671–690.
Cameron, L., & Maslen, R. (2010). Metaphor analysis: Research practice in applied linguistics, social sciences and the humanities. London, United Kingdom: Equinox.
Citron, F., Cacciari, C., Funcke, J. M., Hsu, C. T., & Jacobs, A. M. (2019). Idiomatic expressions evoke stronger emotional responses in the brain than literal sentences. Neuropsychologia, 1311, 233–248.
Citron, F., & Goldberg, A. (2014). Metaphorical sentences are more emotionally engaging than their literal counterparts. Journal of Cognitive Neuroscience, 26(11), 2585–2595.
Cocklin, A. A., Mansell, W., Emsley, R., McEvoy, P., Preston, C., Comiskey, J., & Tai, S. (2017). Client perceptions of helpfulness in therapy: A novel video-rating methodology for examining process variables at brief intervals during a single session. Behavioural and Cognitive Psychotherapy, 45(6), 647–660.
Duncan, B., Miller, S., Sparks, J., Claud, D., Reynolds, L., Brown, J., & Johnson, L. (2003). The Session Rating Scale: Preliminary psychometric properties of a “working” alliance measure. Journal of Brief Therapy, 3(1), 3–12.
Fluckiger, C., Del Re, A., Wampold, B. E., Symonds, D., & Horvath, A. O. (2012). How central is the alliance in psychotherapy? A multilevel longitudinal meta-analysis. Journal of Counseling Psychology, 59(1), 10–17.
Foster, N. (2011). An investigation of early sudden gains in cognitive-behavioural therapy for depression: Client and within-therapy predictors of change (PhD), Massey University, Auckland, New Zealand.
Goncalves, O. F., & Craine, M. H. (1990). The use of metaphors in cognitive therapy. Journal of Cognitive Psychotherapy, 4(2), 135–149.
Hague, B., Scott, S., & Kellett, S. (2015). Transdiagnostic CBT Treatment of Co-morbid Anxiety and Depression in an Older Adult: Single Case Experimental Design. Behavioural and Cognitive Psychotherapy, 431, 119–124.
Harnett, P., O’Donovan, A., & Lambert, M. (2010). The dose response relationship in psychotherapy: Implications for social policy. Clinical Psychologist, 14(2), 39–44.
Hatcher, R. L., & Gillaspy, J. (2006). Development and validation of a revised short version of the Working Alliance Inventory. Psychotherapy Research, 16(1), 12–25.
Hayes, S., & Hofmann, S. (2017). The third wave of cognitive behavioral therapy and the rise of process-based care. World Psychiatry, 16(3), 245–246.
Hill, C., & Regan, A. (1991). The use of metaphors in one case of brief psychotherapy. Journal of Integrative and Eclectic Psychotherapy, 101, 56–57.
Horvath, A. O., Del Re, A., Fluckiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. In J. C. Norcross (ed.), Psychotherapy relationships that work: Evidence-based responsiveness, 2nd ed. (pp. 25–69). New York, NY: Oxford University Press; US.
Horvath, A. O., & Luborsky, L. (1993). The Role of the Therapeutic Alliance in Psychotherapy. Journal of Consulting and Clinical Psychology, 61(4), 561–573.
Kahlon, S., Neal, A., & Patterson, T. G. (2014). Experiences of cognitive behavioural therapy formulation in clients with depression. the Cognitive Behaviour Therapist, 71, null-null.
Kazdin, A. E. (2011). Single-case research designs: Methods for clinical and applied settings (2nd ed.). New York, NY: Oxford University Press.
Kuyken, W., Padesky, C., & Dudley, R. (2009). Collaborative case conceptualization: Working effectively with clients in cognitive-behavioral therapy. New York, NY: Guilford.
Mathieson, F., Jordan, J., Bennett-Levy, J., & Stubbe, M. (2018). Keeping metaphor in mind: Training therapists in metaphor-enhanced cognitive behaviour therapy. The Cognitive Behaviour Therapist, 11(E8).
Mathieson, F., Jordan, J., Carter, J. D., & Stubbe, M. (2016). Nailing down metaphors in CBT: Definition, identification and frequency. Behavioural and Cognitive Psychotherapy, 44(02), 236–248.
Mathieson, F., Jordan, J., Merrick, P., & Stubbe, M. (2017). Juicy conceptualizations: Increasing alliance through attending to client metaphoric language. Behavioural and Cognitive Psychotherapy, 45(6), 577–589.
Mathieson, F., Jordan, J., & Stubbe, M. (2014). The metaphoric dance: Co-construction of metaphor in CBT. Paper presented at the Aotearoa New Zealand Association for Cognitive Behavioural Therapy Conference, Christchurch, New Zealand.
McMullen, L. M. (2008). Putting it in context: Metaphor and psychotherapy. In R. W. G. Jr. (ed.), The Cambridge handbook of metaphor and thought (pp. 397–411). New York, NY: Cambridge University Press.
Otto, M. (2000). Stories and metaphors in cognitive-behavior therapy. Cognitive and Behavioral Practice, 7(2), 166–172.
Padesky, C. (1996). Developing cognitive therapist competency: Teaching and supervision models. In P. M. Salkovskis (ed.), Frontiers of cognitive therapy (pp. 266–292). New York: Guilford Press.
Padesky, C., Kuyken, W., & Dudley, W. (2011). Collaborative Case Conceptualization Rating Scale and coding manual, version 51(Vol. 19thJuly).
Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95–103.
Seiden, H. M. (2004). On Relying on Metaphor: What Psychoanalysts Might Learn From Wallace Stevens. Psychoanalytic Psychology, 21(3), 480–487.
Stott, R., Mansell, W., Salkovskis, P., Lavender, A., & Cartwright-Hatton, S. (eds.). (2010). Oxford guide to metaphors in CBT: Building cognitive bridges. Oxford, United Kingdom: Oxford University Press.
Sudak, D. M., Codd, R. T., III, Ludgate, J., Sokol, L., Fox, M. G., Reiser, R., & Milne, D. L. (2016). Teaching and supervising cognitive behavioral therapy. Hoboken, NJ: John Wiley & Sons.
Tay, D. (2017). The Nuances of Metaphor Theory for Constructivist Psychotherapy. Journal of Constructivist Psychology, 30(2), 165–181.
Voutilainen, L., & Perakyla, A. (2016). Interactional practices of psychotherapy. In M. O’Reilly & J. N. Lester (eds.), The Palgrave handbook of adult mental health: Discourse and conversation studies (pp. 540–557). New York, NY: Palgrave Macmillan.
Weiste, E., Voutilainen, L., & Perakyla, A. (2016). Epistemic asymmetries in psychotherapy interaction: Therapists’ practices for displaying access to clients’ inner experiences. Sociology of Health and Illness, 38(4), 645–661.
Witztum, E., van der Hart, O., & Friedman, B. (1988). The use of metaphors in psychotherapy. Journal of Contemporary Psychotherapy, 18(4), 270–290.
Yarbrough, D. B. (1991). The reliability and validity of a measure of reported affinity for figurative language. Creativity Research Journal, 4(4), 317–335.
Cited by (8)
Cited by eight other publications
Malhotra, Bani, Laura C. Jones, Heather Spooner, Charles Levy, Girija Kaimal & John B. Williamson
2024. A conceptual framework for a neurophysiological basis of art therapy for PTSD. Frontiers in Human Neuroscience 18
Pfeifer, Valeria A., Karen L. Weihs & Vicky T. Lai
2024. Narratives about Cancer: What Metaphors can tell us about Depressive Symptoms in Breast Cancer Patients. Health Communication 39:9 ► pp. 1888 ff.
Shugaylo, I. V.
2024. Conceptual Metaphors in Psychotherapeutic Discourse (Using the Example of the Works of Art by Irwin Yalom and Ken Kesey). Discourse 10:3 ► pp. 152 ff.
Volkmer, Anna, Jade Cartwright, Leanne Ruggero, Maria Loizidou, Chris JD Hardy & Deborah Hersh
2024. Muddles and puzzles: Metaphor use associated with disease progression in Primary Progressive Aphasia. Aphasiology 38:6 ► pp. 1100 ff.
Kirmayer, Laurence J.
2023. Cultural poetics of illness and healing. Transcultural Psychiatry 60:5 ► pp. 753 ff.
Marcelos, Maria de Fátima, Ronaldo Luiz Nagem & Alan Rodrigo Andrade
2023. Comparative structure of similarities and differences between tree and cognitive model of Cognitive Behavioral Theory. Estudos de Psicologia (Campinas) 40
Fatteme Raiisi & Mina Riyassi
2022. Understanding Cancer Patients' Lived Experience of Pain through Metaphors: A Qualitative Study. International Journal of Musculoskeletal Pain Prevention 7:3 ► pp. 759 ff.
Schmitt, Rudolf & Thomas Heidenreich
2022. Metaphernreflexive Beratung und Psychotherapie. In Die Praxis der systematischen Metaphernanalyse, ► pp. 263 ff.
This list is based on CrossRef data as of 25 october 2024. Please note that it may not be complete. Sources presented here have been supplied by the respective publishers.
Any errors therein should be reported to them.