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Article published In:
Metaphor in Mental Healthcare
Edited by Dennis Tay
[Metaphor and the Social World 10:2] 2020
► pp. 320–337

Rewriting burnout as metaphor

Metaphoric Affect Processing in healthcare

 | San Martino Hospital
Today’s healthcare professionals shoulder consequences of budget cuts, staff shortages, longer hours and a growing, aging patient population. To address support for both patients and staff in this challenging context, the kidney dialysis unit of a major Italian hospital was chosen for a three-phase pilot study of Metaphoric Affect Processing (MAP). MAP is a metaphor-based interview technique designed to enhance wellbeing in hospital settings by facilitating the identification, verbalization and regulation of affect as metaphor. The subject of this article is Phase 1 of the study, which focused on mitigation of burnout symptoms among peritoneal and hemodialysis nurses. In Phase 1, nurses were offered weekly group sessions of MAP training. All participants learned to use codified, “poetic” dialogue to explore, share and metaphorically “rewrite” present-moment feelings. By the end of training, a number of nurses also qualified as MAP facilitators themselves. Nurses’ pre-training burnout levels were measured in subcategories of depressive anxiety, loss of empathy, and reduced sense of personal achievement. Assessment after MAP training confirmed nurses’ self-reports of having engaged metaphor to address these aspects of burnout, reducing stress levels, increasing empathy among colleagues and expanding perspective. Phase 1 outcomes suggest that MAP may be an effective intervention to boost wellbeing for healthcare workers at high risk for burnout, and merits further study. This article also offers an overview of MAP’s early development with patient populations in cancer treatment and acute care psychiatric settings.
Keywords: burnout, empathy in healthcare, Metaphoric Affect Processing, metaphor-mirror
Article outline
  • 1.Introduction
    • 1.1MAP: What, why and for whom
    • 1.2Intuitive vs. rational thinking
    • 1.3Discovering MAP’s super-powers
      • 1.3.1Sensation comes first
      • 1.3.2Intrinsic empathy
      • 1.3.3Definitional commentary
      • 1.3.4Rewriting emotion
    • 1.4MAP in oncology and psychiatry
    • 1.5MAP and healthcare operators
  • 2.Methodology
    • 2.1Setting
    • 2.2Participants and attendance
    • 2.3Scales and questionnaires
      • Maslach burnout index (MBI)
      • Reflections & Feedback Questionnaire (RFQ)
      • The sense-metaphor questionnaire (SMQ)
  • 3.A MAP session with dialysis nurses
    • 3.1MAP Step I: Framing
    • 3.2MAP Steps II & III: Perception and description
      • 3.2.1Embodied resonance
      • 3.2.2Emotion becomes poetry
    • 3.3MAP Step IV: Definitional commentary
  • 4.Results
    • 4.1Maslach Burnout Index scores
      • 4.1.1MBI scores before MAP training
      • 4.1.2MBI scores after MAP training
      • 4.1.3Comparing MBI scores before vs. after MAP training
    • 4.2Reflections & Feedback Questionnaire (RFQ)
    • 4.3A sample of nurses’ end-of-session comments
  • 5.Limitations
  • 6.Speaking metaphorically going forward
  • Acknowledgments
  • Note
  • References
Published online: 13 November 2020
DOI logo
https://doi.org/10.1075/msw.00009.joh
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