There are different ways of using metaphors in a clinical context. One typical approach is to choose metaphors that fit what clients are struggling with, in order to help them look at their experiences from a different perspective. For example, looking at attempts to suppress thoughts, emotions, or sensations as a struggle in quicksand can help a client notice counter productive effects of experiential avoidance. It’s also possible to craft new metaphors by using principles of relational frame theory (RFT) (Foody et al, 2014; Villatte et al., 2014) or to notice metaphors that clients naturally use, and induce behavior change inside this context. This third option is covered in Chapter 8 of Mastering the Clinical Conversation (Villatte et al., 2016) and extensively by Niklas Törneke in his excellent upcoming book on metaphors (already available in Swedish). Let’s look at the main aspects of this approach.
Our language is “full” of metaphors. Some metaphors are called “frozen metaphors” because we are so used to using them that we don’t remember they once meant something else, usually something more concrete (like in “language is full of metaphors”). Other metaphors are more intentionally used as a way of making something abstract easier to grasp (here is another metaphor!). For example, a client might struggle with describing a feeling and say at some point “it’s like a shadow above my head”. Because the client brings up the metaphor, we are sure it means something to her (i.e. the metaphor refers to something that it is necessarily part of her culture or else she wouldn’t use it to describe her experience).
Thus, using metaphors spontaneously brought up by our clients has the advantage of always making sense to them. However, in order to transform the way a client is relating to her experience, we need to unpack the metaphor a little further. This is why it is useful to know how to craft metaphors with RFT principles, even if you might end up always using clients’ own metaphors.
Once you spot a metaphor in the client’s speech (this can happen in pretty much every sentence), you can embrace this new symbolic context and explore the therapeutic processes inside it. For example, if a client describes her feeling as “a shadow above her head” and what you would like to do is help the client refine her observation skills, you could ask her about the shape, the size, the movements of this shadow. You could explore her responses to this feeling by asking her what she does in response to seeing the shadow. Does she hide? Does she try to make it go away by turning on the light or going to a sunny place? Or does she go to a dark place instead? And then what happens? Does the shadow disappear? Does it come back ? Etc.
The point of using a metaphor in therapy is generally to induce change in the way a client is responding to an experience. So, what you want is to unpack the metaphor used by the client with the general principles that define your therapeutic approach. For example, in contextual behavioral therapies like Acceptance and Commitment Therapy (ACT), therapists want to encourage clients to observe what works and what doesn’t work, and to do what works for a meaningful purpose. Therapists using this approach don’t need to know exactly where they are going, but they need to help clients observe their own experiences and responses, and draw conclusions in terms of effectiveness. The metaphor is also an opportunity to explore alternative responses. For example, “what would happen if you let the shadow be above your head instead of going to a dark place?”
Here is a short example of an interaction that demonstrates the use of a client’s metaphor to help her gain awareness:
Client: I’m feeling quite ambivalent about telling you what is going on in my mind. I’m like torn between protecting myself and getting help from you, I guess.
Therapist: Torn like a piece a paper can be torn apart?
Client: Hmm… no. More like a piece of fabric pulled in two opposite directions, so strongly that it’s about to break.
Therapist: So, it’s about to break, but not torn apart at this point?
Client: No, not yet. I guess it’s pretty close. I’m feeling very ambivalent.
Therapist: Who is pulling the fabric in opposite directions?
Client: Me!
Therapist: You?
Client: Yes. I’m doing that to myself. I know I can talk to you, but I have all these fears. It’s absurd, I know it, but I’m worried about what you will think if I tell you what is going on in my mind.
Therapist: What would happen if the piece of fabric actually broke?
Client: Hmm. I don’t know.
Therapist: Has it ever happened?
Client: No. I don’t think so. I always end up making a decision in the end.
Therapist: One of the hands that is pulling the fabric wins over the other, without breaking the fabric?
Client: Yes! I never thought about it this way, but that’s pretty much what happens. I feel torn but I am not really torn apart. I’m more like I’m pulled in different directions, and I end up choosing one.
Therapist: Why do you think the fabric never breaks?
Client: Because I don’t want it to break. I’m careful not to break it.
Therapist: Are you saying you are gently pulling the fabric in opposite directions, but not to the point of tearing it apart?
Client: Yes, I think so. I guess I’m sort of allowing myself to be ambivalent. At least a bit, because I don’t want to go too fast.
This short interaction gives an idea of how you can use the client’s metaphor and explore something that is directly relevant to their psychological life inside this new symbolic context. Often, talking metaphorically creates some distance that allows the client to talk about difficult things with less pressure. This was probably the case in this vignette. Although she was ambivalent to talk about what was going on in her mind, she was able to do just that inside the metaphor.
Here is something you can do to practice using your client’s metaphors. Spot a metaphor that one of your clients is using (either frozen like in the vignette above, or more explicit) and try to unpack it through experiential questions that evoke the client’s observation. If you are not sure you can do it yet, start with simply noticing metaphors that are spontaneously brought up by your clients, and then write down what questions you could have asked to continue the exploration process inside this metaphor. As you keep practicing this skill, noticing and using clients’ spontaneous metaphors will become more natural.
–Matthieu Villatte, PhD
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Foody, M., Barnes-Holmes, Y., Barnes-Holmes, D., Törneke, N., Luciano, C., Stewart, I., & McEnteggart, C. (2014). RFT for clinical use: the example of metaphor. Journal of Contextual Behavioral Science, 3, 305-313.
Villatte, M., Villatte, J. L., Hayes, S. C. (2016). Mastering the Clinical Conversation: Language as Intervention. New York: Guilford Press.
Villatte, M., Villatte, J. L, & Monestes, J. L. (2014). Bypassing the traps of language with experiential practice. In N. Afari & Jill Stoddard (Eds). The Big book of ACT Metaphors: The Complete Guide to ACT Metaphors and Experiential Exercises.Oakland, CA: New Harbinger.
language as intervention 