The use of metaphor by clinical psychologists using cognitive behavioural techniques

Metaphor has been widely used and studied generally in psychotherapy, often being seen as a pathway to the unconscious mind. However metaphor has not been widely considered by CBT therapists or clinical psychologists, although the literature that has done so has suggested it could be a powerful tool in CBT. This study takes a widely quoted view of metaphor (Lakoff and Johnson, 1980), which suggests that language is fundamentally structured by metaphor, and attempts to relate this to the practice of CBT. The study looks at both the immediate context of therapy (termed 'process metaphors') and the metaphors that construct the context of therapy (termed 'structural metaphors'). The current study involved interviewing six qualified clinical psychologists, who use cognitive-behavioural therapy to treat adults with depression. The interviews were tape-recorded and transcribed. The resultant data was analysed using a qualitative, grounded theory approach, located within a social constructionist epistemology. The results of the analysis suggested that the interviewees saw process metaphors as operating through three mechanisms namely explanatory, persuasion and emotional processing. Client metaphors were suggested as being either investigated in detail or left aside in a way that reduced their persuasive power. Finally the structural metaphors relating to the concept of clients as mentally ill and therapy as scientifically structured were considered. The study concludes by suggesting that metaphor is often ignored in cognitive-behavioural therapy, perhaps due to friction with the empirical nature of CBT research. The possibility that metaphor may operate differently to formal propositional logic is suggested as a target for further research. The study aims to offer CBT therapists chance to reflect on how metaphors structure everyday practice and research in CBT.