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Twelve transcripts, three from each of four patients, taken from the early, mid and late phases of open‐ended, long‐term psychoanalytic psychotherapy with the same therapist, were analysed for metaphor. Metaphors were categorized into key, novel and conventional. Using grounded theory metaphors were categorized by theme and function. It was found that all metaphors – novel, conventional and key – could be representative of key concepts such as the self, others/relationships and therapy/self transformation and diagnosis or psychopathology; chart change; indicate mentalization (Fonagy et al. 2004). In addition use of metaphors by different patients showed different patterns that co‐occurred with good or bad outcome.

The research reported in this article aims to demonstrate a method for the systematic study of the therapist/patient interaction in psychoanalytic psychotherapy, drawing upon the tradition and methods of 'pragmatics'--the study of language in interaction. A brief introduction to the discipline of pragmatics demonstrates its relevance to the contemporary focus of clinical theory on the here-and-now dynamics of the relationship between analyst and patient. This is followed by a detailed study of five segments from the transcript of a therapeutic dialogue, drawn from a brief psychoanalytic psychotherapy, in which therapist and patient negotiate the meaning of the patient's symptom: Is it psychosomatic? The research seeks to show how the therapeutic process can be observed and studied as an interactional achievement, grounded in general and well-studied procedures through which meaning is intersubjectively developed and shared. Implications of the analysis for clinical theory and practice, and further research, are discussed.