Digging down or scratching the surface: how patients use metaphors to describe their experiences of psychotherapy

Abstract

Background In the present study, we wanted to explore which metaphors patients suffering from major depressive disorder (MDD) use to explain their experience of being in therapy and their improvement from depression. Methods Patients with MDD (N = 22) received either psychodynamic therapy (PDT) or cognitive behavioral therapy (CBT). They were interviewed with semi-structured qualitative interviews after ending therapy. The transcripts were analyzed using a method based on metaphor-led discourse analysis. Results Metaphors were organized into three different categories concerning the process of therapy, the therapeutic relationship and of improvement from depression. Most frequent were the metaphorical concepts of surface and depth, being open and closed, chemistry, tools, improvement as a journey from darkness to light and depression as a disease or opponent. Conclusions Patient metaphors concerning the therapeutic experience may provide clinicians and researchers valuable information about the process of therapy. Metaphors offer an opportunity for patients to communicate nuances about their therapeutic experience that are difficult to express in literal language. However, if not sufficiently explored and understood, metaphors may be misinterpreted and become a barrier for therapeutic change. Trial registration Clinical Trial gov. Identifier: NCT03022071. Date of registration: 16/01/2017.

How therapists in cognitive behavioral and psychodynamic therapy reflect upon the use of metaphors in therapy: a qualitative study

“…In general, the PDT-therapists seemed to think that the concept of tools was counterproductive in therapy and that they did not possess the “tools” that patients wanted. However, we could not find any signs that dissatisfaction with the lack of tools was more prominent in patients who got PDT than CBT in our previous study [ 24 ]. The “lack of tools” was a critique presented by patients in both groups.…”

“…As metaphors are common and not specific to any therapeutic approach, we were also open to the possibility that there might not be any significant differences between the groups. This view was supported by our previous article, where no obvious differences in the use of metaphors were found between patients who received CBT or PDT [ 24 ].…”

“…This study aimed to explore how therapists in CBT and PDT reflect upon the use of metaphors in therapy and how they react to some of the patient-generated metaphors we identified in our previous study [ 24 ]. There are some differences between CBT and PDT-therapists in how they reflect upon the use of metaphors, and these differences seem in large to be in line with the theoretical rationale behind the therapeutic approaches.…”

“…The therapists were first questioned about metaphors in general, and then asked about some of the metaphors we identified in our previous study [ 24 ]. We included the metaphors we found to be most common.…”

“…The first, second and last author read all the transcripts looking for answers to the question: How do therapists reflect upon metaphors in therapy and how do they react to the patient metaphors identified in our previous study [ 24 ]? The first author familiarized himself with the data.…”