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THERAPISTS' EXPERIENCE OF METAPHORIC COMMUNICATION IN THERAPY
Dissertation
Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate School of The Ohio State University
By:
Carina Sudarsky-Gleiser, M.A.
The Ohio State University 1995
Dissertation Committee: Approved by: Pamela S. Highien James E. Lantz Richard K. Russell Bruce W. Walsh Adviser Department of Psychole DMI Number: 9612281
UMI Microform 9612281 Copyright 1996, by DMI Compamy. All rights reserved.
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UMI 300 North Zeeb Road Ann Arbor, HI 48103 ACKNOWLEDGMENTS
Many individuals were instrumental in the completion of this dissertation; to them, I would like to offer my most sincere appreciation.
First, I have felt blessed by the love and support of my family. I want to thank my husband, Saul, and our children Joanne, Joel and the little one that is on the way. Saul, your patience, encouragement and support made possible the completion of this dissertation. Thanks also for your trips to the library and for your help with formatting and typing corrections during the frequent revisions of this document. Joanne and Joel thanks for your frequent kisses and hugs, for you understanding, and for giving up your time with mommy. To the little one, thanks for your kicking; it maximized the encouragement and inspiration offered by your siblings. I hope I will be able to offer you a more peaceful lifestyle once you arrive in this world in November.
To my mom and dad, thanks for your faith in me and for your encouragement throughout my graduate school work. Thanks also for taking care of the kids during your visit to the U.S. Knowing that they were in loving hands gave me some peace of mind during crazy times. Dad, your help with cross-checking references benefited me
u greatly. Thanks to my brother and sister, to my in-laws, and to my friend Silvia Cuevas, for their love and faith in me. To my adviser. Dr. Pamela Highien, thanks for your encouragement, advice and frequent revisions of this dissertation. Your support during my graduate school work helped me move through the different "rites of passage" that characterize our profession. I would also like to thank Dr. Jim Lantz, Dr. Rich Russell, and Dr.
Bruce Walsh for their willingness to serve as members of the dissertation committee and for their flexibility in accommodating the dissertation defense. Thanks to them for their comments and suggestions. Special thanks to Dr. Jim Lantz for his useful guidance and recommendations regarding the qualitative methodology of this dissertation.
I would also like to thank my co-workers: Dr. Jeff Pollard, Sandy
Darfus, and Bud Walkup. Jeff, thanks for your encouragement and for your interest in helping me place this dissertation in its proper perspective. Your help with the tables and figures for this document benefited me immeasurably. Sandy, thanks for your optimism, your support and your listening ear. Bud, thanks for your understanding and support. Thank you all for your flexibility during months of craziness.
Thanks to the peer debriefing group for their valuable suggestions during the research process. To Heather Finley, thanks for your help with the technical equipment used in this dissertation and for your willingness to code a complete interview to enhance the rigor of the study.
in My heartfelt thanks to the therapists who agreed to participate in this study. Their willingness to use their valuable time to be
interviewed made this dissertation possible. The interviewing
process was an exciting experience for me; connecting with them and learning from their knowledge and experience was personally and professionally stimulating.
IV vrrA-
April 1 9 ,1 9 6 1 Bom—Bogota, Colombia
1983...... Psicoioga, Unlversldad de los Andes, Colombia.
1989...... M.A., Developmental Psychology, The OhioState University.
1987-1991 ...... Bilingual Counselor (1987-1989); Coordinator Counseling Services (1989-1991 ), Casa de Esperanza, Catholic Social Services, Columbus, Ohio.
1991-199 2...... Graduate Administrative Associate, Coordinator, AIDS Education and Outreach Program, Counseling and Consultation Services, The Ohio State University.
1992-199 3...... Graduate Administrative Associate, Hispanic Outreach, Counseling and Consultation Services, The Ohio State University.
1993-199 4...... Psychology Intern, Counseling and Consultation Services, The Ohio State University.
1994-Presen t ...... Staff Counselor, Denison University, Granville, Ohio.
PUBLICATIONS
Highien, P. S., & Sudarsky-Gleiser, C. (1994). Co-essence model of vocational assessment for racial/ethnic minorities (CEMVA-REM): An existential approach. Journal of Career Assessment. Z. 304-329.
FIELDS OF STUDY Major Field: Psychology TABLE OF CONTENTS
ACKNOWLEDGMENTS...... ü
VITA ...... V
LIST OF TABLES ...... xii
LIST OF FIGURES ...... xiiL
CHAPTER
I. INTRODUCTION ...... I
Rationale ...... 6 Purpose and Objectives ...... 7
II. REVIEW OF THE LITERATURE ...... 9
What is a Metaphor? ...... 10 Metaphors in Everyday life ...... 1.4 Metaphoric communication; A Multicultural and Historical Perspective ...... 15 Symbolic Healing and Psychotherapy ...... 25 Metaphoric Communication Across Theoretical Orientations in Counseling and Therapy ...... 28 Therapeutic Metaphors Across the Treatment Process ...... 35 Metaphoric Communication Across Treatment Modalities ...... 41 Metaphoric communication in Individual Therapy ...... 41 Metaphoric Communication in Group Therapy ...... 50 Metaphoric Communication in Family Therapy ...... 54 Metaphoric Communication in Multicultural Counseling ...... 60 Concluding Remarks ...... 65 Phenomenology & Grounded Theory ...... 69
vi III. METHODS ...... 23
Participants ...... 2.4 Data Collection ...... 31 The researcher ...... 31 Setting ...... 8.1 Pilot Interviev/s ...... SZ Open-ended Interviews ...... 3 2 Observational Notes, Methodological Notes and Theoretical Notes ...... 8.4 Methods of Establishing Rigor ...... 86 Triangulation ...... 86 Data triangulation ...... 86 Theoretical Triangulation ...... 3 7 Methodological Triangulation ...... 87 Triangulation through multiple analysts...... 3 8 Member Checks ...... 3 9 Bracketing ...... 90 Peer Debriefing Group ...... 9Z Data Analysis ...... 93 Transcription of tapes ...... 94. Identification of Individual Themes and Themes across Therapists ...... 95 Identification of Individual Models ...... 9 5 Open Coding ...... 9.6 Axial Coding ...... 99
VI. RESULTS ...... 102
Identification of Individual General Themes ...... 103 Therapist #1 Individual Themes ...... 104 Philosophical Understanding of Metaphors ...... 104 Metaphors in Clinical Practice ...... 105 Values regarding Therapy ...... 105 Therapist Developmental Process Associated with Metaphor Work ...... 106 Therapist #1 Model of Metaphoric Communication ...... 106
vii Feedback through the members check procedure ...... 107 Therapist #2 Individual Themes ...... 107 Philosophical Understanding of Metaphors ...... 107 Metaphors In Clinical Practice ...... 107 Values regarding Therapy ...... 108 Therapist’s Developmental Process Associated with Metaphor Work ...... 108 Therapist #2 Model of Metaphoric Communication ...... 109 Feedback through members check procedure ...... 109 Therapist #3 Individual Themes ...... 110 Philosophical Understanding of Metaphors ...... 110 Metaphors in Clinical Practice ...... 110 Values regarding Therapy ...... 110 Therapist Developmental Process Associated with Metaphor Work ...... 110 Therapist #3 Model of Metaphoric Communication ...... 111 Feedback through members check procedure ...... 112 Therapist #4 Individual Themes ...... 112 Philosophical Understanding of Metaphors ...... 112 Metaphors in Clinical Practice ...... 112 Values regarding Therapy ...... 113 Therapist Developmental Process Associated with Metaphor Work ...... 1 ] 3 Therapist #4 Model of Metaphoric Communication ...... 113 Therapist #5 Individual Themes ...... 114 Philosophical Understanding of Metaphors ...... 114 Metaphors in Clinical Practice ...... 115 Values regarding Therapy ...... 115
vm Developmental Process Associated with Metaphor W ork ...... 115 Therapist #5 Model of Metaphoric Communication ...... 116 Feedback through members check procedure ...... 117 Therapist #6 Individual Themes ...... 117 Philosophical Understanding of Metaphors ...... 117 Metaphors in Clinical Practice ...... 1.17 Values Regarding Therapy ...... 118 Therapist Developmental Process Associated with Metaphors Work ...... 118 Therapist #6 Model of Metaphoric Communication ...... 118 Feedback through members check procedure ...... 119 Therapist #7 Individual Themes ...... 1.20 Philosophical Understanding of Metaphors ...... 120 Metaphors in Clinical Practice ...... 120 Values regarding Therapy ...... 120 Therapist Developmental Process Associated with Metaphor Work ...... 121 Therapist #7 Model of Metaphoric Communication ...... 121 Feedback through members check procedure ...... 122 Therapist #8 Individual Themes ...... 122 Philosophical Understanding of Metaphors ...... 1.22 Metaphors in Clinical Practice ...... 122 Values Regarding Therapy ...... 123 Therapist Developmental Process Associated with Metaphor Work ...... 12.3 Therapist #8 Model of Metaphoric Communication ...... 123 Feedback through members check procedure ...... 124
IX Themes Across Participants ...... 125 Open Coding ...... 128 Axial Coding ...... 1...... 126 Therapists' Developmental Process of Metaphoric Communication ...... 129 Professional Influences ...... 1.39 Personal Influences ...... 1 .4 2 Philosophical understanding of metaphors in clinical practice ...... 147 Metaphor as technique ...... 14.7 Metaphor as technique-tool-being ...... 147 Metaphor as a way of being ...... 148 Conditions Metaphor Effectiveness ...... 1.52 Metaphor-based conditions ...... 152 Therapist-based conditions ...... 156 Relationship-based conditions ...... 157 Applicability of metaphors ...... 161 Rationale for Metaphoric Effectiveness ...... 168 Feedback Regarding the Effectiveness of Metaphors ...... 1.72 In session feedback ...... 173 Feedback across sessions ...... 173 Client change ...... 172 Impact on the therapist ...... 1.73 Categories of metaphors ...... 173 Consequences ...... 179 Consequences for the Client ...... 179 Consequences for the Therapist ...... 187
V. DISCUSSION ...... 192
Therapists' Developmental Process of Metaphoric Communication ...... 193 Theoretical Orientation and Metaphor Work ...... 194 Philosophical Understanding of Metaphors ...... 196 Effective Metaphors Moderating Variables ...... 197 Applicability of Metaphors ...... 200 Categories of Metaphors ...... 206 Clinical Advantage of the Use of Metaphoric Communication ...... 208 Implications for the Field of Counseling Psychology ...... 231 Limitations of the Study ...... 2 1 6 Implications for Future Research ...... 2 IS Concluding Remarks ...... 220
LIST OF REFERENCES ...... 222
APPENDICES
A. LETTER TO PROSPECTIVE THERAPISTS ...... 237 B. OPEN - ENDED INTERVIEW ...... 2 4 0 C. OBSERVATIONAL, METHODOLOGICAL, AND THEORETICAL NOTES...... 244
XI LIST OF TABLES
TABLE PAGE
1. Personal characteristics of the research sample ...... 7S
2. Professional characteristics of the research sample ...... 79
3. List of categories with corresponding codes and textual samples ...... 123
XU LIST OF FIGURES
FIGURE PAGE
1. Therapists development, use, and experience of metaphoric communication in clinical practice ...... 137
xiu CHAPTER I
INTRODUCTION
As long as recorded history has been around, and in myths that date back into the farthest and dimmest memories of human existence, metaphor has been used as a mechanism of teaching and changing ideas. Shamen, philosophers, and prophets alike have intuitively known and used the power of metaphor ...It then comes as no surprise . . . to find the use of metaphor in the behavior of the intuitive clinician, the 'modem' practitioner of psychotherapy (Bandler, cited in Gordon, 1978, p. xi).
The word "metaphor" has its origin in Greek language and refers to "a transfer". One word, phrase, image, or action that applies to one kind of object or concept is applied to another, thus suggesting an analogy between them (Rosenblatt, 1994). The essence of metaphor is the experiencing and understanding of one thing or event in terms of another; metaphors link parts together into a functional, coherent whole (Richardson, 1994). Through their linking activity, metaphors add new meaning to the original event
(Aristotle, / 1 962). Metaphors stimulate imagination, ease communication, and facilitate learning (Bettelheim, 1989). Even Aristotle, who has been considered the master of rational thinking, stressed the interconnection between wisdom and myth (Lankton & Lankton, 1989), Myth turns people toward their inner life, toward
their spiritual being so that they can actually feel the experience of being alive (Campbell, 1988).
Metaphors may be linguistic and nonlinguistic in nature. Stories and fables are examples of linguistic metaphors; rituals, dreams, and pictorial symbols are examples of nonlinguistic metaphors. Linguistic and nonlinguistic metaphors have been used historically across cultures to teach the most valued concepts of human
interaction, as well as the most sophisticated concepts of
knowledge (Sanders & Sanders,! 984). Gordon (1978) documented that stories have been used to transmit important cultural, sociological and moral information between generations. Storytelling has been the vehicle for teaching and exchanging human knowledge and experience since earliest history, in Sanders and Sanders' (1984) words.
The roots of metaphoric teaching . . . are not to be found in recent research, rather these roots can be found in the recorded oral histories of almost all cultures . . . [which] demonstrate the timeless universality of teaching concepts with metaphors (p. 50).
Storytelling, with its unique metaphorical constructions, has
been used for therapeutic, as well as didactic purposes.
Metaphors, stories, and tales have been used for healing purposes historically across cultures (OAMCD). The therapeutic use of stories, myths, tales and rituals is prevalent for example, in Native-American (e.g. Kluckhohn, 1976), Mesoamerican (e.g. Fow,
1986), African (e.g., Peters, 1984), and Jewish (e.g., Frankel, 1989) cultures. Given the Western cultural bias towards rational, logical, linear, left-brain thinking, people in the West have become alienated from the more intuitive and holistic style of processing information (Orbstein, 1972). A need for a more balanced existence through the utilization of right-brain functions, symbols, and metaphors has been stressed by several authors (e.g., Lévi-Strauss, 1979; Orbstein, 1972; Samples, 1983). The field of counseling psychology has recognized this need and has characterized metaphoric communication as a valuable resource in therapy (Kostere & Malatesta, 1985). Given that therapy aims to (a) motivate people for action, (b) facilitate consideration of new ideas and possibilities, and (c) stimulate discovery of meaning in life, metaphors have been described not only as useful, but as necessary tools in the therapeutic process (Lankton & Lankton, 1989).
Theoretical formulations and anecdotal reports from clinical cases emphasize the value of therapeutic metaphors. Reality therapy, as well as Jungian, Ericksonian, and Symbolic-
Experiential orientations have stressed the power of metaphoric communication in therapy. Jungian theory, for instance, has emphasized the universal value of myths, dreams and symbols (Humbert, 1984). The individual and the collective unconscious express themselves through symbolic and metaphoric images. Ericksonian approaches have stressed the value of therapeutic metaphors in assisting clients move towards specific goals
without interference from the conscious mind (Zeig, 1980). Symbolic-Experiential therapists, such as Carl Whitaker and Virginia Satir, have documented the usefulness of metaphoric communication to access primary processes and to facilitate here and now experiences (Satir, 1987; Whitaker, 1982). William
Glasser's reality therapy values metaphors for their ability to
facilitate client-therapist communication and Gregory Bateson for their capability to establish connections between conscious and unconscious processes. In addition to the theoretical writing on the therapeutic value of metaphors, anecdotal reports have characterized metaphors as devices that enhance the therapeutic alliance, diminish resistance, and accelerate the therapeutic process (Thompson, 1990). Given the trend in our field towards brief counseling, cost reduced interventions, and managed care, it is possible to predict that practitioners will be more willing to experiment with innovative interventions that promise to expedite the process of therapy.
Quality care, not just low-cost care, is the goal which conscientious therapists aim for (Sleek, 1995). Given metaphors' power to access meaning, facilitate insight, and promote long term benefits for clients, they have been described as facilitators of healing and growth (e.g.. Barker, 1985; Hendrix, 1992; Lankton &
Lankton, 1989). Metaphors, through their connection with myth, fairytales, stories, and play, seem to be much more than 5 interventions that expedite counseling. Metaphors constitute a way to communicate through which clients can connect with the child within, ancestors, and the universe. When metaphors and
myths are used, it is possible for people to capture the evolutions encapsulated in them and to open up to their own self evolution. "When childlike listening can be recaptured through metaphor, magical transformations can occur" (Thompson, 1990, p.254).
Metaphors have been described as valuable resources throughout the treatment process (e.g.. Rule, 1984) and across treatment
modalities, including individual (e.g.. Barker, 1985; Crawford,
1990), group (e.g.. Gladding, 1984; Kolb, 1983), and family therapy (e.g., Bryant, Katz, Becvar & Becvar, 1988; Imber-Black, 1988).
They have also been characterized as effective techniques across age groups, including children (e.g., Bettelheim, 1989; Hallock,
1989), adolescents (e.g.. Bowman & Halfacre, 1994; Sharlin & Shenar, 1986), and adults (e.g., Lerner, 1978; Lewis, 1992).
Metaphors have been used with clients manifesting diverse
presenting concerns, such as weight control (e.g., Adams &
Chadbourne, 1982), sexual abuse (e.g.. Bowman & Halfacre, 1994; Lewis, 1992), Multiple Personality Disorder (e.g., Crawford, 1990); and post-traumatic stress disorder (e.g., Witzum, Dasber & Bleich,
1986).
Although didactic and therapeutic metaphors have been used historically and across cultures, and although they have been increasingly used in counseling and therapy, metaphors have been
neglected in psychological inquiry (Billow, 1977). One possible reason for this dearth of research in metaphoric communication is psychology’s bias toward linear, rational thinking.
Rationale In the pursuit of rational knowledge creative, symbolic, and right brain strategies have been virtually ignored (Sanders & Sanders,! 984). Only recently, metaphors have received attention in the field of counseling psychology. However, the focus on therapeutic metaphors has been mostly through theoretical writing, and unsystematic, anecdotal reports based on clinical cases (e.g.. Rule, 1983; Gladding, 1984). Systematic empirical research is needed to compensate for the paucity of research on metaphor use in clinical practice (Billow, 1977). Several authors (e.g., Berlin, Olson, Cano & Engel, 1991 ; Mazza, 1993) stressed the need for rigorous research to validate the therapeutic use of metaphors. The purpose of this study was to address this concern by examining therapists' experience of metaphoric communication in clinical practice.
The need to complement the anecdotal focus in the literature was not the only reason why this study was conducted. Given my own use of symbolic language in clinical practice, I felt personally motivated to learn from the subjective experiences of colleagues who incorporate metaphoric communication in therapy. Through my training in Counseling Psychology, my practicum and internship experiences and now in my professional role as a counselor, I have experienced movement towards an increased sense of freedom to 7 use my creativity and my symbolic, metaphoric communication. I had been intrigued by this process and by my intuitive belief in the power of metaphors. This dissertation responds to my own personal need to understand the meaning, value and applicability of metaphors in clinical practice.
Purpose and Objectives The purpose of this study was to explore mental health professionals' use of metaphoric communication in therapy. The qualitative, discovery-oriented focus aimed to uncover therapists' subjective experience with metaphors and to produce a data-based model of these experiences. More specifically, the study (a) examined therapists' developmental process of metaphoric communication; (b) explored therapists' understanding of metaphors and their role in clinical practice; (c) examined the impact of moderating variables on metaphor effectiveness; (d) identified examples of therapists' metaphoric work; and, (e) explored the impact of metaphoric communication on the therapists themselves. Mental health practitioners, over the course of two in-depth open-ended interviews, were invited to explore their use of metaphors in clinical practice.
Research results will be useful to mental health practitioners, clinical supervisors, counseling trainees, and social science researchers and theoreticians. The exploration of the nature, applicability and effectiveness of symbolic communication in clinical practice may increase therapists' awareness of the 8 therapeutic advantages of metaphor work. This awareness may translate into increased flexibilily and receptivity toward metaphors. The use of metaphoric communication may complement
verbal, linear, and rational approaches to therapy (Lankton & Lankton, ^ 989). The researcher's hope is that clients will benefit from therapists' increased awareness, openness, and receptivity to the use of metaphors in therapy. CHAPTER II
REVIEW OF THE LITERATURE
Although metaphors have been used through history and across cultures as a means of teaching, exchanging knowledge and experience, influencing others, and transmitting cultural, sociological and moral information (Gordon, 1978; Sanders &
Sanders, 1984; Wallas, 1985), relatively little research has been done on the use of metaphors in counseling and therapy. The counseling literature regarding therapeutic metaphors falls into two basic categories. The first category is composed of theoretical/narrative publications that (a) inform the reader about the applicability and benefits of metaphoric communication, and
(b) provide guidelines for the practical delivery of metaphors
(Barker, 1985; Gordon, 1978; Lemer, 1978). This literature relies on theoretical and testimonial formulations primarily based on
Jungian and Ericksonian treatment approaches. The second category involves unsystematic reports based on clinical cases (e.g., Briggs, 1992; Busby & Lufkin, 1992; Fineberg, 1984; Gavazzi & Blumenkratz, 1993; Lewis, 1992). These reports are primarily anecdotal accounts from mental health practitioners. Little empirical evidence supports these reports, and none of them 10 include an in-depth systematic description of therapists' experience of metaphoric communication. The counseling literature is characterized by a dearth of systematic and empirical exploration regarding metaphoric communication in clinical practice.
This chapter covers a review of the literature. It begins with a definition of metaphoric communication and proceeds with a description of the use of metaphors in everyday life. A multicultural-historical perspective on the use of metaphors is provided to familiarize the reader with a socio-cultural-historical background regarding the use of symbols. The chapter continues with a description of the use of metaphors within diverse theories of psychotherapy and proceeds with a presentation on the applicability of metaphors throughout the treatment process and across treatment modalities. The chapter ends with a brief description of the philosophical tenets of qualitative research with special emphasis on phenomenological and grounded-theory approaches.
What is a Metaphor?
The word "metaphor" is derived from the Greek meta pherein meaning "to carry over." In Poetics. Aristotle described metaphor as involving a transference of a word or name from one object to another (Aristotle, / 1 982). The New Merriam-Webster Dictionary. defines a metaphor as a figure of speech in which a word denoting one object or idea is used in place of another to suggest a likeness between them. According to Harley (1985), metaphor is any PLEASE NOTE
Page(s) not included with original material and unavailable from author or university. Filmed as received.
ÜMI 12 in the stomach, for example), not the words but what the client
feels is what it is most significant Finally, the fourth language is that of metaphors. Metaphors do not have universal meaning in the
sense that a "listener will take what [she or] he hears and represent it in terms of his [or her] own experience" (Gordon, 1961, p.9). Not the words themselves but what is perceived is what is most significant Although metaphors may be nonlinguistic (e.g.,
ritual, pictorial), linguistic metaphors (e.g., stories, fables) receive most of the attention in the literature (Rosenblatt, 1994). For the purpose of this study, metaphoric communication was broadly defined to include the language of symbols and the language of metaphors (linguistic and nonlinguistic metaphors). Metaphoric communication was defined as any verbal or visual illustration, description, representation or symbol with no literal meaning or interpretation. Words, images, or objects are categorized as metaphors if they imply more than their immediate
meaning. Multiple meanings and interpretations are embedded in metaphoric language. Barker (1985) classified therapeutic metaphors into several categories: (a) Major stories designed to deal with complex clinical situations; (b) Anecdotes and short stories aimed at achieving specific goals; (c) Tasks with metaphorical meanings, such as rituals, homeworks, etc. that can
be performed in or out of sessions; (d) Metaphorical objects or symbols; and e) Artistic metaphors (e.g. drawings, paintings, clay modeling, etc.). 13 Barker, (1985) also has distinguished similes, proverbs, fairy tales, and Biblical parables from metaphors. According to Barker
(1985), similes, in contrast to metaphors, resemble the object or situation with which it is compared (e.g., "he swims like a fish"). Proverbs, fairy tales and parables differ from metaphors in that they teach specific lessons (i.e., didactic function), while metaphors offer new choices, new ways of looking at experiences, tapping into beliefs and ideas that have been dormant in the client’s mind. For the purpose of this study, analogies, myths, anecdotes, poetry, stories, fables, metaphors, and rituals, as well as dreams, images, and symbols (e.g., projectives, sandtray miniatures, clay modeling, etc.) were considered metaphors. Support for the more inclusive definition of metaphors comes from several sources: (a) Broad definitions of metaphor as a way of expressing and illustrating a phenomenon in terms of another (Harley, 1985; Kopp,
1971 ); (b) Barker's (1985) inclusive classification of therapeutic metaphors; (c) Anecdotal counseling literature which refers to diverse figurative structures such as verbal metaphors, stories, tales (e.g.. Barker, 1985; Gordon, 1978; Kostere & Malatesta, 1985), poetry (e.g., Lerner, 1978), rituals (e.g., Imber-Black, Roberts, & Whiting, 1988), and symbolic objects (e.g., Fineberg,
1984; Ryce-Menuhim, 1992) as metaphoric communication devices; and (d) Hallock’s (1989) and Combs and Freedman's (1990) position that although the field of linguistics distinguishes between different types of figurative communication, for counseling 14 purposes, they all can be classified as metaphoric in nature.
Metaphors in Evervdav life
"Metaphor making—the imaginative act of comparing dissimilar things on the basis of some underlying principle that unites them - is one of the ways we construct a new reality" (Siegelman, 1990, p. ix). We construct a new reality through a bridging operation, an operation that does not reduce but connects (Siegelman, 1990). Connections between previously unrelated events give rise to insight. These connections or metaphors are irreplaceable; they allow us to understand ourselves and our world in ways that no other thought processes can (Lakoff & Turner, 1989). Language and knowledge expand by comparing the known with the unknown; it is through metaphor that we gain understanding and through metaphor that language itself develops (Siegelman, 1990). Metaphors, then, are not a product of extraordinary language or extraordinary creativity; they are present in everyday life and govern our daily functioning. Even cultural values are reflected metaphorically in everyday expressions; one example is the conceptual metaphor
"argument is war" (Lakoff & Johnson, 1980, p. 4). According to Lakoff and Johnson (1980), this metaphor is reflected in our language through expressions such as "His criticisms where right on target' or "He shot down all my arguments" (p. 4). These authors state that in a culture where arguments are not viewed in terms of war, where no one loses or wins, where there is no need to defend or attack, people would experience, carry, and talk about 15 arguments in a very different way. They may not structure their discourse in terms of war, but they may use instead metaphoric constructs that would describe arguments in terms of, for instance, a dance. Another example of how cultural values are reflected metaphorically in everyday language is the Western concept "time is money" (Lakoff & Johnson, 1980, p. 7).
Contemporary English expressions such as "I've invested a lot of time in her", "He’s living on borrowed time", or "You need to budget your time" (Lakoff & Johnson, 1980, p. 8) clearly reflect the
Western cultural value of time as a limited resource and a valuable commodity.
Metaphoric Communication: A Multicultural and Historical Perspective
Down through the ages, stories have been used for the purpose of entertainment, enchantment and teaching. In the cultural history of most people there lies a vast storehouse of learnings known as folklore. These tales have no specifically known origins and are passed down by word of mouth from generation to generation. As in any art form, many of these stories have stood the test of time and offer learnings as relevant today as when they were first told (Kostere & Malatesta, 1985, p. 2 1 7 ).
Anthropologists such as Lévi-Strauss (1979) and Joseph Campbell (1988) have documented the role of myths in the history
of diverse cultures. Western cultures have become disunited from
stories, myths, and metaphoric thinking as a consequence of a 16 cultural bias toward rational, left-brain thinking. Orbstein (1972) explained that the left hemisphere can be characterized as the logical, rational side of our existence. The left hemisphere is analogous with light, daytime, time-oriented, linear thinking, focused attention, rationality and, with the oriental term "yang".
The right hemisphere, on the other hand, is characterized as the
more holistic, diffuse, intuitive style of information processing.
The right hemisphere is analogous with night, dark, sensuality, intuition, holistic processes, timelessness, diffused attention, and with the oriental term "yin". People in the West have become alienated from the "yin". "As scientific thinkers we use a very limited amount of our mental power. We use what is needed by our
profession, our trade, or the particular situation in which we are
involved at the moment" (Lévi-Strauss, 1979, p. 18). Orbstein (1972) stated the need for a more balanced existence by facilitating a revival of our mystic selves. One culture that is particularly rich in the use of mystic elements is the Native-American culture. Among different Native-
American tribes, metaphors are used to pass information across generations. Myths and stories serve a didactic function (Campbell, 1988). They facilitate understanding among the People, and also between different Peoples (Storm, 1972). Because the People did not have a written language, stories were memorized and passed across generations. The conservation of traditions and the teaching purpose of stories and tales are exemplified by two well known Eskimo sayings; "We Eskimos do not concern ourselves 17 with solving old riddles. We repeat the old stories in the way they
were told to us and with the words, we ourselves remember", and we keep the old rules in order that we may live untroubled" (in Kluckhohn, 1976, p,101). Similarly, when Navaho singers are questioned why certain rituals are performed in a particular way, they usually answer "because the Holy People did it that way in the first place" (in Kluckhohn, 1976, p,101 ). It is clear from these sayings that stories, tales, myths and rituals serve to protect cultural continuity and to maintain socio-cultural norms and behavior. Stories, myth and tales promote social solidarity, enhance the integration of the society, provide formalized statements of social values, and afford a means for transmission of cultural ideologies across generations (Kluckhohn, 1976).
Comstock (1971) identified three basic latent functions of myths and rituals: a social, a biological-psychological, and a depth-psychological function.
The social function of rituals makes reference to its social integrative purpose. Communal rites and rituals offer society one way to overcome threats towards disintegration and dissolution of social bonds (Comstock, 1971 ). Totemism through its symbolic characters offer cultural groups a representation of social structures. Totemic societies use symbolic images to reinforce the social and religious organization of the group (Lévi-Strauss,
1963). Through the sociological function, myths, symbols, and rituals support and validate a certain social order (Campbell,
1988). An example is the religious pyramid of the gods among the 18 Tikopia. This pyramid corresponds exactly to the pyramids of social relationships existing among the clans. The hierarchy of gods provides a symbolic representation of their social reality.
Through myths and rituals the social situation receives a justification. Rituals can also help in the formation, change, and transition of the social order. As Confucius (cited in Comstock
1971 ), expressed long ago, "ritual serves as a buffer protecting the delicate egos of the participants while enabling unpleasant actualities, such as the ascendancy of one man over another, to be stated in a way that is palatable and acceptable to both. The blunt edge of the truth is softened by the pleasing complexity of the ritual" (p. 40). In contemporary psychotherapy, the social function of rituals is evident primarily in treatment interventions with couples, and families. Membership and belief negotiation rites are examples of the type of rituals used by family therapists to facilitate integration of family members (for a detailed description, see section on metaphoric communication in family therapy).
Another social function of myths and rituals makes reference to its performing character. Rituals accomplish social integration by inviting members of a society to act out or perform an integral act together. In fact, Munn (1973) described rituals as a medium of social interaction. Rituals link the individual to a community of significant others through the symbolic representation of shared life meanings. In contemporary psychotherapy, the counseling process itself has been described as a ritual that offers clients a 19 medium for social interaction. In fact, Combs & Freedman (1990) describe each therapeutic session as part o f a large ceremony of transformation and growth. When the ceremony is successful, it can be one of the most important ceremonies in a person's life.
Myths and rituals offer a creative way to help resolve social and personal dilemmas. Stories, tales, and rituals provide direct means for people to solve difficulties and release tension in their social relationships. Among the Navaho, for instance, myths and rituals serve to channel the hostility and uneasiness generated by the rigors of their physical environment, geographical isolation, physical illness, and intrafamily tension. Repression and projection, as well as shame and guilt, have been documented among Navaho Indians. Chronic anxiety is a common symptom which tends to be described as "feeling sick all over". Rites and ceremonies to "cure" this "illness" are used frequently. Tension is channeled through the symbols involved in the rituals.
Ceremonies and rituals are used in contemporary psychotherapy.
Healing, identity, and celebration rituals are used in treatment as symbolic-experiential acts that not only mark a transition but that make a transition possible (Roberts, 1 9 8 8 ). Rituals are used to create a context in which change can occur by offering clients opportunities to participate in new patterns of behavior (Combs & Freedman, 1990).
In addition to the social function of myths and rituals, they serve a bioloQical-Dsvcholoaical role. The biological-psychological function of symbols, myths and rituals makes reference to their 20 role in identity formation of members of society. Psychological-
biological phenomena focus on personal and biological concerns associated with birth, maturation, and sexual life and their
connection to personal identity. Initiation rites and rites of passage are of assistance in the problem of forming personal identity among Native Americans, as well as other cultures. These rites are both civil and religious in nature as initiants are
introduced to their social and religious responsibilities (Comstock, 1971 ). Rites of passage are used in contemporary psychotherapy as a way to assist clients to deal with transitions in their lives. Initiation rites have been used, for instance, in prevention and treatment efforts with adolescents (Gavazzi & Blumenkratz,
1993). They also have been useful in helping clients celebrate life transitions when there are no socially established rituals to mark a new life phase, e.g., gay couples who may not have the opportunity of a legal marriage (Imber & Black, 1988).
The third function of rituals and myths is a deoth-psvcholoaicaI function. This function focuses on the pedagogical role of symbolism (Campbell, 1988). Myths transmit information of how to live a human life under any set of circumstances; how to resolve conflict or danger when resources and defenses are threatened, limited or inadequate. Ritual and myth are used to face this aspect of human experience in several ways: seeking to enhance ordinary powers through magical spells, being encouraged to greater effort by rituals that sustain hope, or finding in a story consolation and acceptance of that which cannot be changed. The Navaho Ceremony 21 of the Evening Way is an example of this lype of ritual. The Navaho singer has the power to disperse evil and ignorance, stop bad
dreams and deter insanity. The Greenland Eskimos also use rituals that have a depth-psychological role. They use poems as a way to
dispel gloom and anger (Blinderman, 1 9 8 5 ). In this manner, rituals
facilitate expression of emotion in a socially approved manner and
offer The People an acceptable way to deal with inter- and intra personal tension.
In addition to the role metaphoric communication plays in the lives of Native-Americans, the use o f tales, rituals, and symbols was and still is common among other cultural groups. Ancient
Mesoamerican people for instance, shared a large number of cultural symbols (Taube, 1993). Mesoamerican myths are more than sacred tales and narratives regarding the origin of the world. They contain profound teachings for socially approved behavior; while courageousness was considered a valuable human trait, arrogance and excessive pride were devalued and condemned. Tales, myths, and symbols representing misfortune for those who behave with arrogance and greed are common in the Aztec and
Mayan mythology. In Aztec mythology, for instance, "it is not the vain and wealthy Tecuciztecatl but rather the humble yet brave
Nanahuatzin who eventually becomes the sun" (Taube, 1993, p. 17).
Similarly, the PodoI Vuh among the Mayas relates the story of the hero twins who are able to slay the monster bird Vucub Caquix because of his excessive pride. 22 Ancient myths and rituals continue to play a role in the lives of all people (Jung, 1964). The concepts of collective unconscious and archetypes, within the Jungian tradition, describe the connection between the unconscious mind o f modem individuals and the unconscious expressions of our ancestors.
For the analogies between ancient myths and the stories that appear in the dreams of modem patients are neither trivial nor accidental. They exist because the unconscious mind of modem man preserves the symbolic-making capacity that once found expression in the beliefs and rituals of the primitive. And that capacity still plays a role of vital psychic importance. In more ways that we realize, we are dependent on the messages that are carried by such symbols, and both our attitudes and our behavior are profoundly influenced by them (Jung, 1964, p.107).
Joseph Campbell (1988) also stressed the role of myths in the lives o f modern individuals. Through the use of myths and archetypes, he believes that one achieves increased self awareness and self knowledge:
Myths are clues to the spiritual potentialities of the human life ... We are so engaged in doing things to achieve purposes of outer value that we forget that the inner value ... is what it is all ab o u t... Myth helps you to put your mind in touch with the experience of being alive (Campbell, 1988, p. 5-6).
The same ideas were expressed by Ryce-Menuhim (1992) when he described symbols as being imbued with real life, containing conceptual and emotional values, hidden meanings, and universal 23 themes, Ideas, and thoughts.
In addition to the impact of ancient myths in the lives of modem individuals through the collective unconscious and archetypes, many of the indigenous myths, tales, customs, rituals, and beliefs survive to this day in the culture and communication patterns of the living descendants of the Mayas, the Aztecs, and other natives of Mexico and Central America through direct transmission across generations (Taube, 1993). An example is the custom of dream sharing and interpretation among the descendants of Mayan Indians in Guatemala. Dream sharing was used by Mayan Indians as a teaching tool to transmit cultural wisdom (Tedlock, 1992). In addition to the use of this symbolic and metaphoric communication practice, Otomi shamanism is another way in which symbols are used in Mesoamerica. Dow (1986) studied the magical healing that characterizes Otomi shamanism following a qualitative-ethnographic research approach. His work presents the symbolic structures characteristic of Otomi shamanism as described by a highly respected and active practitioner shaman among Indians and non-Indians in the Sierra Norte de Puebla in Mexico.
Shamans, like many contemporary therapists, use a variety of symbols in their rituals. Magical paper figures are important symbolic elements in shamanic healing. Figures made in bark paper symbolize the soul force, called "the zaki," of the figure represented by it. When a shaman cuts a figure, he gains power over the motivations of the person, animal or plant that it 24 represents. Shamans heal sickness, weakness and depression by attracting the zaki back to the person. Sometimes evil figures are used in magical cleaning ceremonies to attract their zaki of evil away from the house and patient. Shamans use other type of symbols to perform their rituals. According to the shaman interviewed by Dow (1986), "the form of the symbols should be decided more by the patient than by the healer. A professional shaman uses the symbols that the client believes to be the most effective " (p. 44). In serving families, for instance, shamans not only use paper figures representing the different family members but they also utilize symbolic objects brought in by families. The main responsibility of shamans is to alleviate suffering. It is their duly to diagnose illness correctly and to prescribe the course of action that is in the patient's best interest. Successful shamans tend to have dramatic and powerful ritual styles; shamanic visions and dreams contain solutions to the concerns presented by the shaman's patient; the shaman communicates ritual options to real problems (Dow, 1986).
Solution of problems, healing practices and transmission of cultural norms through rituals, tales, fables, myths and msetaphors are part of the cultural history of many other ethnic and cultural groups. The African culture and the Jewish culture represent communities that still rely on metaphoric communication as a problem solving and teaching tool. 25 The African culture relies on mythology, folklore, rituals, and symbolism to pass information across generations (Peters, 1984; Ray, 1 9 8 6 ). African myths, rituals, and symbols reflect upon many aspects of life and provide solutions to a vast range of problems including personal, familial, spiritual and communitarian concerns (Peters, 1984). African symbols are concerned with human life: they emphasize the concept of family and the human-nature link. Myths focus on philosophical questions such as the meaning of life, the origin of all things, and the end of life. African myths and tales can be characterized as world affirming, given their focus on the joy in life and human activity (Parrinder, 1967). African ritual has a social-functional character that strengthens the people as a whole through reinforcement of group solidarity. An example of the instrumental role of symbols and rituals in Africa is the Suna's Shrine ceremony in southern Uganda. During this ceremony, people gather at the shrine singing and dancing as a way to express deep reverence for their kings. The shrines serve as symbols that represent the mythic, spiritual, and historical foundation of the kingdom. The ceremonies reinforce the social identity of the royal class and the historic continuity of the kingdom with its sacred past. The Jewish community is another group that relies on metaphor, stories and symbolism as teaching tools and problem solving devices. Jewish tales address a collective experience and transmit a worldview. Jewish stories focus on unity, on all things being connected, on a single spirit infusing the world with meaning 26 (Frankei, 1989).
The Rabbis of the Talmud told stories to teach, to prove, to persuade or simply to delight each other and future listeners. The worldview and value system of the Jewish tradition (i.e., study, worship, and deeds of loving kindness) are represented and dramatized in Jewish stories and tales. New tales are created by Rabbis and Jewish storytellers to address the new challenges facing their people. An example is the presence of Hasidic storytelling. Stories and tales serve multiple functions in Hasidic culture: They serve as (a) a technique of social control by making acceptable and unacceptable behavior explicit; (b) a pleasant way to introduce the young to the guidelines of conduct and religious practices; (c) a source of entertainment; and (d) a powerful, therapeutic and even magical function through their problem solving and reassuring impact. A tale that presents a successful conclusion to a problem, a tale that conceals a prayer, or a tale that is used to shape desired ends may serve as a symbolic healing device.
Symbolic Healing and Psychotherapy Several attempts have been made to connect shamanic, cultural and religious symbolic healing with metaphoric healing present in modern psychotherapy. Dow (1986), for instance, talked about the power of suggestion as a common element in shamanism and psychotherapy: "The essential element in suggestive techniques is the healer's ability to develop new patterns of thought and behavior in the patient in a way that the patient could not achieve 27 by himself [or herself] In his [or her] normal environment” (Dow, 1986, p.138). By manipulating symbols, shamans, other religious leaders, and modern mental health practitioners suggest to their clients new ways of perceiving and experiencing the world. Catharsis is another element that has been discussed as an element common in both shamanic healing and current psychotherapy (Dow, 1986). The power of rituals at capturing emotional and experiential knowledge and their role in reaching the client's cultural and personal experience connects with psychotherapeutic techniques that invite clients to dramatize and project their concerns and emotional states into dreams, metaphors, and other symbols. Lévi-Strauss (1967) illustrated the power of symbolic healing through his description of a Cuna myth used by a shaman to help a mother cope with a difficult childbirth. The myth describes the adventures of some powerful and heroic characters on a difficult journey. Places described in the myth serve as analogies for the birth canal. The myth is said to have a hypnotic effect that serves as a coping mechanism for a woman dealing with difficult labor.
The use of symbols, tales, myths, and metaphors is not isolated in history. Metaphors are not just the property of philosophers and shamans. In fact, metaphors have become widely accepted tools in counseling and psychotherapy (Kostere & Malatesta, 1985). Several theoretical orientations make use of metaphoric communication as a major therapeutic tool. 28 Metaphoric Communication across Theoretical Orientations in Counseling and Therapy
All social science and psychological theories rely heavily on metaphors (Rosenblat, 1994). Social psychological theories, for Instance, draw on metaphors from drama (role theory); cognitive theories build on metaphors from computer science and electronics. Within counseling psychology, metaphors are widely used by therapists across theoretical orientations (Bryant, Katz, Becvar & Becvar, 1988).
Metaphors in Junoian psychotherapy. Jung's (1964) use of the symbol, for instance, "shares many of the qualities associated with metaphors . . . For Jung the symbol involves something more than the meaning that is immediately associated with a given word or image" (Trad, 1993, p.261). Transmutation of libido through symbols is rooted in human nature: "Because there are innumerable things beyond the range of human understanding, we constantly use symbolic terms to represent concepts that we cannot define or fully comprehend" (Jung, 1964, p. 21). The conscious production of symbols is only one aspect of individuals' use of symbols. The unconscious production of symbols is another important psychological function. The individual unconscious, as well as the collective unconscious, express themseives through symbols (e.g., dreams, images, impressions, myths). Dreams, for instance, inform the dreamer about repressed desires, hidden dynamics, and new viewpoints, serving to enlarge the conscious field (Humbert,
1984). In this sense, dreams and symbols are living entities; they 29 force themselves upon the person and mobilize psychic energy. The function of the symbol is to portray archetypes. As such, symbols represent spiritual and emotional qualities of the human experience. For analysts to explore the meaning of these symbols, they need to comprehend their origins and significance.
Symbols and metaphors are also important elements in other theoretical approaches. Ericksonian Psychotherapy, Neuro-
Linguistic Programming, Experiential Psychology, and Reality Therapy are examples of therapeutic approaches that have emphasized metaphoric communication. Metaphors In Ericksonian psvchotherapv. Milton Erickson has been considered "one of the most effective and innovative psychotherapists of our time" (Rosen, 1985, p.vii). For many years,
Erickson criticized a theory-based approach in psychotherapy. He, however, is often cited as being one of the founders of neuro linguistic programming. Erickson employed linguistics and paralinguistics therapeutically; he used indirect verbal and nonverbal communication to alter problem behavior. Erickson influenced change through his use of metaphors, analogies, teaching tales, contradiction, or just plain talk (Fish, 1 9 90). One of the characteristics of Erickson's approach was his use of stories and anecdotes as teaching devices and therapeutic tools. Erickson’s approach was based on the idea that things function best without interference from the conscious mind. As such, he made use of indirection to reach the unconscious. The majority of anecdotes 30 used by Erickson were nonfictional in nature; they were
descriptions of events from his life and the lives of his family and patients (Zeig, 1 9 8 0 ). Erickson used anecdotes during diverse therapeutic processes and for diverse clinical purposes. He used anecdotes diagnostically, in a similar way to the use of projective instruments. Anecdotes provide stimuli that lead to responses th a t have diagnostic significance. Erickson used anecdotes also for rapport building, to empathize with the patient and with the
dynamics th at are inside and outside the patient's conscious
realizations. Anecdotes were used by Erickson in treatm ent to make and illustrate a point, to suggest solutions, to get people to recognize themselves, to seed ideas and increase motivation, to embed directives, to decrease resistance, and to reframe and redefine a problem (Zeig, 1980). An example of the reframing
function of metaphors is Sanko's (1 9 8 6 ) description of Erickson's work with an amputee patient. The patient complained of phantom limb pain. Erickson introduced a metaphor in which he reported working with another amputee patient who described scratching an itch. In the metaphor, Erickson introduced the possibility of having
phantom good feelings, not just painful ones. Erickson used
anecdotes to create confusion and promote hypnotic
responsiveness as well as to model flexibility and creativity. "Anecdotes have th e... effect of modeling to the patient a creative and flexible way of being in the world ... Patients learn ... that they can confront their own rigidities and confining habits and become more flexible and effective in their living" (Zeig, 1980, p.26). 31 Erickson structured his anecdotes so that they were analogous to the experiences of his patients (Wallas, 1985). The structural equivalence between the client's situation and that portrayed by the story is illustrated through a case in which a female client is being told a tale directed at helping her diminish her activities as the neighborhood meddler. Part of the tale told to her runs like this:
In the forest community there lived an anteater named Wag . . . Wag had a long nose. This didn't bother her, but she could see that it was often the focus of attention in the fo re s t. . . (in Gordon, 1978, p.22).
Erickson modeled the patient's world with stories; clients' symptoms, concerns, or life situations were represented in the tales. Through stories, Erickson offered solutions, or ways of dealing with clients’ concerns, without arousing clients' resistance. Erickson's tales not only added charm and beauty to his practice of psychotherapy, but they increased his therapeutic effectiveness (Rosen, 1985).
Metaphors in Svmbolic-Exoerientia! approaches. Erickson is not the only symbolic-experientialist clinician who relied on metaphoric communication devices. Carl Whitaker and Virginia Satir also emphasized the use of metaphors in clinical practice.
Symbolic-experiential therapy is growth oriented, and it relies on interactive processes and symbolic language (Keith, 1982),
Symbolic-experiential therapy stresses intuition and right brain functions. As a consequence, Erickson, Whitaker, and Satir 32 resisted left-brain intellectual descriptions of their work (Mitten
& Piercy, 1993). They communicated with the right hemisphere of their clients in their own creative ways. Whitaker (1982), for instance, emphasized the need to access primary processes by inviting families to share their dreams and free associations. His interventions were in the form of stories and metaphors that included covert messages intended to alter clients' symbolic worlds. An example of this work is Whitaker's intervention with a couple dealing with sexual difficulties. The couple had shared that they enjoyed reading novels together. Whitaker invited them to sit facing each other as they did when reading a novel and co-write a first sex-scene for a novel.
Satir (1967) also emphasized the use of metaphoric communication. Satir uses metaphors and other symbolic devices as a medium to facilitate here and now experiences and to integrate reception of information across sensory systems.
Sculpting, verbal metaphors, rituals, and experiential games are examples of her use of symbolic means in therapy. Satir uses metaphors in clinical practice to integrate the parts of clients that often struggle for power and control. In one example, clients are asked to identify the different parts of their personalities and to include them in a "guest list". All guests are invited by the "hosts" (i.e., clients) to attend a "parts party". Identification of parts and their presence in a specific moment of time makes it possible for clients to observe their interaction. If clients are ready to work towards synthesis of their parts, Satir facilitates 33 an "integrative ritual". "Hosts" accept ^ e parts as well as responsibility to be in charge. Clients understand that parts can cooperate and function in an integrated manner (Satir, 1987). Metaphors in Reality Therapy. William Giasser's Reality
Therapy approach also emphasizes metaphoric communication in counseling and therapy. Giasser's use of metaphor is clearly illustrated in Hallock's (1989) description of Giasser's work. Giasser's use of metaphor is total, encompassing his work with clients, his training, and his own personal life to reflect how he expresses himself in the world (Hallock, 1989). Glasser adapts metaphoric communication to fit the client's internal world. To a bickering couple, for instance, he said, "You're like two armies; you're tired out, and I am coming in here with a white flag ..." . The white flag metaphor preceded some strong prescriptions for change (Hallock, 1989, p. 25). Glasser not only suggests metaphors to clients, but he is also tuned into metaphors offered by clients. Metaphors are valued in Reality Therapy as ways to ease communication and as effective venues for assigning meaning both to what clients tell therapists and to what therapists tell clients.
Metaphors in Batesonian therapy. Gregory Bateson is another therapist who emphasized the role of metaphors in treatment. As a consequence of his belief that everything is metaphor, he considered that skill in working with metaphors was essential for effective communication (Combs & Freedman, 1990). In psychotherapy, Bateson used metaphors to facilitate the connection between the conscious and unconscious minds and to 34 offer clients spectrums of options. Through metaphors, clients can
see patterns in their situation that were not available to them before. By seeing and applying new patterns, clients can distinguish new possibilities. Metaphors offer clients choices and flexibility (Bateson, 1979). Because metaphors are indirect, multimeaningful, multisensorial, and multidimensional, they
incorporate a certain level of randomness in therapy. Clients'
responses to this level of randomness and the therapist's reaction
to clients' feedback through new metaphors create a therapeutic system that enhances learning through trial and error (Combs & Freedman, 1990). Bateson (1979) emphasized the need to respect nonconscious processes; stories were frequently used by him to
help the unconscious mind connect individual bits of information and facilitate insight.
The presentation of the literature on the use of metaphors within different theoretical frameworks offered an appreciation of the applicability of metaphoric communication in therapy. The literature is based primarily on theoretical and testimonial information with little support from systematic research. In fact, some therapists, such as Whitaker, have evaded clinicians who seek to study or operationalize his work (Mitten & Piercy, 1993).
As will be seen in the following section, the literature on the application of therapeutic metaphors across the treatment process is also characterized by a dearth of empirical investigation. 35 Therapeutic Metaphors Across the Treatment Process Given that metaphors are present in daily language and given that communication is the medium in psychotherapy, metaphors may not only be present in the therapeutic process, but they may
also play an important role in it. In fact, metaphors have been described as useful and even essential communicative devices in counseling and therapy (Barker, 1985). As Siegelman (1990) stated, "Much of psychotherapy consists in identifying previously
unconscious metaphors and discovering how we unwittingly live by them" (p.67).
Anecdotal information from clinical cases has suggested specific advantages regarding the use of metaphors in psychotherapy. Metaphors serve as a technique to facilitate both process and outcome, and they are useful at different stages within the therapeutic process (Rule, 1984). Hendrix (1992) described a useful metaphor for the beginning stages of counseling, in which clients are told that participation in counseling is like "Spring Housecleaning";
The worst feelings in therapy and in housecleaning occur when everything is out in the open. If the therapy or housecleaning is stopped at that time, nothing gets put away. . . As items are dusted off and returned to their storage places, good feelings of accomplishment result (Hendrix, 1992, p. 236).
This metaphor is useful to prevent client drop-out; it can be particularly helpful for clients who enter therapy expecting immediate change. 36 Because metaphors may help to make the familiar unfamiliar, they are useful in problem identification. An example comes from
Gordon's work (1978) with a client dealing with marital difficulties. The client complained about his wife not being involved in the relationship. To achieve a better understanding of the problem the therapist asked whether it was like "being involved in a game and [your wife] doesn't want to play"? or whether it was more like "working on a project together, and she wants you to do it all"? (Gordon, 1978, p. 13). The answer frorr the client clarified the nature of the presenting concern. In addition to metaphors helping in the process of problem identification, they are useful in setting treatment goals (Gordon, 1978). Kostere and
Malatesta (1985) described a case of a client who defined therapeutic goals in terms of wanting to be a "bear," i.e., to be assertive enough to ask his boss for a raise.
Metaphors are not only useful in problem identification and clarification of treatment goals, but they are useful to reframe problems and concerns (Gladding, 1986). Clients and therapists can gain a different perspective of a problem or situation through the use of imagery and metaphors (Gladding, 1986). A perceptual change often promotes change in thinking, feeling and behaving
(Baruth & Huber, 1985). In this sense, metaphoric communication is useful in problem resolution. Kostere and Malatesta (1985) provide an example of problem resolution in their description of
Erickson's work with a couple who manifested a presenting concern of sexual discord. The problem originated with the husband's 37 desire to immediately have intercourse and the v/ife's interest in extending foreplay. Erickson gave the couple the task of planning and cooking a meal together, with the wife In charge of the entree and the husband in charge of appetizers.
Gordon (1978) further explained the usefulness of metaphors in problem resolution by highlighting the therapeutic use of tales and fables. According to Gordon, although tales vary in content, there are no major structural differences among many of them (e.g.,
Alice in Wonderland, Don Juan, The Odyssey). In essence, the characters are confronted with problems which require them to tap Into their personal resources to overcome them. Fables can be useful in the problem resolution stage in therapy by offering clients the message that problems can be solved, that they have power to change things, that they may need to focus on their intra personal resources, and that they can identify and learn diverse ways of solving problems from others (i.e., the protagonist).
Kostere and Malatesta (1985) illustrated the use of tales and fables in the treatment of a client torn with a decision about returning to school. The following metaphor was constructed to facilitate the decision making process:
Once upon a time there was a king who lived in a magical kingdom . . . One day it came to the king's attention that there was trouble in the northern province. The king knew that this trouble needed to be dealt with in order to restore a sense of peace, however, he was not sure how to do it... While in a deep sleep [the king] had a dream in which he... had a 38 meeting of the officers of the kingdom. At this meeting there was present the minister of the interior, the minister of the exterior, the minister of health, education and welfare and the minister of natural resources. During the process of the meeting the cabinet officers were able to settle their business in such a way that each one was satisfied. When the king awoke from his sleep he was joyous because he had learned a new way to solve the problem (pp. 223-224).
The metaphor was designed to fit the client's presenting concern and to offer options and hope for resolution. The effective use of therapeutic tales requires equivalency between the metaphor and the character and events in the client's life (Kostere
& Malatesta, 1985). Effective metaphors fit the client's model of the world, i.e., they are isomorphic or equivalent to the client's perceived situation (Gordon, 1978). Well formed metaphors pace the client in terms of background, interests and talents (e.g., telling a florist a tale about gardening or telling a physicist a story about science) and match the client's dominant system of perceiving the world (e.g., for an auditory person, metaphors may use vocabularies such as harmony or music). Effective metaphors help clients reframe unwanted or painful experiences and are conducive to problem resolution; as such, they serve as a bridge between the problem and the desired outcome (Gordon, 1978). In an example that stresses the power of metaphoric communication, Peseschkian (1 9 8 6 ) compared the use of therapeutic stories with the use of medication; 39
Used at right time in the right form, a story can became the central point of the therapeutic effort and can lead to changes in attitude and behavior. But, given in the wrong dosage, told in an insincere and moralizing way, its application can be dangerous, (p. xvi)
Summarv. In summary, effective metaphors can assist clients in several processes: (a) identifying and defining the nature or the presenting concern; (b) refocusing and reframing problems; (c) connecting with affect; (d) resolving impasses and resistance; (e) searching for solutions; and (f) encouraging action for change
(Rule, 1984). Several authors (e.g., Barker, 1985; Bettelheim, 1989;
Gordon, 1978; Sanders & Sanders, 1984; Siegelman, 1990) stressed different processes in which metaphoric communication is helpful. Littman (in Barker, 1985), for instance, explained that the power of metaphors lies in their ability to bypass defenses. Similarly, Bettelheim (1 9 8 9 ) stressed that an indirect approach, such as the use of metaphors, is essential in dealing with clients' resistance.
With the use of metaphors, one can evade the possibility that the client will reject a point of view because of a conscious realization of the need to protect him or herself against new discoveries (Barker, 1985). In Siegelman's (1990) words, a "metaphor can open a window on the patient's psyche: it helps the patient entertain a possibility he or she is defending against"
(p. 104). The clinical use of metaphors, then, is based on the assumption that while the conscious level may take a metaphor in a literal way, the unconscious level will perceive its symbolic 40 meaning (Barker, 1985). it Is the perception of the symbolic meaning that facilitates insight The metaphor creates an image which sparks insight, insight that facilitates the perception of the world in an innovative way (Sanders & Sanders, 1984). Sandler and Grinder (1975) explained how metaphors are experienced by clients. According to their model, clients are exposed to the surface structure of words with their respective apparent surface meaning. In the process of determining the surface meaning of the words, clients activate deeper levels of meaning. At first, this deeper meanings may appear irrelevant to clients. Gradually, they recognize the relevance of these meanings to their personal experiences. Thus, the full implications of a metaphor may not be immediately apparent to a client; however, eventually they emerge into conscious awareness. Summarv. In sum, metaphors have been described as insight provoking techniques across the treatment process. The effectiveness of metaphoric communication throughout the counseling process has been documented only through theoretical formulations and anecdotal and unsystematic descriptions of clinical cases. Neither has systematic empirical research been done to evaluate the impact of metaphors across the therapy process, nor has there been any research exploring therapists' experience of metaphoric communication. As will be seen in the following sections, metaphors have been identified as useful tools across treatment modalities (i.e., individual, family and group psychotherapy) and within both brief and long-term therapy 41 approaches, but little empirical data support such claims. Metaphoric Communication across Treatment Modalities
Psychotherapy has been defined as a process to help people "solve some problem,... find ways to use personal qualities more effectively, o r... make an important life decision" (Osipow, Walsh & Tosi, 1984, p.7). Through psychotherapy, people learn how to acknowledge their choices and use their power to decide how to behave or respond emotionally in diverse situations (Barker, 1985).
According to Thompson (1990), therapeutic methods can be seen as
"multiple paths to one end: the [normal] functioning of the individual" (p. 247). If, in fact, metaphors tap into the conscious and the unconscious at the same time, if they enable listeners to perceive things in new and different ways and, if they reduce client's resistance, metaphors can be considered essential communicative devices in therapy and across diverse treatment modalities.
Metaphoric communication in individual therapy. Sanders and
Sanders (1984) described metaphors as "tools for insight, for creativity, for concept development, for learning, for true understanding" (p.4). Metaphors offer opportunity for clients to use the meanings contained in the metaphor in their own way and for their own purpose (Barker, 1985). Metaphors also serve a defensive function as they enable clients to maintain necessary distance between content and feeling (Reider, 1972). The meaning of the content is ego dystonie, a factor that permits insights that can be tolerated. Metaphors can actually increase the power of 42 therapists by allowing them to be more ambiguous in assigning meaning and allowing clients to choose the most meaningful
interpretation to the metaphor (Thompson, ^ 9 9 0 ). By freeing
clients in the meaning-making process, they have the possibility of choosing what they need at that specific moment.
Metaphors, stories, and non-verbal symbols have been used in individual psychotherapy with diverse populations: children (e.g.,
Hallock, 1989; Ryce-Menuhim, 1992), adolescents (e.g.. Bowman &
Halfacre, 1994; Gavazzi & Blumenkratz, 1993; Sharlin & Shenar, 1986) and adults (e.g., Hynes, 1986; Gladding, 1979; Lerner, 1978; Lewis, 1992; and Murphy, 1978). Clients dealing with diverse type
of issues, such as sexual abuse (e.g., Lewis, 1 9 9 2 ), weight control (e.g., Adams & Chadbourne, 1982), multiple personality disorder (e.g., Crawford, 1990; Kluft, 1982), PTSD (e.g., Witzum, Dasber &
Bleich, 1 9 8 6 ), and schizophrenia (e.g., Aleksandrowich, 1 9 6 2 ) have responded to metaphors and symbols. Ryce-Menuhim (1992)
described, for instance, the use of symbolic work with children through the use of sandplay to illustrate the applicability of sandpiay in assessment and treatment processes. In working with a 12-year-old girl with a Wilms tumor, he noted that the girl
constructed a small town where everything was calm and in
perfect order. The giri repeated the scene almost identically in
following sessions symbolizing her wish to immobilize her illness
and fossilize time and space. The use of sandplay facilitated the
identification and expression of her unconscious motives and
desires. Sandplay therapy has a role in remedial therapy; it 43 facilitates increased awareness regarding feelings and thoughts. The power of sandplay therapy is related to its discouragement of rational thinking through the preverbal nature of the work
(Weinrib, 1983).
Hallock (1989) also described the use of metaphoric communication in child therapy in her illustration o f a case in which she introduced a borrowed metaphor to help two children deal with parental divorce. She gave them a kaleidoscope with the following remarks:
This is a kaleidoscope . . . the pieces of colored glass make new designs, depending on how you hold and turn the kaleidoscope. Those pieces of colored glass represent your family, and they are always the same pieces . . . [with] a new design. Same people, new design . . . We are like [the pieces of glass] in that we are all in our own space and relationships; birth mother, birth father, daughter, son; these pieces don't change, (p. 26).
Through the use of the kaleidoscope, the therapist introduced a concrete example for children to understand the possibility of change occurring without complete loss or disturbance of what is to remain stable, i.e., children's biological relationship to their parents.
In addition to the use of symbolic language with children, some authors (e.g.. Bowman & Halfacre, 1994; Gavazzi & Blumenkratz,
1993; Sharlin & Shenar, 1 9 8 6 ) have documented the use of metaphors with adolescents. Sharlin and Shenar (1 9 8 6 ), for 44 instance, demonstrated the diagnostic value of poetry in the detection of suicidal behavior. The researchers compared the poetry of two adolescents who committed suicide with the writings of two non-suicidal adolescents. The results from semantic analysis demonstrated significant differences between the two groups in the loaded words and occurrence of two major themes: "death" and "bad situation." Bowman and Halfacre (1994) illustrated the use of poetry as an adjunct to actualizing therapy in the treatment of a 19-year-old male who was sexually abused as a child. Through a sequence of four poems composed by the client, the authors demonstrated the movement of emotionally charged metaphors and symbols towards healing and resolution of the trauma. Based on clinical judgment. Bowman and Halfacre (1994) stated that poetry enhanced the therapeutic relationship by allowing the client to maintain control over closeness and distance. The creation of poetry permitted rehearsal of secrets before revealing them in the therapeutic environment. The poems facilitated recollection of memories and expression of feelings. Gavazzi & Blumenkratz (1993) also used metaphoric communication (in particular rites of passage) with adolescents. They described the use of initiation rituals in primary prevention and treatm ent efforts. The Rite of Passage Experience program (ROPE) introduces youth to their emerging adolescence and impending adulthood through an initiation ceremony and a series of activities designed to prepare them for the responsibilities of adulthood. The program encourages 45 community participation through volunteer experiences and presents drugs, alcohol, sexual promiscuity issues as "negative rites of passage". Through anecdotal case reports, Gavazzi &
Blumenkratz (1993), documented the effectiveness of ROPE in prevention and treatm ent. In an unpublished manuscript, Hawkins (1989, cited in Gavazzi & Blumenkratz, 1993) reported that adolescents participating in the ROPE program demonstrated greater family involvement and attachment to school, and less drug and alcohol consumption than a control group. The use of metaphoric communication has also been documented in individual therapy with adults. Lewis (1992) discussed the advantages of the use of creative arts (e.g., drawing, sculpting, poetry or story writing, sand play) in psychotherapy.
Through case examples, she illustrated the therapeutic power of metaphors at (a) establishing rapport with individual clients through a right-brain-to-right-brain relationship; (b) accessing and transforming trauma; (c) rejoining split-off parts of the self;
(d) addressing transference and countertransference issues; (e) reducing the power of internalized critical parents; and (f) developing inner loving parental figures.
Lewis illustrated the advantages of metaphors through the following case example. She invited a survivor of abuse to represent her experience employing the sandtray. As described by Lewis, the woman
placed an infant figure and a young giri in the sand. A half-human male figure rode an angry dinosaur. A 46 witch stood beside it with her finger pointed at the young aspects of [the] patient. [When the therapist] encouraged [her]. . . to explore needed protection. She . . . placed tiny, insignificant boundaries around the two figures. [The therapist with the client’s permission]. . . arranged the sand so that her feminine self stood behind a hill and created a moat around her by baring the blue bottom of the sand box. Lastly, [the therapist] placed male and female warrior parents and an erect dragon on her side of the moat facing the abusive introjected parental figures (p. 318).
Lewis (1992) concluded that the sandplay intervention helped the client move towards a healing state in which she felt protection, power, and self acceptance. Sandplay stimulates a regulatory and a healing function. Through symbols, patterns, shapes, and composition the form connects with meaning, bridging what is familiar to what is strange, the past to the present, and the present to the future (Ryce-Menuhin, 1992).
Gladding (1 9 7 9 ) also illustrated the use of metaphoric communication in individual therapy with adults. The client, a male who described life as a "series of fires" (i.e., heated arguments), used the "fire metaphor" to express his concerns and feelings within the counseling process. This metaphor led the client to new insights, which resulted in problem resolution:
"he . . . extinguish[ed] his hot temper" (Gladding, 1979, p. 286).
Adams and Chadbourne (1982) demonstrated the use of therapeutic metaphors as an approach to weight control in the treatment of obese individuals. Metaphors serve as a means of accessing information regarding clients' history around weight and 47 facilitate clients' recognition of possible options besides overeating. A clinical example illustrates Adams and Chadbourne's
(1982) use of metaphors to explore the variables involved in the origin and maintenance of weight gain. A client described herself as a "huge stuffed pepper," a metaphor that progressed to reveal hidden anger "I’m hot angry — the stuffing keeps me cool" (p. 511 ). Treatment proceeded to facilitate expression of anger, as weight loss may have not been accomplished without dealing first with the underlying feelings of anger. Metaphors have also been used to help overweight clients explore coping behaviors. The following is an example of a metaphor used by Adams and Chadbourne (1982) to help a client talk about losses in her life and discover options and choices:
When her mother left, the little pony sulked into her stall. She put her head down . . . and spent days just eating and sulking . . . never looking outside ... she didn't see the sun shining . . . or feel the warmth all around h e r... all she knew was the pleasure of grain. Then one day, the farmer gently led the pony outside . . . she could not believe the beauty all around h e r... Other ponies . . . came to play. Life was warmth and fun (p. 511 ).
The metaphor reached the client in a non-threatening manner and assisted her to make changes at unconscious as well as conscious levels (Adams & Chadbourne, 1982).
In addition to the use of stories, verbal metaphors, and symbolic devices such as the sandbox, the use of poetry has been described as a useful metaphoric device in treatment with 48 individual adults. Gladding (1 9 7 9 ) reported diverse ways in which poetry could be used with individual clients: (a) inviting clients to use poetry to describe their current reality; (b) having the therapist respond to the client in poetic form; or (c) having the clinician share with clients treatment impressions written in poetic form.
Crawford (1990) described the application and therapeutic role of metaphors with clients in need long-term therapy, clients manifesting dissociative states and Multiple Personality
Disorders. Individuals facing inner conflicts can access the opposite parts of the self, explore the differences, and create some form of integration or resolution more easily when treatment involves metaphors and imagery (Crawford, 1990). Kluft (1982), developed personalized images of union, images of merger, images of dance, "images of streams joining into a river, or the snow on many mountain peaks melting and flowing together into a lake"
(Kluft, 1982, p. 236). In a similar fashion, Lewis (1992) helped psychotic individuals rejoin split parts of the self by inviting them to use visual images to quiet the fragments and to represent them symbolically as a whole, like "pieces of a holographic puzzle" (p. 320). Similar approaches have been described with hospitalized schizophrenics in individual treatment. Aleksandrowich (1962) for instance, reported that direct communication with a woman suffering from schizophrenia was achieved by first accepting and working within the patient's metaphoric expressions. 49 In contrast with Aleksandrowich (1962), and Lewis (1992), clinical impressions regarding the effectiveness of metaphor work with schizophrenics and psychotic individuals, Ryce-Menuhin
(1992) wrote about the difficulties of doing symbolic work, in particular sandplay therapy, with these populations. Using his words, "The control of words chosen by an analyst enables verbal treatment to be more clinically helpful over time to psychotics than sandplay usually is" (p. 34).
Metaphors have been described as useful devices in the treatment of clients suffering from combat-induced post- traumatic stress disorder. Witztum, Dasber and Bleich (1986) noted the advantages of metaphoric interventions through a case study of a 28-year-old male veteran from the 1973 war between Israel and Egypt. The introduction of a metaphor (i.e. "You are hiding in a shelter") by the therapist generated intense introspection and insight by the patient (Witzum et al., 1986). The authors concluded that matching metaphors to the therapeutic experience of clients offers an indirect approach to deal with excessively painful and untouchable memories.
In sum, the use of metaphors seems to facilitate progress in therapy within an individual counseling format. Systematic research, however, is not available to support such a conclusion. The literature on the topic focuses primarily on anecdotal reports from clinical cases. Rigorous research is needed in the field to complement its reliance on clinical impressions. As will be seen in the following section, the literature on the use of symbolic 50 language in group therapy is characterized by similar difficulties. Metaphoric Communication in Group Therapy
The use of metaphoric communication in group treatment is advocated as a means of enhancing intrapersonal and interpersonal growth (Gladding, 1984, p. 151). Metaphors in group work provide several benefits for members. Metaphors are important initiator devices; they provide an example to group members on connections between two seemingly dissimilar things. Increased awareness of connection may facilitate rapport building, bonding, empathie understanding, and interpersonal relations in groups. Exploration of how metaphors change or grow, as individuals or the group develops, is another benefit of exploring metaphors in group therapy. Metaphors are also important for their latent effects; group metaphors may continue in members' minds long after the group has terminated (Gladding, 1984). In addition, metaphors have been described as safety devices that permit group members to indirectly express issues of concern that are too threatening to be addressed in more direct ways (McClure, 1989). Metaphors can be amplified, illuminated or interpreted within the group. The metaphor can be amplified by continuing work within the framework of a symbol or story. Amplification maintains the safety of symbolic language and permits further processing of difficult, unsafe, or risky material. Metaphors can be illuminated by having group members work on the possible meanings of their symbolic structure. Finally, metaphors can be interpreted by having the group leader connect the possible meaning of the 51 metaphor with the group's current Issues (McQure, 1 9 8 9 ). Zambelli, Clark, and Jong Hodgson (1 9 9 4 ) have used art as a metaphoric treatment device in group treatment with children who had recently lost a parent The art of bereaved children participating in this group generally contained symbols that reflected loss, grief, and death. Based on clinical judgment, the authors concluded that by giving group members the opportunily to express their active grieving through ait, children had an outlet for intense feelings of loss. Trotzer (1 9 7 7 ) is one author who has used metaphoric communication in group treatment with adults. He devised an exercise, "The Poem of Self," through which he invites group members to list words that describe how they act, how they look, what nouns remind others of them, and what places they would like to be. These metaphors are shared later in group, providing the opportunity for members to gain insights about inter- and intrapersonal dynamics.
In a similar fashion, Wenz and McWhirter (1 9 9 0 ) have used creative writing exercises in group therapy. In one of their exercises, group members are asked to respond symbolically and metaphorically to a series of questions such as, "What did the sky feel like to you this morning?" (p. 38) and to arrange their answers into a pattern or essay. Their metaphoric productions are shared in group. In another exercise, group members are invited to design a personal logo or symbol and tell a story about it. Through clinical impressions with the use of these exercises, the authors concluded 52 that metaphoric writing facilitates trust building and cohesion in
group, provides significant material to be processed in session, and extends the therapeutic impact. Mazza and Price (1985) also used metaphoric devices as therapeutic agents in group treatment- Poetry and music were used in a short-term group with college students by inviting them to share existing poems or songs and construct collaborative poems. Based on clinical judgment, the authors concluded th at the
use of poetry and music was helpful in stimulating interpersonal interactions and in addressing affective and behavioral processes. Poems and music facilitated a sense of universality and connectedness among participants. The collaborative poem was particularly helpful at facilitating group cohesion and at increasing members' commitment and involvement in group. Work on the collaborative poem across sessions provided a sense of continuity across the treatment process. The themes represented in the collaborative poem were congruent with themes characteristic of the different stages of group. The final collaborative poem served as a ritual to deal with termination issues (Mazza and Price, 1985). A similar application of poetry in group treatment was described by Buck and Kramer (1974). The purpose of their group was to facilitate interpersonal communication in a group of college students and hospital patients. Poems were read, as well as created, in session. Based on clinical impressions, the authors concluded that sharing poetry increased group cohesion (reflected 53 in common themes across group members' poems) and facilitated self disclosure, intimacy, and expression of feelings.
Ganz (1991), Katz (1983), and Zaslav and Kalb (1989) have reported the use of metaphors in group work with psychiatric patients. Zaslav and Kalb (1989) noted that patients' communications about their use of medication revealed interpersonal difficulties. These linguistic formulations were used as metaphors to address interpersonal issues, particularly in connection to the area of intimacy. Similarly, Ganz (1991 ) described the use of clients' communication about traffic to explore, in the here and now, "dangerous intersections" in group (p. 128). Metaphors created a shared language within the group context, a factor that symbolized group members' shared experience within the group therapy process.
Katz (1 9 8 3 ) has stressed th at the use of metaphors in psychiatric hospital groups makes it possible to reach group members at differing levels of ego development. Metaphoric discussion in the context of group provides psychotic patients the opportunity to play together and to interact with each other. Through metaphors, formerly isolated psychotic patients were suddenly able to interact with each other around the symbolic object, in this case a fish tank (Katz, 1983). Patients identified with the fish, which they saw as dependent, fragile, and in need of constant attention. The fish bowl brought connections with their sense of being in a self-contained environment and also with their feelings of being observed by staff members. Based on clinical 54 judgment, Katz (1983) concluded that symbolic objects and
spontaneous metaphors provide psychiatric group members with an easier and safer means to talk about difficult issues; through
symbolic discussion, group resistance begins to diminish and,
adaptive, creative and integrative processes begin to flourish (Katz, 1983). Dreams are other type of symbolic expressions that have been used in group therapy. Kolb (1983), following a psychodynamic
orientation, focuses on the value of dreams as a vehicle to uncover unconscious conflicts. Dreams facilitate insight and lead to the client's affect and drives more intensely than any other clinical experience. The author uses dreams in groups by encouraging members to associate with their own dreams and by inviting other
members to associate with the dreamer. This format facilitates understanding of the dream, the dreamer, and other group members' dynamics (Kolb, 1983). Through examples of dreams revealed during different group phases, the author concluded that dream
analysis facilitates exploration of intra- and interpersonal
processes throughout the different stages of group work. Metaphoric Communication in Family Therapy
In addition to their role in individual and group treatment, metaphors have been described as useful techniques in family therapy. Bryant, Katz, Becvar, and Becvar (1988) explored the use
of therapeutic metaphors among members of the American
Association of Marriage and Family Therapy (AAMFT). Through a
survey study, the researchers gathered information regarding (a) 55 the extent to which metaphor is used by members of the AAMFT, (b)
variables associated with the use of metaphors, (c) the sources
AAMFT members draw upon to generate metaphors, and (d) the
manner in which AAMFT members deliver metaphors. Results indicated that 95% of the 102 members of this organization who responded their survey (n=20) reported using metaphors in their clinical work. Moreover, 65% of responding members reported using metaphoric communication on a regular basis. The primary
sources of metaphors were client metaphors, therapists' self disclosure, and use of movies and literature. The most common
modes of delivering metaphors were reframes, storytelling, and religious symbols. In addition, therapists reported the use of poetry, pictures, and art. Three major themes emerged from
content analyses of metaphors used by AAMFT therapists: (a) Metaphors pertaining to the process of change; (b) Metaphors relevant to the stages in the family cycle; and (c) Methods by which therapeutic metaphors are constructed and delivered.
Examples of metaphors for each category were presented by the authors.
Briggs (1 9 9 2 ) described the use of metaphors in three different contexts of family therapy: first, metaphors as presented by a family in the form of symptomathology or presenting concerns;
second, metaphors as a means of joining a family; third, metaphors
as a way to present insights and suggestions for change. The
symptoms presented by a family are often metaphorical or
analogical expressions of otherwise unspoken problems whose 56 direct expression is seen as too threatening (Briggs, 1992).
Madanes (1981 ) explained that the symbolic representation of a problem is functional for the family as it serves to protect
members from the pain associated with the actual concern. The
unexpressed problems may be too sensitive or cause too much discomfort for the family to deal with them in a direct manner. Metaphors, can be used in family therapy to address presenting issues in a playful and much less threatening manner (Briggs, 1992). Metaphors are also useful in joining together a family
during therapy. Family therapists communicate a deeper level of understanding and empathy by building on the metaphors the family
brings to the therapeutic environment, or by communicating
through the use of family specific metaphors, (e.g., using sports metaphors with athletic families, using orchestra metaphors with a musical family). Metaphors are also useful resources to present insights and suggestions for change to family members. The use of
metaphors can serve as a resource to introduce change in an
indirect manner in order to avoid resistance and defensiveness in family therapy: "Metaphors cut through the haze to bring out the sun, they provoke thought to evoke feeling, they sink through the conscious to swim into the unconscious. They provide happy
endings to unhappy stories" (Briggs, 1992, p. 51).
Rule (1983) stated that metaphors are useful tools in various stages of the family therapy process. The author described specifically the usefulness of the "pie metaphor" in a family therapy approach. Given the many analogous properties of the "pie" 57 (parts contributing to a whole, nourishment, varying the cooking/ingredients affects outcome, recipes can be passed through generations), the pie metaphor is particularly suited to communicate concepts such as connectedness and relationships between parts and the whole. Similarly, Duhl (1 9 9 3 ) illustrated the use of the rope metaphor as a therapeutic tool. He reported the benefits of handling a rope to a couple in discord and inviting them to physically act what they were communicating verbally. By using the rope, the couple gained insight into the quality and the dynamics of their interactions. The rope facilitated discussion regarding the function of the fights in the relationship and helped the couple experientially feel, in the here and now, the tension of their fights and the effects of stopping the fights. The couple discovered that their fights provided them with a form of intense connection, an insight which promoted movement towards positive intensity. In a similar fashion, Duhl (1993) described the use of the rope metaphor with a mother presenting concerns regarding her son's inability to become independent. By asking her to let go of a rope whenever she was ready, she gained insight regarding her role a t fostering dependency. Based on these and other examples of his clinical work, Duhl (1993), concluded that rope techniques help clients gain awareness of their dynamic intents. Rope techniques bypass clients' defenses and resistance. By responding on a physical level, it is hard for clients to mask their motives and intents (Duhl, 1993). 58 Cornille and Inger (1 9 9 2 ) also described the use of a specific metaphor, the armor metaphor, in their work with couples and families. The metaphor of armor provides a symbolic representation of the ways family members protect themselves from perceived interpersonal danger. The advantage of the armor metaphor in therapy is that it provides a safe language to explore the natural element of protectiveness in family systems. The use of such language avoids the use of negative labels such as defensive, uncooperative, or resistant The armor metaphor facilitates family members' understanding of their own protective needs and their protective styles. Such awareness may promote the development of more effective resources and better relationships among family members. Cornille and Inger (1992) noted that the armor metaphor can be successfully used in families with children and adolescents, given children’s familiarity with armors of television’s super heroes.
In addition to the use of verbal and experiential metaphors,
Chavis (1986) discussed the use of poetry in couples and family therapy. Chavis (1986) presented diverse poems and described their applicability in therapeutic encounters. From this presentation, she concluded that poetry not only can enhance the therapeutic encounter for both client and therapists but it can also help clients express feelings, stimulate awareness of conflicts, and encourage problem-solving.
In addition to the use of verbal metaphors in family therapy, some authors (e.g., Gavazzi & Blumenkratz, 1993; Imber-Black, 59 Roberts & Whiting, 1 9 8 8 ) discussed the use of rituals in clinical work with families. Imber-Black (1988) described five different categories of rituals useful in the process of treatment with couples and families; membership, healing, identity, belief expression/negotiation, and celebration. Membership rituals are designed to redefine membership, to facilitate entrances and exits, and to delineate boundaries both within the family and between the family and the outside world. Membership rituals could be designed to help families deal with transitions such as the entry of a step-parent into a family unit or the exit of a young adult leaving home. Healing rituals are designed to facilitate personal and relationship healing. Healing rituals could be designed in therapy to help family members deal with death, end of relationships, loss of health, losses due to migration, and unhealed losses in previous generations. Identity definition and redefinition rituals are used in family therapy to reify the identity of their members. Rituals could be used to facilitate family members' move from identity constraining labels such as "the difficult child" or "the anorexic" to more affirming identities. Belief expression and negotiation rituals are used in treatment to facilitate family members' expression and negotiation of norms and beliefs. These rituals are particularly useful when clients present conflicting bellefe. Finally, celebration rituals are used in family therapy to mark particular achievements and life transitions.
Another non-verbal metaphoric communication device useful in family therapy is the use of family play. Busby and Lufkin (1992) 60 illustrated the applicability of play in the treatment of a couple frustrated with their relationship patterns. They represented their relationship dynamics through drama, him turning the handle of a jack-in-the-box toy and her popping out in response. The therapist invited the couple to participate in a different way of playing that would be more satisfying to both of them. Through this and other examples of clinical cases, Busby and Lufkin (1 9 9 2 ) concluded that family play not only facilitates identification of themes and relationship patterns but it also facilitates disclosure of secrets and areas of tension in a non-threatening way. Pretend play can be used to rearrange realities, identify options, and try new behaviors (Busby & Lufkin, 1992).
In sum, metaphoric language has been described as a useful therapeutic approach in family therapy. The literature on the topic, however, is based primarily on anecdotal reports from clinical cases. Few systematic studies addressing the use of metaphors in family therapy (e.g., Bryant, Katz, Becvar, & Becvar, 1988) have been published. Metaphoric Communication in Multicultural Counseling
Metaphors are used in diverse treatment formats and are described as techniques which can increase therapeutic effectiveness. Not only are metaphors recognized as useful therapeutic devices in individual, group, and family therapy modalities, but they are also considered important resources in multicultural encounters. Clients from "visual cultures" (Alexander, 1991, p. 106) or "high-context cultures" (Jackson & 61 Denise, 1993, p. 145) may be particularly responsive to metaphoric communication. High-context cultures, such as Chinese, Japanese,
Arabian, Latin American, and Mediterranean, are characterized by a polychronic concept of time and particular communication patterns. Polychronic time refers to the concept that time is a process; time is not linear. "On time" means "when it happens." Communication patterns in "low-context cultures are written- word dependent... Messages are explicit and words carry most of the information" (Jackson & Denise, 1993, p.145). In high-context cultures, on the other hand, communication patterns are more process focused: "Less information is contained in the verbal part of a message, and more is in the context" (Jackson & Denise, 1993, p.145). Metaphors, then, may be particularly helpful in the therapy process with clients from high-context cultures. In fact, Highlen
& Sudarsky-Gleiser (1994) recommended the use of symbolic language including sandplay, art, metaphors, and stories in vocational counseling with clients from visual cultures. Similarly, McClusky's (1988, cited in Alexander, 1991) work with Native American students demonstrated t^iat Native Americans are exceptionally responsive to metaphorical thinking. Even their language seems to be qualitatively metaphorical. Hopi language, for instance, seems to be more symbolic, and less phonetic and abstract than English. As such, it seems to appeal to the right hemisphere, i.e., the metaphoric mind (Samples, 1 9 8 3 ). Hiscox
(1995) also endorsed the use of a nonverbal treatment modality in cross-cultural counseling; she particularly recommended the use 62 of art therapy in the treatment of West Indian clients as a way to engage clients in cross cultural counseling encounters. She reported that symbolic communication facilitates clients' expression of feelings without worrying about possible cultural bias of therapists. Lantz and Harper (1992) described the effectiveness of metaphors in cross-cultural counseling with Appalachian clients, detailing their use of stories and tales to overcome resistance in the treatment of urban-Appalachian families. The authors illustrated how they used three published children's books written by Appalachian authors in treating an Appalachian family recently relocated in a urban community. These tales not only helped family members engage in family logotherapy, but they also helped them rediscover the meanings, values, and traditions of the family's daily life and the family's Appalachian background. Stories and tales can be used "as a way to help the family bring repressed meaning potentials to family consciousness, as a way to overcome family resistance and as a way to support and encourage family change while maintaining traditional Appalachian family values" (Lantz and Harper, 1992, p. 460).
Narayanan, Keshavan and Padi (1986) also emphasized the value of metaphoric communication in multicultural counseling. The
authors studied the impact of dream interpretation in an
outpatient therapy group run in Bangalore, India. Group members were invited to share the content of their dreams and to interpret their meaning. Other members of the group were asked to respond 63 to the material. The authors classified dream content In six different categories: anxiety, wish fulfillment, aggression, neutral daily events, depression, and other. Through anecdotal case studies, the authors concluded that dream analysis benefited the therapeutic process by breaking down resistance, generating insight, releasing repressed material, and exploring affective processes. Dream interpretations made by group members led to clients "revealing very significant and painful information to the group which might otherwise have taken a very long time" (p.591 ).
The authors observed a transformation of dream content that moved from anxiety and depression to aggressive, assertive, and finally religious themes. Such transformation was interpreted as an indication of clinical progress and recovery. Several members reported dreams that symbolically represented the therapy group; the therapist was often represented as a religious leader or guru. Narayanan et al. (1986) concluded that "dreams are . . . the royal roads not just to the individual unconscious but even to the collective unconscious” (p.592).
Metaphoric communication has been used also in feminist therapy. According to Buker (1994),
Stories evoke images that invite readers into new worlds, different realms, new cosmic entities -spaces reserved for dreaming and fantasizing. Storytelling encourages the suspension of critical Judgments and skepticism which frees us from being on guard and while serving as the price of entrance into these new realms ( p i ) . 64 In this way, Buker (1994) continues, stories foster emotional understanding, nurture openness, engagement, acceptance, innocence. Metaphoric communication also has been described as a useful approach in the treatment of persons with disabilities. McDowell,
Bills and Eaton (1989) explained that metaphors provide a means to package meaningful communications through which clients open themselves up to possible patterns of change. The authors illustrated the use of metaphors in the treatment of disabled individuals. One of their clients, a bright man with extensive musical background, presented with difficulties in maintaining successful job placement The client revealed that internal dialogues distracted him from his job responsibilities. The therapist told him a story about two pianos, a little upright and a concert grand, that resolved their differences through the direction of a creative concert master. The two pianos "joined in harmony . . . and were astounded at their abilities to tune in on one another" (p. 153). Implicit in the metaphor was the possibility of flexibility, balance, and integration of functions into an effective working relationship. Through this and other anecdotal examples from their clinical work, McDowell, Bills and Eaton (1 9 8 9 ) concluded that metaphoric techniques can aid clients with disabilities in the resolution of problematic situations and development of abilities and personal resources. Metaphors can help disabled clients utilize their assets, appreciate themselves, and enhance their quality of life. 65
Metaphoric communication has also been described as a valuable resource in the treatment of homosexual couples. Imber-Black
(1988) described, for instance, the usefulness of relationship- confirming rituals for committed gay couples. Similarly, therapeutic healing rituals for the end of relationships are particularly useful since family members, and the community may consider the loss as less painful than a divorce or may not acknowledge the break-up as a loss. Symbolic actions, such as burying or burning metaphors for the relationships, may be used to represent finality (Imber-Black, 1988).
Rituals are also useful in the treatm ent of migrant and international clients. Therapeutic healing rituals designed to acknowledge the losses due to migration have been described as useful therapeutic tools (Imber-Black, 1988). Healing rituals may help clients deal with unrecoverable aspects of life, such as when a client cannot return to his or her country of origin. Rituals can serve also to celebrate traditions and memories, as well as affirm connections between two cultures. Concluding Remarks
As seen through the literature review, little systematic research has been done on metaphoric communication in counseling and therapy. Only recently, metaphors have been included as a focus of research in counseling psychology. Anecdotal case studies and illustrations from individual clients, families, and group therapy cases dominate the field (e.g., Minuchin & Fishman, 1981 ; 66 Rule, 1983; Gladding, 1984; Lantz & Harper, 1 9 9 2 ). Systematic and
rigorous research is needed. In fact, Berlin, Olson, Cano and Engel (1991) expressed the need for research addressing the process by which therapists develop effective metaphors. Systematic and rigorous research is needed to explore whether therapists construct their metaphors based on the kind of clients they are working with, the presenting concern they are treating, or the therapist’s theoretical orientation. Furthermore, research is needed to understand therapists and clients' use of metaphors to orient and focus the treatment process (Berlin, Olson, Cano & Engel, 1991). Mazza (1993) formulated a research agenda based on the scarcity of systematic research on the use of metaphoric communication, particularly the use of poetry, in therapy. He emphasized the need to (a) formulate research questions addressing process and outcome question in poetry therapy; (b) promote both experimental and qualitative research in the field; (c) investigate the characteristics of client's/clients' concerns that increase responsiveness to metaphoric work; (d) explore the applicability of diverse forms of poetry across the treatment process. As Mazza (1993) stated, the field is "now past the stage of good intentions and anecdotal reports" (p. 56). A substantial research base to validate the use of metaphoric communication is needed.
The present study responded to such need. The purpose was to explore and analyze therapists' perception of the utility, significance, characteristics, and impact of metaphors within the 67 counseling process. The study had a discovery-oriented focus; it was not intended to test pre-determined hypotheses. Instead, its purpose was to explore and uncover the phenomenon of therapeutic metaphoric communication as perceived by experienced therapists. To inquire into the experiences of therapists who use metaphoric interventions in their clinical practice was considered a necessary and important approach to rigorously explore therapists' experience and perception of the characteristics, meaning, purpose, and impact of metaphors as therapeutic devices. Given the limited systematic research in the area, the exploratory purpose of the study, and the focus on therapists' experience and meaning-making processes, a qualitative research approach was considered to be the most appropriate orientation for the present study. Lakoff and Johnson (1980) stressed that the study of metaphoric communication requires an experientialist approach. The purpose of qualitative studies is to describe and understand the ways that people give meaning to their own and others' behavior. Qualitative methods make use of inductive logic oriented toward exploration and discovery. Data in qualitative inquiry describe the phenomenon. Qualitative inquiry designs cannot be completely specified a priori. The design is specified in terms of its focus, plans for data collection, and primary questions formulated in an open-ended interview format.
No operational variables or hypotheses are formulated. A priori formulation of hypotheses is not only impossible but inappropriate, given the naturalistic and inductive nature of 68 qualitative inquiry: "A qualitative design unfolds as fieldwork unfolds" (Patton, 1990, p. 61 ). Qualitative research is not unilaterally controlled by the researcher. Instead, participants are consulted as to what would constitute meaningful questions and whether the interpretations and conclusions accurately represent their experience. The research process does not follow a predetermined uniform structure or a preplanned uniform linear sequence of questions; instead, it is open to feedback and allows for changes based on emergent dialectical interactions and new patterns of understanding (Hoshmand, 1989). The objective of this description is "to take the reader into the setting" (Patton, 1990, p.31) and to permit understanding of how respondents perceive and experience the phenomenon. Qualitative design is holistic (Janesick, 1994). It emphasizes people's internal constructions as the basis of knowledge; thus, they rely on the perspective of the people being studied rather than on outside observational schemes (Heppner, Kivlighan & Wampold, 19 9 2 ).
Each individual is treated as a unique entity with his or her own particular perspective and meaning making processes (Patton, 1 9 9 0 ).
It is under a qualitative research design that the subjective complexities of therapists' experiences of metaphoric interventions may be explored, analyzed and understood. Given that the purpose this study was to understand the core meaning
(i.e., essence) of therapists' experience of metaphoric communication in clinical practice, a phenomenological research 69 approach was deemed necessary: "It is the comprehension of the meaning of another person's experience, which requires the special mode of inquiry considered to be phenomenological"
(Hoshmand, 1989, p. 22). Grounded theory methodology complemented the phenomenological approach. Although grounded theory has been described as general methodology for developing theory, it has also been characterized as a procedure useful for discovery purposes, description of human experience, theme analysis, and concept development (Strauss & Corbin, 1994).
Phenomenoloov and Grounded Theory
The study of therapists' unique experiences of metaphoric communication in therapy requires a method that is sensitive to individual differences, a method that focuses on the quality of experience, and a method that fits the counseling process. A phenomenological, qualitative mode of inquiry fulfills these requirements. The focus of this study was congruent with phenomenological inquiry: "What is the structure and essence of experience of this phenomenon for these people?" (Patton, 1990, p.
69). A phenomenological research paradigm matches the therapeutic process by allowing for follow-up questions to clarify and understand the unique experiences of participants and the meaning of the experience for them. Qualitative phenomenological methods are inductive, are well suited for discovery purposes, and give primacy to experience and meaning (Hoshmand &
Polkinghorne, 1992). The purpose of phenomenological research is to discover the implicit meaning of experience of the participant's 70 experience through thematic analyses of the data. Phenomenological studies focus on human awareness and aim to understand, clarify; and describe it (Polkinghorne, 1983). Direct
interaction with participants makes possible the description and understanding of external behavior and also facilitates the
comprehension of internal states, worldviews, values, symbolic constructions, and concepts. Limiting research to observable human action misses the most important issue: the meaning attached to it by the participants themselves (Nielsen, 1990). A
phenomenological, qualitative research approach permitted the exploration of therapists' experience and meaning-making process of metaphoric communication in psychotherapy without losing its essence. Previous investigators, such as Beal (1 9 9 3 ), have used phenomenological research to study the unique experiences of
therapists. She specifically explored the essence of
transpersonal psychology as experienced by five therapists who described themselves as following a transpersonal theoretical orientation.
In addition to the phenomenological qualitative approach,
grounded theory, as developed by Glasser and Strauss (1967), was chosen among diverse qualitative research methods. Although the
development of grounded theory focused on theory building and theory development leading to prediction and control (Highlen &
Finley, in press), Strauss & Corbin (1 9 9 4 ) suggested the use of grounded theory procedures for discovery purposes, theme
analysis, and concept development. In fact, grounded theory has 71 been described as an approach to human science that aims to understand, discover, and represent the meaning of a phenomenon as experienced by participants (Rennie, 1994). Grounded theory
(Glasser & Strauss, 1967) is an approach to knowledge development characterized by analytical examination of lived experiences. Grounded theory aims to discover patterns of action and interaction among concepts, i.e., the process that govern plausible relationships among concepts and set of concepts
(Strauss & Corbin, 1994). Grounded theory focuses on inductive logic to discover and illuminate basic social and psychological processes shared by a comparative group of subjects (Glasser & Strauss, 1967). Theory is grounded in the direct experience of participants rather than imposed a priori through hypotheses or deductive constructions. The analytic procedures of grounded theory research are designed to give the research process the rigor necessary and help the researcher to break through the biases and assumptions brought to, and that may arise during, the research process. The data analyses methods provide the grounding to describe the phenomenon under investigation in a manner that approximates the reality it represents (Strauss & Corbin, 1 9 9 0 ).
Several previous investigators (e.g. Frontman & Kunkel, 1994;
Rennie, 1994; Watson and Rennie, 19 9 4 ) have used grounded theory procedures to study counseling processes. Rennie (1 9 9 4 ), for instance, utilized grounded theory to study clients' deference in psychotherapy. Frontman and Kunkel (1994) investigated 72 therapist's experience of success in an initial counseling session through grounded theory analysis. Watson and Rennie (1 9 9 4 ) explored clients' subjective experience of problematic reactions following a grounded theory paradigm. A detailed description of the phenomenological and grounded theory methodological components of this research is presented in Chapter III. CHAPTER 111
METHODS
"Qualitative inquiry cultivates the most useful of all human capacities-the capacily to learn from others." (Malcolm, cited in Patton, 1990, p.7)
Understanding the phenomenon of metaphoric communication as experienced by mental health practitioners requires a sensitive method of uncovering the unique experience of each therapist as well as the shared patterns that cut across therapists, it also requires a systematic and rigorous approach of data management and data analysis. Such properties are intrinsic strengths of phenomenological and grounded theory research. These methodological approaches are useful in exploring and understanding the experiences of people who can illuminate the phenomenon of interest (Patton, 1990). The phenomenon of interest in this study was the subjective experience of those therapists who are aware of their use of metaphors in clinical
73 74 practice. Phenomenology, as well as grounded theory approaches, make use of interviews and research records as sources of data.
As stated by Patton (1990), qualitative interviewing is based on the assumption that the knowledge and perspective of others is
meaningful and relevant Phenomenology and grounded theory approaches were used to systematically analyze therapists' experiences, which were gathered through qualitative interviewing techniques.
The processes of sample selection, data gathering and data analysis used in the study will be presented in detail in this section. The chapter starts with a description of the participants, and follows with an in depth description of the data collection process, including the settings where data gathering took place, the characteristics of the interview process, the adjunct sources of information that were used (i.e., observational, methodological, and theoretical notes), and the methods of establishing rigor that were utilized (i.e., triangulation, member checks, bracketing, and peer debriefing). The chapter ends with a description of the different steps that were utilized in the data analysis process (i.e., transcription of tapes, identification of themes, open coding, and axial coding).
Participants
"Qualitative inquiry typically focuses in depth on relatively small samples,. . . selected purposefully. . . The purpose and power of purposeful sampling lies in the selecting information-rich cases . . . whose study will illuminate the questions under study" (Patton, 1990, p.169). 75 Participants in this investigation were mental health
professionals who identified themselves as being aware of using metaphors in their clinical practice (participants will be referred to as therapists throughout the document). They were identified following a "snowball or chain sampling" (Patton, 1990) procedure. The principal investigator, based on direct knowledge of
practitioners, invited mental health professionals to participate in the study and asked them to name individuals whom they believed could offer meaningful insights into the therapeutic use of metaphors. Non of the therapists contacted rejected the offer to participate in the study. The Ohio State Universitv Revised Guidelines for use of Human
Subjects in Research guided the process of therapists' involvement. Mental health practitioners were invited to participate in the study after a brief description of the goals, methodology and duration of the research. The voluntary basis of their participation was stressed, and the procedures to assure confidentiality were explained (i.e., number coding rather than names were used; other identifying information was deleted in transcription of open-ended interviews). Prospective therapists were assured that at any time and for any reason they could withdraw from the study. Except for a phone interview with the therapist from Colorado, and a second interview for another participant who resides part of the year in Florida, therapists scheduled a one and a half hour face-to-face first session for an open-ended interview. Later in the process, therapists scheduled a 76 one hour second session for follow-up questions and to check the accuracy of themes and patterns identified in the transcripts of their first interviews (Members Check procedure). A detailed description of the interview process is presented later In this chapter. The letter to prospective participants included all this information (See Appendix A). Both interviews were audio-taped and transcribed verbatim.
Given that the major concern in the present study was not generalization of results, sample selection did not follow a random sampling procedure. The purpose of the study was the discovery and description of therapists' experience of the use of metaphoric communication in clinical practice. As such, Intensity sampling. as well as maximum variation sampling, guided the process of sample selection. According to Patton (1990), "an intensity sample consists of information-rich cases that manifest the phenomenon of interest intensely" (p.l 72). Exploratory work on the part of the researcher was needed to identify information-rich therapists. Maximum variation sampling is a strategy that maximizes heterogeneity in a small sample (Patton, 1990). The procedure is based on identification of criteria for sample construction. The selected criteria in the study looked for heterogeneity in terms of therapists’ age, gender, ethnic/cultural/religious background, professional training- professional identity (e.g. psychiatry, social work, counseling psychology, developmental psychology, etc.), theoretical orientation, type of practice (e.g. counseling center, private 77 practice, mental health center, etc.), client population (e.g. individuals, families, adults, children) and years of experience. (Although ethnic diversity was considered an important aspect of the selected criteria, due to practical reasons, ethnicity was not represented as fully as originally intended. Similarly, age of the sample was not as heterogeneous as originally planned. The limited age diversity may have been a consequence of the snowball
sampling procedure. Snowball sampling leads to homogeneity). The sample consisted of eight mental health professionals who identified themselves as being aware of their use of metaphors in clinical practice. Table 1 outlines therapists' personal characteristics, and Table 2 outlines their professional diversity. Table 1
As shown in Table 1, ages of the sample ranged from 37 to 57,
with a mean of 47.25 years. With the exception of therapist #5 all other therapists were older 44 years of age or older. Five therapists were in the 44-49 year-old range and two in the 51-59 range. Five (62.5%) of the therapists were male and three (37.5%) were female. Ethnic background was represented in the following way: six (75% ) of the therapists were Caucasian (one of them
emphasized his Ukrainian background and another one his Jewish heritage), one (12.5) was Appalachian, and one (12.5) was mixed
Caucasian-Native American. In terms of religious affiliation, two
(25%) of the therapists were Catholic, two (25%) were Jewish, two (25% ) had no religious affiliation, one (12.5% ) was Methodist, and one (12.5% ) was Christian. Relationship status was divided in the 78 following manner six (75%) of the therapists were married, one (12.5) was divorced, and one (12.5) was single.
T a b le 1 Personal Characteristics of the Research Sample
C.I. Age Gender Ethnicity Religion Relationship Status
#1 4 8 M Ukrainian-Anrf None Married
# 2 45 M Jewish^ Jewish Married
# 3 4 4 M Caucasian Jewish Married
# 4 51 M Appalachian Christian Married #5 3 7 M Caucasian None Divorced
# 6 47 F Caucasian Methodist Single
# 7 57 F Cauc-NatAm Catholic Married
#5 -.49-, F Caucasian Catholic Married Note: therapists' numbers were assigned randomly. 3 Therapist #1 identified himself as Caucasian but emphasized his Ukrainian heritage. ^ Therapist #2 although Caucasian, identified himself with Judaism not only as a religion but as a Nation.
Except for one of the mental health professionals who resides in Colorado, all other therapists who were interviewed reside in the Columbus, Ohio area.
As shown in Table 2, professionally the sample was divided into the following groups: five (62.5% ) psychologists, two (25%) social workers, and one (12.5% ) psychiatrist. The group of psychologists was diverse in terms of their training: two graduated from Table 2 T ab le 2 79 Professional Characteristics of the Research Sample
C.I. Prof. id. Years of Prof. setting Client Theor. Practice Pop. O rient
#1 Psychiatrist 10 Couns. Ctr. Ind. Ericksonian CMHC Adults Priv. Pract. Urban/Rural
#2 Psychologist 22 Couns. Ctr. Ind. Ericksonian Couns. Psych. Urban Adults NLP,Gestalt
#3 Psychologist 18 Priv. Pract Ind/Fa Behav. Dev. Psych. Urban Child Eclectic
# 4 Soc. Worker 2 0 Priv. Pract Ind/Fa Existential Counselor Academia Couples Urban Adults
#5 Psychologist 7 Couns. Ctr. Ind. Dynamic Couns. Psych. Urban Adults Eclectic
# 6 Psychologist 8 Priv. Pract. Ind/Fa Existential Sport Psych. Rural Adults Transp.
# 7 Psychologist 10 Retired ___ a Jungian Dev. Psych.
# 8 Soc. Worker 2 0 Priv. Pract Ind. Pragmatism Urban Adults
Note: Couns=Counseling, Dev=Developmental, Psych=Psychoiogy, Soc=SociaI, Priv. Pract.=Private Practice, Couns.Ctr=Counseiing Center, lnd=lndlvidual therapy, Fa=Family therapy, Beh=Behavioral, T ransp=T ranspersonal. 3 Therapist #7 worked primarily with Individual Adults before she retired. 80 Counseling Psychology programs, two from Developmental Psychology, and one from Sport Psychology. Years of practice ranged from 7 to 22 with a mean of 14.3 years. Professional settings were diverse: Private Practice, Counseling Centers,
Community Mental Health Centers, and Academic settings were represented. Most (five) of the therapists worked in urban settings. Two (one of them half time) worked in a rural setting. Four (50% ) of the therapists worked primarily in individual therapy with adults, and three (37.5% ) worked with individuals and families (or couples). Of the three therapists who do both individual and family therapy, one specializes in children, and the other two work primarily with adults. One therapist had recently retired. She had been in private practice, primarily working in individual therapy with adults. Diverse theoretical orientations were represented among therapists. Two of them described themselves as following an Ericksonian approach (one adding NLP as a basis for his work), two as Existential (one of them adding a transpersonal component), one described herself as Jungian, one as
Psychodynamic-Eclectic, one as Behavioral-Eclectic, and one as pragmatic.
Summarizing, the sample was heterogeneous in terms of gender, religious affiliation, professional identity, professional setting, client population, and theoretical orientation; it was rather homogeneous in terms of age, ethnicity, relationship status, and place of residence. 81 Data collection yield two different types of analysis: (a) High- qualily, detailed descriptions of each individual case, with a focus on its uniqueness, and (b) important shared patterns that cut across diversity. Data Collection
As described by Lincoln & Cuba (1 9 8 5 ), the rigor of qualitative research is a function of the credibility of the investigator and the rigor of the methodology used in data gathering and data analysis. The researcher. The characteristics and credibility of the researcher are essential components in qualitative inquiry, as she or he is the instrument for data collection as well as the person performing data analysis and interpretation (Lincoln & Guba, 1985). it is the researcher's belief that her training and professional practice contributed to the credibility and rigor of the present study. Through her graduate work in counseling psychology, she received intense training and supervision in observation and interviewing skills, which strengthened the quality and rigor of the data gathering process, in addition, given that she has been involved in clinical practice for over four years, she was familiar with the mental health professional "culture." As stated by Lincoln and Guba (1985), knowledge of the "culture" of the therapists serves to increase the rigor and credibility of the study. Setting. The selection of the setting for each interview was negotiated with each therapist. The environmental criteria included that the setting provide privacy and be appropriate for conversation and taping, in addition, the setting needed to be 82 convenient for therapists in terms of accessibility and travel time. The settings for first interviews were divided in the following manner three took place at the therapist's office (therapists # 3, 4, and 8), three at the researcher's office (therapists # 1 ,2 , and
5), one at the participant's house ( therapist #7) and one was a phone interview. The settings for second interviews were participants' offices (6 interviews; therapists # 1, 2, 3, 4, 5, and 8) except for two interviews that were done over the phone (therapists #6 and 7).
Pilot Interviews. In order to evaluate the clarity and relevancy of the interview questions, to test the technical equipment, and to gain familiarity and confidence with the interviewing process, the researcher conducted a pilot interview.
As a result of this pilot interview, it was decided to include questions addressing a broad conceptualization of metaphoric communication, as well as the diversify of symbolic devices used in therapy (e.g., stories, tales, sandtray, etc.). The final open- ended interview guide is presented in Appendix B.
In addition, the researcher used two tape recorders (phone interviews did not permit such procedure) in order to prevent loss of information due to technical difficulties. Qoen-ended interviews. Each therapist was interviewed on two occasions. Data for the first interview were collected through an open-ended guide (see Appendix B) that consisted of seven questions regarding therapists' demographic information, five questions regarding their professional practice and their 83 philosophical view of therapy, and 23 questions pertaining to therapists' experience with metaphoric communication. Questions continued to be added or modified based on emergent data and feedback gathered throughout the data collection process. The question addressing office decor as a form of metaphoric communication (see Appendix B) is an example of additional questions based on emerging data. That question was added based on therapist's #3 statements about the purposeful use of symbols within his office environment
Mishler (1986) stated that the power of the research interview is that it blends a formalized research method with the natural flow of discourse. The interviews in this study conformed to this characterization. The open-ended interview served as a guide.
Questions were generated, omitted, or shifted in the order of presentation based on the flow of the interaction and the information shared by the therapist. Whenever a therapist's response seemed unclear or ambiguous, the interviewer generated follow up questions to understand or expand on the therapist's intended meaning, interviews lasted approximately one and one half hours.
Second interviews were used to ask follow-up questions and to invite therapists' reflection on the accuracy of themes and patterns identified by the researcher based on first interviews
(Members Check procedure). Second interviews lasted approximately 45 minutes to an hour. 84 Interviews are the basis of what Guba (1 9 7 8 ) calls the "discovery mode" in qualitative inquiry. Therapists' answers to questions from both interviews were transcribed verbatim and reported in the form of direct quotations. Direct quotations are a
basic source of data in qualitative research, revealing respondents' experiences, thoughts, perceptions and belief? (Patton, 1990).
Observational, methodological, and theoretical notes. The researcher's detailed observational, methodological, and theoretical notes were used as adjunct sources of Information during the research process (See Appendix C). Observational notes, as explained by Glasser and Strauss (1967), include a description of what the investigator has observed, felt or experienced.
Observational notes were used during the study to describe the
setting, the context, the characteristics of the relationship with
the therapist, and the researcher's feelings and reactions.
Methodological notes are messages regarding how to collect data. Methodological notes were used in the study to address concerns and suggestions about the equipment and recording, as well as to
note ideas or guidelines for future contact with the therapist. Theoretical notes are written records of hypotheses, conceptual
connections, and interpretations (Glasser & Strauss, 1 9 6 7 ).
Theoretical notes were used to record the researcher’s conceptual
understanding of the data gathered in each interview, as well as to note hypotheses and inferences that emerged across observations. Observational, methodological, and theoretical notes were of paramount importance throughout the study. They offered 85 guidelines to refine data collection and methodological procedures. They were also a valuable resource for identification of emerging themes and formulation of conceptual interpretations. Attention to these written records, as suggested by Miles and Huberman
(1984), permitted the researcher to interactively cycle back and forth between thinking about existing data and generating strategies for collecting data. The decision to interview therapist #3, for instance, was based on the observation that other therapists worked primarily with adults. The inclusion of a child specialist was considered important to increase the heterogeneity of the sample. Similarly, the inclusion of therapist #6 was intended to explore and describe the experience of a therapist practicing with families and individual clients in a rural environment. Heterogeneity was also sought by including a therapist (therapist #7) whose metaphoric work was predominantly non-verbal (e.g., dreams, sandtray).
The researcher's decision to use a sound grabber rather than a conventional microphone after the fourth interview illustrates the impact of methodological notes on the refinement of technical procedures and exemplifies the ongoing corrective process characteristic of qualitative research . In addition, attention to observational, methodological, and theoretical notes guided the researchers' formulation of follow up questions for the second interviews. Theoretical notes were extremely important for the identification of themes across therapists. The researcher, reflecting on theoretical notes was 86 able, for instance, to make inferences regarding therapists'
philosophical understanding of metaphors (i.e., metaphors as a
technique, metaphors as technique-tool-being, and metaphors as being). The validity of these inferences was checked with the participants during second interviews (member check procedure). In summary, the investigator's systematic and detailed research notes guided concurrent data gathering and data analysis
processes. As explained by Marshall and Rossman (1 9 9 5 ) the simultaneous, nonlinear collection and analysis of data is a characteristic of qualitative inquiry. Methods of Establishing Rigor Diverse methods were used to establish rigor and to accomplish what Cuba (1978) calls the "verification mode" in qualitative research. Multiple triangulation, member checks, bracketing, and involvement in a peer debriefing group were strategies used to increase the rigor of the present study. Triangulation. According to Patton (1990), triangulation, a strategy that involves checking out findings against other sources and perspectives, is an important method that contributes to validation of qualitative analysis. The concurrent use of at least two methods of triangulation is called multiple triangulation
(Mitchell, 1986). Data, theoretical and methodological triangulation, as well as triangulation through multiple analysts, were used in the present study.
Data triangulation, as explained by Mitchell (1986), involves using different sources of data such as people or data collected at 87 different times. Data sources included open-ended interviews, follow-up interviews and written research notes.
Theoretical triangulation was used to strengthen the rigor of the study. "Theoretical triangulation involvesD using different theoretical perspectives to look at the same data" (Patton, 1990, p. 470). The purpose is to explore how findings and interpretations are affected by different frameworks that derive from diverse disciplines and theoretical perspectives. One criteria for sample selection was diversity with regard to theoretical orientation and disciplinary traditions. Theoretical triangulation was achieved by having this theoretically diverse group involved in data analysis evaluation (refer to member check procedure described below). Given that the sample was composed of therapists from diverse disciplines, the study relied on interdisciplinary triangulation.
According to Janesick (1994), interdisciplinary triangulation tends to broaden our understanding of method and substance.
Methodological triangulation is a method of overcoming biases th a t may originate from using any single method of data collection (Mitchell, 1986). It consists on having a number of different methods to explore a phenomenon. Methodological triangulation was accomplished by having half the sample (randomly selected) read and check the transcription from the first interviews before the second interview. Four therapists received hard copies of the transcribed interviews several days before their second interview. During the second interview, all therapists had the opportunity to comment on and discuss the results of a preliminary analysis of 88 their original answers with the investigator. No substantial differences were observed between the two groups of therapists. A possible explanation is that except for therapist #3, therapists
who received the transcripts did not invest the necessary time to
carefully review them. In fact, therapists #5 and 8 disclosed that
they had only reviewed the transcripts superficially. Therapist #3 did refer to the content of the first interview. Among the group of therapists who did not receive the transcripts, one (therapist #1 ) commented about difficulty remembering what he had shared in the first interview, it is possible that qualitative differences may have been noted among the two groups had therapists invested the necessary time to review the transcripts. Triangulation through multiple analysts was accomplished by having a fellow researcher involved in the data analysis process. A graduate student in psychology, who is also involved in qualitative research, coded one interview transcript. Her codes were later compared with the researcher's to check for consistency. Such comparison resulted in agreement 82% of the codes, measured following Miles and Huberman's (1984) suggestion of dividing the total number of agreements by the total number of codes (agreements and disagreements). Codes with a different label but similar meaning (e.g. "always use metaphors" and "metaphor always
present" or "child's vs. therapist's metaphors" and "Client's
metaphor-Therapist's metaphor") were considered agreements. In addition, one unbiased individual (a person with graduate education
but no psychological training) was involved in the process of 89 categorizing codes (refer to open coding described later in the chapter). Categorizing was done by discussing possible ways in which codes could be classified under more abstract categories.
Categories were established once there was mutual agreement on
•die category label and the codes that were covered by it. Finally, a member of the dissertation committee served as a reviewer of conceptual interpretations and analyses. She was instrumental, for instance, in refining Figure 1 (see Chapter IV) to more accurately reflect the data (i.e., she pointed out interactions between influencing conditions that were not indicated in the original presentation of the Figure).
In addition to the use of multiple triangulation procedures, the researcher used "Member Check" techniques to increase the rigor of the study. Member Checks consist of having therapists review the findings
(Patton, 1990). Therapists met individually with the principal investigator during a second interview to examine how accurate the data analysis reflected their experience. The feedback of each therapist regarding the accuracy of individual themes and models is included in Chapter IV (See feedback through member checks procedure following each therapist's model of metaphoric communication in clinical practice). The member check technique was also used to evaluate the accuracy of conceptual interpretations that emerged across therapists. The researcher, for example, had hypothesized the presence of a continuum regarding therapists' philosophical understanding of metaphoric 90 communication. As formulated by the researcher, "Metaphor as technique" was at one end of the continuum and "Metaphor as a way of being" at the other end; "Metaphor as tool" was in the middle.
With the exception of therapist #3, all other therapists disagreed with the concept of a continuum. Therapists #4 and #6 for
instance, expressed that these philosophical perspectives reflected for them qualitative more than quantitative differences,
i.e., philosophical differences in how metaphors are understood and experienced. Therapists #2 and 5 also manifested disagreement with the hypothesis of a continuum. Metaphors, according to them,
reflect all of those philosophical perspectives at once. Based on the therapists' input, the category of "metaphors as tool" was
reformulated to "metaphors as technique-tool-being", and the
concept of a continuum was eliminated.
Having therapists evaluate the accuracy of the data analysis reduced the potential bias that comes from a single person doing the analytical work (Patton, 1990). "Member checks" and the
process of refining tentative results based on therapists' reactions is a way of establishing "face validity" in qualitative research (Lather, 1986).
In addition to the use of triangulation and member checks to guard against investigator biases distorting the logic of evidence, a process of "systematized reflexivity" (Lather, 1986) or "bracketing" (Denzin, 1 9 8 9 ) was used. Bracketing. According to Giorgi (1985), "bracketing" is a process that allows the researcher to become aware of her or his 91 biases. Increased awareness of expectations and biases is supposed to protect against the possible distorting influence of the interviewer.
To minimize distortion of data, the researcher bracketed her presuppositions, expectations, and biases prior to data collection and throughout the research process. For example, a bracketed expectation was the anticipation that metaphors would be used predominantly by therapists who described themselves as visual. Although this hypothesis was true for two therapists (therapists #5 and #8), diversity of cognitive styles was represented within the sample. Similarly, the researcher supposed a connection between the use of metaphors and therapists' spiritual awareness.
Whereas this hypothesis was at times supported (e.g., therapist #6 talked about metaphoric communication as a manifestation of her essence), metaphor work was not always associated with spirituality. Implicit in these expectations was the researcher's assumption that metaphoric communication reflects therapists' inner characteristics, personality traits and value systems more than formal training. Although therapists did report the impact of personal variables (e.g., family/ethnic/cultural/religious background, personal attributes, personal growth experiences) on their developmental process of metaphoric communication, six considered specialized training to be an important additional factor in use of metaphors. One therapist (therapist # 8 ) considered specialized training essential for the effective use of metaphors. The researcher assumed also that therapists would 92 emphasize the need for metaphors to match client's demographic characteristics, (e.g., gender, sexual orientation, ethnicily).
Specifically, the researcher assumed that therapists would be inclined to use metaphoric communication and cultural stories (e.g., Native-American, African tales) with ethnically diverse clients. Although one therapist discussed the use of Appalachian tales with Appalachian families, therapists did not particularly addressed the use of metaphors with ethnically diverse clients.
Therapists stressed the need for metaphors to fit clients characteristics, but the variables they emphasized had more to do with clients' interests, dominant representational systems or cognitive slyles, and worldview than the demographic variables the researcher had anticipated. Other bracketed expectations were related to the researcher's belief in the following advantages of metaphors: (a) integrate sensory systems, (b) facilitate integration of right and left brain functions, (c) reduce resistance, (d) provide a shared symbol for clients and therapists to make reference to complex phenomena, (e) facilitate a sense of continuity across sessions by the use of a metaphor throughout the counseling process, and (f) have lasting effect on clients. Several of these therapeutic advantages of metaphors, (i.e., "a", "c", and "f") were stressed by therapists.
Peer debriefing group. Involvement in peer debriefing with fellow researchers who were also involved in qualitative research projects not only helped the interviewer familiarize herself with the technical equipment used in the study (e.g., transcriber, data 93 analysis software), but it allowed the researcher to receive recommendations for data collection and data analysis. Members of the group, for instance, offered suggestions for sampling procedures and agencies or individual therapists to contact The group also discussed ways to record observational, methodological and theoretical notes and shared written forms for doing so. In addition, the group was instrumental in exploring and validating coding schemes. On one occasion, for instance, four fellow researchers and the investigator independently codified a significant portion of the first interview. The coding strategies each researcher used and the codes that each one assigned to the transcript were discussed. One result of this process was the decision to codify transcripts by focusing on meaning units that varied in length from a phrase or paragraph to over a page, instead of using a line-by-line coding strategy.
Data Analvsis
A rigorous qualitative study not only requires a systematic approach of data collection but also a sound and methodic data analysis procedure. Data analysis in this study followed phenomenological, as well as grounded theory procedures. The phenomenological approach was used to uncover therapists' individual themes, as well as general themes that emerged across therapists regarding their experience of metaphoric communication. Grounded theory methods, in particular data analysis procedures suggested by Strauss and Corbin (1990), were utilized to identify and describe complex models of therapists' 94 metaphoric work.
The data analysis process followed a sequence characterized by the following phases: Transcription of tapes, identification of individual themes, and themes across therapists, identification of individual models, open coding, and axial coding. Transcription of taoes. Upon completing interviews, tapes were transcribed verbatim. Approximately 60% of the interviews were transcribed by professional typists; the other 40% were transcribed by undergraduate students with extensive typing experience. Paralinguistics were noted through underlining or italicizing to indicate emphasis or a high intensity in speaker's tone of voice. Parentheses were used to make notes on other paralinguistic clues such as speaker's pauses, stuttering, laughing, etc. Transcripts were reviewed for accuracy twice before they were analyzed. The first revision was done by an undergraduate student who did not transcribe the tapes; the second revision was done by the researcher. This last check often times resulted in additions of data missed by the typists, as well as in minor changes associated with technical or professional terminology or corrections in spelling of names, references and authors.
Technical difficulties resulted in two types of missing data. Noise and interference during face-to-face interviews resulted in minor gaps in transcripts, such as words or short sentences.
(These difficulties occurred even though two tape recorders were used). Problems with the equipment used for taping phone interviews resulted in large losses of information on certain 95 portions of the first interview with therapist #6 and the second interview with therapist #8. Missing data from therapist #6 were addressed by asking the therapist to reconstruct her answers during the second interview. Missing data from therapist #8, on the other hand, were reconstructed by having the researcher, with the help of notes, dictate missing information soon after the problem was noted, minutes after the interview ended. Identification of individual themes and themes across therapists. Individual themes and themes across therapists were identified by having the researcher involved in a holistic and inductive procedure of data analysis. Individual transcripts were read by the researcher at least three times in order to garner a sense of the whole as well as to identify recurrent themes in each interview, individual themes were identified on the basis of repetition and emphasis given by the therapist. A notebook was used to record emerging themes for each therapist. Once individual themes had been identified, the researcher (as suggested by
Highlen and Finley, in press) copied them on newsprint in order to study commonalties and discrepancies across therapists. The accurate representation of each therapist's experience (i.e., individual themes), as well as the validity of inferences made across therapists were ensured through the utilization of a member check procedure (see above). (Individual themes and themes across therapists are presented in Chapter IV.)
Identification of individual models. In addition to the identification of general themes, the researcher identified a model 96 of therapeutic communication for each therapist. As with individual themes, the models were identified by reading the individual transcripts three times. The researcher focused on the therapists' presentation of conditions and consequences of metaphor use as an initial attempt to apply Strauss and Corbin's (1990) dimensions of axial coding (see below). The identified conditions and consequences were validated using the HyperResearch software (see below) searching for the codes: "Conditions metaphoric effectiveness", "Advantages of metaphors", and ""Metaphor: impact on therapist" on each therapist's transcripts. The accuracy of the individual models was ensured through a member check procedure. For a presentation of individual models of metaphor work refer to the results section (Chapter IV).
Open coding is the part o f the analysis that focuses on naming and categorizing phenomena through close examination of data (Strauss & Corbin, 1 9 9 0 ). Transcripts were formatted to be used with a software program for qualitative research, the
HyperResearch (Tesh, 1990). This qualitative analysis program offers two main functions. First, it allows the coder to attach codes to meaning units on the transcript, and second, it allows the researcher to search for codes and regroup them.
Data were divided into discrete parts or meaning units varying in length from a phrase to over one page of text. Meaning units were closely examined and compared for similarities and differences. Two analytical procedures were used during this 97 coding process: making comparisons, and asking questions. For the creation of codes, the investigator assigned an appropriate label to every meaning unit. Each meaning unit (a sentence, a paragraph, an idea) received a name or label that represented a phenomenon.
Concepts, could be literature-derived or "in vivo" codes (i.e. words and phrases used by informants themselves) (Strauss & Corbin,
1990). Some examples of literature-derived codes were
"metaphor archetypal quality", "transference-countertransference issues." Examples of in vivo codes were "Metaphors: spontaneous associations," and "Metaphor as metaphoric quality." On certain occasions, more than one code was attached to a text segment. This multiple coding was utilized when a meaning unit was relevant to more than one category. The following transcript from a second interview provides an example of multiple coding.
Researcher The following are some themes that I identified throughout our first interview. You mentioned that metaphors don't come from an intellectual place but instead, they come from your soul, from your essence.
Therapist: Yes, absolutely fits!
This meaning unit received three different codes: "Metaphor reflection of self"; "Metaphor reflection of therapists' spirituality"; and "Validating theoretical model".
A total of 120 codes resulted from this process. The final list was only considered complete when saturation was reached (i.e., when no new codes or labels emerged form the data). 98 Triangulation through multiple analysts, as well as feedback from the peer debriefing group, were included during this process to increase trustworthiness and rigor. The second part of the computer aided data analysis focused on clustering meaning units under particular codes. HyperResearch has the capability to automatically retrieve an sort identical codes with their corresponding meaning units form each interview, as well as for the whole set on interviews. The end product of these operations was a list of the different codes with their corresponding set of meaning units. Once this task was completed, the researcher focused on the process of creating categories.
Cateaorizing was performed by comparing and grouping codes into categories in order to reduce the number of units (Strauss &
Corbin, 1990). During the process, 18 codes were either renamed or combined. For example, "Professional degree" and "professional identity" were combined; "Metaphors compared to other techniques" was renamed as "Advantages of metaphors." In addition, 23 codes were discarded. Codes with less than two meaning units (e.g.,
"Long history of metaphors;" "Origin of sandtray") or those that did not speak to the experience of metaphoric communication (e.g.,
"Frustration with managed care") were eliminated. The final codes were grouped into categories that pertained to the same phenomena. The phenomenon represented by a given category received a conceptual name that was more abstract than the one given to the concepts grouped under it. Categories were named to 99 logically and graphically represent the data. Index cards were created for each category, and all pertinent codes were written on each category card. The HyperResearch printout with the different codes and their corresponding meaning units across interviews was organized under the different index cards (Rennie, 1994). Triangulation through multiple analysts was used during this process as a way to legitimize and enhance methodological rigor. Seventeen categories resulted from this process. The following is an example of one of these categories with its corresponding conceptual labels:
Category Conceptual Labels Personal Influences on -Metaphor work reflection Developmental Process of family background. Metaphoric Communication -Metaphor work reflection self. -Metaphor work reflection cultural background -Metaphor work reflection religious background. -Metaphor work reflection spirituality -Personal growth experiences See Table #3 in results section (Chapter IV) for the complete list of categories that emerged from this process.
Axial coding was the final step in the data analysis process. (Strauss & Corbin [1 9 9 0 ] recommended an extra step, i.e., selective coding for those researchers interested in developing a theory and suggested that researchers end with axial coding when the aim of the study is exploration, understanding and description of human experience). Axial coding involves a set of procedures where data 100 are reintegrated after open coding (Strauss & Corbin, 1990). Axial coding was performed by making connections between categories.
The purpose of axial coding was to specify a phenomenon or category in terms of the conditions that give rise to it, the context or properties in which it is embedded, the strategies by which it is carried out, and the consequences or impact of the phenomenon per se. The end result of axial coding was a paradigm model that denotes and links the phenomenon to its causal and intervening conditions as well as to its consequences. The paradigm model that reflects the product of axial coding is presented in Chapter IV (see Figure 1 ).
A member of the dissertation committee was involved during axial coding to explore the proposed connections between categories and the accuracy of the final paradigm model.
Concluding Remarks
The present study included sound methods and techniques for gathering and analyzing data. Methodological rigor was achieved by inclusion of multiple methods of triangulation (i.e., triangulation through multiple analysts as well as data, methodological and theoretical triangulation) and a member check procedure, as well as by having the researcher involved in systematized reflexivity, bracketing, and peer debriefing. The study also included a rigorous data analysis procedure that incorporated phenomenological and grounded theory procedures.
To accurately represent the results that emerged from these 101 analyses, "thick description" was used. Thick description involves including sufficient description and direct quotations to allow the reader to enter into the perspectives and experience of the people represented in the report (Patton, 1990). Chapter IV presents "thick description" to let "the voices, feelings, actions and meanings of interacting individuals be heard" (Denzin, 1989, p. 83). CHAPTER IV RESULTS
This chapter presents the common and unique experiences of
therapists’ use of metaphoric communication. Results of data analyses using the phenomenological and grounded theory approaches described in the previous chapter are presented in this section.
As explained by Cote, Salmela and Baria (1993), results in qualitative research can be presented in a hierarchical diagram of codes and categories or through a description of themes that best
describe the data. The researcher's aim was to present both a
brief description of themes, as well as a detailed presentation of hierarchical analyses. As such, this chapter begins with a presentation of the results that unfolded from phenomenological
analyses, including Individual General Themes for all eight
therapists, as well as models of their individual experience of metaphoric communication. This presentation is followed by a
descriptive list of General Themes that emerged across therapists.
The chapter ends with a detailed presentation of the models that unfolded from grounded-theory procedures, i.e., open and axial
102 103 coding. As suggested by Atkinson (1990), Denzin (1989), and
Patton (1990), highly graphic passages were included to illustrate a theme or a statement that the researcher was attempting to present. Narratives were selected to represent commonalties across therapists, as well as to exhibit contrasting or unique perspectives. At times, narratives with a certain perspective were juxtaposed with others to provide a sense of contrast of opinion or experience. Quotations were selected using the HyperResearch printout which presents each individual code with the meaning units that were classified under it (refer to Chapter III for description). Identification of Individual General Themes
Identification of individual themes addresses the main objective of phenomenological research: Understanding the therapist's unique and subjective experience of the phenomenon under study (Holstein & Gubrium, 1994). The process of identifying individual themes gives voice to therapists, to reveal how they make sense and meaning of their metaphoric work, to "tell the[ir] story" (Strauss & Corbin, 1994, p. 281). Individual themes, as well as models regarding understanding and experience of metaphoric communication in practice for each therapist, were uncovered by reading each individual transcript of first interviews at least three times (refer to Chapter III for detailed description of procedures). Themes were selected based on repetition, emphasis, and relevance for the study. For the purpose of presentation, themes have been organized under four 104 major categories: (a) Philosophical understanding of metaphors, (b) Metaphors in clinical practice, (c) Values regarding clinical practice, and (d) Developmental process associated with metaphor work. Individual models reflecting each therapist description of his or her therapeutic use of metaphors were organized based on conditions, phenomenon, and consequences of metaphor work (Strauss & Corbin, 1990). As explained in Chapter 111, conditions and consequences were identified by reading the transcripts three times. The identified conditions and consequences were confirmed with the HyperResearch Software by searching for each therapist under the codes "Conditions metaphor effectiveness", "Advantage of metaphor", and "Metaphors impact on the therapist."
Member checks involving individual themes and models were presented to each therapist during second interviews to validate accuracy of representation of their experiences. Results from the member checks are noted following the presentation of general themes and models for each therapist. Thick description was not included in this portion of the presentation; it is provided in the more detailed discussion of models that resulted from axial and open coding presented later in this chapter.
Therapist #1 : Individual Themes Philosophical Understanding of Metaphors Therapist #1 believes that there is not such a thing as a basic reality; everything is metaphor. The therapeutic process is a metaphor, it is a ceremony. Medication and the process of prescribing are metaphor, ritual. The placebo effect may be a 105 reflection of the metaphoric nature of medication. One's theoretical orientation is a metaphor. Transference and Counter
transference issues are metaphors. Therapist #1 noted that the resurgence of metaphors may reflect clinicians' increased
awareness and familiarity with the power of metaphors, as well as a response to manage care emphasis on short term treatment. Metaphors in Clinical Practice
Metaphoric work offers a respectful model of working with clients. Metaphors respect the client's process without the therapist ever needing to know what it is: "You shoot the arrow and whatever it hits is the target." Therapist #1 stressed that all
clients are responsive to metaphors, and that metaphors are appropriate at any stage in the therapeutic process. He stated that
pacing is a necessary condition for metaphors to work. Effective metaphors fit (a) clients' identity, (b) clients' dominant representational system, and (c) clients' experience and interests.
Clients offer feedback regarding the appropriateness of metaphors through verbal and non-verbal clues as well as through behavioral
changes.
Therapist #1 also noted that he uses diverse types of
metaphors in clinical practice: verbal metaphors, homework, movies, and rituals.
Values Regarding Therapy Therapist #1 emphasized his belief that the therapeutic relationship is everything and that change is always possible. He stressed that people tell you how they will change. The role of the 106 therapist is to empower people to open themselves to new learning, to discover. He also stressed the need for therapists to take responsibility when therapy is not moving and noted that the ultimate feedback is the clients' achievement of their treatment goals. Therapist's Developmental Process.Associated with Metaphor Work Specialized training, in particular hypnosis and Ericksonian psychotherapy training, as well as personal characteristics such as the ability to dissociate were described as important influences by therapist #1 in terms of his developmental process of metaphoric communication. Therapist #1 : Model o f Metaphoric Communication in Clinical Practice
Therapist #1 cited several conditions for the effective use of metaphors and noted the consequences associated with metaphor work. The following were the conditions he presented: If the timing and pacing of metaphoric communication are appropriate, if metaphors match clients' experience, i.e., if they fit client's identity, demographics, representational system, and interests, then the resulting phenomenon is that the client takes in the metaphor. As a consequence, clients feel connected with the therapist, and the metaphors offer them a new or broader reality.
Metaphors energize people to learn and empower them to be open and discover ways to grow. Ultimately, clients use the metaphor according to their needs and what make sense to them. Metaphors facilitate and promote change and personal growth. 107 Therapist #1 explained that the use of metaphoric communication also has an impact on the therapist. Through the
use of metaphors, the therapist feels connected to and in trance with the client. Metaphors make the process of therapy more exciting and fun.
Feedback through the member check procedure revealed that therapist #1 does not feel that there is need for the metaphor to be cognitively or consciously understood to be effective (a condition stated in the original model presented to the therapist for review).
Therapist #2: individual Themes Philosophical Understanding of Metaphors
Therapist #2 emphasized the universal value of metaphors.
Metaphors are resources that help people move from where they are to where they would like to be.
Therapist #2 hypothesized that metaphors are becoming more popular in the counseling field as culture becomes more multicultural. He stressed that cross-cultural interactions translate into the learning of diverse stories. He manifested concern regarding the survival of metaphor work in the managed care environment due to the emphasis on technology and programmatic standardized treatments. The interest in metaphor may reflect a reaction against that trend.
Metaphors in Clinical Practice
Therapist #2 stressed that metaphors are embedded in the treatment process and in the therapeutic relationship. For him, 108 metaphors are a therapeutic resource that expands clients' model of the world. Metaphors are useful at any stage during the therapeutic process. The appropriate use of such resource can be judged by clients' feedback. Clients use verbal and non-verbal clues to indicate theD appropriateness of the metaphor or story being used.
Therapist #2 noted the diverse types of metaphor he uses in clinical practice. Stories, movies, and spontaneous associations from his personal experience or from experiences with other clients are some of the most frequent metaphoric devices he uses in treatment. Values reoardina Theraov
Therapist #2 stressed that his philosophy of treatment is based on the belief that change is possible at any moment and that people have a choice in how they live their lives. He noted th a t people make the best choices they can based on the resources that are available to them. The therapist's role, then, is to help clients build their resources by helping them access their existing resources and discover new resources. Therapist's Developmental Process Associated with Metaphor Work
Therapist #2 cited different influences on his developmental process o f metaphoric communication. Family, ethnic, and religious background were emphasized by the therapist as major influences. He stressed the role of his mom using stories as a teaching tool and the influence of the Jewish, Yiddish tradition. He also emphasized the influence of his specialized training with 109 Milton Erickson, David Gordon, as well as his NLP training. Therapist #2: Model of Metaphoric Communication
in ClinicalPractice
Therapist #2 cited several conditions for the effective use of metaphors and noted several consequences associated with the use of metaphoric communication in therapy. The following were the conditions he presented: If the timing and pacing of metaphors are appropriate; if the metaphors are analogous and isomorphic with the client’s worldview, i.e., if they fit clients' model of the world, their personality, interests, vocabulary and dominant representational system; if I start where the client is, if I feel in trance with the client, and if I feel free and creative, then, the resulting phenomenon is that the client hears and uses the metaphor. As a consequence, the metaphors pass clients' defenses; metaphors touch the conscious and unconscious mind at the same time and offer the clients new models of the world (reframing function). Metaphors promote change in the way clients think and experience particular events. Through the use of metaphors, clients become more interested and open in the therapeutic process. Metaphors increase clients' creativity and offer them a resource to use in the future.
Feedback through the member check procedure revealed that it is feeling creative, free and in trance with the client that helps him work with metaphors, rather than these being consequences of metaphor work as was originally presented to him for review. 110 Therapist #3: Individual Themes Philosophical Understandinqof Metaphors
Metaphors are resources that help people stretch their thinking and move away from positions that limit their ability to consider new possibilities. Therapist #3 noted that the new interest in therapeutic metaphors may represent a reaction against standarized assessment and treatment, and reflects the increasing influence of child and family therapy in the field. Metaphors in Clinical Practice
Therapist #3 noted that metaphors are just a piece within the treatment process. There are several other pieces around metaphors that are essential to treatment. The major advantage of metaphors is that theyD work in the process of stretching people's thinking.
Therapist #3 documented the use of diverse type of metaphors in clinical practice: Stories, tales, games and play, sand tray and office decor. Values regarding Therapy
The major philosophical principle that underlies the practice of therapist #3 is his belief that people are capable of making changes. The role of the therapist is to enable clients to stretch their thinking, to consider new possibilities, perceptions, and frames of reference.
Therapist's Developmental Process Associated with Metaphor Work
Therapist #3 noted that certain personal attributes such as his playful attitude, his experience with children as his primary client I l l population, and his professional training in terms of projectives
have been important influences on his development of metaphoric communication in practice. During his second interview, therapist # 3 added his ethnic/cultural background, i.e., Jewish heritage as an additional influence on his developmental process of symbolic communication.
Therapist #3 Model of Metaphoric Communication in Clinical Practice Therapist #3 cited several conditions for the effective use of metaphors and noted a number of consequences associated with them. The following were the conditions he presented: If I am ready, capable and willing to be playful, if I am free and open to let my thoughts come out and share them with clients, if I do something different than what is being offered outside, and if I have enough variety of metaphors, then the resulting phenomenon is that clients find the metaphor they need. As a consequence. clients make a direct, unconscious connection between metaphors and what is going on in their lives. Through the use of metaphors clients may consider relating, engaging and sharing with me.
Metaphors work through clients' resistance and touch the unconscious, opening doors for the client to consider new possibilities. In this manner, metaphors stretch people's thinking. Clients become better able to consider diverse ideas and resources. The impact of metaphors is long lasting as they extend clients' resources. 112 Therapist # 3 noted also the impact metaphor work has on him. He revealed feeling anxious regarding his ability to offer what is needed. Generally, through the use of metaphoric communication, he experiences a sense of absolute amazement Feedback through the member check procedure revealed that the connection clients make between the metaphor and life events is at the unconscious level rather than consciously understood, as it was originally presented to therapist #3 for review. Therapist #4: Individual Themes Phiiosophical Understanding of Metaphors
Therapist #4 stressed the metaphoric quality of life. According to him, any situation or event can be experienced metaphorically: the assessment process is a metaphoq one's theoretical orientation is a metaphor; communication in itself is metaphorical. Through the use of metaphors psychotherapy is moving back to a more humane direction; it is moving against technology. Metaphors in Clinical Practice
Metaphor was defined by therapist #4 as a two-pronged communication process. Metaphors reach the conscious and the unconscious at the same time, and they facilitate primary and secondary reflection. Metaphors help clients get in touch with meaning and meaning potentials.
Therapist #4 emphasized that metaphors are helpful to both the client and the therapist. Metaphors, however, are not effective in themselves. The therapist is effective through the use of 113 metaphors.
Therapist #4 stated that he uses diverse types of metaphors in clinical practice; Stories, tales, poetry, art, and play. Values regarding Theraov
The purpose of therapy is to help people reflect upon meaning and meaning potentials. For therapist #4, therapy is something you are, not something you do. As such, formal training is not as
important as one's own personal work in the process of becoming a therapist. Therapist's Developmental Process Associated with Metaphor Work
Therapist #4 emphasized the role of his familial, ethnic, and
cultural background (Christian, Appalachian) as well as his personal growth experiences on the developmental process of
metaphoric communication. Additionally, he stressed that work
experience with children, mentors in graduate school, and specialized training with therapists such as Carl Whitaker had been important influences on his metaphor work. Therapist #4: Model of Metaphoric Communication
in Clinical Practice Therapist #4 cited several conditions for the effective use of
metaphors and noted a number of consequences associated with them. The following were the conditions he presented: If I know
my own metaphors, if I am comfortable doing metaphor work on myself, if I start where the client is, and if my pacing and timing are appropriate, then thOe resulting phenomenon is that clients' conscious and unconscious are touched by the metaphor. As a 114 consequence, metaphors help decrease clients’ resistance
(metaphors respect clients' resistance rather than fight through
resistance). Qients reflect on what they don't know by talking about what they know, or they talk about what is not comfortable by talking about what is more comfortable. Clients get in touch with meanings and meaning potentials. They may start thinking in terms of metaphors and they may be able to move from one stage to the next in their life cycle. Metaphors stretch people's
imagination and challenge constriction.
Therapist #4 emphasized that metaphor work not only impacts the client, but it also affects the therapist. Through metaphoric communication, the therapist feels touched and connected with client at a deeper level. Metaphors also facilitate a therapist’s
move, change, and personal growth. Feedback through the member check procedure revealed that
although the representation of the process matched how therapist
#4 described it (i.e., in a linear fashion), in actuality he experiences it as more chaotic, more like a circle. Clients notice
meaning potentials, they actualize them, they honor them and the cycle starts all over again. Therapist #4 manifested awareness of the difficulty in describing and writing about the process as it actually is.
Therapist #5: Individual Themes
Philosophical Understanding of Metaphors
Therapist #5 emphasized that metaphors are universal and that everything could be seen as a metaphor; the process of therapy 115 could be perceived or experienced as a metaphor. Metaphors are not an intervention but a different level of thinking.
Therapist #5 noted his belief that the resurgence of interest in metaphors may reflect the need to fill gaps left by families and culture in terms of people's experiences with myths and stories. He stressed that through the use of metaphors, clinicians contribute to the collective unconscious and help society move towards nature and away from technology. Metaphors in Clinical Practice
Therapist #5 stressed that metaphors access different components or processes such as conscious and unconscious functions and cognitive and affective processes. Metaphors are also multisensorial and non-intrusive resources for therapy. Therapist #5 noted that clients across the board use metaphors and benefit from them. Values regarding Theraov
For therapist #5, the therapeutic process is more important than the outcome. He emphasized the role of the therapeutic alliance and the role of the therapist as facilitator of clients' movement towards their desired state.
Therapist's Developmental Process Associated with Metaphor Work Therapist #5 noted that he familiarized himself with the process of metaphor work primarily through his own reading and through contact with other clinicians. He stressed that metaphoric communication was neither stimulated nor reinforced during his graduate work, nor had he received formal training in the use of 116 metaphors in therapy. Therapist #5 stated that working with athletes had a direct influence on his use of metaphors in practice. He expressed also that by freeing himself to experience and to be his whole self in session, he has been able to be more attentive to metaphors. Therapist #5: Model of Metaphoric Communication in Clinical Practice
Therapist #5 cited several conditions for the effective use of metaphors and noted a number of consequences associated with them when the following conditions are m et If the timing and pacing of the metaphors are appropriate; if the metaphors match clients' experience; if they are symbolic of their lives, then the resulting phenomenon is that through metaphors, clients are reached at unconscious and physiological levels. As a consequence. clients engage and bond with the therapist. Metaphors help bypass clients' resistance. Metaphors reach the clients’ cognitive and affective processes, as well as their preconscious, unconscious, and conscious mind. Through metaphors, clients may achieve higher levels of insight and may experience a paradigm shift through the integration of the metaphor into their way of thinking. Through metaphors clients move forward in therapy; they move in the direction of their desired state. Metaphors have a long term impact which is associated with clients' openness to life experience.
Therapist #5 stressed that metaphors impact the therapist by making him or her feel more present and engaged with the client. 117 Metaphors make therapy more interesting. Feedback through the member check procedure revealed that therapist #5 manifested difficulty with the description of the
process in general, universal terms. He emphasized the idiosyncratic nature of therapy and of the metaphoric process per se. He stressed the importance of reflecting on the context and the individualily of the process for each client. Therapist #6: Individual Themes Philosophical Understanding of Metaphors
Therapist #6 stressed the universal value of metaphors, as well as the spiritual connection she feels when working with metaphors. According to therapist #6, metaphors allow her soul to use her mind to touch people.
Therapist #6 noted that the new interest on metaphors in the counseling field may be a reaction to the increasing emphasis in brief solution focused therapy. Because metaphors facilitate quick and powerful connections between people, they fit well into short-term treatment models.
Metaphors in Clinical Practice
Therapist #6 emphasized that metaphors are a way for people to connect at a deeper level. Metaphors do not come from an intellectual place; they come from the soul. Therapist #6 stressed the need to trust the metaphors, value them, and not judge them. When metaphors emerge, therapist #6 trusts that the context and the timing are appropriate. 118 Therapist #6 noted that she uses diverse type of metaphors in her clinical practice: Fairy tales, movies, spontaneous symbolic associations, experiential exercises and experiential drawing. Therapist #6 noted that possible contraindications for metaphor work include clients who are diagnosed as Borderline. Values Regarding Theraov
Therapist #6 explained that her approach in therapy is related to her belief that people are spiritual beings that inhabit a physical body and not physical beings that have a spirit. The therapeutic journey is the client's journey, so it is a very unique experience for each individual. The most important element in treatment is the is-ness, i.e., the sharing of the essence. Therapist #6 stressed that her approach in therapy is related to her pe'sonal growth and where she is in her journey. She also emphasized that healing in therapy always involves the healing of the therapist. Therapist #6 sees the role of the counselor as a facilitator or a partner in the therapeutic process.
Therapist's, Developmental Process Associated with Metaphor Work
Therapist #6 emphasized that metaphors are something that spontaneously unfold.
Therapist #6: Model of Metaphoric Communication in Clinical Practice
Therapist #6 cited several conditions for the effective use of metaphors and noted a number of consequences associated with them when the following conditions are met: If I am centered and 119 open to the experience of working with people; if I don't have preconceived ideas of how therapy is supposed to go; if I trust the process; if I don't judge it; and if 1 work on my own issues, then the resulting phenomenon is that metaphors emerge spontaneously and unfold in session, and my true self comes through in the therapy process. Metaphoric communication translates into a series of consequences for the client and for the therapist
Metaphors help clients deal with the stigma of therapy; therapy feels magical and non-threatening. Metaphors reduce clients' resistance; they pass their defenses and "walls." Clients connect with the metaphor because metaphors touch a deeper part of who they are. Clients can take the image or symbol with them, use it, and relate to it.
Therapist #6 stressed that metaphoric work also has advantages for the therapist. By communicating metaphorically, the therapeutic process becomes a fascinating experience. The therapist not only enjoys observing the process, but it becomes a freeing and healing experience for the clinician.
Feedback through the member check procedure revealed that Therapist #6 agreed with the representation of the process but added that it is not really a prerequisite for all conditions to be present because sometimes the process works in spite of personal limitations. Sometimes, all the prerequisites are there, but it does not work. Using her words: "I can't say it is a linear [process]. 1 can't guarantee that if these six things are there, there is going to be magic that day. I can't... It's unpredictable." 120 Therapist #7: Individual Themes
Philosophical Understanding of Metaphors
Therapist #7 stressed that humans are meaning making organisms; thus, humans learn from symbols and metaphors. Metaphors facilitate people’s exploration of their experiences and the meaning these experiences have for them. Therapist #7 emphasized that there are opportunities for symbolic work in everything.
Metaphors in Clinical Practice
Therapist # 7 noted th a t metaphors are an avenue that helps people be and know themselves better. Metaphors compress the process of treatment and facilitate long-term personal growth. She described the use of diverse type of metaphors in her clinical practice: Fairy tales, sand tray, dreams, painting, and flashbacks.
Therapist #7 stated that there are certain clients (i.e., ENFPs and INFPs Myers-Briggs personality types) that are more responsive to symbolic work. She also noted some contraindications of metaphor work: clients in crisis or those diagnosed as borderline, schizophrenic or compulsive. Values regarding Therapy The major philosophical principle underlying the practice of therapist #7 is her belief that therapy works best when it touches people at the meaning level. Dealing Just with the behavioral aspects of the client’s experiences promotes only temporary change. 121 Therapist's Developmental Process Associated with Metaphor Work Therapist #7 emphasized the role of several influencing variables on her metaphoric communication in therapy. She noted
the role of personal attributes such as being highly intuitive as
well as the impact of personal growth experiences, i.e., her belief that symbols facilitated movement and healing in her own therapy. She also stressed the role of specialized training in Jungian psychology as an influencing variable in the development of her metaphor work. During the second interview, therapist #7 added the influential role of her Native-American heritage. Therapist #7: Model of Metaphoric Communication
in Clinical Practice Therapist #7 cited several conditions for the effective use of metaphors and noted a number of consequences associated with them. The following are the conditions under which metaphoric work is most effective: if the metaphor respects and subscribes to the client's worldview; if symbolic work fits into the client's purpose in therapy; if the therapist can serve as a container for clients to gain awareness into what they are doing and feeling; if the therapeutic relationship is characterized by good rapport and trust; if the client has a robust ego and is ready for symbolic work. The resulting phenomenon Is the client's involvement in symbolic work. As a consequence of this work, clients feel liberated, they understand themselves better, and they find new meanings in their lives. Clients are also more willing to take risks and to make changes and corrections in their daily experiences. Metaphors have 122 also the advantage of compressing the treatment process. The personal growth clients experience through symbolic work is long lasting, given that clients generally continue to use metaphors and symbols after treatment has ended.
Therapist #7 emphasized that metaphoric work not only has a positive impact on clients but it also affects the therapist. By experiencing clients exploring their symbols, therapists learn and find new meaning in their own lives.
Feedback through the member check procedure revealed that the representation of therapist's #7 experience was precise and accurate. As a revision of the original model, she only suggested adding that clients’ purpose in therapy should be congruent with symbolic work for metaphoric communication to be effective. Therapist #8: Individual Themes
Philosophical Understanding of Metaphors
Therapist #8 emphasized that her metaphor work reflects the use of the techniques developed by David Grove. Metaphors, according to her, are powerful tools given that they facilitate healing of wounds from the past in the past.
Therapist #8 noted that the new interest in metaphor work in counseling reflects clinicians' openness and receptivity to new methodologies. Metaphors in Clinical Practice
Therapist #8 emphasized that metaphors are the vehicle through which she most effectively works as a catalyst. Metaphor work is a technique that needs to be incorporated into the overall 123 treatment repertoire. For metaphors to be effective, they should be discovered by the client first and only then by the therapist. The therapists asks specific questions intended to facilitate
metaphor transformation and development When the metaphor transforms, what is attached to the metaphor (i.e., personal and inter-generational wounds) also transforms.
Values Regarding Theraov
Therapists #8 emphasized that healing unfolds from within. The therapist serves as a catalyst in the treatment process. The role of the therapist is to facilitate clients' discovery of their own healing process.
Therapist Developmental Process Associated with Metaphor Work
Therapist #8 stressed that her intense specialized training in
David Grove's method of metaphor had a direct influence on her developmental process of metaphor work. Therapist #8: Model of Metaphoric Communication in Clinical Practice
Therapist #8 cited several conditions for the effective use of metaphors and noted a number of consequences associated with them. The following are the conditions under which metaphoric work would be most effective: If I empower clients to be active in their own healing process, if I allow information to materialize and emerge from material that is within the client, if the metaphor is the property of the client and if it comes from the client's experience; if 1 begin where people are; if I ask a series of specific open-ended questions; if I am patient enough to let clients 12 4 develop what is inside them; if I create a safe environment; if I don't judge clients or their behavior; if clients can trust me; if I serve as a mirror for clients to view and make decisions about their own behaviors, then, the resulting phenomenon is that the client discovers the metaphors within. As a consequence, the client discovers where the pain comes from. Through metaphors, wounds from the past are healed in the past because as the metaphor transforms, it transforms what is attached to it. Through metaphors, the underlying reasons for defenses are resolved. Ultimately there is a resolution of the wound, a healing experience.
Therapist #8 stressed that metaphor work impacts both clients and therapists. Through metaphor work, therapist #8 has achieved higher understanding of the complexity of the psyche. She emphasized that metaphoric communication feels like an adventure of discovery. She experienced it as a sacred process. She noted that she is deeply affected through this work and that she achieves a sense of fulfillment of her life purpose.
Feedback through the member check procedure indicated that the representation of therapist #8 was precise and accurate. When asked if the model was too linear she responded: "Not at all... 1 think It may be useful in training people in using metaphor work
...It is in and of itself a cohesive organizational look at what for me [is an] amorphous [process]." 125 Summary
The description of individual themes and models was presented to give a voice to each of the eight therapists, in order to help the reader appreciate the unique perspectives of individual therapists. Following is a presentation of the general themes that were identified across the sample.
Themes Across Therapists The themes that emerged across therapists are briefly described below as a way to tie individual data together, as well as to summarize the commonalties that arose from comparisons across the sample. This step serves as a bridge between the presentation of individual themes and the more detailed presentation of therapists' shared experience that emerged through grounded theory analyses (see results from open and axial coding).
Regarding the Dhilosoohical understanding of metaphors, five therapists (T#1, 2, 4, 5, and 6) shared a belief in the universal value of métaphore. This belief was reflected in statements such as "all clients are responsive to metaphors" (T#l ), and "Clients across the board benefit from metaphors" (T#5).
Two related but qualitatively different positions regarding metaphors were: (a) "everything is metaphor", a position shared by two therapists (T #1 and #4) and, (b) "everything could be treated as a metaphor", a position shared by three other therapists (T#2,
# 5 , # 7 ). Examples of position "a" include: "Therapy is a metaphor, a ceremony, a ritual" (T #1 ); "Theoretical orientation is a metaphor" (T #1, T #4). An example of position "b" is "You can use 126 anything as a metaphor" (T #2); "!'!! treat things as metaphors where [it will be] useful to treat [them] as metaphors."
Regarding metaphors in clinical practice, therapists referred to the use of metaphors either as a technique (T#8), a resource, an avenue, a way of thinking (T# 2, 3, 5 and 7), or as a way to communicate and connect (T# 1, 4 and 6). These different ways of perceiving metaphors were later classified as "metaphors as technique", "metaphors as technique-tool-being", and "metaphors as being", (respectively refer to open and axial coding).
Common to all therapists was a focus on the therapeutic advantages of metaphoric communication, e.g., metaphors stretch client's thinking (T#3); metaphors reach conscious and unconscious processes (T#2, 4 and 5); metaphors respect clients, and are non-intrusive (T#1 and 5); metaphors facilitate primary and secondary reflection (T#4); metaphors facilitate client- therapist connection (T#6); metaphors help clients know themselves better; metaphors help clients transform their perception of reality (T#8).
Therapists' values reoardina theraov were diverse. They all however, explicitly or implicitly stated their belief in people's ability to change. All therapists talked about the role of the therapist as a facilitator in the process of changeO. Four therapists (T #1,2,3 and 5) stressed the need for therapists to help people stretch their thinking, open themselves to new learning and build resources. Two therapists (T#4 and 7) emphasized the role of therapists in facilitating discovery of meaning in people's lives. 127 One therapist (T #6) focused on the role of therapists in touching people's essence, while another therapist (T #8) stressed the role of the therapist in facilitating healing that unfolds from within the client
Therapists presented diverse and even contradictory opinions regarding the reasons behind the resurgence of metaphoric communication in counseling. While four therapists (T #2, 3, 4, and 5) hypothesized that metaphor work may represent a reaction against the trend towards technology and a movement to a more
humanistic approach, two (T #1 and 6) discussed that metaphor work may represent a response to the managed care emphasis on short-term treatment. One therapist (T #8) stated that the use of metaphors reflects the ever evolving nature of the counseling profession and therapists' openness and receptivity to innovative counseling strategies. Therapist #7 response to this question may have been lost due to technical difficulties during her second interview.
Regarding therapists' developmental process of metaphoric communication, all therapists discussed the role of professional and/or personal variables on their metaphor work. Regarding professional influences, all but two therapists (T#5 and 6) revealed the influencing impact of formal training: Five therapists stressed the role of specialized training after graduate school
(T # l, 2, 4, 7, and 8), and two stressed the role of mentors during graduate work (T#3 and 4). Three therapists (T# 3, 4, 5) stressed the role of clinical practice with specific populations (e.g.. 128 children, athletes). In terms of personal influences, four therapists (T#2, 3, 4, 7) emphasized the role of family/
ethnic/cultural background, and three therapists (T# 4, 6, 7) stressed the impact of personal growth experiences (e.g., therapy).
The presentation of the themes that emerged across therapists aimed at providing the reader with a general picture of the shared experiences of therapists. A more detailed description is presented in the following sections (i.e., open and axial coding). Open Coding
As explained in the previous chapter, open coding is the procedure by which data are codified and categorized following a
hierarchical procedure (Strauss & Corbin, 1990). Transcripts of interviews were divided into meaning units and codified using
HyperResearch software. The method of constant comparison was used during coding in order to have text with similar content or meaning codified under the same label. Codes, in turn, were grouped under more abstract and global categories (i.e., categorizing). Table 3 presents the results of open coding, i.e., the list of categories with their corresponding codes and textual examples.
As can be seen in Table 3, codes are grounded in the data and categories are grounded in the codes they subsumed. This hierarchical model was used during the next phase of data analysis, i.e., axial coding. Table 3 List of categories with corresponding codes and textual examples
Category Codes Textual Examples
Characteristics of the sample
-Demographics -Age "On fvlonday 1 will be 69 years old" T#6
, -Cultural/ethnic background "Ukrainian American" T#1
-Religious affiliation "f\^y religious background Is Jewish" T#3
-Relationship status "1 am Married, i'm In a long term marriage" T#8
-Professional Characteristics -Professional Degree "My master's in Counseling Guidance, and my Ph.D. is In counseling Psychology" T#5
-Professional background/ "I've done Counseling Center work for 7 years" T#5 experience
-Professional practice "Private practice, mainly (through) referrals" T#7
-Client population "The population I'm working with are children . . . referred by insurance companies" T#3
-Specialized training "i had advance training . . . in marital therapy" T#4
-Theoretical orientation "1 thoroughly believe in Erickson's approach" T#1
-Training: Theoretical orientation "My training was very humanistic, Rogerlan." T#6
VO Table #3 Continued Developmental Process of . Metaphoric Communication "1 studied at the Jungian Institute, there 1 learned a lot A. Professional Influences -Specialized training infl. metaphor wk about sandlrays and symbols." T#7
"The more experienced you get... the freer you are to -Profess, experience Infl. metaphor wk tell stories In therapy" T#2
"You can't work with kids without using metaphors" -Specific client pop. infl. metaphor wk T # 4
"An specialty area for [my advisor] was projective -Mentors infl. metaphor wk. technique" T#3
"1 certainly never had anything during my formal 'Metaphors not in graduate program training that encouraged my use of metaphors" T#5
"Clinical supervision enhances self knowledge and -Personal Growth through supervision. discovery of one's own metaphors." T#4
B. Personal Influences -Metaphor work reflection self "1 process Information visually" T#8
-Metaphor work reflection family "In my family, teaching tales were used to help us background learn" T#4
-Metaphor work reflection cultural "Appalachians do a lot of teaching through stories" T#4 background
-Metaphor work reflection religious "The Yiddish tradition Is famous for stories" T#2 background
-Metaphor work reflection spirituality "My essence guides my personal growth and my metaphors" T#6 eu o Table #3 Continued Philosophical Understanding .-Definition of metaphor "I see metaphor as sort of a two pronged of Metaphor Work communication" T#4
-Rationale new interest in metaphors "The increased emphasis on brief solution focused therapy . . . metaphor slips nicely into that" T#2
-Understanding metaphor work "it (metaphor] allows the essences of two people to merge in session" T#6 -Metaphor as technique/Metaphor as being "Metaphor is a wonderful way to learn, but it's much more than a technique" Tf/6
A. Metaphor as Technique -Metaphor work: a technique "Development of metaphors is facilitated through a series of specific kinds of open ended questions" T#8
B. Metaphor as a Tool -Metaphor: another resource "Metaphors are tools that we effectively use." T#3
0, Metaphor as a Way of -Metaphors always present "There are opportunities for metaphor and symbolic Being work in everything." T#1
-Metaphors spontaneous associations "i find myself talking metaphorically just because it’s a natural process of what 1 do." T#1
-Metaphoric quality "One of the qualities of metaphor is that any activity could be metaphorical." T#4
-Presenting concern as metaphor "A lot of times what [ciients] are presenting is the symbol of their problem." T#3
-Medication as metaphor "The medicine becomes a metaphor, a ritual." T#4
-Theoretical orientation as metaphor "Theoretical orientations are metaphors" T#1
-Therapy as metaphor "What we do in therapy is kind of a metaphor" T#5 ÜJ Table #3 Continued Condition Metaptior -Condition metaphor effectiveness "I think there needs a certain level of trust for It Effectiveness (metaphor) to work," T#8
-Pacing the Client "The particular metaphor or the particular moment in time has to be right." T#3
-Misuse metaphors "Some stories could be harmful. . . suggesting that something is going on In the client that Isn't." T#2
-Transference/Counter-Transference "Therapeutic sessions, always Involve the healing of issues the therapist." T#6
Applicability Metaphors -Metaphor archetypal quality "Existing stories . .. have some sort of Jungian archetypal quality to them." T#4
-Universal value metaphors "Myth connects with something that's deeply a part of us . . . so there Is a universality to that." T#6 I -Metaphors across cultures "Metaphors . . . are used In folk societies . . . as parts of Initiation rights." T#4
-Effectiveness based on client "Women are more amenable to the use of fairy tales, men are more amenable to the use movies." T#7
-Contraindications metaphor work "I would be concerned about using metaphors with certain kinds of borderline personalities." T#6
-Metaphors across Treatment process "A story could be appropriate at any time during therapy" T#2
CM K) Table #3 Continued Client Feedback Regarding -In session feedback "Body language . . . or non-verbal communication . . . Metaphor Effectiveness helps me to understand whether or not I'm connected" T # 1
-Feedback: future use metaphor "The client starts thinking In terms of metaphors and (across sessions) they bring them (to session)." T#4
-Feedback: Change In and out of Treatment "The changes that I see . . . (Inform] me that they have Incorporated what we've discussed" T#1
Rationale Metaphoric -Rationale metaphor effectiveness "People are very receptive to metaphor. .. they can Effectiveness take It through quickly and then utilize It." T#5
-Bypass resistance "By using metaphors, therapy becomes non threatening." T#6
-Connects with spirituality "Metaphor Is a way In which your soul can use your mind to touch people." T#6 I -Connects with nature and universe "The sun,... Is a metaphor to someone." T#8
-Respects Client's process "Metaphoric work doesn't encroach upon people" T#1
-Reach conscious and unconscious "Metaphor. . . may access both the conscious and unconscious at the same time." T#2
-Facilitates rapport building "Metaphor. . . Is a nice way to build rapport." T#5
-Metaphors: Crosses boundaries "Metaphor... crosses In many cases age, gender, and/or education boundaries." T#6 -Metaphors: Multlsensory quality "Using metaphor, I think, works across a lot of different levels, not just verbal." T#5 A) A) Table #3 Continued
Categories Metaphors -Verbal metaphors "People can tell their own fairy tales and they can tell childhood stories." T#2
-Non-verbal metaphors "1 do a lot of art materials, puppets, and 1 have play materials." T#4
-Client metaphors-Theraplst metaphors "It has to be their [clients'] metaphor because If It's mine It's not going to have any meaning." T#8
-Specific categories metaphors "Sometimes activities evolve from the metaphor (1 refer to them as] activities grounded In metaphors" T # 6
-Office decor metaphors "1 got this kuku clock . . . kids see that and think of me as being as absolutely Insane as they want." T#3
Examples Metaphors -Examples metaphor work "I talk about use of medication . . . being like the training wheels on a bicycle." T#3
-Example Inappropriate use of metaphors "1 tried metaphor with a person who was not very abstract In his thinking . . . that concrete look, 1 guess It just doesn't work." T #7
-Metaphor use during Interview "Maybe 1 am Just making a war where there's not one" T # 4
U) Table #3 Continued Consequences Metaphor W ork A. For the Client -Liberating effect "You can use [metaphors] to give people . . . a greater sense of freedom." T#4
-Facilitates meaning making process "Symbols can teach . . . and that's the key to finding the meaning in our own lives." T#7
-Facilitates developmental process "Metaphors also work to move people from one stage of life to the other one." T#4
-Leads to change "Metaphor speaks their reality then ... it leads to change and movement." T#1
-Increases Insight "Metaphors can help them [clients] develop more insight." T#5
-Heals person in the past "Wounds of the past have to be healed In the past, that’s why the metaphor work is so effective, because it allows you to work with the child within the adult." T # 8
-Long term impact "Metaphors stretch people's thinking . . . they enable them to Identify new strategies, ideas, and resources that they can use in the future." T#3
-Expands client model of the world "Metaphor speaks for the client, it will open channels so they will able to see a bigger perspective." T#1
-Compresses treatment "Six months of symbolic work, compresses work that might have had to be done In like 2 or 3 years." T#7
-Personal experience associated with "Metaphoric work is... helpful to both parties, 1 get OJ B. For the Therapist metaphor touched." T#4 en 136 The process of axial coding was executed to uncover the relationships between categories, as well as the paradigm items
(i.e., conditions, phenomenon, consequences), described by Strauss and Corbin (1 9 9 0 ). Axial Coding
As explained in the previous chapter, axial coding is an inductive and deductive process aimed at discovering and relating categories in terms of a paradigm model (Strauss & Corbin, 1990). The paradigm model includes the following dimensions: Causal conditions (happenings that lead to the occurrence of a phenomenon); intervening conditions (structural conditions that facilitate or constrain the development of the phenomenon); the phenomenon per se (the central idea or happening; the event to which a set of actions are directed); and the consequences
(outcomes or results of actions and interactions). In Figure 1, the results of axial coding are presented. As the Figure shows, the process of metaphoric communication in counseling is very complex; it cannot be described in a linear fashion. Instead, the multiple arrows in the model indicate intricate interactions among phases and categories. Following is a description of these phases and categories with supporting documentation in the form of clinical examples and direct quotations from therapists.
In the interest of readability and clarity, and to maintain therapists' anonymity, quotations have been edited; however, the essence of meaning is intact. 137 ■Causal and Intervenfng Conditions r A) Professional Influences B) Personal Influences * Specialized training *Family Background * Mentors *Culture/Religion * Practice w/specific population *Personal Attributes * Professional Experience *Spirituality * Personal Growth (Supervision) *Growth Experiences
D
Phenomenon 1
Therapist Development Metaphoric Communication
IPhilosophical Metaphor as t Understanding ------Metaphors Technique Technique-Tool-Being Being If Causal and Intervening Conditions A) Metaphor-based conditions ■<— ►B) Counselor-based conditions Appropriate pacing/timing ^ *Open/Free/Ready/Patient *Fit client - worldview, identity *ln touch with self/ -personality, interests Aware of personal -representational syst. journey C, C) Relationship-based conditions *Rapport/T rust/Safety
Phenomenon 2 Effective Metaphoric Communication in Clinical Practice
Figure 1 Therapists Development, Use, and Experience of Metaphoric Communication in Clinical Practice 138 Figure 1 (cont.) Phenomenon 2 — Effective Metaphoric Communication in Clinical Practice
-Applicability metaphors *Universal applicability *Based on client’s characteristics *Metaphors across Tx modalities *Metaphors across Tx process H -Rationale metaphoric effectiveness -Feedback effectiveness metaphors
Categories Verbal Non-verbal Client Specific Office Metaphors ______Therapist ______Decor
Examples - Effective metaphoric communication \ - Inappropriate use of metaphors Consequences f For Clients — For Therapist
A) Process A) Process -4- Improves Rapport In trance with client Non-threatening Deep connection w/client Bypasses resistance Enjoys process/ Talks indirectly about the problem Excitement/Fun Reaches CS and UCS at same time Compresses treatment process
B) Outcome - 4 ------B) Outcome Healing Personal Growth/Healing Expands client model of world Freeing Increases insight Learns about self Discovers meaning/ Finds new personal meaning potentials meanings Increases creativity Increases resources Sense of empowerment Long lasting personal growth Change 139 Therapists Developmental Process of Metaphoric Communication As represented in Figure 1, participating therapists delineated influences on their developmental process of metaphoric communication: Professional and personal. Professional influences
included specialized training, mentors, professional practice with specific populations, and personal growth experiences through supervision. Personal influences reflected family/ethnic/cultural/religious background, personal attributes, spirituality, and personal growth experiences. Professional Influences (Denoted by arrow A in Figure 1 ). In terms of professional influences on the developmental process of metaphoric communication in clinical practice, therapists discussed the importance of specialized training, professional mentors, professional practice with specific populations, general professional experience/professional growth, and personal growth experiences (i.e. supervision). Five therapists (T# 1, 2, 4, 7, and 8) emphasized the role of specialized training. The following thick description reflects their experience:
Therapist #1 : "I had . . . hypnosis training . . . To me that was the right brain part of it... I had a chance to see some real strategic people from MRI and Palo Alto. . . and got some left brain structure to what was in my brain, they were teaching me metaphorically. . . Over time I went to two or three of the Erickson's congresses . . . and the neat thing about Erickson is that his work was a good metaphor of what he taught... you have a hundred people that take a look at Erickson's work and you have a hundred different ideas about what it is that he did".
Therapist #2: "I became aware of [the use of metaphors in practice] . . . with my NLP and Ericksonian Hypnosis training; with NLP there 140 was significant training in the use of therapeutic metaphors [which are discussed] in David Gordon's book and he . . . gave some talks; we looked at the structure of metaphors and some good ways to tell stories".
Therapist #2: "I'd say the NLP training best was formalizing the use of metaphors, I got more comfortable telling stories after that training".
Therapist #4: "[I] Did some training with Carl Whitaker, and then another guy named Hugh Mullen back in the early 60's and Hugh was very much into talking metaphorically, and trying to use the treatment situation and the transference, to talk about that metaphorically".
Therapist #7: "I... studied at the Jungian Institute . . . [I got] a lot of information about sandtrays, [and] symbols".
Therapist #8: "It was when I began to study David [Grove's] work that 1 begun to see the usefulness of the intentional development of the client's metaphor".
In addition to specialized training as an influencing variable in the developmental process of metaphor work, there were two therapists (T#3 and 4) who stressed the role of mentors in their work with metaphors:
Therapist #3: "A specialty area for [my advisor in graduate school] . . . was projective technique . . . Looking at what people do as . . . a representation of who they are. . . was something that I had demonstrated very clearly".
Therapist #4: "I took all my courses with Marty Andrews, and he's a . . . nationally known family therapist. He basically talked a lot about the conscious and the unconscious being , and trying to learn to talk to people in a way that got both levels; he was Just a wonderful master at it".
The role of professional practice with specific populations was emphasized by three of the eight therapists (T# 3,4,5) as an 141 influencing variable in their metaphor work. The following are the most salient examples:
Therapist 3#: "Children live in a world of stories and tales and imagination, and make believe, and the more I worked with them, the more I begun to use [metaphors]".
Therapist #4: "After 1 got out of my master's, I was working in [a] treatment institution for kids and I got really interested in play therapy and art therapy and . . . I went to training sessions with Bettelheim lust learning how to talk with kids and . . . to communicate with kids forces you to be metaphorical".
Therapist #5 response to the question "Developmentally speaking .. . when was it that you became more comfortable and willing to be creative?:
"Maybe it was when I started working with student athletes because. . . their strong experience as athletes really was a right kind of environment for the use of metaphor because . . . personal kind of problems that they are experiencing, you can relate to their athletic experience and vice versa so, I think that's the first time; I started to use it more and . . . the more I have used it the more comfortable I have become and the more aware I am".
In addition to the influence of specialized training, mentors, and experience with specific populations in the developmental process of metaphor work, the role of general professional experience/growth was emphasized by four therapists (T# 1, 2, 4,
5). The following quotations best illustrate their experience;
Therapist #1 : "[My developmental process of metaphor work] was a more gradual subtle thing . . . the more I did it, the easier it was to do, especially with the kind of excitement that came [from] seeing how people responded to it. That probably more than anything 142 really created a positive snowball... to where it just kept getting better, building and building in a positive way".
Therapist #2: 'The more experience you get, probably the more free you are to tell stories in therapy because in beginning graduate programs, I think, students initially are tending to be more restrictive in their range of responses . . . 1 think it’s when people are more experienced [that] they start to tell more stories and see that that's a great way to get information across".
Therapist #5: "In my evolution as a clinician, I have been a lot more attentive to my own use and inclinations to metaphor and I have done a lot more with that, and the more experience I have accumulated the more I have done just because 1 have not been worried about things that you have to worry about initially when you're first starting".
In addition to the professional influences on the developmental process of metaphoric communication, therapists stressed the impact of personal variables on the development of their metaphoric work. Personal Influences (Denoted by arrow B in Figure 1 ). Four therapists (T # 2, 3, 4, 7) cited family and ethnic/cultural/reliolous background as major personal variables impacting their use of metaphors.
Therapist #2: "When I think of my greatest influence on my therapy work, it's. . . my mom's. [She is] a therapist and she'd tell stories all the time . . . my mom would . . . tell me how she would tell [stories about me] in her therapy and all the clients would know me . . . She was really training me to be a therapist from early on by telling me stuff like that... So even if that wasn't emphasized in the graduate program, I've known that from a full time private practitioner that this is a curative way to operate." 143 Therapist #2: " [My mom] is from a Yiddish tradition where stories were how people learned . . . if you wanted to teach something . . . you [would] teach it through stories".
Therapist #3 (second interview): "My religious background is Jewish, I know that has had an impact"
Therapist #4: "I basically grew up with someone teaching me the parables. . . to help me be good or do right. . . in my family and in our church parables and metaphors were used a lot, as teaching tales to help us learn what we were supposed to learn".
Therapist #4: "I'm from an Appalachian family. And, Appalachians tell stories. A lot of teaching is done through stories".
Therapist #7 (second interview): Therapist remembers her Native- American grandmother telling her stories. She explained that even though her grandmother did not know how to read and write, she was able to narrate stories. (As explained in the methods section, due to technical difficulties part of the recorded interview for this therapist was lost. The researcher, with the help of notes, dictated missing data soon after the problem was noted, minutes after the interview ended). In addition to the family/ethnic/cultural/religious background, five therapists described personal attributes as an important variable influencing their use of metaphors. Therapists # 1, 3, 5,
7, and 8 spontaneous self-disclosure and/or their response to the question "Anything about you as a person that might have motivated you to use symbolic language or metaphors?" clearly described the impact of personal attributes as an influencing variable. As can be seen through the following thick description three therapists (T # l, 5, and 8) emphasized the role of their dominant cognitive/learning style. The researchers' bracketed expectation was that therapists involved in metaphor work would exhibit a dominant visual cognitive style. This was only the case 144 for therapists #5 and #8.
Therapist #1 : "Even though I look at that training back in the early 80's as Dbeing a significant exposure to me, I think that why that seemed to excite me so much was because it did fit so well with who I am . . . A lot of my learning is that way".
Therapist #3: "I never grew up . . . I don’t take life too seriously. . . I am very musical, and maybe that’s the link. . . I sense there’s something else back there that I just am not consciously aware of, that led me to maintain a more playful perspective on life".
Therapist #5 (second interview): "I think schematically as opposed to literally. So, 1 often think in things that are diagrams or metaphors."
Therapist #7: "I have always beOen, ever since I was a small child, very intuitive . . . Being very intuitive . . . let me begin to look at symbols as interesting. I often wondered about my dreams as a child".
Therapist #8:1 think that probably one of the reasons that this is easy for me is because I tend to think in metaphor. That probably has something to do with how I process information. I process information in global terms; I process information visually; I’m not a logical sequential thinker".
In addition to demographic variables and personal attributes, one therapist described spirituaiitv as important in her clinical work. The impact of spirituality on metaphor work was an expectation the researcher had bracketed at the beginning of the study. Only therapist #6 disclosed a connection between spirituality and metaphoric communication.
Therapist #6 (second interview): "My essence guides my behavior and not my personality or my pathology. . . 1 Just trust that this is a part of my experience now because it’s part of the bigger picture. 145 cosmically".
Therapist #6 (second Interview): "I can offer more to people through metaphors. .. because more of my soul is present and connected with my behavior"
In addition, Personal growth experiences were reported by three therapists (therapists #4, 6, and 7) as a relevant variable influencing their use of metaphors in clinical practice. The following examples best illustrate their position:
Therapist #4: "You cannot do metaphorical work unless you know your own metaphors and unless you are comfortable doing metaphorical work on yourself’.
Therapist #7 :"As I got more . . . interested . . . in trying to explore myself, in terms of feelings and what my intuition meant, whether it was valid or invalid, the avenue of symbols seemed to really helped me. I begun to do dream journals"
A clear example of therapists' own use of symbols in their personal work was shared by Therapist #7:
"When my mother was dying I was often visited in my dreams by an old woman who was just really old and awful looking and scary and I would just run from her in my dreams . . . Then I decided at one time in the dream process that when she came back, I was going to turn and face her and 1 did that and she became very comforting and beautiful".
These quotations, reflecting the impact of personal growth on professional awareness suggest an interrelationship between personal and professional variables (Denoted by arrow C in Figure 1 ). The following quotation further supports the presence of such interconnection. 146
Therapist #6: "I'm doing my very best to surrender to the [metaphoric] process and to trust the process. And as I'm doing tiiat more and more [in] my personal life, [it] allows [me] to do that in my professional life. Examples of the impact of personal growth through clinical training and supervision, further sustain the proposed.relationship between personal and professional variables.
Therapist #4: "The self of the therapist as a teaching tool, is the most important thing in terms of metaphorical work. . . Academic training [in terms of] . . . peer supervision. . . or quality supervision where people are actually examining their own self... is an important aspect of metaphorical work".
In sum, personal and professional variables (arrows A and B in
Figure 1) as well as the interrelationship between them (arrow C) were reported by therapists as having an impact on the developmental process of their use of metaphoric communication in clinical practice. Following is a description of diversity among therapists regarding their philosophical views of therapeutic metaphors. Three categories seemed to capture this diversity: "metaphors as a Technique", metaphors as Technique-Tool-Being", and "metaphors as Being."
Philosophical Understanding of Metaphors in Clinical Practice Diverse philosophical world views regarding the use of metaphors in clinical practice were revealed by therapists. The researcher reflecting on theoretical notes (see Chapter III) identified three different and mutually exclusive categories that encompass this diversity: metaphors as technique, metaphors as 147 technique-tool-being, and metaphors as a way of being. As explained in Chapter III, member checks moved the researcher to conceptualize therapists' philosophical understanding of metaphors under these three qualitatively different categories rather than as the original hypothesized continuum. The following transcripts represent these three different philosophical views of metaphors. Metaphor as Technique. One of eight therapists (T#8) described metaphors as a technique:
Therapist #8: "The use of his modality [David Grove’s method of metaphor] is more the technique and it’s called metaphor work . . . For me the use of metaphor in therapy is confined to use David Grove’s metaphor method".
The following description of how this therapist works through metaphors further exemplifies the prescriptive nature of her work:
"[Metaphors] are consciously developed. So . . . if you talked to me about a crazy mom. I’m going to just ask you what kind of a crazy mom could that be an then. I’m going to listen while you say . . . that's a too busy mom, that's an unorganized mom, that's a hard to understand mom, and them I'm going to repeat all that back to you, which values what you've said, and then I'm going to say and is there anything else about that unorganized, hard to understand, crazy mom ... and then I'm going to say 'and where did that crazy mom come from? And when I find out where that crazy mom came from. I'm going to find out what kind of a place was that. So we will develop, move back, develop, move back".
Metaphor as Technique-Tool-Beina. Four of eight therapists (T#2, 3, 5, and 7) represented this philosophical views of metaphors: 148 Therapist #5 (second interview): "I don't think you can artificially separate out into those categories. I think it is all three, I think it's a way of viewing the world and I think it's both inclusive and exclusive; so, I mean it's the yin-yang, its both/and . . . I think is all those things. I think it is a technique. I also think it is descriptive of the therapeutic process and I think it's something that kind of flows naturally too. I think it's all three things. In that way, I think it's really appealing incorporation into the therapeutic process because it's a natural entity, and it's also something that people can learn to use from a technique perspective or to be more attentive to or to kind of develop and polish".
Therapist #2, (second interview): "An intervention could be constructed as a technique. I mean it's how did you help this person move from here to here? Well, I told the story about... those are techniques . . . but they're also just stories. And, you don't necessarily present them as technique. And that's some of the reason it's so palatable to the client. . . So is that a technique, yes, would the client experience it as a technique, hopefully not."
This presentation of metaphor as technique and as an intervention contrasts with the therapist's view of metaphor as part of being, which he clearly manifested in response to the question, "Any other professional activity in which you find yourself using metaphors?"
Therapist #2, (second interview): "I don't think of it that way, I mean you breathe, and you 're breathing when you are in session, ... are there any other circumstances where you find that you breathe? And you probably say well, it seems like breathing is available to me wherever I go!"
Metaphor as a wav of being. Three of eight therapists (T#1, 4 and 6) described their experience of metaphors as a way of being. 149 Therapist #1 : T o me metaphor is much more a way of life and part of what I do anyway. It's part of how I see and experience the world, so it becomes a very natural process to me".
Therapist #4: "I just can’t imagine not talking metaphorically to one level or another; you always are . . . I guess is impossible not to be metaphorical, so the difference between the metaphor therapist and the non-metaphor therapist is not that they don't use metaphors. It's that one knows that they are doing it, and the other one doesn't".
Therapist # 6 (second interview): "The metaphor is a wonderful way to learn, but it's much more than a technique; it's part of a life process that is this marvelous gift and reminds us of how interconnected we are. That we are not essentially separate, we're all essentially connected and a part of something much greater than ourselves".
Based on the data, it is possible to infer the presence of a developmental process underlying therapists' philosophical understanding of metaphor work (i.e., metaphor as technique, metaphor as technique-tool-being, metaphor as being). The following transcripts support this interpretation:
Therapist #1 : "Back in the early 80s when [hypnosis, metaphor work] was . . . new, [it was] much more mechanical. . . 1 don't think anymore about whether people are using visual language, or kinesthetic or auditory. .. 1 just go into my own trance as soon as my client walks into that office and that's a real, natural part of it".
Therapist #4: "There was a period of time when 1 [thought]... metaphors . . . were an activity so 1 would say stupid stuff like 1 am going to use this metaphor with this child, to get this result and [then it was replaced] with an understanding that just simply life is metaphorical, and the only thing that I'm doing now is being more conscious of the metaphorical process. So, I used to think it was a procedure, now I think it is just simply an awareness". 150
Therapist #5: 'The more 1 have used [metaphors], the more comfortable I have become and the more aware I am, and now... for me it's not really an intervention, I guess it's another level of thinking . . . now it's a lot more integrated I think, before maybe I saw it as an intervention; now I see it more as just a thread in a therapy tapestry"
Therapist #5: As a clinician there are decisions I make about why I'm using [metaphors, stories], how I'm using, when I will be using, and . . . the more that becomes integrated with the work I do . . . the more I am aware of it but the less it feels like it's just kind of a tool. .. I am aware of making those decisions but it's not. .. in a manner that takes me out of the experience ... I think that earlier in my work, I... would had to think about it and it would have taken me away from the experience."
The data also suggest that the salience of personal and professional influences varies according to therapist's philosophical understanding of metaphor work, i.e. metaphor as technique, metaphor as technique-tool-being, metaphors as being (denoted by arrows D and E in Figure 1 ).
The therapist who understands metaphors as technique, for instance, seems to consider specialized training as a necessary condition for the development of the ability to use metaphors effectively in clinical practice. The following transcript represents her position:
Therapist #8: "What makes it challenging in terms of David Grove's metaphor work is that it is not easy to learn. It's not something that you can just go to a couple weekend seminars and be able to use with any sort of effectiveness . . . It takes a long time". 151 Therapists who perceive metaphors as technique-tool-being, as well as those who experience metaphors as way of being considered their personal growth and/or their ability to free themselves as important fectors. Although five of these therapists (T#1, 2, 3, 4, and 7) had some specialized training in symbolic work, only three of them (T#1, 2, and 7) stressed the impact of such training on their developmental process of metaphor work. Two therapists, one in the "metaphor as technique-tool-being" group (T#5) and the other in the "metaphors as being" group (T# 6), minimized the need for specialized training in the development of metaphoric communication. Therapist #5 had no specialized training in the use of symbolic language and therapist #6 stressed that for her, metaphoric work has unfolded spontaneously. Personal growth, along with a connection to spirituality, facilitated therapist #6's use of metaphor in clinical practice. The following are excerpts from transcripts in which she described her experience.
Therapist #6: "As I open to the experience of working with people, [metaphors] come spontaneously. I haven't gone to a book; 1 don't have a list. They come from a part, I don't know where they come from".
Therapist #6: "It was not something that I thought out, it's not something I planned for, or prepared for. Is something that unfolded, as I have been working with people".
Therapist # 6 (Second interview); "I think literally that my journey and facing my issues and my pathology and connecting with my essence in a real way; those are the things that support my capacity to work with others much more than any formal education I've ever had; much more than any experience I've had as a 152 counselor". in summary, results Indicate that personal and professional influences had an impact on therapists' developmental process of metaphoric communication. The salience of these influences seems to relate to therapists' experience and understanding of metaphoric communication in clinical practice.
Following is a presentation of therapists’ descriptions of conditions, rationale, applicability, and consequences of metaphor work. As will be seen in the following section, therapists' description of the conditions for effectiveO metaphor work vary based on their philosophical understanding of metaphors, i.e., metaphors as technique, metaphors as technique-tool-being, and metaphors as being (denoted by arrow F in Figure 1 ). Conditions for Metaphor Effectiveness
Metaphor-based conditions. Therapists cited several conditions for metaphors to be effective in clinical practice. All therapists discussed the need for the metaphor to fit clients' oersonalitv and interests, worldview and identity, and/or dominant representational system. For the therapist who approaches metaphors in a technological way (T #8), this condition seems to be implicit in her work as she uses only the metaphors that come from clients themselves.
Reoardino Personality and Interests: Six therapists (T #1, 2, 3, 4, 5, 6) made statements about the need for metaphors to fit clients' personality and interests. The following transcripts best illustrate their position: 153 Therapist #2: "I do it in two ways, one is based on the other person's vocabulary and the other person's interest i'll come up with a story or anecdote that fits that".
Therapist #4: "Sometimes you [are with a client] that's just very concrete and very pragmatic and you want to talk to the client about spiritual issues or values. .. then a metaphor can be used to talk about those things through his or her language. . . and you find out that he is an auto mechanic... so you use ... cars, auto mechanic [language]. . . to get the person talk about... love". Therapist #1, #2 and #5 further illustrated this condition for the effectiveness of metaphors through case examples of their clinical work:
Therapist #1 : "I had a patient. .. who's chronically depressed . . . and has been trying to get into veterinary school for four years . . . she is persistent... but she doesn't feel that she's ever going to make it... but one area of her life. . . that she really loves and feels pretty good at is rock climbing. So we talked a lot about rock climbing because she . . . got this negative kind of thinking that you can't make a mistake and that you've got to know ahead of time that the decisions that you make are correct. .. so we talked about. .. what happens [when you're rock climbing] and you run into a situation that's different from you plan . . . Well you have to try a different way and, how quickly do you climb? Is the goal to get to the top or is it the climb itself?"
Therapist #2: "[I have been working with] a client who is a horseback rider and she is not doing well on exams, she panics on exams but doesn't panic during horse shows, so we used the horse show as symbolic. .. it's an image that would represent her... facing a competitive testing situation . . . That would be out of that client's experience . . . that's using what the client has interest in".
Therapist #5: "Recently I was working with this guy who. . . was feeling very discouraged about ever being able to meet anybody that he might be compatible with . . . He is a farmer. . . And we talked about how in farming . . . there are some things you need to do . . . if you don't... plant your crop, you can't expect to have one. 154 And that there are things that you can do to optimize having a crop".
Regarding Worldview and Identity Three therapists (T #1, 6, 7) specifically discussed the need for metaphors to fit clients' identity and worldview. The following are the most salient examples:
Therapist #1 : It's not only whether they're an engineering or a fine arts student. It has to do with whether they're tall or short. . . male/female, cultural background, first bom, second born, last born or an only child . . . So, that's where I'll look for the pacing . . . and my language will lead there".
Therapist #7: "I think that a rule of thumb, for doing work with people is that you do not offend them, you do not do something that is outside of their set of conditions and prohibitions. You have to be careful and respect exactly where the person is coming from . . . I might work with the systems that they subscribe to . . . but of course you have to know enough about their system to do that".
Therapist # 7: "Symbols come to teach us and I do not have to project or intrude on what a person does, so it would depend on their background and what would be available to them and what they are comfortable with".
Regarding Representational System: Three therapists (T # l, 2, and 5) stressed the importance of metaphors fitting clients’ dominant representational system:
Therapist #1 : "It may come down to as basic as the representational systems of learning. People who use lots of visual language, I see what you mean or it looks good to me, tells me that they're visual learners . . . If I am going to use a metaphor [then], it may be a visual one to . . . match their experience".
Therapist # 2: "If someone is more orative, they may like you 155 telling them stories, if they're visual, you might want to embellish on the visual imaging portion of that".
Therapist #5: "If you use a really potent metaphor that really creates a strong visual representation for a person and that's the sensory mode that they use to process information, they might be really responsive to that, but if you use something th a t is kind of auditory loaded, that same person might not respond as much, so I think that part of it is finding metaphors that really seem to fit with the person's real experience,. . . I think that when you use metaphors it's like anything else, you really have to tailor them to the individual experience and what you've picked up when you've done your history with them".
Therapist #2 illustrated his position regarding the need for metaphors to fit client's representational system through the following example:
Therapist #2: "If a person says that they have a headache and you ask what's your headache like and they say it's like a hammer in my head that's pounding, that’s an invitation to work with that image . .. so we can have [him or her] imagine putting a [cushion] in their brain that's close to the hammer so that the hammer can't pound [or]. . . it might be that the pounding lessens".
In addition to the need for metaphors to fit clients' reality (i.e., interests, worldview, representational system), five therapists (T#1, 2, 3, 4, 7) stated the need to pace the client and consider the timing of the presentation of metaphors:
Therapist # 1 : "The word for me is pacing in the sense of listening to the language, to give me some sense of, some idea of how people think and how they learn".
Therapist # 2: "A lot of it is timing, if you were in the middle of an emotional speech . . . to interrupt that to tell my story would be 156 intrusive, but it might be that when you were finished.. . one way I could show I'd understood was to give [you] an example either from myself or someone else or to take your story and work with it further; then it would be useful-the timing there would be important".
Therapist # 3: "Like any technique, it's not always going to work.. . the particular metaphor or the particular moment in time may or may not be right. Sometimes your timing is better than others".
Therapist #4: "In social work we call it 'start where the client is'".
Therapist #7: "I think it's important not to be obtrusive . . . I think you need to follow the lead [of whom you are] working with".
In contrast with the position that therapists should be careful regarding the timing of the metaphor, therapist #6 stressed the need to trust the process by which metaphors unfold.
Therapist #6: "When metaphors emerge, I just trust that the context and timing are appropriate. I value them, I don't judge them."
Therapist-Based Conditions. In addition to metaphor-based conditions (timing, pacing and the appropriateness of metaphors at fitting clients' reality), therapists expressed therapist-based conditions for metaphors to work. Therapist openness and readiness were mentioned by two therapists (T#3, and 6) as necessary conditions:
Therapist #3: "The rule means you need to be ready to be playful. And if you are ready, willing, and capable of being playful, whether it's in language or in action, metaphors are wonderful".
Therapist #6: "It's allowing the essences of two people merge in session. It's opening up to that, so I open myself up to having a 157 different part of myself relate, and striving to touch a different part of [clients] that is not protected arid scared, or defensive".
Therapist #6 (second interview); "If I am centered and coming from a loving space, my soul seems to work through me easier. If i am preoccupied, if I am coming from a fear space, if I am muddled, if I have pre-conceived notions about where we need to go or 1 am starting to get afraid because I have only have so many sessions left with this person, my own pathology blocks the process. When it blocks the metaphor process, it blocks the therapeutic process.. . But it is not a prerequisite th a t all things have to be there because sometimes that process works in spite of me".
In addition, two therapists, (T #4, & 6) emphasized the need for
therapists to be in touch with their personal selves in order to use metaphoric communication effectively in their practice. It is not
surprising that both therapists share the philosophical view of metaphors being more than a technique or a tool; they see metaphors as a way of being.
Therapist #4: "You can not do metaphorical work unless you know your own metaphors and unless you are comfortable doing metaphorical work on yourself".
Therapist # 6: "My approach with others, seems to be directly related to my personal growth and where I am in my journey".
In addition to metaphor-based and therapist-based influencing
conditions on metaphoric effectiveness, therapists discussed the role of relationship-based variables on the effectiveness of metaphoric work.
Relationship-based conditions. The need for a solid therapeutic relationship was mentioned by four therapists (T# 1, 5, 7, & 8) as
a necessary condition for the effective use of metaphors in 158 clinical practice. Therapist #1 summed up the importance of relationship by stating that "The therapeutic relationship is everything." Other therapists concurred:
Therapist #5: "Like any other intervention if you build good rapport with a person . . . and the issues of safety and comfort and nurturance . . . have been addressed . . . that might make a person more responsive".
Therapist #7: "If [clients] do not feel comfortable with you in a therapeutic relationship, they do not reveal anything, even if they are symbolically predisposed".
Therapist #8: "There needs to be a certain level of trust. I certainly don't believe that this work will be effective if the client doesn't trust the therapist".
Summarizing, relationship, counselor, and metaphor-based conditions were described by therapists as influencing the effectiveness of metaphoric communication in clinical practice. Such influence is denoted by arrow G in Figure 1. Although not directly stated by therapists, it is possible to infer complex relationships among these different influencing variables (denoted by the fine line arrows "a, b, c" in Figure 1 ). It is reasonable to propose for instance, a reciprocal relationship between metaphor- based conditions and counselor-based conditions (denoted by fine line arrow "a" in Figure 1 ). How self-aware, open, free and patient the therapist is, will probably impact his or her ability to offer appropriate metaphors. Similarly, the ability to appropriately pace and fit clients through metaphors will probably have an effect on the therapist willingness to be open and to free him or herself in 159 session.
It is also reasonable to assume that appropriate metaphors in terms of timing as well as congruence with client's reality will positively impact clients' perception of the therapist and the therapeutic relationship (denoted by fine line arrow "b" in Figure 1 ). Well placed metaphors will probably provide clients with a sense of being understood; they may experience the therapist as trustworthy and the therapeutic relationship as a safe one. In contrast, metaphors that do not fit clients' experiences of the world may damage the therapeutic alliance. Therapist #4 discussed the connection between metaphor inappropriateness and relationship damage through a clinical example:
Therapist #4: "Just a couple of weeks ago, I was trying to help a couple understand how frightening it was... to allow themselves to be intimate with each other. And I was . . . having difficulty, they were very defensive... So, one of the things I tried was . . . I had them read a . . . piece . . . from... [a] book called The things they carried . . . The story [is about] a guy in Vietnam and he loses his best friend and he is filled with grief... he shoots up a water buffalo. It is a gross story . . . [but it is a] perfect story to talk about how awful intimacy is . . . Intimacy is lovely, but is also awful, because it makes you so vulnerable.. . They were pissed at me, and it really hurt our relationship. I don't know what I was thinking [when I had] this particular couple read it".
In addition to the impact that metaphors may have on the therapeutic relationship, it is possible to suggest that the quality of the relationship will impact the metaphors being used (denoted by the double fine line arrow "b" in Figure 1 ). A sense of safety in the relationship may impact, for instance, clients' level of 160 openness and willingness to share personal information. As a consequence, therapists may not have sufficient information about their clients to select appropriate metaphors. In addition, a poor therapeutic relationship may impact clients' willingness to disclose their own metaphors in session. Finally, it is possible to suggest a mutual relationship between counselor-based conditions and relationship-based conditions
(denoted by the fine line double arrow "c" in Figure 1 ). Therapists' self-awareness as well as their ability and willingness to be open and patient will probably, have an impact on the therapeutic alliance. The quality of the therapeutic relationship, on the other hand, may impact therapists' willingness to free themselves in the therapeutic environment.
In addition to the relationships just presented, it is possible to infer that personal and professional influences have an impact on each of the intervening variables labeled "Metaphor," "Counselor," and "Relationship-Based Conditions" (denoted by the fine line arrows "d" and "e" in Figure 1 ). It is reasonable to suggest that professional influences such as specialized training, practice with specific populations, and professional experience will impact therapists' ability to appropriately pace clients as well as their capacity to identify, appreciate, value, and respond to clients' reality. It is also possible to suggest that professional experiences will have an impact on their ability to establish therapeutic relationships and on their capacity and willingness to be open, free, and more in touch with themselves in the therapeutic 161 environment.
The fine line arrow "e" in Figure 1 suggests that personal influences also have an impact on the metaphor, counselor, and relationship-based conditions. It is possible to infer, for instance, that personal influences such as therapists' personal familiarity with metaphors, as well as their level of awareness of their own journey will be reflected in (a) their ability to select appropriate metaphors, (b) their capacity to relate to their clients, and (c) their willingness to be open and free in therapeutic encounters.
The following section focuses on the characterization of metaphoric communication in clinical practice with an emphasis on applicability of metaphor work, rationale for metaphoric effectiveness, categories of metaphors, and consequences of the use of symbolic communication in clinical practice.
APDlicabiiitv of Metaphors
Therapists' positions regarding the impact of client characteristics on the effectiveness of metaphor can be divided in two major groups. While one group of four therapists (T# 1,4, 5, &
6) stressed the universal applicability of metaphors, a second group of four therapists (T# 2, 3, 7, 8) described specific characteristics of clients that impact their responsiveness to metaphoric work. The position of the first group, i.e. universal applicability of metaphors, is illustrated by the following examples;
Therapist #1 : "They all respond to metaphor; it's just a matter of finding the one that will fit for that person". 162
Therapist #4: "Existing stories and legends and folk tales have been around for a time . . . [they have] a Jungian archetypal quality to them".
Therapist #4: "If people are alive, then metaphors are always to be of help".
Therapist #5: "I think that clients across the board benefit from the use o f metaphor. . . my experience has been that with clients . . . of varying intelligence. . . varying kinds of presenting concerns . . . Axis I and Axis II [metaphors are] equally as beneficial".
Therapist #5; 'The nice thing about metaphors is that it is . . . universal. . . it works across clients and concerns".
Therapist #5: "Metaphors work universally because there is a shared experience that people have".
Therapist #6: "Myth connects with something that's deeply a part us from hundreds and thousands of years.. . There is a universality to that, across cultures".
Therapist #6:1 think the whole value of myth is something that is almost genetically grounded within us"
Therapist #6: "All of us are impacted on by cultural stories, religious stories, myth, children stories. Children stories. . . are all grounded in some universal concepts that maybe touch our essence in a way that we can never intellectually define".
Among this group of therapists, three (T#1, 4, & 6) talked about the use of metaphors in specific cultures as a way to emphasize the universal use and applicability of metaphors. These three therapists share the philosophical view that metaphoric communication in clinical practice reflects a way of being. The following are the most salient examples regarding their description of multicultural uses of symbols: 163
Therapist #1 : "I know. . . that in other parts of the world. . . there are many other ways to intervene. .. that have to do mostly with ritual. . . some of the Native American ceremonies for instance, and. . . ju st any kind of ritualistic feeling that. . . could access a mindset where people are healing themselves".
Therapist #4: "I would be more inclined to find a metaphor that is universal, but most of them ans... The metaphors that you can [find] through a book of African stories. . . are about the same as Hans Christian Anderson, in terms of their deeper structure".
Therapist #6: "In New Zealand, the Shamans in the tribe would ask people to do [the Maori Drawing] on the ground. And then the Shaman would interpret it... Based on the quadrant th at has the most images, you are asked to work in that area throughout the next twelve months. . . It's a way for people in [that] culture to establish goals and direction".
Therapist's # 4 described his use of Appalachian tales in his clinical work, further illustrating the applicabilhy of metaphors across cultures:
"One of the metaphors that I use a lot is a metaphor. . . from a book called From the Tide. It's basically about an Appalachian family that gets their house flooded, and the story talks about how they have . . . to dig out... to discover their. . . buried treasures . . . That's a really beautiful metaphor to help some families who are very concrete, or very problem centered . . . talk about more spiritual things."
In contrast to therapists who expressed applicability of metaphors across cultures and the universal value of metaphor work, a second group of four therapists (T# 2, 3, 7, & 8) suggested that certain client characteristics affect their responsiveness to metaphoric communication. Their position is reflected by the 164 following examples:
Therapist #2: There are many clients who are fairly counter intuitive and they want things specific... they don’t want to deal in symbols. . . they want things practical. . . and they don't like to get into the realm of metaphor".
Therapist #3: "[Metaphors are more effective] for those persons who are willing to be more playful in their thinking".
Therapist #7: "Some people will jump right into metaphors and fairy tales . . . I think it depends on the readiness of the individual".
Therapist # 7: "Generally both men and women are more likely to feel comfortable working with dreams . . . Women are more amenable to use fairy tales, men are more amenable to use movies. It’s that concrete vs. abstract thing. Men are more... defensed in our culture . . . in using abstract information . . . With children is so much fun because they come uncensored and unprescribed; they are very symbolic. They find it very easy".
Therapist #8: "I think that probably males are somewhat more likely to be in that strong cognitive place and I think is largely a m atter o f acculturation.. . females more easily drop into this".
Therapist #7: "I think you could almost use the Myers-Briggs to determine who would be more amenable to symbolic work: the ENFP, the INFP. ETPJs would have a real hard time into anything symbolic".
Therapist #8: "People who are in terms of Myers-Briggs, NFPs will Just fall into this.. . but the really cognitive folks have some difficulty, people who are major controllers have some difficulty".
Therapists cited few contraindications for metaphor work. Two of them (T#7 and #8) expressed that it may be inappropriate to do symbolic work with clients who are in crisis or fragmented. They both stated the need for clients to feel stable before they can engage in metaphoric work. In addition, one therapist (T #8) 165 reported difficulty working through metaphors with people who have neurological damage, and another therapist (T #4) expressed the need to be cautious while using metaphors with clients who are diagnosed with antisocial personality disorder. Two therapists (T # 4 ,7 ) stated that metaphoric communication may be contraindicated when working with schizophrenic clients. Similarly, four therapists (T#4, 6, 7, and 8) stated that metaphoric communication may not be appropriate when working with clients diagnosed as borderline. Two of these therapists (T#6 and 8), however, explained that they have used metaphors with this population. Therapist #8, for instance, reported that she has done effective metaphor work with borderline clients once a strong therapeutic relationship was established. In summary, therapists' position regarding the applicability of metaphors was divided in two general groups. While one group emphasized the universal applicability of metaphor work, the other stressed the impact of clients' demographics and other clients' characteristics on their responsiveness to metaphoric communication. The applicability of metaphors across cultures was documented by three therapists. Finally, therapists enumerated a series of possible contraindications of metaphor work based on client's diagnosis.
In addition to the presentation of applicability of metaphors based on clients, therapists discussed the applicability of metaphors across the treatment process. Six therapists (T#1, 2,
3, 4, 5, & 6) described metaphors as useful and applicable 166 throughout the therapy process.
Therapist #1 : "We go at [metaphors] right from the beginning . . . it's kind of constant".
Therapist #2: "If you describe the process of therapy or the stages of therapy. . . it looks [like a] linear [process]. As you actually do the work, it doesn't. . . you may have that sequence in mind but, the first thing the person says, you may respond with a story. It's not like you have to wait until the intervention stage because you can have an impact at any point. . . therapy starts right away and if... talking to them starts right away then, a story could be appropriate at any time because you can use the story to demonstrate that you understand . . . you can use the story to open up new possibilities, you can tell a story to give a hint of possible solutions". Therapist #6: "[Metaphor work] could happen any time".
Among the six therapists who talked about metaphors as useful
throughout counseling, two (T#4 and 5) stated that metaphors may
vary in form and content at the different stages of the therapeutic process:
Therapist #4: "You have different kinds of metaphors at different stages in the treatment process. For instance, metaphors in the beginning stage of treatm ent. . . often have something to do with . . . what is therapy. . . and metaphors are used to help people understand how they're supposed to work. . . Metaphor can be used . . . [to teach] people . . . how to use the process . . . in the middle stage . . . metaphor can be used in terms of assessment. . . the projective phases are metaphorical. . . metaphors have to do with providing people with paths or roads to get around their resistance. And in the ending stage. . . metaphors end up talking about separation . . . People need to talk about that, they often talk about it through metaphors. So,... metaphors change at different parts of treatment and they are . . . developmental in that sense". 167 Therapist #5: "There are some differences based on where you are in therapy and the kind of metaphor you might use".
In addition to ^erapists' description of the use of metaphors through the treatment process, they discussed the applicability of metaphoric work across treatment modalities. Six therapists (T # 1 , 2, 3, 5, 7, & 8 ) focused on the use of metaphors in individual therapy and two (T #4 and 6) stressed the applicability of metaphors with couples and families. Their focus seems to reflect the dominant treatment modality of their practice. These results reinforce the value of using observational notes to guide data collection. As explained in Chapter III, the researcher's decision to include family therapists in the existing sample responded to the data reflected in observational and theoretical notes. Therapists #7 and 8 presented clear examples of the applicability o f metaphors in individual therapy:
Therapist #7: "One woman . . . picked up a fairy tale about a girl whose father had cut her hand. .. She was able to see how much she had really been constrained by the relationship with her father. It was helpful for her to understand that".
Therapist #8: "I was doing a meditation in metaphor style with a client who suffers from chronic depression and the feeling he was working with was sadness. And the sadness started as a dark cloud . . . eventually that cloud went through a lot of steps and transformed into a light filmy scarf that could [be] easily removed from his neck. . . and it was something that fit so lightly around him that it didn't constrict him in any way".
In addition to these examples of therapeutic work from individual cases, therapist #6 shared several examples of her 168 metaphoric work within a family therapy approach. The following is one of the most salient ones:
Therapist #6: "I had a family come in one night and the father... was having some problems with his tooth . . . and we spontaneously went into what the family tooth aches were. . . what things were happening in the family that caused pain, that no one could see . . . and then I picked up the little bottle of medicine . . . and said: And what medicine do you have available. . . to [deal] with the family tooth ache? And it worked because everybody could connect with the tooth ache". Rationale for MetaDhoric Effectiveness Therapists emphasized several characteristics of metaphors to explain the power of metaphoric communication in clinical
practice. Six therapists (T # l, 2, 3, 4, 5, & 6) stressed the power
of metaphors in bypassing clients' resistance. The following examples best capture their point of view:
Therapist #1 : "It is not necessary to deal head o n ... with the problem that [clients] come in with but to work in a parallel... way, metaphorically with another issue that may... help them change. Just simply. . . because there may be more resistance for approaching things more directly or head on".
Therapist #3: "Using metaphors, more often than not, will allow you to work through the resistance . . . I get people who have been cornered and lectured at, screamed a t... They don't want to talk about that. . . anymore. . . By using available metaphors... 1 deal with that material in a new way".
Therapist #4: "[Clients] will talk about things they are not comfortable talking . . . by talking about what's comfortable".
Therapist #5: "For someone who is really defensive [metaphors provide] a way to get a point across and to suggest something that they probably wouldn't be receptive [if] more literary [means were used]". 169
In addition to the strength of metaphors in bypassing resistance, therapist #6 stressed the power of metaphors at crossing diverse tvoe of boundanes (factor probably implicit in her and other therapists' presentation of the universal applicability of metaphors). The following thick description reflects her position.
Therapist #6: "Metaphors crosses. . . age boundaries, gender boundaries, socio-economic boundaries and education boundaries".
Therapist #6: "We may be very different people; different life experiences, lots of things are different, yet. . . [metaphors] bring forth the similarity rather than emphasize the difference."
Connection with nature, the universe, and spirituality was emphasized by three therapists (T#4, 6, & 8) as a factor underlying the power of metaphors.
Therapist #4: "I think of a metaphor as a way to talk to a person on a primary and a secondary reflection level. . . Secondary reflection is spiritual reflection, reflection on values, meanings .. . where primary reflection is more technology problems".
Therapist # 6: "The use of metaphors . . . touches something that is . . . much deeper or more heart-centered or spiritual-centered or essence-centered; gets away from just touching the mind".
Therapist #6: 'The metaphor is a way in which my soul can use my mind to touch people".
Therapist #6: "Through metaphors, the essence of two people merge in session".
Therapist #8: "A lot of times... metaphors go back to some element of nature and it's almost as if there's something primordial in the effectiveness of metaphors". 170 Therapist #8: "At some level we are all.connected to that very basic life process, and this work gives us a way to articulate that and use the energy and that belief system to affect our own healing".
Examples of therapist #8's clinical work further emphasize the impact metaphors have at facilitating clients' connection with nature and the universe:
"[One metaphor] 1 have seen recently. . . was a brook that formed from the action of the sun . . . the sun evaporated something that then condensed and rained down and became a brook. .. And the brook went back and forth across the Atlantic Ocean . . . and healed up some stuff in Europe . . . Then we had the cosmic fabric that enfolded things, did its healing through enfolding, softly, gently".
In addition to the power of metaphors at bypassing resistance, crossing diverse type of boundaries, connecting with spirituality, nature and the universe, their strength at reaching the conscious and the unconscious at the same time was stressed by six therapists (T # l, 2, 3, 4, 5, & 7). The following quotations best represent this issue:
Therapist #4: "You can use [metaphors] to give people permission to change on an unconscious level. . . without them really [knowing] . . . they experience you talking to them at two levels but they are not exactly sure what. . . is going on".
Therapist #5: "It gets a person in touch with . . . conscious, unconscious and preconscious, that allows for a shift that you may not get in doing . . . normal talk therapy".
Therapist #7: "The metaphor is always something that taps. . . an unconscious level, it opens up some doors . . . and you gDet that unconscious material coming into that pre-conscious area . . . presenting itself to you." 171 The multisensorv Quality of metaphors was stressed by one therapist (T #5) as an important factor underlying the power of metaphors.
Therapist #5: "metaphors tend to be multisensory.. . they pull on people's auditory, visual, kinesthetic, olfactory [systems]... Since they pull for all the senses. . . you are able, with the metaphor . ..t o reach a person both at an unconscious level and also at the physiological level." The power of metaphors at facilitating raosort building was emphasized by five therapists (T#2, 3,4, 5, & 6). The following are the clearest and most salient of their statements:
Therapist #3: "If 1 do something different, [children] may be willing to at least consider relating to me. . . they'll even go as far as considering engaging with me"
Therapist #5: "For some clients . . . it's a nice way to build rapport".
Therapist #6: "It allows for a quick connection to potentially be made between the therapist and the clients".
Metaphors as a respectful intervention or method was emphasized by four therapists (T #1, 3, 5, & 8). They stressed this characteristic of metaphors as an important factor underlying their therapeutic power.
Therapist #1 : "[With metaphors] I don't need . . . to understand fully [clients'] reality but to be an agent of change with them. That indirect method then, tends to be much less intrusive".
Therapist #5: "[A metaphor] is not a terribly intrusive . . . intervention . . . it doesn't encroach upon people the way some other [interventions] do". 172 Therapist #8: "The whole work is about _ .. allowing information to materialize and emerge from the material that's within the client, and discovering what that information is about rather than having a preconceived idea about what it is about".
Case examples from therapist #1 ftirther support the position that metaphor work can be characterized as a respectful approach in clinical practice:
"I frequently will ask patients to go and see a particular movie . . . I think this could be useful for you in some way. And I keep it very open and . . . very vague . . . I don't want to focus it or constrict it out of what my understanding would be . . . Much of the time when they come back and . . . they tell me what they got out of the movie . . . it doesn't have [anything] to do with what I though they would get. And that to me is part of that process, ..is less important what my understanding . . . is, [than] what my patient will do with it".
Feedback Regarding the Effectiveness of Metaphors
Therapists' description of the processes by which they receive feedback regarding the effectiveness of metaphors can be classified in four major categories: (a) In session or immediate feedback; (b) Feedback across sessions; (c) Client change; and (d) Impact on the therapist While in session feedback makes reference to the verbal and non-verbal clues that clients provide to counselors during the therapy session, feedback across sessions relates to clients' disclosure of their use of metaphors between sessions or the use of a specific metaphor in another session. Client change refers to clients' growth throughout the treatment process, and impact on the therapist makes reference to the effect that metaphors have on the therapist. Examples of the different 173 processes of feedback are presented in the following paragraphs.
In session feedback.
Therapist 1 ; "In a nnoment to moment process within the session, it's that feedback whether it be with body language or whether it be w i^ non-verbal communication . . . or even their language coming back to me in a myriad of ways, that's the immediate feedback that helps to guide me and helps me to understand whether or not I'm connected".
Therapist #2: "As you tell the story their eyes may glaze, they may nod their head".
Feedback across sessions.
Therapist #4: "If you start playing with metaphors,. . . the client starts thinking in terms of metaphors and they bring in [their own] metaphors".
Client change.
Therapist #1 : 'The changes that I see patients making, the kind of things I hear them talk about, give me an idea that they've incorporated what we've discussed".
Therapist #2: "Her stories were darker and her imaging was less cohesive, and she started putting wizards in there and other characters that could help her through certain events so, her inner world was less frightening"
Impgct on the thergpist
Therapist #1: "I get totally connected with [clients],... that's part of my feedback".
Therapist #4: "Both parties change. Then, my guess is that the client's change could be measured by the level of change in the therapist". Categories of Metaphors
Therapists noted that they use diverse type of metaphors in 174 tiieir clinical practice. All eight therapists discussed using verbal metaphors (e.g., stories, tales, myths, fables, legends, poetry, analogiies, anecdotes, spontaneous metaphors) in treatm ent. The following thick description and examples from therapists’ clinical work illustrate their use of verbal metaphors.
Therapist #2: "I worked with one woman for years. . . all the work would be through writing, she would write stories".
Therapist #2: "Similes, probably certain analogies,... stories from our experience or we can make them u p ... fairy tales. . . children’s stories [are all metaphors that 1 use in practice]".
Therapist #3: "Sometimes kids have stories or I’ll give them the assignment to go . . . and bring back a story on tape or writing down, I will create a story pertinent to a mutual story-telling technique. Sometimes I will incorporate it into a game".
Therapist #4: "1 have people read poems from time to time . . . sometimes we write poetry. 1 give them poems to collect".
Therapist #6: "I have a [metaphor] called 'the family as a movie crew, and [we explore] who is the director of the movie, who is the sound technician, who is the producer".
Therapist #6: "1 don’t do this [metaphor] very much because 1 don't have very many people that use computers. . . we talk about saving and deleting family messages by hitting the delete button or hitting the save button".
Therapist #6: "The drawbridge [metaphor] is one that 1 use a lot with dependent women . . . who don't have well defined boundaries in terms of the men they let into their lives. And so we talk about a castle and a moat filled with alligators or piranhas or some unpleasant animal. And that people that come into their lives are .. . standing across the way on a hill.. . asking to come in ... and we talk about. . . the structure of gaining trust t o ... lower the drawbridge down to five people permission to walk into their 175 castle. And . . . the concept of the body, as a castie. . . being consciously aware of what it [means] to lower [the drawbridge and to . . . invite someone into their castle. . . and they can choose based on the behavior of the other.. . to escort them out of their castle . . . and lift the drawbridge back up".
Therapist #3: "I talk about use of medication especially for a condition that is not.. . likely ongoing, lifelong [condition]. . . being like training wheels on a bicycle".
Therapist #8: "Someone who has a dynamic operating . . . moving in and out of a relationship and [I ask] moving in and out like what? And it could be like a drawer.. . and we may. . . develop that metaphor as a symbol of this [dynamic]".
In addition to the variety of verbal metaphors used by
therapists in practice, six therapists (T #1, 3, 4, 6, 7 and 8) disclosed using non-verbal metaphors (e.g., arts, plays, movies, dreams, sandtray, games, flashbacks). The following quotations and case examples illustrate therapists' use of non-verbal metaphoric communication.
Therapist #3: "In checkers, if [clients] are playing . . . carefully not to lose any of their men, I may make a comment about how it seems like they are really worried.. . you can challenge them to play the game in a different way. . . how about we play that you have to jump this time".
Therapist #4: "I do a lot of art, so I have art materials, puppets, and I have play materials".
Therapist #4 (second interview): "We do a lot of drawing . . . I have art [materials] available . . . I ask people to do drawings, sometimes I do drawings and give them to them".
Therapist #7: "I often used dreams and things that stand out to people in their environments and having them explore . . . the 176 meaning of objects and events”.
Therapist #7: "I had people who were comfortable, not necessarily artistic. . . draw or paint their dreams".
Therapist #7: "I would invite [clients] . . . to select a piece of music o r... finger paint. . . or body paint or whatever they felt they needed to do to participate with the paint, and my only instruction was to draw or produce nothing".
Therapist #1 : "[Working with] a person who was very artistic. . . 1 asked her... to sculpt something that represented her struggles and her pain and she did and we had a whole ritual set up where she . . . left that creation in a particular place . . . it v;as a very freeing experience for her".
Therapist #4: "1 worked with a guy who's a Vietnam veteran . . . and he started having flashbacks after. .. his kid's 13th birthday . . . the metaphor we were using . . . was that your flashbacks are not a symptom of illness... but. . . your beginning attempt to rem em ber. . -. and it ended up that . . . [he] remembered . . . killing a young kid who has about the same age as his son . . . eventually... he and his wife ended up adopting a couple of Cambodian kids". Therapist #6: " I do an experiential thing with balloons and . . . have families keep the balloons in the air, and then see what happens when there are too many balloons and you can't bat them anymore, so you start to feel anxious".
Therapist #7: "[While working with a client with] panic attacks, the fear brought her flashbacks, so we used flashbacks and symbolic work to see what meaning they had for her and what they have come to teach her".
in addition to the use of metaphors classifiable under the general categories of verbal and non-verbal metaphors, therapists discussed more specific types of metaphoric devices. Therapist
#2, for instance, distinguished between metaphors that are universal and the metaphors that are unique to the client.
Therapists #3, 6, 7, and 8 distinguished between the metaphors 177 that are created by the client and the ones that are fostered by the therapist. Therapist #3 differentiated metaphors based on their level of explicitness, i.e., whether non-verbal productions are turned into words or not and whether connections between the metaphor and real events in clients' lives are directly stated or not. Therapist #4 distinguished between "root metaphors" and
"surface metaphors" in the second interview: "Root metaphors... are metaphors that are . . . rooted in existence. . . almost like a
Jungian archetype."
Therapist #6 distinguished between "spontaneous metaphors" and "activities grounded in metaphors":
Therapist #6: "Sometimes activities evolve from the metaphor. They are not just an image, a vision, a universal concept, a connector. Things evolve from that.. . [An example is] in the case [in which] we talked about family scars and family stars, it evolved into a lifeline . . . where there were scars that happened. We did a couple of the lifelines. One lifeline was the physical scars, when they had surgery o r... had stitches and the other... where we talked about the family wounds".
Therapist #8 distinguished between "interactive metaphor work" and "meditative metaphor work". In interactive metaphor work, the therapist asks specific questions to help the client develop the metaphor and transform his or her perception of the event by the transformation of the metaphor. In meditative metaphor work, the therapists develops meditations in metaphor style. 178 A final category of metaphors that therapists discussed is fiie metaphoric quality of the office decor. While four therapists (T# 3, 4, 5 and 6) disclosed having specific symbols in their office to metaphorically communicate with clients, one therapist (T #2) expressed not having any particular symbol in his office to intentionally use as a metaphor. He, however, explained that he could use any object metaphorically. The following thick description reflects therapists' statements regarding their office decor.
Therapist #2: "I don't.... use any element in my office as a metaphor but I think you can use anything . . . I mean I've got a tennis ball. . . th a t can be used as a way of looking into your life and coming up with an image. .. the clock over here could be [used] to do age progression and regression . . . but I don't have a particular item in here that I have in here so that it's a particular metaphor for anybody".
Therapist #3; "I have toys out... it sends the message that you can use [them]. . . I [have] this colorful poster [with] two penguins and one it's large and [one is] small, so ... messages of family... and [this] one . . . it's from a comic magazine . . . [with this] actor [who] died o f AIDS . . . adolescents. .. need the message that there are things in life you need to think about".
Therapist #4: "I put up certificates . . . things that make me look as though I'm competent. . . I have a lots of Victor Frankl's book "Man in Search for Meaning", I give those out. .. because it helps people understand that even when crap is really awful, it's possible to change . . . I have pictures of my family up... I want people to see . . . th at I have a family... that I have ancestors... because I want them to talk a lot about family... I have some . . . powerful pieces of art in my office . . . I have some statues. . . I have a lot of poetry books". 179 Therapist #6: "What I strive to do is have the office reflect who I am. And that's evolving . . . I have more plants . . . I have rocks from the land th a t mean something to me that hold certain kinds of energy. I have pictures on the wall that mean something to me".
CoDssquencgs In terms of the consequences of metaphoric communication in counseling, therapists discussed advantages in relation to the therapy process, as well as positive consequences in terms of treatment outcome. Consequences of metaphoric communication were, discussed in terms of advantages for the client and in terms of the impact of metaphoric work on the therapist.
Consequences for the Client
Therapists presented a series of advantages that metaphors bring to the counseling process. Several of this advantages, i.e., facilitate rapport building, bypass resistance, connect with the conscious and unconscious at the same time, were discussed previously in the section regarding the rationale for the effectiveness of metaphors. They will be briefly presented here emphasizing their role in the treatment process perse. Five therapists (T#2, 3, 4, 5, & 6) discussed the impact metaphors have at facilitating rapport and level of connectedness.
Therapist #4: "[Metaphors are] more holistic because you are able to connect with different parts of the person . . . [the metaphor] touches different levels s o ... it helps you connect at a deeper level". 180 Therapist #6: ‘Through metaphors, the essence of two people merge in session".
Therapist #6: "[Clients] can relate to ... stories. [A story] can touch a deeper part of who they are. . . they may not even know is being touched. In addition, six therapists (T#1,2, 3, 4, 5, & 6) stated that metaphors bvoass resistance and facilitate clients' perception of the treatment process as less threatening.
Therapist #2: "When you tell stories, people are less defensive; they're more open; they're more interested".
Therapist #2: "If you want to reach the person at their inner core level a lot of that may tend to be at the unconscious level and you're bypassing conscious resistance and when you're using metaphors, that's a real easy way to do that".
Therapist #3: "Generally, using metaphors . . . will allow you to work through some of the resistance. . . by deal[ing] with [the] material in a new way".
Therapist #4: "Metaphors [offer a way] of respecting resistance [rather that]... fighting with resistance . . . With the use of metaphors [you can] get around resistance or talk through it".
Therapist #6: "[Clients] can relate to . . . a story.. . it doesn't scare them, it doesn't threaten them so, they are not very resistive, not resistive at all".
Therapist #6: "[metaphors offer a way to] pass defenses and walls, a way to go in the back door rather than passing through the wall"
Associated with decrease in resistance is the characterization of metaphoric communication as an indirect wav to deal with the presenting concern. All therapists discussed this advantage of metaphors. Two of them (T#l and 4) explained it explicitly while 181 the other therapists pointed out this advantage of metaphors through examples of their work with clients.
Therapist #1 : "If we can talk about a hobby or if we can talk about something that is fun or enjoyable or an area of interest, . . . then we can use the language that goes along with that to deal metaphorically with the problem without ever talking about it directly".
Therapist #4: "A metaphor can be used to talk about [spiritual issues or values]... through [the client's] language". The following are some case examples that reflect the role of metaphors at facilitating indirect communication.
Therapist #2: "If a person needs to be able to deal with change maybe I’ll talk about playing tennis in the wind and how you need to . . . accommodate to that".
Therapist #5: "I have been working with [a client] on social skills . . . and he has talked about basketball... so I begun talking about dating and social relationships [by suggesting] to him that... some people learn to become good preliminary shooters but it takes experience and practice".
Therapist #6; "I [use a metaphor] called the refrigerator search . . . you go to the refrigerator and you open the door and you are looking for something . . . but you are not sure what it is. So,I relate that to . . . the search for happiness or the search for... the soul being peaceful".
Therapist #6: "A lot of people have dogs so,. .. I [use] a flea on the dog metaphor. .. and what one flee can do in a home . . . and it can evolve into many flees . . . you can keep scratching one flee . . . [but] the dog can be allergic to flee bites, so there is an infection, it’s inflamed . . . and all kind of things happen".
Therapist #8: "One woman that I worked with last week [used the metaphor of] a banquet. .. and she developed what she needed in a banquet. And then we took that banquet to her mother who had her 182 own wounding and it was a different kind of banquet for that mother. And then we took it to a grandmother. .. and that banquet was a different thing to every person . . . but it was healing for whatever the particular pain was”.
Related to the advantage of metaphors at facilitating indirect communication is the impact metaphors have at addressing the conscious and unconscious mind at the same time. Six therapists (T # l, 2, 3, 4, 5, & 7) discussed this advantage of metaphors in the treatment process. The following are some illustrative examples of their position:
Therapist #2: "I tend to include stories [when] talking with [clients] so I'm working with both the conscious and the unconscious".
Therapist #4: "I see a metaphor as . . . a two pronged communication . . . with one prong into what people know which is then used to help them reflect on stuff they don’t know. Sometimes I think of it in terms of a way to talk to the conscious and the unconscious at the sarrie time". A final advantage that metaphors offer in terms of the process of therapy is their role at compressing the therapeutic process.
Three therapists (T #6, 7, and 8) discussed this advantage of metaphors. The following are the most salient transcripts reflecting this advantage of symbolic communication.
Therapist #6: "I said in a talk... that one good metaphor was worth three hours of discussion, three days of therapy, three weeks of therapy".
Therapist #7: "Six months of symbolic work can . . . compress the work th at might have had to be done in ... two or three years". 183 In addition to the benefits that metaphors bring for clients in relation to the therapy process, therapists discussed the advantages of the use of metaphors in treatment outcome. Six therapists (T#1, 2, 3, 4, 5, & 8) discussed the role metaphors play at expanding clients' models of the world.
Therapist #1 : "[The reason] people come into our offices. . . has to do with some necessary constriction of their world . . . They feel that they have exhausted possibilities. . . so, they feel stuck... [metaphors] begin to expand that process. .. they are helpful to get them moving again".
Therapist #2: "[metaphors serve] as good illustrations that can . . . provide [clients] with openness to possibilities. . . they help them expand their model of the world".
Therapist #3: "Very often [clients'] problem is that they had gotten stuck. . . in realities that limit their abilities to consider new possibilities. 1 need to help them learn how to stretch their thinking . . . [metaphors] stretch people's thinking".
Therapist #5: "[A metaphor] encourages a paradigm shift. . . it enlarges [clients'] schema of how to view life."
Related to the impact metaphors have at expanding clients' model of the world is their role at facilitating insight and discovery of meaning. Four therapists (T #2, 3, 5 and 7) noted that metaphors help clients Increase insioht and four (T#2, 4, 7, and 8) stressed that metaphoric communication facilitates discovery of meaning. The following are the most salient quotations:
Therapist #5: "[Metaphors] can be used as a way to help [clients] .. . know themselves better. . . to develop more insight". 184 Therapist #7: T h e major advantage [of-metaphors] is that it is an avenue that helps [clients]. . . know themselves better and become that functioning person they can be".
Therapist #4: "[Metaphors help clients] get in touch with meaning and meaning potential. .. they will be able to do their primary and secondary reflection"
Therapist #7: "Symbols can teach [clients]. . . [Symbols] are the key to finding meaning in our own lives"
Four therapists (T#2, 4, 7, 8) discussed the liberating and
empowering effect metaphors have on clients. The following thick description reflects the therapists' presentation of this benefit of metaphoric work.
Therapist #4: "[Through the use of metaphors, clients] often feel a greater sense of freedom... they feel cleansed".
Therapist #8: 'The. . . process of empowerment is rooted in the resolution of [the client's] own wounding o r the resolution of the pathology of the generations [through metaphor work]. . . So that [clients] have the power to make choices that. .. [are in their] best interest".
In addition to the impact metaphors have in expanding clients' models of the world, facilitating discovery of meaning in their lives, and empowering them, all therapists discussed the role of metaphors at facilitating clients' healing, personal growth and change. The following are the most salient examples of therapists' description of the process of change associated with metaphor work.
Therapists #1 : "Whether the metaphor is ... understood or not... may n o t... be the issue. I'm not sure that understanding is a prerequisite for change from the standpoint of how metaphors . . . 185 work. . . It’s much more unconscious. .^ so that understanding in a conscious way is not necessary... But th a t leads to change and movement".
Therapist #4: "You can use metaphors to help people move from one stage to the next in the life cycle... Metaphors are often teaching tales to help people move from one stage to the next".
Therapist #4: "[When working with clients with] narcissistic personalities. . . [you want them] to begin to imagine existence of others. . . expand their awareness... and metaphors do that".
Therapist #4: "Some clients are too tight so the job is to metaphorically help them to [loosen up]... some clients are just so loose and chaotic th at you're playing with metaphors in terms of helping them with tightening up."
Therapist #6: 'There is sometimes magic with [metaphors], it feels very magical that [clients] are able to relate to [stories] and understand and move."
Therapist #8: "Wounds of the past have to be healed in the past . , . that's why the metaphor work is so effective . . . it is interacting with that wounded child within".
Therapist #8: 'The new piece of that metaphor work. . . is extremely exciting . . . because [it will help clients heal not only from their own] baggage [but also from] the baggage that belongs to previous generations... I've worked with one man whose father survived three different Nazi death camps. . . and all of his father's experience of the Holocaust is in him . . . He's carrying his father's woundedness".
The following examples of therapists’ clinical work illustrate the role metaphors play in the process of change.
Therapist #2: "I worked with a catcher in baseball who wanted to work on his throwing and he came up with the metaphor of throwing being like a whip. And that conjured an image that made his throwing more accurate and having more snap to it because he 186 could picture that".
Therapist #7: " I worked with [a man] who began working with his dreams. He was at first very unwilling to work with dreams and then. . . [he] started working with them. He was a particularly rigid . . . Individual. . . He started recording [his dreams] and he typed them into a computer and made copies of them, all very well prescribed . But 1 began having him relate to the objects and people in his dreams and h e ... began to take some risks . . . and opened up . . . He began to soften . . . His life became much better as he worked with his dreams and gave up a Jot of that rigidity.. . he did much better in his profession,. . . he wrote a book. . . It freed him up in lots of ways".
Therapist #8: "His whole affect is different... because . . . metaphorically, when he was a child, he had closed himself into a prison cell so th a t he was protected and so that he couldn’t be hurt, but that same prison cell that protected him also kept him from being present in the world at a feeling level so the only thing he could do was to relate out of his head . . . and he is like a great new person . . . he is having a wonderful time forming relationships . . . He is affirming peoples and he was always terribly distant. . . he invites people in".
Finally, five therapists (T#3, 5, 6, 7, & 8) discussed the Iona term impact of metaphoric work on their clients.
Therapist #5: "For people to be able to take in the metaphor... entails a certain openness to life and life experience so, it opens people up in a way that once they have a taste of that. . . it makes them more aware of their experience and... once a person starts on that path, they will continue".
Therapist #7: "When you use symbols. . . they usually work with a person for a long time".
Therapist #7: "[With symbolic work] there is often greater qualitative change that [clients]... incorporate into their lives . . . they seem to be able to change their lives for the better for a longer period of time". 187 Therapist #7; "More behavioral changes come from symbolic work that is sustaining than from behavioral work".
Therapist #8: "A lot of techniques that i've seen work on a temporary basis, but if the client continues to carry around the baggage or the wounds from previous generations or of their own history, the defenses that were developed to cope with those wounds and to continue carrying on in life that were necessary, are going to continue to operate. .. [Through metaphor work] the reasons for the defenses are resolved, altered, changed . . . then the particular defense no longer needs to be".
Consequences for the Therapist Regarding the impact that metaphoric work has on mental health professionals, therapists discussed consequences in terms of the treatment process and in terms of their own personal growth. Regarding the process of therapy, all therapists talked about professional satisfaction either through a deeper connection they feel with clients and/or a sense of excitement associated with this type of work. The following transcripts best reflect therapists' description of this process:
Therapist #1 : "Until then I thought about leaving this field . . . it was pretty boring, it was difficult. . . too hard work to stay in it Well I haven't had that feeling much since 1981 . . . the fact is that it is more fun".
Therapist #1 : "The kind of excitement that came for me was seeing how people responded to it, that probably more than anything really created a positive snowball. . . to where it just kept getting better, building and building in a positive way".
Therapist #1 : [as we get involved in metaphor work] "I get lost, I get totally connected with [clients]. . . I know I'm connected when I'm not aware of anything else . . . I'm totally altered because I am right there with them . . . I leave or walk out the door, and it is almost like coming out of a movie". 188
Therapist #2: "I’m tuned in with the client. . . I'm probably into a trance. . . that would help me be probably more creative with the story, more tuned in and freer".
Therapist #4: [the metaphor process] "connects with both people but if it doesn't connect for both it's probably not very powerful".
Therapist #5: "I really love to use metaphor, I like to play around with words that clients use, because to me it makes the whole process. . . more interesting. . . so using metaphor, stories, things that engage you, I think, really can help the process become more enjoyable and interesting for the clinician and can't help but have a positive effect on the interaction kind of experience . . . I think otherwise therapy has a potential of getting rather banal".
Therapist # 6: "It's a fascinating process for me. I really, really enjoy observing it".
Therapist #8: "Metaphor work is the vehicle through which I most effectively can function as a catalyst. And the whole thing for me is a sacred task. . . It's a fulfillment of my life process . . . I've never found. . . any tools or techniques that allow me to have as clear a sense of that healing process as metaphor work does".
Regarding outcome, three therapists (T#4, 6, & 7) expressed that metaphoric communications oftentimes resulted in their personal growth.
Therapist #4: "The metaphors that you tend to discover, tend to be metaphors that are also relevant for yourself. The client is there not to help the counselor, but the fact of it is that [when] you do good work with the client, you actually often do get help; that's a side effect, that's not what is supposed to be . . . but it happens".
Therapist #4: "I think is expansive to me. . . metaphorical work is metaphorical for both parts and it's helpful to both parties. I get touched". 189
Therapist #6: "[metaphor work] has been really freeing for me".
Therapist #6: " I think th at the healing th at goes on in a therapeutic session always involves the healing of the therapist, always!".
Therapist #7: "I do not think thait you can be in an experience of that sort and not have an impact too, so I would find new meaning in listening to other people's interpretations of their own experience and finding their meanings, and finding meanings in myself, in my own life, in my own experiences".
It is reasonable to infer the presence of relationships among the diverse type of metaphoric consequences: consequences for the client and for the therapist in terms of both process and outcome.
These assumed relationships are delineated in Figure 1 by the fine line arrows " f , "g", "h", "i", "j", and "k". It is possible to assume for instance, that the effect metaphors have on the therapist in terms of process, i.e., feeling a deep connection with the client, enjoying the therapeutic process, will have an impact on the process for the client and vice versa (This reciprocal relationship is denoted by the double arrow "f" in Figure 1 ). In fact, a quote from therapist #5 supports the presence of this type of relationship.
Therapist #5: "Using metaphor, stories, things that engage you can help the process become more enjoyable and interesting for the clinician and can't help but have a positive effect on the interaction".
Similarly, outcome consequences for the client may impact the outcome for the therapist (denoted by arrow "g" on Figure 1). One 190 of therapist #7's statements supports this connection: "I find new meanings [in myself] in listening to other people interpretations of their own experience.”
The therapeutic process for clients will probably impact their therapeutic outcome, and the outcome may in turn impact clients' perception of the therapy process (This mutual relationship is denoted by the double arrow ”h" in Figure 1 ). A similar relationship
between process and outcome may be present for the therapist (denoted by the arrow "i" in Figure 1 ). Finally, a client's process in therapy may impact the outcome for the therapist, and the therapist’s process may impact the outcome for the client The therapeutic outcome for clients may, in turn, impact how therapists perceive the therapeutic process, and the outcome for therapists may impact the process of therapy for clients. (These relationships are denoted by the double arrows "j" and "k" in Figure 1 ).
Concluding Remarks
The results described in this section addressed the main focus of the research: Therapists' experience of metaphoric communication in clinical practice. The uniqueness, as well as the commonalties, of therapists' experience with metaphors have been described in this chapter. Results from phenomenological and grounded theory analyses have addressed the main questions presented in the open-ended interviews. In the interest of relevance, readability, and clarity, information not directly germane to the purpose of the study (e.g., therapists' philosophy of 191 psychological training, frustration with the politics of therapy) has been omitted. . As Patton (1990) stressed, "even a comprehensive report will have to omit a great deal of information . . . [Researchers] who try to include everything risk losing their readers in the sheer volume of the presentation" (p.429). CHAPTER V DISCUSSION
Therapists' metaphoric communication in counseling has been described based on their unique and common experiences. In this chapter, the essential characteristics of these experiences will be discussed in relation to the existing literature and their contribution to the field of counseling psychology. Implications for training and clinical practice, as well as directions for future research will be addressed. Limitations of the study will also be discussed.
The literature on therapeutic metaphors is based on theoretical description and anecdotal data from clinical cases. The present research complements previous work on metaphor by providing an in-depth and systematic exploration of the experience of metaphor work from the clinicians' perspective. This study is the first to systematically examine how mental health practitioners understand and experience metaphoric communication in therapy.
As such, it adds an empirically derived description of therapists' developmental process of metaphor work and an exploration of their philosophical understanding of metaphoric communication.
192 193 The present study complements previous writing through the description of therapist based variables that impact the effective use and delivery of metaphors. Therapists' Developmental Process of Metaphoric Communication.
The therapists interviewed stressed the role of personal (e.g., family/cultural/religious background, personal growth experiences) and professional influences (e.g., specialized training, mentors, personal growth through supervision) on the developmental process of metaphoric communication in therapy.
As such, they described a complex set of variables that influenced their ability to communicate metaphorically. The theoretical and anecdotal literature on the therapeutic use of metaphors does not address the complexity of this developmental process. Underlying this omission seems to be the assumption that therapists can learn to use metaphors therapeutically if they can follow certain guidelines regarding the construction of effective metaphors (e.g.,
Gordon, 1978; Kostere & Malatesta, 1985) or if they can extrapolate and apply the diverse metaphoric devices that have been reported in anecdotal case studies. Gordon (1978), for instance, stated that "constructing and utilizing therapeutic metaphors is learned the same way one learns... math" (p. 158). None of the therapists interviewed reported that they developed metaphoric communication in this manner. Four therapists (50% of the sample) for instance, emphasized the role of family/ethnic/ cultural and religious background on their use of metaphors, and three therapists (37.5% of the sample) stressed the need for 194 personal exploration to effectively work.with metaphors. Professional practice with specific populations, increased professional experience, and specialized training were also identified as important factors by three, four, and five therapists, respectively (comprising 37.5%, 50%, and 62.5% of the sample).
These findings have important implications for counseling practice and training of therapists. It is clear that therapists
interested in engaging in metaphoric communication with clients need more than examples and simple guidelines on how to construct and deliver metaphors. Depending on their orientation and philosophical understanding of metaphors, therapists may see the need to engage in the following: (a) intensive specialized
training; (b) practicum or volunteer experiences where they can
learn metaphoric communication from mentors, supervisors and/or
clients; (c) experiences that promote self-awareness and understanding of personal metaphors (e.g., clinical supervision and/or personal therapy); (d) in-depth exploration of their background, personal attributes and spirituality to allow their spontaneous metaphors/associations to unfold; and (e) theoretical courses, workshops, and conferences addressing the theoretical orientations that focus on metaphor.
Theoretical Orientation and Metaphor Work. The therapists interviewed followed diverse theoretical orientations, including Ericksonian, NLP, Existential,
Transpersonal, Psychodynamic, Jungian, Behavioral and Eclectic therapy which is consistent with the literature regarding 195 metaphors being used across theoretical orientations (Bateson, 1973; Bryant, Katz, Becvar & Becvar, 1988; Hallock, 1989; Jung,
1964; Keith, 1982; Trad, 1993; Zeig, 1980). The literature focuses on Ericksonian, Experiential, Jungian, and Reality therapy approaches. The manner in which therapists #1 and #2 use metaphoric communication is influenced by the tenants of the Ericksonian approach. Their use of stories and anecdotes is consistent with Erickson's belief in the advantage of reaching the unconscious without interference from the conscious mind (Zeig, 1980). Therapist #5 considers himself a follower of a psychodynamic-eclectic therapeutic approach; several of his statements (e.g., need to facilitate client's movement from the present state to the desired state) and the emphasis he placed on clients' representational systems indicates the influence of an NLP orientation. Therapist #3 defines his orientation as behavioral- eclectic. He emphasized the value of the behavioral aspect of his orientation during the assessment process and described the eclectic aspect of his approach in terms of his willingness to try "whatever works" including symbolic communication. The manner in which therapist #7's describes symbols, archetypes, and dreams as communicators of meaning reflects her Jungian orientation.
Myths, stories, and dreams provide meaning to the experience of the external world and raise to conscious awareness the archetypes submerged in the unconscious mind (Estes, 1992).
Therapist #6's, focuses on the role of metaphor at touching the inner soul and the spiritual potential of people, reflecting a 196 transpersonal orientation. "A chief objective of transpersonal theory is to integrate spiritual experience within a larger understanding of the human psyche" (Capra, 1984, p. 145). The use
of symbolic processes among transpersonal psychologists facilitates clients' connection to their soul and promotes increased self-knowledge through altered states of consciousness (Beal, 1993). Therapist #4 described himself as following an existential approach. The attitude of care from an existential perspective, calls for creativity and openness to reality (Van
Kaam, 1966, p. 54). Existential psychotherapy is not a technical approach; its emphasis is on the quality of the therapeutic relationship and the uniqueness of the client (Yalom, 1980).
Metaphoric communication is not perceived as a technique but as a development within the context of a loving relationship. Symbolic language facilitates exploration of life values, meaning, and direction. For therapist #4, metaphors play a role in facilitating understanding of meaning and meaning potentials.
Philosophical Understanding of Metaphors. In addition to the variety of theoretical orientations represented in the sample, diverse philosophical worldviews regarding metaphors were revealed by the therapists. The researcher, reflecting on theoretical notes, identified three categories that encompass this diversity: "Metaphors as Techniques", "Metaphors as Technique-Tool-Being" and "Metaphors as Being". Except for some theoretical writing (e.g., Jungian, transpersonal approaches) and Wallas' (1985) work, the literature 197 on therapeutic metaphors appears to ignore the "Being," i.e., the role that the therapist's essence and his or her unique set of
values, beliefs, experiences, and feelings have on the therapeutic
process. As noted, the literature seems to treat metaphors as techniques that can be learned by following a series of guidelines (e.g., Gordon, 1978; Kostere & Malatesta, 1985). Little is said about therapist-based variables, as if the therapist's essence, background, personality, and attributes were not essential
features for the effective use of metaphors. In contrast with the limited attention that the metaphor
literature has assigned to therapist-based variables, the supervision literature has emphasized the need to address the personal aspect of therapists (Bernard, 1979). Loganbill, Hardy and Delworth (1982), for instance, stressed that the development of a therapist requires more that an incremental learning of counseling skills. Bernard (1979) agreed: "Because counseling is both personal and personalized, it is difficult to become a more efficient and skilled counselor without also experiencing greater personal growth" (p. 63). The importance of therapists' personal growth was particularly stressed by the therapists who understand metaphors as a way of Being (primarily therapists # 4 and 6 ). For them, metaphors are not something that technically can be learned and applied. Metaphors are a way of life.
Effective Metaphors: Moderating Variables
The information revealed in this study is consistent with much of the theoretical and anecdotal literature concerning the 198 need for metaphors to match (a) the clients' model of the world
(stressed by three therapists, 37.5% of the sample); (b) their dominant representational system (stressed by three therapists); and (c) their background and interests (stressed by six therapists, 75% of the sample) (Gordon, 1978; Hallock, 1989; Kostere &
Malatesta, 1985; Wallas, 1985). These moderating variables were described in the study as "metaphor-based conditions". The majority of writing that stressed these moderating variables come from Ericksonian and NLP approaches. Consistently, all therapists interviewed who reported following an Ericksonian or NLP approach emphasized the need for metaphors to match client's sensory mode, representational system, and interests. An attempt to facilitate rapport building underlies the emphasis Ericksonian approaches place on pacing and matching clients:
"When therapists engage in Ericksonian-style utilization, they commit themselves to a process of continually adjusting the relationship in a positive w ay. . . since the act of [pacing] is so closely linked with positively valuing people's uniqueness, clients tend to experience it as respectful and supportive, which is certainly helpful in developing a therapeutic relationship" (Combs & Freedman, 1990, p. 47).
Within the Ericksonian tradition. Wallas (1 9 8 5 ) has overtly stressed the quality of the therapeutic relationship as an essential ingredient for the effective use of metaphoric communication. In her words, "rapport. . . is the magic 'open sesame' for the effective use of metaphor" (p. 16). Whitaker (1982) also emphasized the role of the therapeutic relationship. Within his approach, there is more 199 of a focus on the curative factors embedded in the therapeutic relationship and the therapeutic process than on the specific methods or techniques used to facilitate change. The characteristics of the therapeutic relationship (e.g., rapport, trust,
and safely) that impact the effective utilization of metaphors
were described in the present study as "relationship-based conditions"; four therapists (50% of the sample) stressed the need for a solid therapeutic relationship. The counseling literature has emphasized relationship-based conditions as variables that moderate the effectiveness of counseling interventions (e.g., Hill, 1 9 9 2 ). As is the case for other clinical interventions and
counseling skills, the context of a positive and supportive relationship seems to moderate the effectiveness of metaphors. In addition to the "metaphor-and relationship-based conditions", the study revealed a series of "counselor-based conditions" (e.g., therapist openness, awareness of own personal journey, knowledge of own metaphors, etc.) that enhance the use of metaphors. The limited attention to these conditions in the metaphor literature reflects a possible bias towards a skill acquisition (i.e., metaphor-centered) paradigm at the expense of a person-centered orientation. Some exceptions include Wallas' (1985) writing, the literature underlying a Jungian approach (Jung, 1964; Trad, 1993), and the work of symbolic-experiential therapists such as Carl Whitaker. Wallas (1985) argued that the effectiveness of metaphoric communication depends on the therapists' willingness to open themselves to their own 2 0 0 unconscious processes. Whitaker (1982), emphasized the need for therapists to discover and develop their own therapeutic slyies to match their worid view and personality. Implicit in Whitaker's approach is a celebration of the uniqueness of the therapist, and an emphasis on the need for therapists' self-exploration and self- knowledge. Within the Jungian approach, Von Franz (1964)
emphasized that therapists should begin by working on themselves if they are to help others uncover the unconscious processes manifested in myths and symbols. The counseling and supervision literature also stresses the role of counselor-based variables on the quality and effectiveness of therapeutic interventions. The need for therapists' personal analysis described in the psychoanalytic supervision literature
(Moldawsky, 1980), along with the need for therapists' self exploration stressed in client-centered approaches to supervision, reflect that therapist-variables are as important as skill- variables for effective therapy to take place.
Applicabilitv of Metaphors.
Results were particularly consistent with the literature on the applicability of metaphoric communication. The literature (Gladding, 1986; Gordon, 1978; Hendrix, 1992; Kostere &
Malatesta, 1985; Rule, 1984) stresses the applicability of metaphors at different stages of the therapy process, across treatment modalities (individual, group, family), and with diverse type of clients (e.g., children, adolescents, adults, hospitalized clients, clients in outpatient treatment, clients dealing with 2 0 1 diverse presenting concerns). Consistent with the literature
(Gladding, 1986; Gordon, 1978; Hendrix, 1992; Kostere &
Malatesta, 1985; Rule, 1984), six therapists (75% of the sample) stressed the applicability of metaphors across the treatment process. The literature stressed the role of metaphors in the beginning stages of therapy, in particular in prevention of client drop-out (Hendrix, 1992), problem clarification (Gordon, 1978), and identification of treatment goals (Gordon, 1978; Kostere & Malatesta, 1985). Given the ability metaphors have to enhance rapport and to communicate therapist' empathie understanding, metaphoric communication was described by six therapists (75% of the sample) as a particularly valuable process at early stages of therapy. Similarly, given the power of metaphors to bypass resistance, challenge constriction, increase insight, and offer options and solutions, metaphoric communication was characterized by all therapists as a useful resource for the intervention stage of therapy. Finally, given that metaphors facilitate exploration of abstract and spiritual issues, they were described by two therapists (25% of the sample) as particularly useful devices during termination.
Consistent with the literature focusing on the applicability of metaphors across clients (e.g.. Bowman & Halfacre, 1994; Gavazzi
& Blumenkratz, 1993; Gladding, 1979; Hallock, 1989; Lemer, 1978;
Lewis, 1992; Ryce-Menuhim, 1992) and across treatment modalities (e.g., Adams & Chadbourne, 1982; Briggs, 1992; Crawford, 1990; Gladding, 1984; Mazza & Price, 1985; McClure, 2 0 2 1989; Rule, 1983; Trotzer, 1977), therapists in the sample
emphasized the role of metaphor work with children, adolescents (primarily therapist #3) and adults as well as with couples, families (primarily therapists #4 and #6) and individual clients. Attention to observational, methodological, and theoretical notes permitted the researcher to interactively cycle back and forth between data collection and data analysis. The researcher's decision to include a child specialist and a lamily therapist probably influenced therapists' discussion of the applicability of metaphors with these populations. Given that group work is not a primary treatment modality for any of the therapists interviewed, it is understandable that they did not address the applicability of metaphor work with groups. Similarly, given that the therapists work primarily in outpatient settings, they did not address the use of metaphors with hospitalized clients. The role of metaphors in groups and in the treatment of psychiatric clients remains an empirical question. Future research should strive to include therapists who work regularly with groups, as well as therapists involved in treatment of psychiatric patients. Therapists addressed the applicability of metaphors with clients of diverse ethnic/racial background primarily from a philosophical and theoretical perspective. During the open-ended interview, a specific question was asked to explore the use of metaphors with culturally diverse clients (including ethnic background, religion, sexual orientation). Therapists addressed this question by focusing on the use of metaphors in specific 203 cultures, but little was reported about tbeir own work with ethnically diverse clients. One exception was therapist #4 who specifically discussed the use of Appalachian tales with
Appalachian families. Given that four therapists (50% of the sample) described their ethnic background as a significant influencing variable on the development of metaphoric communication, and based on the literature regarding the use of
symbols across cultures (e.g., Campbell, 1988; Highlen & Sudarsky- Gleiser, 1994; Hiscox, 1995; Jung, 1964; Lantz & Harper, 1 9 9 2 ), it is possible to assume that ethnically diverse clients would be particularly responsive to the use of metaphoric communication. The assumption that culturally diverse clients would respond to metaphor work was bracketed by the researcher before her involvement in data collection. It was the researcher's belief that therapists would be particularly prone to use metaphors with ethnically diverse clients and that they would be inclined to use cultural stories (e.g., Native-American tales) in their work with clients of diverse cultural backgrounds. Therapists' minimal discussion of metaphoric work with ethnically diverse clients may reflect limited work with this population (particularly true for therapists #3, 6, 7, and 8), a low level of multicultural awareness and sensitivity, and/or an inclination toward a broad definition of muticulturalism which considers that "all counseling is multicultural in nature" (Speight, Myers, Cox& Highlen, 1991, p.
31). Therapists' reference to multiple levels of diversity, such as socio-economic status (therapist #6), position in one's family of 204 origin (therapist #1 ), educational level (therapist # 6), interests (therapists #1, 2, 4, 5, 6) or developmental level (therapist #3), seem to imply a broad definition of multiculturalism. Under this view of multiculturalism is the notion that multicultural counseling is embedded in any counseling relationship. Optimal theory proposes a redefinition of multiculturalism that moves away from a fragmented perception of individuals and breaks through the barriers of artificial and superficial differences among people (Speight et al., 1991 ). Metaphors were considered vehicles th at bypass artificial barriers between individuals (stressed particularly by therapist #6). Statements such as "We may be different people . . . yet [metaphors] bring forth the similarity rather than emphasize the differences" (therapist #6), and "Metaphors go back to some element of nature. . . and at some level we are all connected to that very basic process" (therapist #8) illustrate the power metaphors have at facilitating integration among people and connection between people and the universe.
Joseph Campbell (1988) talked about the universality of myth and its role in abolishing artificial divisions among people and between people and the environment:
The only myth that is going to be worth thinking about in the immediate future is one that is talking about the planet, not the city, not these people, but the planet, and everybody in it . . . the society that it's got to talk about is the society of the planet. . . not my nationality, not my religious community, not my linguistic community. . . and this would be the philosophy of the planet, not for this group, that group or the other group. . . When you see the earth from the 205 moon, you don't see any divisions.there of nations or states. This might be the symbol. . . for the new mythology to come (p. 32).
In the study, therapists' statements addressing the archetypal quality of stories and symbols (therapist #4) and those stressing the connection between myth and people's essence (therapist #6) further addressed the universal applicability of metaphors. Therapist #4 stressed an inclination to find universal metaphors within the deep structure of cultural stories. In his words, "the metaphors that you can [find] through a book of African stories. . . are about the same as Hans Christian Anderson, in terms of their deeper structure". Similarly, therapist #6 emphasized the presence of universal concepts within cultural, religious and children stories.
She stressed that these universal concepts connect with people's essence and that their impact is experienced universally across cultures. Therapist #5 reported special interest in Native-American stories. He reported reading Native-American stories to clients independently of their cultural background. His belief is that
"metaphors work universally because there is a shared experience that people have". The focus of therapists #4, 5, and 6 on universal metaphors indicate a belief in the Jungian concepts of archetypes and collective unconscious (Jung, 1964). Fordham (1966) described the presence of archetypes and the collective unconscious in metaphors and symbols, particularly in myths and collective dreams.
Because myths are a direct expression of the collective unconscious, they are found in similar forms among all peoples. . . and when [people lose] the 206 capacity for myth-making [they lose] touch with the creative forces of [their] being. The most direct expression of the collective unconscious is to be found when the archetypes, as primordial images, appear in dreams [and] unusual states of mind. These images seem. . . to possess a power and energy of their own .. . they fascinate us and drive us to action (p. 27).
Myths, dreams, and metaphors are seen as universally useful.
Contrary to the Jungian literature and to therapists' positions regarding the universal applicability of metaphors, four therapists (50% of the sample) cited client characteristics (e.g., intuitive vs. concrete thinkers, Myers-Briggs personality types) that affect their responsiveness to metaphor and talked about certain contraindications for metaphor work (clients diagnosed with neurological damage, antisocial or borderline personality, schizophrenia). Overall the literature on therapeutic metaphors does not address these issues (e.g., Barker, 1985; Gordon, 1978; Kostere & Malatesta, 1985; Wallas, 1985). One exception is Ryce-
Menuhim's (1992) presentation of the type of client who may not benefit from sandplay therapy, e.g., the borderline psychotic, the obsessive compulsive, or the autistic chiid. Categories s£i4e.t9phQrs Therapists' documentation of their use of diverse types of symbols and metaphors in treatment is consistent with the diversity of metaphoric communication described in the literature
(Barker, 1985; Fineberg, 1984; Imber-Black, Roberts, & Whiting,
1988; Lemer, 1978; Rosenblatt, 1994; Ryce-Menuhim, 1992). All therapists stressed the therapeutic use of linguistic or verbal 207 metaphors (e.g., stories, tales, anecdotes, poetry), and six therapists (75% of the sample) stressed the therapeutic advantages of nonverbal metaphoric devices (e.g., rituals, drawings, sculpting, sandplay, dreams, games). In addition to verbal and non-verbal metaphors, four therapists (50% of the sample) differentiated between the metaphors that clients bring in versus metaphors that are generated by the therapist. The literature on therapeutic metaphors makes references to these two different types of metaphoric productions. The literature on dreams (e.g., Mazza & Price, 1985; Wenz & McWhirter, 1990), sandplay (e.g., Lewis, 1992; Ryce-Menuhim, 1992; Weinrib, 1983), and poetry (e.g., Bowman & Halfacre, 1994; Gladding, 1979; Sharlin & Shenar, 1986), for instance, stresses clients' metaphoric creations, while the Ericksonian literature that focuses on well-formed stories and tales (e.g.. Combs & Freedman, 1990; Gordon, 1978; Lankton & Lankton, 1989), emphasizes therapists' metaphoric productions. An additional categorization of therapeutic metaphors was revealed by one therapist (therapist #3). He differentiated metaphors based on their level of explicitness, i.e., whether non verbal productions are turned into words and whether connections between metaphors and clients' issues are direct^ stated. Gordon
(1978) made this distinction when he analyses covert and overt metaphors. He believes that clients who are resistant may be best served by utilizing covert metaphors while clients who are interested in effecting change may benefit more from overt 208 metaphors. The skill of the therapist at.utilizing well-formed,
isomorphic metaphors also plays a role in the therapeutic impact
of covert vs. overt metaphors. When metaphors are truly isomorphic, all the necessary connections and personal changes occur at the unconscious level; there is no need for the client to explicitly or consciously know the meaning of the metaphor (Gordon, 1978).
Clinical Advantage of the Use of Metaphoric Communication.
Therapists’ descriptions of the impact that metaphoric communication has on the therapeutic process and outcome are compatible with the literature addressing the clinical advantages of symbolic work (e.g., Bateson, 1979; Rosen, 1985; Rule, 1984; Sanko, 1986; Satir, 1967; Whitaker, 1982; Zeig, 1980).
Advantages of metaphors within the therapeutic process. Addressing the therapeutic role of metaphors on the therapeutic process, six therapists (75% ) stressed that metaphors bypass resistance and reach conscious and unconscious processes. These observations are consistent with Erickson's focus on the use of indirect verbal and nonverbal communication as a way to reach the unconscious without interference from the conscious mind (Zeig,
1980). They are also consistent with Bateson's (1979) belief in the power metaphors have in facilitating the connection between the conscious and the unconscious, and Whitaker's (1982) use of metaphors to access primary processes. The power of metaphors at bypassing resistance and reaching the conscious and unconscious mind increases clients' openness to treatment, a 209 factor that facilitates progress in therapy. In a study of therapeutic interventions, Orlinsky and Howard (1986) found that clients' openness and non-defensiveness were the most salient positive correlates of treatment outcome.
Advantages of metaphors for clients' therapeutic outcome, in addition to metaphors affecting the process of therapy, six therapists (75% ) characterized metaphors as useful to expand clients' model of the world, and four therapists (50% ) described them as an effective avenue to facilitate insight and discovery of meaning. Metaphors were described by all therapists as powerful resources in facilitating client growth, healing, and positive change; five therapists (62.5% ) reported that the personal growth, change and healing that result from the use of symbols is long lasting.
Several of the advantages of metaphor work (e.g., bypass resistance, having a long term impact) stressed by the therapists in the study match the expectations and assumptions the researcher had bracketed at the beginning of the research process. Other researcher expectations, such as metaphors having an impact on clients and therapists' sense of continuity across therapy sessions, were not addressed by the therapists.
Advantages of metaphors for therapists. In addition to the consequences that metaphoric work brings for clients, therapists revealed the impact that metaphors have had on their work and/or their own personal growth. All therapists disclosed that metaphors have increased their professional satisfaction by either 2 1 0 making the therapy process more interesting and exciting or by facilitating a deeper connection with their clients. In addition, three therapists (37.5% ) said that metaphor work facilitated their own healing and personal growth. The literature on therapeutic
metaphors has neglected to address the impact of metaphoric communication on therapists. Overall, the field of counseling psychology has paid limited attention to the possibility that therapists can team and grow from their contact with clients. The assumption seems to be that relating and communicating at a deep
level with another person has an effect only for one of the parties, (i.e. the client,) and that the process of growth and change is unidirectional. One exception to the emphasis the literature has placed on unidirectional change is Highlen and Hill's (1984) article regarding factors affecting client change in individual counseling.
The concept of change was characterized by the authors as an interactional and reciprocal process. As such, it is possible to infer the presence of relationships among the advantages that metaphors bring for clients and therapists in terms of both process and outcome. As stated in Chapter IV, it is possible to assume that the effects metaphors, have on therapists will impact the quality of the therapeutic process for the client and vice versa. Highlen and Hill (1984) stressed that therapists and clients are reciprocally influenced by each other. What a client chooses to disclose for instance, is influenced by his or her perception of the tJierapist and of the therapeutic relationship. The therapist, in turn, is influenced by what is shared and by the quality of the 2 1 1 relationship with the client. The process, of change is reciprocal. Implications for the Field of Counseling Psychology The findings from the present study have important implications for training and practice. The advantages that metaphoric communication bring to clients and therapists provide compelling support for changing current approaches to training. Training programs may maximize or even accelerate therapists' developmental process of metaphoric communication by: (a) integrating opportunities for self exploration, (b) encouraging exposure to mentors experienced in the use of metaphor, (c) offering training environments conducive to the development of creative and metaphoric thinking (e.g., inviting speakers, offering courses, reading assignments, or training opportunities on the use of symbolic devices: art, poetry, dreams, music, projectives, etc.), (d) offering students practicum experiences that foster symbolic language (e.g., identifying therapists experienced in the use of sandtray, dream interpretation, storytelling to serve as supervisors in practicum sites), (e) providing specialized training on the use of symbols in therapy, (f) facilitating exposure to diverse theoretical frameworks that stress the use of therapeutic metaphors, and (g) encouraging trainees to use symbols and metaphors in their case conceptualizations. Amundson (1988) and
Ishiyama (1988,1989) have emphasized the usefulness of symbolic representation of cases. Based on clinical judgment and an unsystematic case study, Amundson (1988) concluded that counselors’ case conceptualization through the use of metaphors. 2 1 2 drawings, and collages provided meaningful summaries and themes for case conference and supervisory discussions. Ishiyama (1 9 8 9 ), through an empirical study, found that counseling students rated the use of metaphors and drawings in case processing more positively than the use of non-visual case conceptualizations. In terms of practice, the results of the study suggest a need for mental health professionals to explore their philosophical understanding of metaphors (i.e.. Metaphors as Technique, Metaphor as Technique-Tool-Being, Metaphor as Being) as this understanding influences therapists' approach to the therapeutic use of symbols. To maximize the chances that clients will benefit from metaphors, therapists will need to consider the different moderating variables (i.e., metaphor-, counselor-, and relationship-based variables) that impact the effective use of metaphors. Given that the context of a positive therapeutic relationship seems to moderate the effectiveness of metaphors, it is crucial for therapists to focus on establishing rapport with their clients. Similarly, it is important for therapists to attend to clients' worldview, identity, interests, and teaming styles in order to offer metaphors that would be heard and received by clients. Therapists should also attend to their own metaphors and personal journeys if they are to help others uncover meaning and unconscious processes manifested in symbols and metaphors. To obtain the advantages of metaphor work, practitioners may need to trust their own creativity, intuition, and the value of their metaphoric minds. They may benefit from openness to diverse lypes of symbolic devices, including linguistic 213 (e.g., stories, tales, poetry) and non-linguistic metaphors (e.g., rituals, games, art).
Given that metaphors were described as helpful devices in (a) individual and femily therapy, (b) the treatment of children and adults, and (c) the therapeutic process of clients manifesting diverse presenting concerns, it is reasonable to suggest that adding metaphoric communication to the therapeutic repertoire would have a positive impact on the therapy process. Clients and therapists could benefit from the personal growth and healing that metaphors generate. Therapists may need to be cautious regarding the use of metaphors with clients diagnosed with antisocial and borderline personality disorder, schizophrenia or neurological damage as these diagnoses were described as possible contraindications for metaphors work.
The researcher's hope is that the description of the clinical value of metaphors will encourage and empower practitioners to allow their metaphors to unfold in session. Implicit in therapists' disclosure of their experiences with metaphors is an invitation for practitioners to experiment with symbolic communication. It is important for therapists to explore their possible bias toward perceiving rational language as more mature, appropriate, or useful than symbolic language. There is a high probability that practitioners may manifest this lype of bias, given the social and behavioral sciences’ commitment to rational and empirical thinking. There is evidence to suggest that individuals engaged in different disciplines tend to be committed to different modes of 214 knowing. Graduate students in the analytical sciences tend to be predominantly rational, those in the life sciences, predominantly empirical, and those in the humanities predominantly metaphorical (Clark, 1987). The general implication of the present study is that verbal, linear, rational language may not be a sufficient communication device in therapy. Therapists who avoid metaphoric communication in favor of rational and direct approaches to therapy may not be able to facilitate personal growth in those clients unable to respond to direct suggestions and assignments (Lankton & Lankton, 1989). Metaphors help
individuals embrace new options, gain awareness of emotional experiences, and become motivated for action. Metaphors enrich and invigorate the therapeutic process (Lankton & Lankton, 1989). In multicultural encounters, particularly while working with clients from high-context cultures, metaphors may not be only helpful, but necessary (Highlen & Sudarsky-Gleiser, 1994).
Because of the qualitative nature of the present research, it served an important purpose in terms of the philosophy of science in the field of counseling psychology. As stated by Polkinghorne
(1 9 9 1 ), Gelso (1 9 7 9 ), Goldman (1 9 8 9 ), Hoshmand (1 9 8 9 ), Helms (1989), and Howard (1984), the counseling psychology profession could benefit from a broader range of research methods.
This study demonstrates the rigor of qualitative approaches in counseling research. Not only were data analyzed following
^stem atic phenomenological and grounded-theory procedures, but diverse methods were used to establish rigor. Observational, 215 methodological and theoretical notes were used as adjunct sources of information during the research process. In addition, multiple triangulation (Le., triangulation through multiple analysts, data, theoretical, and methodological triangulation), member checks, bracketing, and peer debriefing were used to ensure the rigor of the study. The researcher’s hope is that graduate students and psychologists will recognize the rigorous manner in which qualitative studies can be carried out and that they will acknowledge the contribution that qfjglitative studies can make to the field of counseling psychology.
The present study not only contributed to the discipline of counseling psychology a demonstration of the rigor of qualitative research methods and a descriptive model of therapists’ metaphoric communication, but it also gave a voice to the therapists who participated in the study. As Strauss and Corbin
(1994) stated, "we who aim at grounded theories also believe . . . that we have obligations to the actors we have studied: obligations to tell their stories" (p.281 ). Another important contribution of the present study was the impact that it had on respondents’ self- understanding. It is important to recognize the reality-altering impact of the research process itself (Lather, 1986). The metaphoric mode of knowing involves an intuitive grasp on how objects relate to each other and how one concept can be expressed in terms of another. This intuition may not be fully understood by the conscious mind (Kopp, 1971 ). Because of the nature and methodology of the present study, therapists gained insight into 216 their metaphorical mode of knowing. In ia c t, during second interviews, three therapists reported a significant impact of the study on their self-understanding or the understanding of their metaphor work. Therapist #4 for instance, expressed that since our first meeting he had been trying to read more Appalachian stories; therapist #6 explained that since her involvement in the study, she presented a workshop on the use of metaphors, and therapist #8 reported having gained conceptual understanding for what previously had been for her an amorphous process. A final contribution of this study relates to its impact on the researcher herself. The study not only facilitated increased awareness of the benefits of metaphor work but it has motivated her to experiment with diverse metaphoric devices (e.g., she recently built a sandtray and has been using it in her practice). Thanks to the involvement in the study, the researcher has felt freer to reveal her spontaneous metaphors in her work with individual clients, group members, and supervisees.
Limitations of the Study
Although this study made significant contributions to the literature, it was not without limitations. Given the homogeneity of the sample in terms of age, relationship status, ethnicity, professional experience, and place of residence, results should be taken with caution. Therapists were formally trained and experienced therapists. Years of practice ranged from 7 to 22 with a mean of 14.3 years. As such, the generalizability of results may be compromised. The results of the study may not reflect or may 217 not be congruent with the perspectives.of less experienced therapists, therapists in training, or native healers. Similarly, the limited representation of ethnic minorrty therapists among therapists limit the generalizability of results. Six therapists (75% of the sample) were Caucasian, one was Appalachian, and one was mixed Caucasian-Native American. Metaphor work as experienced by a more culturally/ethnically diverse group of therapists remains an empirical question to be addressed. The present research focused exclusively on therapists' experience of metaphoric communication. As a consequence the study offered only a partial view of the phenomenon. The experience of metaphor work from the client's perspective remains unknown and the following questions remain unanswered: Do clients value metaphoric communication? If so, do they value it for the same reason therapists do? What is the experience of clients when metaphoric communication is used in therapy? Do therapists and clients concur on their description of the characteristics and consequences of therapeutic metaphors? Gathering data from clients would have provided a more complete picture of the phenomenon. It would have also provided an additional source of triangulation that would have strengthened the rigor of the study.
Although several methods were used to increase the rigor of the study, the fact remains that one researcher performed most of the data analyses and data reporting. This concern could have been avoided by having independent readers (e.g., students, professors, other therapists) participating throughout the complete data 218 analysis process. Professionals in other.disciplines (e.g., anthropology or linguistics) could have been involved in data analyses and interpretation. A related issue is that the. analysts used as sources of tnangulation had been trained in U.S. institutions. "When one studies psychology in a Western culture, the philosophy of that culture affects one's perceptions as... climate and geology combine to control the plants that grow In a particular place" (Samples, 1983, p.42). It is possible to assume that a researcher or a team of co-investigators trained in a non- Westem society may arrive at different analysis and interpretation of the data. The rigor of the study could have been further strengthened if additional triangles would have been built witiiin triangulation methods. Interviewing therapists who were not aware of their use of metaphoric communication, interviewing clients after they had listened to therapists' interviews, facilitating a discussion meeting with the therapists who participated in the study, are examples of additional triangles that could have been built in this study.
implications for Future Research
To compensate for the limited presence of ethnic diversity among therapists, future research should include broader representation of ethnic minority therapists. Similarly, therapists at different levels of training and experience should be included in the sample to explore their understanding of metaphor work. In addition, the field could benefit from longitudinal studies to 219 further explore and corroborate findings regarding therapists' developmental process of metaphoric communication. The description of the developmental process in the present study was based on therapists' retrospective accounts. As a consequence, it was subjected to the possibility of unintentional distortion. Therapists could be followed through their graduate training and professional practice, or therapists at different stages of professional development could be interviewed to further explore and validate the variables involved in the developmental process of metaphor work. DEmpirical research to evaluate the impact of exposing trainees to metaphor work are needed. Studies should be designed to compare the relative usefulness of diverse didactic interventions and to evaluate their effectiveness at different stages in the training process.
The present research focused exclusively on therapists' experience of metaphoric communication. In the future, research may include other perspectives. Studying individual clients, family and group members' experience of symbolic language, may complement therapists' description of metaphor work. Having both clients and therapists describe their experience of metaphoric communication would provide a holistic picture of the phenomenon. DEmpirical studies addressing a "metaphor-client fit" hypothesis are needed. Is the responsiveness to metaphor influenced by clients' Myers-Briggs personality types? Are women more willing to work with fairy tales while men feel more comfortable working with movies? 2 2 0 Future research endeavors may alsoiocus on in-depth
systematic case studies to explore and analyze the experience of
therapists and clients working together through the use of
symbols. Process and outcome research aimed at studying client- therapist dyads involved in metaphoric communication may further illuminate our understanding of the meaning and subjective experience of therapeutic metaphors. Longitudinal studies are also needed to test the validity of therapists' impressions regarding the long-lasting impact of metaphor work. Concluding Remarks
With psychology's historic narrow definition of what constitutes scientific research, with its bias towards measurement and quantitative approaches to knowledge, and with its emphasis on linear, logical thinking, the field has devalued the metaphoric mind. In his autobiography, Darwin (cited in Samples,
1983) described the experience of loss associated with the inability to appreciate metaphors and symbols:
Poetry of many kinds . . . gave me great pleasure . . . pictures gave me considerable, and music very great, delight But now for many years 1 cannot endure to read a line of poetry . . . I have also lost almost any . taste for pictures or music. My mind seems to have become a kind o f machine for grinding general laws out of large collections of fact, but why this should have caused the atrophy of that part of the brain . . . on which the higher tastes depend, I cannot conceive . . . The loss of these tastes is a loss of happiness, and may possibly be injurious to the intellect, and more probably to the moral character, by enfeebling the emotional part of our nature (p. ii). 2 2 1 With psychology's transition toward a more holistic view of science, with the inclusion of qualitative paradigms, and with its increasing acceptance of non-linear thinking, the appreciation and celebration of the metaphoric mind may be resurrected in our field.
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237 238 LETTER TO PROSPECTIVE THERAPISTS
Date Name Address City, State ZIP
Dear Name: I am a Ph.D. student in the Counseling Psychology program a t The Ohio State University. I am currently completing my doctoral dissertation, a qualitative study on therapists' experience of metaphoric communication in Counseling and Therapy. The principal investigator, Pamela Highlen, Ph.D., an associate professor in the department of psychology at O.S.U., will be supervising the different phases of the research.
I am writing to invite you to participate in the study. If you decide to do so, you will be asked to meet with me on two different occasions. In the first meeting, you will be asked to share your opinions, ideas and values regarding the use of metaphors in counseling and therapy. You will be invited also to describe, respecting clients' confidentiality, some of your experiences with metaphoric communication in counseling. This open-ended interview will take approximately one and a half hours. The second meeting will be after a couple of months. The purpose of this second interview is to explore with you how accurate the data analyses reflect your experience. This meeting will require approximately one hour. Both interviews will be audiotaped so that we are not distracted by my note-taking. The first interview will be transcribed. Audiotapes will be erased after transcription and data analyses.
It is important for you to know that the focus of the study is on therapists' (not clients) experience of metaphoric communication in therapy. As such, clients will not be interviewed at any point during the investigation. I want to emphasize also that your name will not be used during the investigation or in the final report. Your confidentiality will be maintained. Please be assured that your participation is voluntary. Moreover, at any time or for any reason you may withdraw from the investigation once you have agreed to volunteer. 239 if you have questions, please do not hesitate to contact me at 3 5 1 -8 6 8 4 or the principal investigator, Pamela Highlen, Ph.D. at 292-5308. We will be happy to answer your questions or concerns.
I would appreciate for you to contact me if you are interested to participate in the study. We can schedule our first interview at a time that is convenient for both of us.
Sincerely,
Carina Sudarsky-Glsiser, M.A. APPENDIX B OPEN - ENDED INTERVIEW
240 241
OPEN - ENDED INTERVIEW
Identification # . Gender ______Age Relationship status ______Ethnic/cultural Background Religious Affiliation Professional Training/Education
* Please describe your professional background and experience. * Please describe the nature of your clinical practice and your responsibilities. * Please describe your philosophical understanding of therapy * Which theoretical orientation would you say best fits your philosophical understanding of therapy and the therapeutic process? * What will a trained person be able to observe/experience in your work as a clinician that will let him or her categorize you as a ______(theoretical orientation mentioned in answer to previous question) therapist? * How do you define metaphors? (Is this different or not from other symbolic communication devices?) * When did you become aware of your/your clients' use of metaphors in counseling? * Trace and describe the developmental pattern of metaphoric communication that you have observed in your clinical practice through your professional development. * What advantages do you see in using metaphors in counseling? * Do you follow certain guidelines to either use of avoid metaphors in counseling? If so what are they? * Are you aware of using other symbolic communication devices in counseling? If so what are they (possible options: stories, tales, sandtray)? How are they different or similar? 242 * Please cite examples of the diverse lypes of metaphoric communication resources/practices you use in counseling. * Anything about your office that has a specific metaphoric purpose or meaning? * Any particular type of client better suited for metaphor use? What (if any) client characteristics make them more responsive to metaphoric communication? Describe and give examples. * Is the effectiveness of metaphoric communication contingent on particular stages of the therapeutic process? Describe * Is the effectiveness of metaphoric communication contingent on particular client issues? Describe * Do you find yourself selecting different metaphors based on client issues, gender, ethnicity, religion, sexual orientation? * What type o f transference/countertransference issues are you aware of as playing a role in the process of metaphor selection? * How does client change produced by metaphors compare to that produced by other communication devices? * Can you recall a time when metaphoric communication in counseling really worked in a client's therapeutic process? Tell me about it- How did you know it worked? * Can you recall a time in your practice when you felt that metaphoric communication was inappropriate? If yes, share that experience. * Are there clients/issues with whom/for which metaphoric interventions may not be recommended? Explain * What are some of your values regarding therapeutic change that are expressed through your use of metaphors in counseling? * What is your experience as you and your client get involved in metaphoric communication? * Anything about you that promotes/motivates your use of metaphoric communication in counseling? * Can you identify or recognize some events th at could have influenced your use of metaphor in counseling? * What theoretical approach (if any) has inspired you to use metaphors in the counseling process? 243 * Describe experiences in your formal training that helped you explore or supported you in the therapeutic use of metaphors? * Is riiere anything you would like to add that might help me understand how you use and how you perceive the use of metaphors in therapy? APPENDIX C
OBSERVATIONAL, METHODOLOGICAL, AND THEORETICAL NOTES
244 245
OBSERVATIONAL NOTES
Observational Notes
T h e ra p is t ______ContactDate __ S ettin g ______Length of Interview
Environmental Distractions ______
What was the relationship with Therapist like?
Own feelings about what was being said
Snowball Referrals
Additional Notes 246
Second Interview:
Therapist ______Contact Date __ Setting ______Length of Interview
Environmental Distractions ______
What was the relationship with Therapist like?
Own feelings about what was being said
Additional Notes 247
Methodological Notes
Concerns about the quality of recording
Which questions did the contact bear most centrally on?
Which questions did the Therapist struggle with?
What information was not obtained in this interview?
Where should the researcher focus most of the energy during the next contact, what sorts of information should be sought?
Suggestions from participant 248
Iheoretical-Notes
What were the main themes or issues presented?
What new hypotheses, concepts were suggested by the participant?
Cross-allusions to themes shared by other therapists
How does the therapist integrates metaphors in his/her clinical practice
How does the therapist experience metaphoric communication
Thoughts about the meaning of what the therapist disclosed