A metaphor analysis in treatments of depression: Metaphor as a marker of change

Illuminating their reality: the use of metaphor by parents of children with disabilities to express their experiences of health care

PURPOSE

To explore the nature and meaning of metaphors used by parents of children with disabilities when describing their healthcare experiences.

METHOD

A systematic procedure was used to identify and analyze metaphors spontaneously mentioned by parents in 13 focus groups held with 65 Canadian parents of children with disabilities. Attention was paid to identifying deep (i.e., meaningful) metaphors rather than common expressions.

RESULTS

A total of 214 deep metaphors were identified and categorized into four target-source groupings. Parents used journey metaphors to describe experiences of uncertainty, conflict and harm metaphors to describe confrontational, harmful, and demeaning experiences of care, games and puzzles to describe the unknowns of care and attempts to resolve these unknowns, and metaphors concerning environmental barriers (i.e., walls and doors) to express feelings of exclusion and difficulties accessing care.

CONCLUSIONS

Parents' metaphors expressed experiences of uncertainty, powerlessness, and attempts to exert agency in healthcare interactions. The metaphorical groupings provide new insights into how and why lack of family-centeredness in service delivery is bewildering, distressing, and disempowering to parents. Implications for service providers include paying attention to what metaphor use reveals about parents' experiences, and discussing parents' metaphors with them to create joint understanding, providing a fertile ground for collaboration.

Older Adults' Metaphorical Perceptions of Aging in Turkey

PURPOSE

To determine older adults' metaphorical perceptions of the concept of aging.

METHOD

Participants in this qualitative study comprised 57 older adults as determined using convenience and criterion sampling methods. Data were obtained using a personal data form and the metaphor form and analyzed with descriptive and content analysis techniques.

RESULTS

Fifty-seven metaphors were identified within three themes: 24 within Mental Aspect, 18 within Physical Aspect, and 15 within Psychosocial Aspect.

CONCLUSION

The fact that most metaphors appeared within the Mental Aspect theme was interpreted as an indication that participants felt the effects of aging more in the mental dimension. Results of the research show that aging is perceived as experience and accumulation mentally, as inadequacy physically, and as the end or loneliness psychosocially. [Journal of Gerontological Nursing, 50(5), 27-34.].

A conceptual framework for a neurophysiological basis of art therapy for PTSD

Post-traumatic stress disorder (PTSD) is a heterogeneous condition that affects many civilians and military service members. Lack of engagement, high dropout rate, and variable response to psychotherapy necessitates more compelling and accessible treatment options that are based on sound neuroscientific evidence-informed decision-making. Art therapy incorporates elements proven to be effective in psychotherapy, such as exposure, making it a potentially valuable treatment option. This conceptual paper aims to inform the neurophysiological rationale for the use of art therapy as a therapeutic approach for individuals with PTSD. A narrative synthesis was conducted using literature review of empirical research on the neurophysiological effects of art therapy, with supporting literature on neuroaesthetics and psychotherapies to identify art therapy factors most pertinent for PTSD. Findings were synthesized through a proposed framework based on the triple network model considering the network-based dysfunctions due to PTSD. Art therapy's active components, such as concretization and metaphor, active art engagement, emotion processing and regulation, perspective taking and reframing, and therapeutic alliance, may improve symptoms of PTSD and prompt adaptive brain functioning. Given the scarcity of rigorous studies on art therapy's effectiveness and mechanisms of alleviating PTSD symptoms, the suggested framework offers a neurophysiological rationale and a future research agenda to investigate the impact of art therapy as a therapeutic approach for individuals with PTSD.

Using metaphors to build hope and hopefulness from depression

Helplessness and hopelessness are common key dynamics of depression that often inhibit therapeutic progress and client recovery. Based on a case example, this article examines the processes for effectively communicating therapeutic interventions aimed toward building hope when other approaches have failed. It explores the use of therapeutic metaphors including assessing for positive outcomes, building the PRO Approach for creating therapeutic metaphors and using Hope Theory as an example of an evidence-based process for facilitating both hope and enhanced treatment outcomes. It concludes with an illustrative metaphor within a hypnotic model and a step-by-step process for building your own hope-enhancing metaphors.

The journey within: mental navigation as a novel framework for understanding psychotherapeutic transformation

BACKGROUND

Despite the demonstrated efficacy of psychotherapy, the precise mechanisms that drive therapeutic transformations have posed a challenge and still remain unresolved. Here, we suggest a potential solution to this problem by introducing a framework based on the concept of mental navigation. It refers to our ability to navigate our cognitive space of thoughts, ideas, concepts, and memories, similar to how we navigate physical space. We start by analyzing the neural, cognitive, and experiential constituents intrinsic to mental navigation. Subsequently, we posit that the metaphoric spatial language we employ to articulate introspective experiences (e.g., "unexplored territory" or "going in circles") serves as a robust marker of mental navigation.

METHODS

Using large text corpora, we compared the utilization of spatial language between transcripts of psychotherapy sessions (≈ 12 M. words), casual everyday conversations (≈ 12 M. words), and fictional dialogues in movies (≈ 14 M. words). We also examined 110 psychotherapy transcripts qualitatively to discern patterns and dynamics associated with mental navigation.

RESULTS

We found a notable increase in the utilization of spatial metaphors during psychotherapy compared to casual everyday dialogues (U = 192.0, p = .001, d = 0.549) and fictional conversations (U = 211, p < .001, d = 0.792). In turn, analyzing the usage of non-spatial metaphors, we did not find significant differences between the three datasets (H = 0.682, p = 0.710). The qualitative analysis highlighted specific examples of mental navigation at play.

CONCLUSION

Mental navigation might underlie the psychotherapy process and serve as a robust framework for understanding the transformative changes it brings about.

Muddles and puzzles: Metaphor use associated with disease progression in Primary Progressive Aphasia

Background

Primary Progressive Aphasia describes a language-led dementia and its variants. There is little research exploring the experiences of living with this disease. Metaphor, words that represent something else, have been studied extensively in health-related narratives to gain a more intimate insight into health experiences.

Aims

This study explored the metaphors used spontaneously by people with PPA, their care partners (family), and speech and language therapists/pathologists (SLT/Ps) providing support along the continuum of care.

Methods & Procedures

This study examined two previously collected data sets comprising naturalistic talk where metaphors were not the specific focus, the first from focus groups conducted with people with PPA and their families and the second from focus groups conducted with SLT/Ps working with people with PPA. Transcribed data were analysed for metaphor use through an iterative narrative approach.

Outcomes & Results

In all, 237 examples of metaphorical language were identified in the data, with 14 metaphors from people with PPA, 116 from the families and 106 from SLT/Ps. Different metaphors were used by participants to describe their experiences depending on which variant of PPA they were living with, and people also described their disease differently over time. SLT/Ps also used metaphors, however, their language reflected the structured, professional perspective of delivering speech and language therapy services.

Conclusions & Implications

SLT/Ps should listen for and recognise the metaphorical language used by people with PPA and their families to ensure therapeutic alignment, see beyond the PPA to recognise the individual's needs, and provide person-centred and empathic support.

Postpartum Mood and Anxiety Disorders: A Lexicon of Metaphors

Undiagnosed and untreated postpartum mental health disorders represent a silent health crisis. The aim of this paper was to develop a lexicon of metaphors women use to describe their postpartum mood and anxiety disorders to assist holistic nurses in recognizing as early as possible these struggling mothers. Mothers may not know the medical terminology to articulate their mental health problems and may turn to using metaphors. The metaphors included in this lexicon were obtained from the author's earlier qualitative studies of metaphors women used to describe their experiences of postpartum depression, postpartum panic disorder, and posttraumatic stress disorder due to traumatic childbirth. In this lexicon these metaphors are organized by these three mental health disorders and includes a table of definitions of each metaphor along with examples of the context of the metaphors represented by quotes from the mothers. Metaphors can be keys that open and unlock doors that stand between holistic nurses and their patients. Being attentive to metaphorical language women use to describe how they are feeling after giving birth can be an innovative approach holistic nurses can use to identify these vulnerable women and provide an opportunity to nurture and empower new mothers.

Narratives about Cancer: What Metaphors can tell us about Depressive Symptoms in Breast Cancer Patients

Metaphors are pervasive in cancer discourse. However, little is known about how metaphor use develops over time within the same patient, and how metaphor use and its content relate to the mental health of the patient. Here, we analyzed metaphor use in personal essays written by breast cancer patients shortly after the time of diagnosis and nine months later, in relation to their depressive symptoms at both time points. Results show that metaphor use can provide important insight into a patient's current mental state. Specifically, patients who had no change in their depressive symptom levels used metaphors more densely after nine months. In addition, metaphor valence in the later essay was associated with depressive symptoms at study entry and nine months after. Lastly, we observed a shift in metaphor reference pattern for different symptom trajectories, such that those who recovered from initially elevated depressive symptoms used fewer self-referencing metaphors and more cancer-referencing metaphors in their later essay. Our work suggests that metaphor use reflects how a patient is coping with their diagnosis.

Expectations for therapy in pediatric rehabilitation: reframing meaning through metaphor

PURPOSE

To propose a holistic approach and an accompanying tool to facilitate conversations about expectations of therapy in pediatric rehabilitation based on meanings generated through metaphor.

METHODS

In this study, five parents and nine service providers took part in narrative interviews. Topics included the content and development of expectations over time. Participants reviewed written summaries of their interviews and provided feedback. Data analysis was grounded in a narrative methodological approach. Multiple levels of meaning from participant experiences were constructed through a parallel thematic analysis and metaphor analysis, revealing meaning participants attributed to expectations directly, and inferred indirectly.

RESULTS

The thematic analysis produced three themes related to the difficult to define characteristics and mixed value of expectations. The metaphor analysis produced four metaphorical concepts related to how expectations affect the therapy process by adding a sense of Force (i.e., therapy momentum), Appreciation (i.e., understanding of the client), Illumination (i.e., envisioning new therapy activities), and Relationship (i.e., therapeutic rapport).

CONCLUSIONS

We propose the "F.A.I.R." approach and tool comprising terminology that can help reframe the meaning of expectations away from focusing on binary realistic or unrealistic outcomes, and toward focusing on a plurality of optimal therapy processes.Implications for RehabilitationMeaningful conversations about expectations for therapy between parents and service providers in pediatric rehabilitation can be challenging, one-sided, or missed.Attention to metaphors used to describe expectations for therapy introduces additional terminology parents and service providers may use to help facilitate conversations.Service providers are encouraged to use a resource proposed here to learn about parents' expectations for therapy through a collaborative process involving shared questioning, observation, and reflection.

Postpartum Depression: A Metaphorical Analysis

BACKGROUND

The reported incidence of postpartum depression in healthy women without a history of depression was 12%, and the prevalence was 17%. A silent health crisis in America is the undiagnosed and untreated mental health of women related to childbirth. Unfamiliar with medical terminology, persons may communicate more effectively by means of metaphors to describe what they are experiencing.

AIMS

To examine the language women used to describe their experiences of postpartum depression with metaphors that can provide a valuable source of insight for psychiatric nurses and other clinicians.

METHODS

Secondary qualitative data analysis of three primary datasets of postpartum depression was conducted. Metaphor identification procedure was the approach used to analyze the texts for metaphorical expressions.

RESULTS

Eleven metaphors were identified that women used to help explain their postpartum depression: being hit by a ton of bricks, being a tightrope walker, living in a nightmare, feeling trapped, being in the middle of the sea, feeling like an alien, being a loner, being a basket case, having cobwebs in the brain, feeling like garbage, and hitting rock bottom.

CONCLUSIONS

These 11 metaphors provide a new voice for women's experiences of postpartum depression. As a result, they provide rich insights for psychiatric nurses and other clinicians to help identify women struggling with postpartum depression.

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

BACKGROUND

Research suggests that metaphors are integral to psychotherapeutic practice. We wanted to explore how 10 therapists reflect upon the use of metaphors in therapy, and how they react to some metaphors expressed by patients treated for of major depressive disorder (MDD).

METHODS

Five therapists practicing psychodynamic therapy (PDT) and five practicing cognitive behavioral therapy (CBT) were interviewed with a semi-structured qualitative interview. Transcripts were analyzed using a thematic analysis approach.

RESULTS

Our analysis resulted in two main themes: the therapeutic use of metaphors, and conflicting feelings towards metaphors used by depressed patients. Most therapists said that they do not actively listen for metaphors in therapy and many said that they seldom use metaphors deliberately. While PDT-therapists appeared more attentive to patient-generated metaphors, CBT-therapists seemed more focused on therapist-generated metaphors. Most therapists did not try to alter the patient-generated metaphors they evaluated as unhelpful or harmful. Some therapists expressed strong negative feelings towards some of the metaphors used by patients. PDT-therapists were the most critical towards the metaphor of tools and the metaphor of depression as an opponent. CBT-therapists were the most critical towards the metaphor of surface-and-depth.

CONCLUSIONS

These results remind us of the complexity of using metaphors in therapy, and can hopefully be an inspiration for therapists to reflect upon their own use of metaphors. Open therapeutic dialogue on the metaphor of tools, surface-depth and depression as an opponent may be necessary to avoid patient-therapist-conflicts.

TRIAL REGISTRATION

Clinical Trial gov. Identifier: NCT03022071 . Date of registration: 16/01/2017.

Seeking Protection, Finding Despair: Closed Preferences as a Model of Neuroticism-Linked Distress

Introduction: Image schemas are perceptual-motor simulations of the world that are likely to have broad importance in understanding models of the self and its regulatory operations. Methods: Seven samples of participants (total N = 1,011) rated their preferences for unspecified entities being “open” or “closed” and scores along this dimension were linked to variations in personality, emotion, and psychopathology. Results: Individuals endorsing closed preferences to a greater extent were prone to neuroticism (Study 1), experiential avoidance (Study 2), negative affect in daily life (Study 3), and symptoms of anxiety and depression (Study 4). Discussion: Although closed preferences are likely to be endorsed for protective reasons (inasmuch as the contents of closed objects are better protected), such preferences are linked to higher, rather than lower, levels of neuroticism and distress. The findings offer new evidence for theories of neuroticism and psychopathology that emphasize operations related to defensive motivation and experiential avoidance.

Stimulating unconscious processes with metaphors and narrative

Metaphors, analogies, fairy tales, parables, myths, aphorisms, anecdotes, stories are effective communication tools used for educational, suggestive and persuasive purposes. They are part of pragmatic and strategic communication with the intent to convey values, suggest feelings, thoughts and behavior aimed at improving the clinical outcome. In the philosophical field these tools are used to concretely explain an abstract thought, such as Schopenhauer's story of porcupines to send the message of the right distance between people: neither too close not to be stung, nor too distant not to feel cold. Freud also used a metaphor to explain the concept of the unconscious as the hidden part of the iceberg. In the psychotherapeutic field these tools are used by those who believe in the greater effectiveness of indirect communication. Metaphors and narratives are intended to address a creative unconscious that can autonomously make connections that promote a process of evolutionary change without having to sift through the logic and rationality of the conscious mind. This article describes the personal use of these tools by the author in her therapeutic practice.

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

BACKGROUND

In the present study, we wanted to explore which metaphors patients suffering from major depressive disorder (MDD) use to explain their experience of being in therapy and their improvement from depression.

METHODS

Patients with MDD (N = 22) received either psychodynamic therapy (PDT) or cognitive behavioral therapy (CBT). They were interviewed with semi-structured qualitative interviews after ending therapy. The transcripts were analyzed using a method based on metaphor-led discourse analysis.

RESULTS

Metaphors were organized into three different categories concerning the process of therapy, the therapeutic relationship and of improvement from depression. Most frequent were the metaphorical concepts of surface and depth, being open and closed, chemistry, tools, improvement as a journey from darkness to light and depression as a disease or opponent.

CONCLUSIONS

Patient metaphors concerning the therapeutic experience may provide clinicians and researchers valuable information about the process of therapy. Metaphors offer an opportunity for patients to communicate nuances about their therapeutic experience that are difficult to express in literal language. However, if not sufficiently explored and understood, metaphors may be misinterpreted and become a barrier for therapeutic change.

TRIAL REGISTRATION

Clinical Trial gov. Identifier: NCT03022071 . Date of registration: 16/01/2017.

Double trouble: Therapists with low facilitative interpersonal skills and without training have low in-session experiential processes

Objectives: This study examined the combined effect of therapist Facilitative Interpersonal Skills (FIS) and Training Status on experiential processes within therapy sessions. In this randomized trial of FIS and Training Status, we predicted that in-session experiential processes would be highest for the high FIS and trained therapist group and lowest for the low FIS and untrained therapists. Methods: Forty-five clients were selected from 2,713 undergraduates using a screening and clinical interview procedure. Twenty-three therapists were selected for their level of FIS (high vs. low) and Training (trainee vs. untrained) and each were assigned two clients for seven sessions each. Two different coder teams independently rated experiencing and narrative process from the third therapy session and computer analysis identified affect words from transcripts. Results: FIS×Training Status significantly interacted on the set of experiential process measures. Relative to all others, therapists who were in the low FIS / no training group had lower experiencing and reflexive content, but higher external content. Conclusions: The findings highlight the importance of therapist characteristics within therapy sessions. Therapists without training and with low interpersonal skills have sessions that are nearly devoid of content that focuses on client experiential processes and emotion.

A Review of Empirical Studies Investigating Narrative, Emotion and Meaning-Making Modes and Client Process Markers in Psychotherapy

Despite the importance of narrative, emotional and meaning-making processes in psychotherapy, there has been no review of studies using the main instruments developed to address these processes. The objective is to review the studies about client narrative and narrative-emotional processes in psychotherapy that used the Narrative Process Coding System or the Narrative-Emotion Process Coding System (1.0 and 2.0). To identify the studies, we searched The Book Collection, PsycINFO, PsycARTICLES, PsycBOOKS, PEP Archive, Psychology and Behavioral Sciences Collection, Academic Search Complete and the Web of Knowledge databases. We found 27 empirical studies using one of the three coding systems. The studies applied the Narrative Process Coding System and the Narrative-Emotion Process Coding System to different therapeutic modalities and patients with various clinical disorders. In some studies, early, middle and late phases of therapy were compared, while other studies conducted intensive case analyses of Narrative Process Coding System and Narrative-Emotion Process Coding System patterns comparing recovered vs unchanged clients. The review supports the importance to look for the contribution of narrative, emotion, meaning-making patterns or narrative-emotion markers, to treatment outcomes and encourages the application of these instruments in process-outcome research in psychotherapy.

[Functions of language in psychotherapy: A qualitative study of psychotherapists' subjective theories of the "talking cure"]

Functions of language in psychotherapy: A qualitative study of psychotherapists' subjective theories of the "talking cure" Objectives: Psychotherapy is traditionally considered as a "talking cure". The specific functions of verbal activity, however, are disputed. The present study aims at identifying central therapeutic functions of verbal activity. Methods: In qualitative interviews n = 23 psychotherapists with psychodynamic (n = 12) or behavioral (n = 11) background were interviewed regarding their theories of the "talking cure." Based on Consensual Qualitative Research (CQR) a category system of therapeutic functions of verbal activity was constructed. Results: The participants described a wide range of relational, experiential, and behavioral functions of verbal activity in psychotherapy. Psychodynamic therapists emphasized relational and experiential functions of verbal activity, while behavioral therapists emphasized behavioral functions. Conclusions: The findings imply that verbal activity fulfills diverse functions in therapeutic contexts. This suggests a basic verbal materiality of many therapeutic techniques and common factors that needs to be specified in subsequent research.

Mother–Infant Interaction During Postpartum Depression: A Metaphor Analysis

Background

Reported in quantitative studies is the negative impact that postpartum depression can have on mother–infant bonding. Metaphors can enhance mothers’ communication with their health-care providers that cannot be captured by medical terminology and provide mothers a different voice to explain their experiences interacting with their infants.

Purpose

The aim of the study was to identify the metaphorical expressions used by women to describe their interactions with their infants during postpartum depression.

Methods

Secondary qualitative data analysis of three primary qualitative data sets of postpartum depression was conducted. The specific type of secondary qualitative analysis used was cross validation where multiple data sets from different studies are compared to expand the results of each individual study to make a more general claim. Data analysis involved using the Metaphor Identification Procedure.

Results

Identified were eight metaphors used by mothers to describe their interactions with their infants during their postpartum depression: a thief, a robot, enveloping fogginess, being at the races, an actor, an erupting volcano, skin crawling, and a wall.

Conclusions

Being attentive to metaphors mothers use can provide a unique approach to helping nurses identify vulnerable mother–infant dyads during postpartum depression.

Do Patients With Depression Prefer Literal or Metaphorical Expressions for Internal States? Evidence From Sentence Completion and Elicited Production

In everyday communication metaphoric expressions are frequently used to refer to abstract concepts, such as feelings or mental states. Patients with depression are said to prefer literal over figurative language, i.e. they may show a concreteness bias. Given that both emotional functioning and the processing of figurative language may be altered in this clinical population, our study aims at investigating whether and how these dysfunctions are reflected in the understanding and production of metaphorical expressions for internal states. We used two behavioral approaches: a sentence completion task and elicited speech production. In the first experiment, patients with ICD 10 depression (n = 26) and healthy controls (n = 32) were asked to complete sentences by selecting an appropriate word out of four alternatives (metaphorical expression, literal expression, concrete distractor, abstract distractor). All participants–irrespective of the presence of depression–chose more literal (60%) than metaphorical (40%) expressions. In the second experiment, patients with depression (n = 44) and healthy controls (n = 36) described pictures showing emotive events. The descriptions were transcribed and coded for type of expression (non-figurative words for internal states vs. metaphorical expressions, valence, type of metaphor, source and target domain of metaphor). In addition, the Thought and Language Index was applied to assess formal thought disorder. When talking about internal states, both groups used more literal than metaphorical expressions. The groups did not differ with respect to the composition of internal state language, but patients with depression tended to verbalize positive content to a lesser extent. Correlation analyses within the patients' group revealed that signs of disorganization in their speech were related to a higher use of internal state expressions, whereas a negative correlation was found with dysregulation phenomena. Taken together, results indicate that people with and without depression prefer literal means in order to verbalize internal states, but they additionally make use of figurative language. Since patients with depression were able to understand and produce metaphors for internal states similar to controls, the concreteness bias cannot be confirmed by the present study. The results contribute to existing research by demonstrating associations between symptoms of formal thought disorder and internal state language.

Metaphorical interpretations of the educator-student relationship: An innovation in nursing educational research

Previous research has shown that collecting and analysing metaphors is a useful strategy in seeking data that are difficult to collect via verbal interviews or that cannot be represented by statistics. This study explored nursing students' perceptions of the educator-student relationship using metaphorical interpretation. A qualitative study with a personal essay approach was adopted. A total of 124 students were recruited from a nursing school in Hong Kong. A personal essay form was distributed to the participants. They were asked to give a metaphor with explanations to describe the power dynamics in the educator-student relationship, within 200 words in English or Chinese. After some thought, the participants each gave their own metaphor individually, because the aim of this study was to collect their subjective experiences. The results were presented as follows: a) The overall description of the metaphors; b) The three groups of metaphors; c) The fives natures of metaphors; d) The most significant metaphors; and e) The four thematic meanings - (i) nurturing role; (ii) guiding role; (iii) insufficient connection; and (iv) promoting development. The implications for research methods and nurse education of collecting and analyzing metaphors were discussed. Discrepancies in metaphorical interpretations are to be expected, as interpretations are dependent on the researchers' socio-cultural background, personal experiences, professional training, languages spoken, and other factors.

Remission from Depression in the DSM: Moving from Rhetoric to Restoration

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, uses the term "remission" to describe the reduction of depressive symptoms. This paper argues that by categorizing someone who no longer has depressive symptoms as "in remission," that person may feel indefinitely tied to his or her diagnosis. Considering the unfortunate stigma associated with mental illness, permanent linkage to diagnosis through records and professional memory may cause individuals to internalize pathology. In fact, the language of the diagnosis can affect self-perception in sensitive souls for a lifetime. As an implication for practice, we propose that cognitive and narrative therapy approaches, mood-memoirs, and use of metaphor present alternative uses of language that can reduce power imbalances between clinicians and clients, providing a bridge to healing.

Self-narrative reconstruction in emotion-focused therapy: A preliminary task analysis

OBJECTIVE

This research explored the consolidation phase of emotion-focused therapy (EFT) for depression and studies-through a task-analysis method-how client-therapist dyads evolved from the exploration of the problem to self-narrative reconstruction.

METHOD

Innovative moments (IMs) were used to situate the process of self-narrative reconstruction within sessions, particularly through reconceptualization and performing change IMs. We contrasted the observation of these occurrences with a rational model of self-narrative reconstruction, previously built.

RESULTS

This study presents the rational model and the revised rational-empirical model of the self-narrative reconstruction task in three EFT dyads, suggesting nine steps necessary for task resolution: (1) Explicit recognition of differences in the present and steps in the path of change; (2) Development of a meta-perspective contrast between present self and past self; (3) Amplification of contrast in the self; (4) A positive appreciation of changes is conveyed; (5) Occurrence of feelings of empowerment, competence, and mastery; (6) Reference to difficulties still present; (7) Emphasis on the loss of centrality of the problem; (8) Perception of change as a gradual, developing process; and (9) Reference to projects, experiences of change, or elaboration of new plans.

CONCLUSIONS

Central aspects of therapist activity in facilitating the client's progression along these nine steps are also elaborated.

The communicative power of metaphors: an analysis and interpretation of metaphors in accounts of the experience of addiction

OBJECTIVES

The aim of this study was to explore how participants use metaphors to express and communicate experiences and emotions that may have been previously unexpressed or unexplored, and perhaps too painful to address directly. In addition, this study investigates the potential of using interpretative phenomenological analysis (IPA) in metaphor research.

DESIGN

Data were collected in semi-structured interviews, designed to capture a rich and detailed description of participants' experiences of addiction and what the experiences means to them.

METHODS

Six participants took part in the study. The data were analysed using IPA.

RESULTS

The results capture the abundance and vividness of metaphorical expressions embedded in participants' accounts and produce insights and a richer picture of the participants' experiences.

CONCLUSIONS

The study highlights the power of metaphors as tools for communicating and sharing experience, as well as the particular ways in which metaphors make sense as part of individual lives. We believe that IPA can make a valuable contribution to metaphor analysis as it attends both to the experiential dimension of metaphors through phenomenological analysis, as well as to the hermeneutic possibilities opening up through the capacity of metaphors to make connections between disparate ideas and concepts.

Narrative research in psychotherapy: a critical review

PURPOSE

This paper is a review of studies which utilise the notion of narrative to analyse psychotherapy. Its purpose is to systematically present this diverse field of research, to highlight common themes and divergences between different strands and to further the development and integration of narrative research in psychotherapy.

METHODS

The paper reviews studies which employ an applied textual analysis of narratives produced in the context of psychotherapy. Criteria for inclusion of studies are, firstly, the analysis of therapeutic and therapy-related texts and, secondly, the adoption of a narrative psychological perspective. The studies were examined on the basis of the notion of narrative they employ and the aspects of client narratives they focus on, and were grouped accordingly in the review.

RESULTS

The majority of the studies reviewed assume a constructivist approach to narrative, adopt a representational view of language, focus primarily on client micro-narratives and relate to cognitive-constructivist and process-experiential psychotherapeutic approaches. A smaller group of studies assume a social constructionist approach to narrative and a functional view of language, focus on micro-narratives, highlight the interactional and wider social aspects of narrative and relate to postmodern trends in psychotherapy.

CONCLUSIONS

The range of conceptualisations of narrative in the studies reviewed, from a representational psychological view to a constructionist social view, reflects tensions within narrative psychology itself. Moreover, two trends can be discerned in the field reviewed, narrative analysis of therapy, which draws from narrative theory and utilises the analytic approaches of narrative research to study psychotherapy, and analyses of narrative in therapy, which study client narratives using non-narrative qualitative methods. Finally, the paper highlights the need for integration of this diverse field of research and urges for the development of narrative studies of psychotherapy which employ a broader social understanding of narrative production and transformation.

The I-C-A-C framework: uncovering patients' experiences

The use of metaphors to enhance nursing knowledge and intervention has not been thoroughly addressed in a Chinese context. Use of metaphors helps people transform feelings from the inexpressible to the expressible, to revise their view of their own strengths from unaware to aware, and to expand a one-dimensional view to a multifaceted one. Based on the therapeutic essence of metaphors, this article proposes the I-C-A-C framework on the use of metaphors, with a case example given to illustrate how nurses can help uncover patients' illness experiences. The I-C-A-C framework has four strategies: I - Inviting the patients to create and share their metaphors; C - Creating many meanings for the metaphors; A - Analysing the metaphors; amd C - Connecting the patients' metaphors to their personal context. Limitations and implications of the framework for nursing practice are suggested.