“Nature cocks the hammer and experience pulls the trigger,” said the presenter. Everyone nodded, in seeming understanding, that in the context of the presentation, eating disorders, too, are more complicated than learned behavior. Grinning at this clever metaphor, I slipped it into my back pocket for when the nature-nurture discussion would invariably arise in my abnormal psychology class.
Metaphors, as figures of speech, have various conversational and literary roles. They also offer powerful therapeutic opportunities for clients that, in my experience, have ringed unconscious bells and helped them to make connections and draw important conclusions. I have always enjoyed using them in treatment, particularly those moments when a well-chosen metaphor has breathed new life into a therapeutic relationship.
“Fred,” I began, “I see you just listening in over there. What do you say?”
“Why should I let my crap bother other people? It’s hard to explain when that happens, anyway. I’ll deal with it,” explained Fred, providing common “logic” often exposed in couples’ work.
“God! You think keeping your stuff to yourself is protecting me somehow,” cried Heather. “I don’t know what’s going on with you when that happens, and it hurts that you’re unwilling to let me in or at least try to talk to me. Now we’re in a therapist’s office. It doesn’t help me to see you suffer.”
To test the waters, I asked Fred what it was like listening to Heather say that. He leaned on the arm of the couch with his forehead in his hand, remaining reticent. Clearly there was room for improved communication, and I had to figure out how to provide Fred with a new perspective to help the couple gain momentum.
During a subsequent session, Fred looked particularly tired and noted that he “felt like deadwood” that afternoon. Noting his “dead” reference, a metaphor that took advantage of Fred’s interest in earth sciences took shape that might illustrate the benefits of communicating emotions.
As the session took shape, I awaited an opportunity to capitalize. The metaphor goddesses were with me, for Fred commented that his classes were draining him.
“Surely,” I began, “you’ve had a class studying the world’s great bodies of water,” getting Fred’s attention.
I continued, “You know, the Dead Sea and the Red Sea are both fed by rivers teeming with life, but nothing survives in the Dead Sea. Do you know what makes the difference?” Fred sat quietly, considering the query, and shrugged. “The Dead Sea has no outlet,” I finished.
Looking up, Fred, nodding, reflected, “It isn’t flushed out, so stuff stagnates and dies.”
The bell was rung, and the message was clear. He was periodically stagnating like the Dead Sea because he was not expressing his emotions and dealing with his conflicts, contributing to his “deadwood” feelings. In the rest of the session, Fred was able to start reframing the consequences of his internalized emotions and why communicating them was important.
Beth was a 31-year-old professional who sought therapy because she had been feeling increasingly moody and exhausted over the preceding few months. After being checked for Lyme, low iron, thyroid complications, and other medical causes, her physician suggested Beth meet with a therapist.
“I feel like I’ve been living on an emotional rollercoaster” she described in our first meeting. While more of an analogy than metaphor, I thought there might be a way to capitalize on this poignant description.
In my clinical experience, “emotional rollercoaster” is a common way that clients, or those in close relationship with them, have described the experience of bipolar disorders or borderline personality disorders. I have had to be cautious; however, not to jump to conclusions in instances like these. Afterall, jumping from a roller coaster can be hazardous to clinical health (I couldn’t resist). “Beth,” I replied, keeping with her description, “I don’t spend much time in amusement parks, but I know there are all different sizes and intensities of coasters. If your emotional experiences were actually a roller coaster, how would you describe the one you’re on?”
Chuckling at the idea of trying to guide me along, she explained, “It’s not fast with steep hills and loops,” she began, “but sometimes I feel totally unbalanced and like I’ll fall off, like my head’s just not on straight.”
“Tell me more about that ‘head not on straight’ description.” Beth shared that she frequently just couldn’t gather her thoughts and focus well, as if “nothing wants to germinate in my mind.” It took extra time to think things through, especially at work where critical thought was involved. Beth added that, at home, she felt lazy and zoned out much of the time, even if she might want to do something. “It’s exhausting,” she signed.
“That doesn’t sound like much motion; a roller coaster moves,” I observed. “What’s the emotional ‘ride’ you initially mentioned?
Beth continued, “Well, most of the time, I feel unenthused and tired, but I get irritated so quickly and can stew on something. It could be how I hate feeling like this. It might be at a friend I’m on the phone with and they don’t silence their dog in the background. It’s so annoying and rude! I’m just mad, and that irritates me more because it doesn’t feel good, and then I’m exhausted again.” Beth detailed that it often happened daily or just a couple times per week.
It seemed her mood changes were generally reactive and short-lived, superimposed on withdrawal and malaise. After more interviewing, she failed to describe anything indicative of the moodiness ever spiking into hypomania/mania or having psychotic symptoms. The fatigue, slow cognition, lack of enthusiasm and dysphoric mood that Beth described was indicative of someone who had been depressed for months. And there it was!
File under: The Art of Psychotherapy, Couples Therapy
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Metaphors, as figures of speech, have various conversational and literary roles. They also offer powerful therapeutic opportunities for clients that, in my experience, have ringed unconscious bells and helped them to make connections and draw important conclusions. I have always enjoyed using them in treatment, particularly those moments when a well-chosen metaphor has breathed new life into a therapeutic relationship.
Fred: Testing Therapeutic Waters
Fred was a 25-year-old graduate school student studying earth sciences. He sought therapy because, according to his girlfriend, Heather, he was “in a funk again.” Heather, who accompanied Fred to his first session, also pointed out that he never spoke to her about how he was feeling during these “funks,” which strained their relationship. Overall, the couple had a lovely relationship, but periodically, particularly when school and work stress billowed, Fred lapsed into one of these brooding episodes, which could last days.“Fred,” I began, “I see you just listening in over there. What do you say?”
“Why should I let my crap bother other people? It’s hard to explain when that happens, anyway. I’ll deal with it,” explained Fred, providing common “logic” often exposed in couples’ work.
“God! You think keeping your stuff to yourself is protecting me somehow,” cried Heather. “I don’t know what’s going on with you when that happens, and it hurts that you’re unwilling to let me in or at least try to talk to me. Now we’re in a therapist’s office. It doesn’t help me to see you suffer.”
To test the waters, I asked Fred what it was like listening to Heather say that. He leaned on the arm of the couch with his forehead in his hand, remaining reticent. Clearly there was room for improved communication, and I had to figure out how to provide Fred with a new perspective to help the couple gain momentum.
During a subsequent session, Fred looked particularly tired and noted that he “felt like deadwood” that afternoon. Noting his “dead” reference, a metaphor that took advantage of Fred’s interest in earth sciences took shape that might illustrate the benefits of communicating emotions.
As the session took shape, I awaited an opportunity to capitalize. The metaphor goddesses were with me, for Fred commented that his classes were draining him.
“Surely,” I began, “you’ve had a class studying the world’s great bodies of water,” getting Fred’s attention.
I continued, “You know, the Dead Sea and the Red Sea are both fed by rivers teeming with life, but nothing survives in the Dead Sea. Do you know what makes the difference?” Fred sat quietly, considering the query, and shrugged. “The Dead Sea has no outlet,” I finished.
Looking up, Fred, nodding, reflected, “It isn’t flushed out, so stuff stagnates and dies.”
The bell was rung, and the message was clear. He was periodically stagnating like the Dead Sea because he was not expressing his emotions and dealing with his conflicts, contributing to his “deadwood” feelings. In the rest of the session, Fred was able to start reframing the consequences of his internalized emotions and why communicating them was important.
Beth: Metaphors to Guide Diagnostic Conversation
While I have found metaphors to be therapeutically useful in guiding patients to new understandings, sometimes patients have used a metaphor to help me understand their experience. While I would never diagnose someone based on a metaphor, I have used them to guide diagnostic conversations.Beth was a 31-year-old professional who sought therapy because she had been feeling increasingly moody and exhausted over the preceding few months. After being checked for Lyme, low iron, thyroid complications, and other medical causes, her physician suggested Beth meet with a therapist.
“I feel like I’ve been living on an emotional rollercoaster” she described in our first meeting. While more of an analogy than metaphor, I thought there might be a way to capitalize on this poignant description.
In my clinical experience, “emotional rollercoaster” is a common way that clients, or those in close relationship with them, have described the experience of bipolar disorders or borderline personality disorders. I have had to be cautious; however, not to jump to conclusions in instances like these. Afterall, jumping from a roller coaster can be hazardous to clinical health (I couldn’t resist). “Beth,” I replied, keeping with her description, “I don’t spend much time in amusement parks, but I know there are all different sizes and intensities of coasters. If your emotional experiences were actually a roller coaster, how would you describe the one you’re on?”
Chuckling at the idea of trying to guide me along, she explained, “It’s not fast with steep hills and loops,” she began, “but sometimes I feel totally unbalanced and like I’ll fall off, like my head’s just not on straight.”
“Tell me more about that ‘head not on straight’ description.” Beth shared that she frequently just couldn’t gather her thoughts and focus well, as if “nothing wants to germinate in my mind.” It took extra time to think things through, especially at work where critical thought was involved. Beth added that, at home, she felt lazy and zoned out much of the time, even if she might want to do something. “It’s exhausting,” she signed.
“That doesn’t sound like much motion; a roller coaster moves,” I observed. “What’s the emotional ‘ride’ you initially mentioned?
Beth continued, “Well, most of the time, I feel unenthused and tired, but I get irritated so quickly and can stew on something. It could be how I hate feeling like this. It might be at a friend I’m on the phone with and they don’t silence their dog in the background. It’s so annoying and rude! I’m just mad, and that irritates me more because it doesn’t feel good, and then I’m exhausted again.” Beth detailed that it often happened daily or just a couple times per week.
It seemed her mood changes were generally reactive and short-lived, superimposed on withdrawal and malaise. After more interviewing, she failed to describe anything indicative of the moodiness ever spiking into hypomania/mania or having psychotic symptoms. The fatigue, slow cognition, lack of enthusiasm and dysphoric mood that Beth described was indicative of someone who had been depressed for months. And there it was!
***
I have come to appreciate that planting a good metaphor is like cultivating the flower instead of pulling out all the weeds.File under: The Art of Psychotherapy, Couples Therapy