A METAPHOR ANALYSIS 1

Levitt, H., Korman, Y., & Angus L. (2000). A metaphor analysis in treatments of depression: Metaphor as a marker of change. Counseling Psychology Quarterly, 13, 23-36.

A metaphor analysis in the treatment of depression:

“The process of unloading burden”

Heidi Levitt, Yifaht Korman, & Lynne Angus

York University, 4700 Keele St., North York, Ontario, M3J 1P3

This paper was derived from a presentation entitled Examining narrative in

a good and a poor outcome process-experiential therapy, held at the

(1996, June) Annual North American Conference of the Society for

Psychotherapy Research, Amelia Island, Florida and from a paper

published in Psicologia: Teoria, Investigao e Practica, Portugal.

Running Head: A METAPHOR ANALYSIS

Abstract

A METAPHOR ANALYSIS 2

This paper examines the use of “burden” metaphors relating to the experience of depression in one good and one poor outcome process-experiential short-term psychotherapy dyad. Burden-metaphors are meaningful as they appear to characterize the way these clients experience the course of their depressions (e.g., Korman & Angus, 1996). Understanding how these experiences are dealt with in productive therapies, as compared to less-productive treatments, can aid in therapist training and in developing therapeutic programmes for depressed clients. The Experiencing Scale (Klein, Mathieu, Gendlin & Kiesler, 1970) and the Narrative Process Coding System (Angus, Hardtke & Levitt, 1996) are used to examine the processes at play when burden-metaphors are used in the good and the poor therapy. Results indicate that, in the good outcome dyad, metaphors of “being burdened” were transformed into metaphors of “unloading the burden” over the course of the therapy, while there was no transformation evident in the poor-outcome dyad. The good outcome therapy tended to have a higher level of experiencing when discussing burden-metaphors, in comparison with the poor-outcome therapy. Furthermore, the successful dyad tended to more often use internal narrative sequences (as identified by the NPCS) in the exploration of metaphoric expression.

A metaphor analysis in the treatment of depression:

A METAPHOR ANALYSIS 3

“The process of unloading burden”

In psychotherapy, irrespective of therapy outcome (Angus, 1996) or

of the therapeutic modality employed by the therapist (Angus, 1984;

McMullen, 1985), clients have been found to use metaphors extensively.

These expressions can function to facilitate insight, to provide new

solutions and to enhance communication and working alliance. If

psychotherapy is seen as a quest for clients to make sense of themselves

and their histories (Siegelman, 1990), then in this process of exploring and

reconstructing a life story, clients can be seen as searching for more

coherent and encompassing personal metaphors.

Metaphoric language is a tool that we use automatically to better

express our experience of ourselves and our world. According to Lakoff

and Johnson (1980), aside from providing a fresh or new understanding,

metaphors also structure our thoughts and actions. They define metaphor

simply as “understanding one thing in terms of another” (p.3). For

instance, in the statement “she is as sharp as a tack,” not only is the

conceptual idea of intelligence expressed, but also a visual and tactual

imagery adds a more vivid level of understanding. Due to the different

layers of sensory and informational meanings, metaphors are more likely

A METAPHOR ANALYSIS 4

to evoke an experiential response in the listener than the relaying of an

adjective alone. Furthermore, at times, metaphors can more accurately

capture the quality of an emotion than an adjective or an emotional label.

Apart from aiding in expression, metaphors can serve several

functions during psychotherapy. They may facilitate (e.g., Strong, 1989;

Barlow, Polio, Fine & Polio, 1977), provide novel avenues of self growth

and suggest new solutions (McMullen, 1985; Strong, 1989; Berline, Olsen,

Cano & Engel, 1991) as well as enhance the communication between the

client and the therapist by introducing new experiential terminology into

the session (Angus & Rennie, 1988; Huckins, 1992; Ingram, 1994;

McMullen, 1985; Rasmussen & Angus, 1996, 1997).

While much has been written about the function of metaphor and

it’s numerous manifestations, relatively few empirical studies have been

undertaken in the context of sequential therapy sessions. Most of the

research literature (e.g., Angus & Rennie, 1988; McMullen & Conway,

1994) consists of single sessions or several sessions of a single case

study. Furthermore, most early studies have focused on metaphors

produced by only one of the two parties in the therapeutic relationship.

Studies of these designs are not able to examine the evolution of

A METAPHOR ANALYSIS 5

metaphors over the course of therapy. Additionally, researchers such as

McMullen (1985; 1988; 1994) and Angus (1993; Angus & Rennie, 1988;

1989; Angus & Rasmussen, 1996; 1997) have recently been calling for the

addition of intensive qualitative analyses of metaphor expression in

psychotherapy to supplement and enhance quantitative analyses by the

generation of heuristic models of metaphor functions in psychotherapy.

Findings from qualitative analyses of metaphoric expression in

psychotherapy have indicated that successful clients tend to use their own

and their therapists’ metaphors to represent inner and personal

experiences throughout the therapeutic relationship, while unsuccessful

clients tend to use their own metaphors to represent external experiences

and they do so mainly in the early stages of therapy (McMullen, 1985). A

series of qualitative studies intensively exploring metaphor episodes in

psychotherapy sessions have consistently found that both cliche and

novel metaphors have profound experiential impact and experiential

meaning for clients and therapists alike (Angus & Rennie, 1988; Angus &

Rennie, 1989; Rasmussen & Angus, 1996; Rasmussen & Angus, 1997).

In addition, clients in successful psychotherapies develop a core

metaphorical theme related to the main issues of the therapy. In contrast,

A METAPHOR ANALYSIS 6

clients in unsuccessful therapeutic relationships use figurative language

to describe external experiences which are unrelated to the major theme

of therapy (Angus, 1996; McMullen, 1989). Moreover, personal change

for the successful clients has been found to be reflected in the figurative

phrases which were used in therapy, such that their phrases are more

often optimistic or change-oriented (McMullen, 1985).

Korman (1995; Korman & Angus, under review) intensively

analyzed sequential therapy sessions of two good-outcome brief

experiential therapy dyads in which both clients were being treated for

moderate depression. It was found that a core set of metaphorical themes

predominated throughout the sessions with “carrying a heavy burden” as

one core theme common to both clients. Metaphor phrases were sorted

into subgroupings, (i.e., “burden” metaphors were divided into “burdened”

and “unloading” subgroupings). The researchers found that the

predominance of the metaphor theme subgroupings shifted over the

course of the therapeutic relationship. That is, as the good outcome

therapies progressed, both clients increasingly used “unloading”

metaphors as opposed to “burden” metaphors which were more common

at the beginning of the therapies. These metaphors appeared to

A METAPHOR ANALYSIS 7

symbolize the clients’ changing experiences of depression, and to

correspond with their self-reports of improvement.

Although Korman and Angus (under review) highlighted how

metaphors can shift over the course of therapy, they did not explore how

this change occurred in the context of the therapeutic discourse, it did not

explore how this change occurred and did not investigate the differential

change processes which may be present in poor versus good outcome

therapies. The present study was designed to address this gap.

Present Study

The present study involves the application of two process

measures, the Narrative Process Coding System (NPCS; Angus, Hardtke,

& Levitt, 1996) and the Experiencing Scale (Klein, Mathieu, Gendlin,

Kiesler, 1970), to discourse units (narrative sequences) which include

metaphors relating to themes of “burden” (or, for the sake of brevity,

“metaphored-sequences”) in one good and one poor-outcome process

experiential dyad.

The process-experiential approach to psychotherapy combines

various aspects of client-centered and gestalt approaches (Greenberg,

Rice & Elliott, 1993). It focuses on clients’ present experience and

A METAPHOR ANALYSIS 8

expression in order to facilitate emotional change and experiential

processing. Active interventions are used including empathy work, such

as Gendlin’s (1979) focusing, and process-directive techniques, such as

gestalt two-chair exercises and the evocation and intensification of

emotion.

The purpose of the present study is to develop an understanding of

how “burden” metaphors were used in a productive therapy, in contrast

with the less successful approaches, as well as to further explore how

metaphors may be used as markers of client change in psychotherapy.

For this study, frequency of metaphoric phrases are not being used as a

measure of outcome (a battery of client-rated outcome measures are

employed for this purpose) but rather the relationship between the

occurrence of metaphor phrases and therapy outcome will be examined.

Since little is known about how metaphors evolve over the course of

therapy, this investigation is exploratory in nature with the goal of

developing grounded hypotheses for future analyses.

Method

Participants

Therapists

A METAPHOR ANALYSIS 9

The two process-experiential therapy dyads used in this study were part

of the National Institute of Mental Health study on depression directed by Dr.

Leslie Greenberg at York University, Toronto, Canada (Greenberg & Watson,

1998). The female therapist involved in the good outcome dyad was a PhD level

clinical psychology graduate student who had undergone extensive training in the

process-experiential approach. The male therapist involved in the poor outcome

dyad was a PhD level graduate student who had over 10 years of experience as a

clinician in private practice. Both therapists had been supervised by Dr.

Greenberg, the founder of process-experiential therapy.

Clients

Clients were self-referred from the community in response to

advertisements seeking clients for a depression study. After a phone interview

and two 2- hour assessment interviews, they were offered free psychotherapy in

exchange for their participation in the research study. Eighty participants were

included in the depression study based on the following criteria: a) they

scored more than 50 on the Global Adjustment Scale (American

Psychological Association, 1987); b) they presented a target complaint or

unresolved interpersonal problem issue; and c) they were classified with

the DSM-IIIR criteria as having a major depressive episode. Excluded

A METAPHOR ANALYSIS 10

from the study were individuals who were either currently in therapy,

receiving psychiatric medication, and/or identified as posing high suicidal

risk. Participants consented to having all therapy sessions audio and

videotaped and were told that they could retract from the study at any

time. In order to ensure confidentiality, initials were used in all transcribed

sessions to identify clients.

The client in the good outcome dyad was a woman in her early thirties,

while the client in the poor outcome was a male in his early sixties. Both were in

brief process-experiential therapy. The good outcome client participated

in 15 sessions (although as one session was not taped properly this dyad

was treated as a 14-session therapy), while the poor outcome client had

19 sessions of therapy. Both of these clients were married with two

children. Both of these clients indicated depression, insecurity and

difficulties in relationships with family members as their target complaints

at the onset of therapy, so similarity existed in terms of their self-identified

complaints.

These clients were selected for this study in order to examine how

metaphors may develop and interact with therapeutic processes within an

exemplary therapeutic dyad when compared with a less productive dyad.

A METAPHOR ANALYSIS 11

The successful outcome dyad selected for this study showed the most

improvement between the pre- and post-therapy outcome measures while

the poor outcome dyad showed the least improvement of all the clients

participating in this study.

Transcripts

The therapy sessions were recorded and then transcribed

according to Mergenthaler and Stinson (1992) guidelines for transcribing.

These guidelines incorporate the notation of silences, emphasis and

interruptions within the sessions. Each therapy session was

approximately 50 minutes in length.

Measures

Outcome Measures

Standardized client-report measures were used to evaluate therapy

outcome. Pre-therapy and post-therapy client ratings on the Beck Depression

Inventory (BDI; Beck, Ward, Mendelson, Mock & Erbaugh, 1961), the Symptom

Check List-90, (SCL-D; Derogatis, 1983), the Inventory for Interpersonal

Problems (IIP; Horowitz, Rosenberg, Baer, Ureno & Villasenor, 1988), the

Rosenberg Self-Esteem Scale (RSE; Rosenberg, 1965) and the Target Complaints

(Battle, Imber, Hoehn-Saric, Stone, Nash & Frank, 1968) were compared in order

A METAPHOR ANALYSIS 12

to identify the therapies as either a good or a poor outcome.

The good outcome client had the highest improvement rate of all

the clients in the process experiential group. Her BDI ratings shifted from

a score of 25 during pre-therapy evaluation to a post-therapy score of 3;

her SCL-D ratings shifted from 2.75 to .46; her IIP ratings changed from

1.31 to .78; and her RSE ratings changed from 20 to 33 (where a higher

score indicates higher self-esteem). In contrast, the poor outcome client

had the lowest improvement rates of all the clients in the process

experiential group. His BDI ratings shifted from a pre-therapy score of 15

to a post therapy score of 13. Little improvement was evident on other

measures as well. His SCL-D ratings changed from 2.15 to 1.23; his IIP

ratings changed from 1.58 to 0.91; and his RSE ratings did not change

and remained at 15 at the end of therapy.

The Experiencing Scale

The Experiencing Scale (Klein, Mathieu, Gendlin & Kiesler, 1970) is

a measure of the clients’ emotional involvement in therapy. It examines

the construct of "experiencing" which is defined as "the extent to which

inner referents become the felt data of attention, and the degree to which

efforts are made to focus on, expand, and probe those data" (Klein,

A METAPHOR ANALYSIS 13

Mathieu-Coughlan & Kiesler, 1986, p. 21). The Experiencing Scale is

derived from Gendlin's experiential theory and Roger's client-centered

theory and is one of the first widely used therapeutic process measures

(Hill & Corbett, 1993).

Klein, Mathieu-Coughlan & Kiesler (1986) reviewed the literature on

this measure, and concluded that Experiencing is related positively to

high-quality therapist interventions from different forms of therapy (i.e.,

client-centered, gestalt and psychodynamic approaches). They also found

Experiencing to be associated with final therapeutic outcome, especially

when considering the degree of change in Experiencing or when

examining Experiencing within the later sessions of treatment.

The Experiencing Scale has seven levels of client functioning. It

evaluates clients' ability to explore their inner state and their ability to be

guided by an inner referent. The first three levels of this scale reflect an

increasing connection to emotional states within the therapy discourse

(e.g., “The family went to the beach” is at level 2, whereas “I enjoyed

playing volleyball with my friends” is at level 3). A shift takes place at the

fourth level where an examination and exploration of emotional experience

becomes the focus of clients’ discourse (e.g., “I just felt really

A METAPHOR ANALYSIS 14

comfortable, happy and content with my friends” is at level 4). Levels five,

six and seven reflect the identification, exploration and resolution of issues

relating to the clients' experiential state (e.g., “I wonder why I don’t usually

feel so happy” could begin level 5 exploration which could lead to “Now I

understand why I rarely let myself be happy in any situation” in level 7

discourse). In terms of applying the Experiencing Scale, units of transcript

are assigned one modal rating (the most frequent Experiencing level

within a unit), and one peak rating (the highest Experiencing level within a

given unit).

Narrative Process Coding System

Angus, Hardtke, and Levitt (1992; 1996) have developed a method

of examining the similarities and differences between approaches to

therapy. Psychotherapeutic discourse is conceptualized as being

composed of three narrative process codes: external or story-telling

sequences (e.g., “My mother told me a horrible story yesterday, it was

about...”); internal or emotion-related sequences (e.g., “Sadness just

wells up in me. I hate hearing about other people in pain...” ); and

reflexive or self-analytic sequences (e.g., “It seems that I’d rather run

away and not listen, just like my father used to do”). This generic,

A METAPHOR ANALYSIS 15

comprehensive classification system, derived from research on several

therapeutic approaches, can provide sequences upon which process

measures can be applied and contrasted (Angus & Hardtke, 1994; Levitt &

Angus, under review). The smallest units in the system must include at

least four complete sentences, in order to provide enough data to be

meaningfully rated, the average narrative sequence in the NPCS system

has been found to be 30 sentences in length (Levitt, 1993; Hardtke, 1996).

Each narrative process sequence type is seen as an important part

of the therapeutic process common to all therapies (Angus, Levitt &

Hardtke, under revision). The NPCS was developed as a method both to

unitize text into segments which can be easily rated on many process measures

and to categorize text into topic and narrative process. Angus and Hardtke

(1994) and Levitt & Angus (under review) argue that the NPCS is an

empirical method to reliably identify discourse units which can be used

across different therapeutic modalities.

A previous study (Levitt & Angus, under review) has examined the

Experiencing Scale in relation to the three narrative sequence types,

finding highest levels of Experiencing in Internal narrative sequences,

followed by Reflexive then External narrative sequences. This study did

A METAPHOR ANALYSIS 16

not target the usage of metaphors within these therapies, however, but

examined Experiencing in relation to all narrative sequences in selected

sessions.

Interrater agreement

To validate the Experiencing ratings in this study, the rater of this

study, using three randomly selected therapy sessions (69 narrative

sequences). An independent rater rating these same sessions achieved

an overall percentage agreement level of 96% for modal ratings and 80%

for peak ratings with an independent rater.

NPCS ratings were validated by comparing codings on an entire

therapy session of the good outcome dyad (36 narrative sequences). This

study’s rater and an independent rater achieved an inter-rater agreement

Kappa level of 71.5, while ratings with a second independent rater

achieved a Kappa level of 71.8 using this same session.

Procedure

Metaphor Analysis

Metaphors were identified using Lakoff and Johnson’s inclusive

definition, that being “the understanding of one thing in terms of another” (1980,

A METAPHOR ANALYSIS 17

p. 3). Metaphors initiated by either the client or therapist were identified. Inter-

rater reliability on the identification of metaphors in two therapy sessions

achieved an agreement level of 87%. The two raters identified a total of 365

metaphors in these sessions.

In this study, the “burden” metaphor theme was selected as it was found to

capture an essential element of the client experience of depression (Korman &

Angus, under revision). All metaphors were identified in both the good and the

poor outcome therapies. Once it was established that the good and poor dyads

shared the theme of “carrying a heavy burden” the analysis was focused on that

theme. Only those metaphors which were agreed upon by two of the researchers

to have a “burden” theme were included in the study.

Metaphors were identified as either having a “burdened” or “unloading”

quality, in correspondence with the findings from the Korman and Angus study

(under review). The good-outcome dyad examined in the present study was one

of the dyads analyzed in the Korman and Angus study. The following table lists

provide examples of burdened and unloading metaphors.

_____________________

Insert Table 1 about here

_____________________

A METAPHOR ANALYSIS 18

The Application of Process Measures

The NPCS was applied to the transcripts to identify the narrative

sequences in which metaphors were embedded. All sequences were assigned a

narrative code: external, internal or reflexive. The Experiencing Scale was then

applied to the narrative sequences such that each sequence received a modal and

peak rating on both scales. Chi-square analyses and analyses of variance were

employed to examine the usage of metaphors in the good and poor outcome

therapy in relation to narrative code and experiencing. Statistical consultation

was provided by the Institute of Social Research, York University.

Results

Frequency of Metaphors

In the good outcome therapy (14 sessions), there were 52 “burden”

metaphors. Twenty-one (40%) of these metaphors were introduced by the

therapist and 31 (60%) were introduced by the client. In the poor outcome

approach (19 sessions) there were 46 burden metaphors, equally divided between

the therapist and the client. A chi-square analysis of variance indicated that the

difference in the number of metaphors introduced by therapist versus by client in

each dyad was non-significant (χ2 =.91, df(1), p=.34). “Burden” metaphors were

A METAPHOR ANALYSIS 19

found in an equal number (13) of sessions from the two therapies.

Content Assessment

The metaphors in the good outcome therapy were found to evolve from an

emphasis on the experience of “carrying a burden” in the initial sessions to the

experience of “unloading the burden” in later sessions (Korman, 1995; see Figure

1). As the client in this therapy made progress in terms of realizing that she was

not responsible for the behavior of others around her, she began to feel relieved of

her depression.

In contrast, the poor outcome dyad had no such pattern (see Figure 2).

Although metaphors of weight or heaviness continued throughout the therapy and

the client would occasionally use metaphors of unloading, these were often in a

wishful tone rather than as an expression of ongoing relief (e.g., “I wish I could

get this off my back” versus “I feel like a burden has been lifted from me”). The

expression of burden in these two dyads did seem to mirror their respective

outcomes and to symbolize the clients’ struggle with their depression.

A Comparison of NPCS Sequence Types and Psychotherapeutic Outcome

In the good outcome therapy, 32% of the metaphor sequences were found

in internal narrative sequences, 67% were in reflexive narrative sequences and no

“burden” metaphors appeared in external narrative sequences. In the poor

A METAPHOR ANALYSIS 20

outcome therapy, 15% of the “burden” metaphors were in internal sequences,

65% were in reflexive sequences and 20% were in external sequences. A chi-

square test indicated that there was a significant difference in the types of

narrative sequences in which the “burden” metaphors were embedded when

comparing the two outcomes (χ2 = 13, df = 2, p<.001).

It appears that in the good outcome therapy, “burden” metaphors were

used when the client was attuned to her emotional state (as indicated by the

proportion of internal narrative sequences) in comparison with the poor outcome

dyad. Metaphors in the poor outcome were more frequently used during story-

telling or illustrative purposes (as indicated by the external narrative sequences)

and were much less frequently used during emotion states. In both dyads,

metaphors were most frequently used when the clients were assessing or

analyzing their experience (as indicated by the reflexive sequences). These high

proportions may point to the basic nature of therapy as a meaning-making task

(see Rennie, 1992) and to the use of the metaphor as congruent with this purpose.

When all sequences were examined (i.e., the comparison of the entire two

therapies) results found were similar to the comparison of the two therapies from

the analysis of “burden” metaphor sequences alone. Specifically, the entire good

outcome therapy tended to be more internal and less external in the narrative

A METAPHOR ANALYSIS 21

processes used then the entire poor outcome. Moreover, both the poor and the

good outcome entire therapies had comparable numbers of reflexive narrative

sequences (69% of the poor outcome therapy and 60% of the good outcome

therapy in the entire therapies), mirroring the findings in the “burden” metaphor

analysis.

A multivariate analysis suggests that there were differences, however,

when “burden” metaphored sequences within each therapy were examined in

comparison with sequences from that entire therapy (F=3.7, df=3, p=.017).

Within the good outcome therapy, a significantly lower proportion of external

sequences (0% versus 10%; F = 39.1, df = 1,26, p = .001) and a significantly

higher proportion of reflexive sequences (67% versus 60%; F = 5.7, df=1,26, p =

.02) were found within metaphored-sequences than within the entire body of

therapy sequences. The proportion of internal sequences was relatively constant

(32% of burden-metaphor sequences and 30% of the entire therapy’s sequences).

Within the poor outcome, the proportions of external and reflexive

sequences did not change considerably when examined within “burden” metaphor

sequences alone (20% of “burden” metaphor sequences and 27% of therapy

sequences overall were external; 65% of “burden” metaphor sequences and 69%

overall were reflexive). It appeared, however, that there was a significantly

A METAPHOR ANALYSIS 22

higher proportion of internal sequences in the metaphored sequences than across

the therapy as a whole (15% versus 3%; F = 4.7, df= 1,30, p = .04).

A Comparison of NPCS Sequence Types and Metaphor Origin

No significant difference was found in the Narrative Process coding of

“burden” metaphors sequences in which the metaphor was introduced by the

therapist when compared with sequences in which the metaphor was introduced

by the client (good outcome - χ2= 3.57, df=1, p=.06) (poor outcome - χ2= 4.59,

df=2, p=.10). It appears that the narrative processes used in discussions about

burden metaphors were more characteristic of the therapy dyad rather than of the

dyad member who introduced the burden experience into the dialogue.

A Comparison of Experiencing Ratings and Psychotherapeutic Outcome

In the good outcome therapy, the mean modal Experiencing scores for

internal sequences was 3.7, and for reflexive sequences was 3.3. There were no

external sequences to be rated. In the poor outcome dyad, the mean modal rating

for the external sequences was 2.0; for internal, 3.3 and for reflexive, 2.4.

The good outcome therapy appears to have achieved higher levels of

Experiencing Scale ratings on sequences which included “burden” metaphors in

comparison with the poor outcome therapy. There were significant differences

between peak (F = 5.63, df(1,93), p=.01) and modal ratings (F= 21.02, df=(1, 93),

A METAPHOR ANALYSIS 23

p=.001) for the two therapy dyads.

A Comparison of Experiencing Scale Ratings and Metaphor Origin

In the good outcome dyad, the mean modal Experiencing rating on

sequences with therapist-originated metaphors was 3.6 and the client-originated

metaphor sequences mean modal score was 3.3. This contrasts sharply with the

poor-outcome dyad, in which the mean modal rating was 2.2 for therapist

metaphored-sequences and 2.7 for the client metaphored-sequences. In the good

outcome dyad it seems that the therapist was modeling high Experiencing, or a

strong connection with emotion, whereas in the poor outcome, the Experiencing

levels for the therapist-originated metaphor sequences were lower than that in the

client-metaphor sequences, perhaps indicating a modeling of disconnection from

emotion.

No significant differences were found when modal experiencing ratings

for sequences in which the therapist introduced the burden metaphor were

contrasted with those sequences in which the client introduced the metaphors

(good outcome - F=1.54, df (1, 47), p = .22 for modal ratings; poor outcome - F=

0.80, df (1, 50), p = .37 for modal ratings). It seems that the level of modal

experiencing in “burden” metaphor sequences was not influenced by the

originator of the “burden” metaphor. In terms of peak ratings of Experiencing,

A METAPHOR ANALYSIS 24

these ratings were significantly higher when the therapist introduced a “burden”

metaphor in the good outcome (F = 3.18, df(1,47), p = .08), while in the poor

outcome, Experiencing peak ratings were significantly higher for sequences in

which the client introduced the metaphor (F = 1.90, df(1,50), p = .047).

A Comparison of NPCS Sequence Types, Experiencing Ratings and

Psychotherapeutic Outcome

In the good outcome, internal and reflexive sequences with metaphors

were not rated significantly different in Experiencing level, for both modal

ratings, (F=1.91, df(1,50) p=.17); or for peak ratings, (F = .51, df(1,50), p = .481).

Experiencing ratings did differ significantly in the poor outcome, however, for

both modal ratings (F= 7.35, df(2,40), p=.01) and for peak ratings, (F = 7.80,

df(2,40), p.=.001), such that the Experiencing ratings were significantly higher

for internal-sequence metaphors than for metaphors occurring in both reflexive

and external narrative sequences.

When Experiencing levels in the reflexive and internal narrative sequences

within the good outcome were compared with these same sequence types in the

poor outcome, higher ratings were found in the good outcome therapy (for

reflexive sequences, F = 5.36, df(2,59), p = .007 and for internal sequences, F =

5.38, df(2,21, p = .013)). The external sequences, which have been associated

A METAPHOR ANALYSIS 25

with the lowest scores in Experiencing (e.g., Levitt, 1993; Hardtke, 1996), were

not frequent in the good-outcome therapy (Hardtke, 1996), and were not at all

present when “burden” metaphors were used. As “burden” metaphors appeared to

capture the ways these clients experienced their depressions, they tended to

invoke stronger feelings and reflexivity by their nature and therefore were not to

be found in external narrative processes.

It appears that in the good outcome dyad, Experiencing levels in

sequences with “burden” metaphors were relatively high regardless of the

narrative sequence type. In contrast, emotion was rarely integrated in the

dialogue when the poor outcome client was engaged in either reflexive or external

narrative sequences. In the good outcome therapy, the lack of external narrative

sequences with burden-metaphors highlights how this therapy intensely focuses

on emotional exploration in comparison with the poor outcome, where there is

less of an emotional focus even when the experience of burden is discussed

explicitly.

Discussion

Metaphor-theme research provides a heuristic for tracking clients’

evolution in psychotherapy. In this study, the analysis of metaphored-sequences

A METAPHOR ANALYSIS 26

seemed to differentiate the good and the poor outcome therapy dyads in two key

ways (a) the content of the metaphor phrases; and (b) the processes which

occurred when the metaphors were used, as indicated by differences in

Experiencing Scale ratings and NPCS coding. In terms of content change,

metaphors seem to be a useful marker for psychotherapeutic change, as the

“burdened” theme in the good-outcome was transformed into an “unloading”

theme, a change which was not evident in the poor outcome.

A limitation of this study results from its focus on only one dyad from

each outcome condition. Although the purpose of this study was to generate

hypotheses about the use of metaphors in psychotherapy in relation to outcome,

the therapeutic outcome variable was confounded with therapist and client

variables making it difficult to separate these causal factors. Caution should be

exercised therefore when generalizing these results to other dyads. The study

has, however, generated grounded and useful hypotheses in an area in which there

has been limited empirical research.

First, it suggests that it may be beneficial for therapists to focus clients on

the feelings embedded in their metaphors (e.g., engaging internal narrative

processes and middle levels of Experiencing) and to help clients to comprehend

the meaning or metaphors in the context of their lives (e.g., engaging in reflexive

A METAPHOR ANALYSIS 27

narrative processes and high levels of Experiencing). Second, as sequences in the

poor outcome dyad with “burden” metaphors introduced by the therapist had

lower Experiencing ratings than client-introduced metaphor sequences, while the

reverse was found in the good outcome dyad, it appears useful to explore whether

productive therapists might use metaphor in a way which may encourages

emotional-connection in contrast with less productive therapists. It would be of

interest to examine there hypotheses in a future outcome study using a larger

sample sizes, and including both good and poor outcome dyads by the same

therapist, in order to distinguish therapeutic outcome from therapist and client

variables.

As a marker of client-change, metaphor analyses can provide a targeted

method of examining shifts in client’s experience of depression, which can be

useful for therapy researchers and therapists alike. This current study indicates

that metaphor analysis can be used to track therapeutic change and can be a

powerful representation of human experience.

References

American Psychological Association. (1987). The Diagnostic and

Statistical Manual III - Revised. Washington: D.C., American

A METAPHOR ANALYSIS 28

Psychological Association.

Angus, L. E. (1996). Metaphors and the transformation of meaning

in psychotherapy. In J. Mio & A. Katz (Eds.) Metaphor: Pragmatics and

applications, (pp. 71-82). Erlbaum Press.

Angus, L. E. (1984). A review of literature on metaphor and

psychotherapy. Unpublished manuscript, York University, Toronto, Ontario.

Angus, L. E. & Hardtke, K. K. (1994). Narrative processes in

psychotherapy. Canadian Psychology, 35(2), 190-203.

Angus, L. E., Hardtke, K. K. & Levitt, H. M. (1996). The narrative

process coding system: A revised manual. Department of Psychology. York

University, North York, Ontario, Canada. Available upon request.

Angus, L. E., & Rennie, D. (1988). Therapist participation in metaphor

generation: collaborative and non-collaborative styles. Psychotherapy, 25, 552-

560.

Angus, L. E., & Rennie, D. (1989). Envisioning the representational

world: metaphoric expression in psychotherapy relationships. Psychotherapy, 26,

372-379.

Barlow, J. M., Pollio, H. R. & Fine, H. J. (1977). Insight and

figurative language in psychotherapy. Psychotherapy: Theory, Research

A METAPHOR ANALYSIS 29

And Practice, 14, 212-220.

Battle, C. C., Imber, S. D., Hoehn-Saric, R., Stone, A. R., Nash, C.,

& Frank, J. D., (1968). Target complaints as criteria of improvement,

American Journal Of Psychotherapy, 20, 184-192.

Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J.

(1961). An inventory for measuring depression. Archives Of General

Psychiatry, 4, 561-571.

Berlin, R. M., Olson, M. E., Cano, C. E., & Engel, S. (1991).

Metaphor And Psychotherapy. American Journal Of Psychotherapy, XlV,

359-367.

Derogatis, L. R. (1983). SCL-90R Administration, Scoring And

Interpretation Manual - Ii. Towson, Md: Clinical Psychometric Research.

Glaser, B. G., & Strauss, A. (1967). The Discovery Of Grounded

Theory: Strategies For Qualitative Research. Chicago: Aldine.

Greenberg, L., Rice, L., & Elliott, R. (1993). Facilitating emotional

change: The moment-by-moment process. New York, The Guilford Press.

Greenberg, L. & Watson, J. (1998). Experiential therapy of

depression: Differential effects of client-centered conditions and active

A METAPHOR ANALYSIS 30

experiential interventions. Psychotherapy Research 8(2), 210-225.

Horowitz, L. M., Rosenberg, S. E., Baer, B. A., Ureno, G., &

Villasenor, V. S. (1988). Inventory of interpersonal problems:

Psychometric properties and clinical applications. Journal Of Consulting

And Clinical Psychology, 56, 885-892.

Huckins, B. A. (1992). Metaphor, psychotherapy, and

transformative experiences: Exploring relationship. Smith College Studies

In Social Work, 62(3), 229-243.

Ingram, J. L. (1994). The role of figurative language in

psychotherapy: A methodological examination. Metaphor And Symbolic

Activity, 9(4), 271-288.

Klein, M. Mathieu, P., Gendlin, E., & Kiesler, D. (1970). The

Experiencing Scale: A research and training manual (Vols. 1 and 2). Madison,

WI: Wisconsin Psychiatric Institute, Bureau of Audio Visual Instruction.

Korman, Y. (1995). Freezing to melting: Metaphor themes in good

outcome psychotherapy. Honours Thesis. Department of Psychology, York

University, North York, Ontario, M3J 1P3.

Korman, Y. & Angus, L. E. From losing to winning: An inductive analysis

A METAPHOR ANALYSIS 31

of metaphor themes in psychotherapy. Manuscript under review.

Lakoff, G. & Johnson, M. (1980). Metaphors we live by. Chicago: The

University of Chicago Press.

Levitt, H. (1993). A comparative analysis of the Narrative Process Coding

System and three standardized psychotherapy process measures: A multi-modal

analysis. Masters Thesis. Department of Psychology, York University, North

York, Ontario, M3J 1P3.

Levitt, H. M. & Angus, L. E. A response to the unit-question: The

narrative process coding system. Manuscript under review.

McMullen, L. (1985). Methods for studying the use of novel figurative

language in psychotherapy. Psychotherapy, 22(3), 610-619.

McMullen, L. (1989). Use of figurative language in successful and

unsuccessful cases of psychotherapy: Three comparisons. Metaphor and

Symbolic Activity, 4(4), 203-225.

McMullen, L. M., & Conway, J. B. (1994). Dominance and

nurturance in the figurative expressions of psychotherapy clients.

Psychotherapy Research, 4(1), 43-57.

Mergenthaler, E. & Stinson, C. (1992). Psychotherapy Transcription

Standards, Psychotherapy Research, 2(2), 125-142.

A METAPHOR ANALYSIS 32

Polio, H. R., Barlow, J. M., Fine, H. J. & Polio, M. R. (1977).

Psychology

And The Poetics Of Growth: Figurative Language In Psychology,

Psychotherapy, And Education. Hillsdale, N.J.: Lawrence Erlbaum.

Rasmussen, B. & Angus, L. (1996) Metaphor in psychodynamic

psychotherapy with Borderline and non-Borderline clients: A qualitative analysis.

Psychotherapy, 33, (4), 521-530

Rasmussen, B. & Angus, L. (1997) Modes of interaction in psychodynamic

psychotherapy with Borderline and non-Borderline clients: A qualitative

analysis. Journal of Analytic Social Work. 4 (4) 53 -63.

Rennie, D. L. (1992). Qualitative analysis of the client’s experience of

psychotherapy: The unfolding of reflexivity. In D. L. Rennie & S. G. Toukmanian

(Eds.), Psychotherapy Process Research: Paradigmatic and Narrative Approaches.

Newbury Park, CA: Sage Publications.

Rennie, D. L., Phillips, J. R., & Quartaro, G. K. (1988). Grounded

theory: A promising approach to conceptualization in psychology?,

Canadian Psychology, 29(2), 139-150.

Strong, T. (1989). Metaphors and client change in counseling, International

Journal For The Advancement Of Counseling, 12, 203-213.

A METAPHOR ANALYSIS 33

Table 1

__________________________________________________________________

BURDENED

You’re weighing me down

Carrying around this great big lump in my chest

My heart feels heavy

I have all this personal baggage

The weight of the world is on my shoulders

UNLOADING

Dumping some of it

I feel like things are getting lighter

Getting it off my back

The pressure has lifted

__________________________________________________________________

Psychology Department Rm. 258 Behavioural Science Building York University North York, Ontario M3J 1P3 December 19, 1996 Departmental de Psychologia Universidade do Minho Campus de Gualtar 4700 Braga, Portugal Dear Oscar,

A METAPHOR ANALYSIS 35

Hello! Thank you for asking us to participate in this special issue with you. I have enclosed a revision of the article that was presented at SPR last summer, entitled, A metaphor analysis in a good and a poor outcome treatment of depression”: “Unloading burden” versus “Being burdened”. Statistics have been added, as well as a more thorough literature review and discussion section. Please let us know if any questions arise in the translation process.

I hope that all is going well with you and that you have had a happy Channukah (and didn’t get too rain-soaked on the way to synagogue) and that you enjoy your New Year. I look forward to seeing you at a later SPR! Sincerely, Heidi Levitt Psychology Department Rm. 258 Behavioural Science Building York University North York, Ontario M3J 1P3 December 19, 1996 Department of Psychology University of Tennessee Knoxville, TN 37996-0900 Dear Dr. Pollio,

Enclosed are three copies of an article entitled, “Relieving a heavy burden”: The use of metaphor in a good and a poor outcome psychotherapy, being

METAPHOR ANALYSIS 33

submitted for review for publication in “Metaphor and Symbolic Activity”. Each of the authors of this paper can be contacted through the above York University address. I can be reached at (416) 656-4022 or through my e-mail address which is levitt@yorku.ca.

We look forward to hearing from you.

Sincerely, Heidi Levitt

Korman & Angus (under review) study shifts in subcategories comprising metaphor themes appeared to markers of conceptual shifts in clients view of self and others in good outcome brief experiential psychotherapy. Department of Psychology 118 Kent Hall Kent State University Kent, Ohio 44242, USA Dear Dr. Dowd,

Enclosed are two copies of our article entitled, A metaphor analysis in treatments of depression: “The process of unloading burden.” We were glad to receive the suggestions your reviewers offered and to improve our paper prior to the third review. Thank you for this opportunity. We now have addressed the concerns of the initial reviewers and have shortened our paper substantially.

On of the reviewers indicated a concern that readers would not be aware of our broader definition of metaphors in relation to the debate over the impact of frozen versus novel metaphors. To address this we have included our definition of metaphor and cited Lakoff & Johnson (1980). As well, we have cited a series of studies which have found both novel and cliche metaphors to have profound experiential impacts and conceptual meanings for both clients and therapists.

METAPHOR ANALYSIS 33

In terms of addressing our subject selection, we have now explicated our rationale to select the best and worse outcome subjects in terms of examining variation in metaphor development in productive and unproductive psychotherapy. In terms of matching characteristics, we have added a description of how the subjects’ target complaints matched, in addition to our explanation that both were experiencing a moderate major depression (DSMIII-R major depression, with a GSI > 50).

We have adjusted the discussion section to better reflect the exploratory nature of our findings, focusing on hypotheses for future research. Brief examples of the levels of the process measures used have been inserted to help provide a concrete sense of how actual therapy transcripts might be rated. We have also clarified the way the Experiencing Scale ratings were applied (one mode and one peak rating per unit).

In terms of our analysis, we used chi-square analyses to examine the discrete data and analyses of variance to analyze the continuous and ordinal variables generated from the Experiencing Scale. We have clarified our usage of these statistics. When examining the relation between discrete data and ordinal data we have chosen to use multivariate analyses as these are robust tests which control well for Type I error.

In order to keep the length of the article in check, we did not elaborate on the the development and theoretical origins of the Experiencing Scale (a widely used process measure) and the Narrative Process Coding System. Instead we have provided references which have information about the development and validity of these measures to which the reader can refer and we have included the interrater reliability ratings from our own study which support our use of these measures.

Thank you again for inviting this revision. Please note that the address of the first author has changed and forward further correspondence to the address above. This process has allowed us to clarify our study and produce a more concise manuscript. We look forward to reading the third reviewer’s response and to hearing from you.

METAPHOR ANALYSIS 33

Sincerely, Heidi Levitt

Figure Captions Figure 1. Content assessment of “burden” metaphors in the good outcome dyad:Changes

METAPHOR ANALYSIS 33

in the frequency of metaphor subcategories across therapy. Figure 2. Content assessment of “burden” metaphors in the poor-outcome dyad: Changes in the frequency of metaphor subcategories across therapy.