Introduction (To give context within the portfolio)
The purpose of this literature review is to examine metaphor in the context of psychotherapy. This piece seeks to give a broad overview of the importance of metaphor, metaphoric cognition and how metaphor is used in psychotherapy. This piece also highlights the specific techniques used in metaphor therapy to inform their translation into a virtual environment.
Metaphor
Metaphor is defined by Lakoff and Johnson as “...understanding and experiencing one kind of thing in terms of another.” [1]. For many, metaphor is restricted to linguistic or poetic bounds and is not present in daily life. However, the origin of the word itself from Latin and Greek, Metaphora meaning “to transfer”, suggests a broader understanding of metaphor [4]. Similarly, Lakoff and Johnson’s conceptual metaphor theory proposes that metaphor is essential to our understanding of the world around us [1]. They argue that our conceptual system of thinking structures how we perceive the world, what we think, and how we act. Perhaps more importantly, Lakoff and Johnson suggest that our conceptual system is fundamentally based on metaphor. For example, as a culture we largely conceptualize argument as war [1]. This shapes how we think and act within argument, such as the idea that there must be a winner and we must attack the opposing side.
Curiously metaphor largely exists in the background of our lives. We tend not to analyze the range of metaphoric conceptualization we use and the various categories these metaphors exist in. Although this is not a comprehensive review of all forms of metaphor, examining those especially relevant to psychotherapy helps elucidate their importance in this context.
Given that psychotherapy is a traditionally verbal exercise, it is important to understand the types of verbal metaphor. Bayne and Thompson suggest that there are three primary types of spoken metaphor: living, dying and dead [2]. Living metaphors are newly formed in the context of historical use. They give new awareness to many when used and often induce feelings of surprise through new mental imagery [2]. Dying metaphors are those that are on the verge of becoming cliche and produce weaker mental imagery than living metaphors. Finally, dead metaphors are those that are cliche and have lost their original imagery completely. Dead metaphors only infer meaning in the literal sense of their use such as “deadline” [2]. Dead metaphors have lost all or the vast majority of their original mental imagery. In the case of “deadline”, the original imagery comes from a line on the prison yard in which prisoners were taken to be executed. Such imagery is clearly lost when “deadline” is used to refer to a terminating date.
Also especially important to psychotherapy are orientational metaphors. These metaphors are more scoping than living or dead metaphors. Orientational metaphors seek to “organize a whole system of concepts to one another” [1]. For example, one of the most predominant metaphors with relation to psychotherapy is the up/down orientational metaphor. At its most basic, this refers to happy as up and sad as down [1]. Other orientational metaphors include, up as conscious and down as low conscious. This metaphor appears as active speech such as “waking up” and “falling asleep” [1]. Similar orientational metaphors relevant to psychotherapy are health as up and sickness as down, as well as high status as up and low status as down. In most of these examples, there is a physical basis for orientation such as in illness being down as we often must lay down when ill. The physical basis for metaphor warrants further examination of the concept of embodiment, especially as it pertains to health.
Metaphor and Depression
Given the high national prevalence of depression and the importance of metaphor in our lives, this section focuses on historical and conventional metaphors for depression [8]. Historically, the modern understanding of the experience of depression was referred to as “melancholia” [3]. Thought to have been caused by a buildup of black bile in the body that rises from the stomach to the brain, melancholia is historically conceptualized as a clouding of thought, consciousness and judgment [3]. The emergent historical metaphor for melancholia became the idea that it is a state of darkness. Other historical metaphors of depression include being weighed down as well as being slowed down. The former persists today as the idea that the mind and body are weighed down. This was historically seen in writing as a slumped posture. Similarly, depression as being slowed down was based on an early concept that the bodily functions followed hydrodynamic flow and motion. Slowing of this flow represented depression and thus the language use surrounding it [3]. Unlike others, depression as slowed down has modern evidence through the concept of “psychomotor retardation” which can contribute to slowed speech and decreased movement in individuals with depression [13].
Other early metaphors for depression find their roots in cultural phenomena and judgments. One prominent example is the idea that depression involves a descent to a gloomy or hell like landscape. This concept has roots in religious thought that individuals with depression were “ sinners [or] souls deserted by God” [3]. Though this metaphor has roots in religion it still persists in language use today. Other prominent culturally driven metaphors of depression involve a judgement of being low or underachieving. Related to others, those suffering from depression are judged as failing to achieve what is expected of them. Language use surrounding this is of low value or low status, similar to individuals who are homeless or even athletes that fail to perform [3].
Empirical research to discover conventional metaphors of depression from therapeutic conversation drives understanding of client metaphors for depression. One such study examined data from 21 clients across 471 audio recorded therapy sessions . From these recordings four metaphors emerged, depression is darkness, depression is weight, depression is captor, and most commonly, depression is descent [3]. Depression as darkness is described by one participant in the study as “it [depression] is just like it is not even me. It’s just like it is a cloud that comes over and ists over me and overcomes me and it’ll stay there awhile and then it goes away” [3]. This suggests that the darkness is external and not controlled by the individual. It looms to pass later independent of action by the individual. The second metaphor, depression as weight, is more literal, described as “I was just like, I was carrying a loud around… just heavy”. The third metaphor depression is captor personifies the experience. Described by one participant as “ When I get depressed, I just am immobilized”. Similar to depression is darkness, the individual does not feel control over the situation. Finally, the most prominent metaphor from the study was that depression is descent. This refers back to Lakoff and Johnson’s orientational metaphor categorization [1]. One participant describes their experience as “I made efforts to pull myself out of that… I made efforts to climb out” [3]. In this case, depression is spoken of as a sense of movement in physical space. This movement goes from a higher to lower position and simultaneously involves a great deal of effort from the individual to ascend. It is not just a constant descent but a process that has a “floor” and requires immense action and effort to escape from this low place.
Despite finding a common theme in metaphoric language use, therapists in the previously mentioned study did not emphasize client language in their sessions. The authors extend this inattention to a societal phenomenon that widespread use of the phrase “feeling down”, as in the descent metaphor, results in large cultural indifference for the details of depression [3]. Depression as a word also has widespread use outside of psychology such as economic depression, further devaluing and desensitizing our attention to the suffering it entails. Attention to language use regarding depression needs improvement both inside and outside of clinical environments.
Embodiment and Metaphoric Cognition
Almost all of the previously mentioned metaphor categorizations are considered “conceptual metaphors” or “mental metaphors” [1][9]. These metaphors map from source to target domains, where the source is generally more concrete and can be experienced through senses such as touch for warmth and the target is something more abstract such as affection [9]. Distinct from this is the idea of an embodied metaphor. Embodiment draws its roots in cognitive science and primarily refers to Barsalou’s theory of embodied cognition that suggests thinking requires simulations of bodily experiences [10]. Barsalou suggests experiences are broken down into discrete inputs such as the sight of a car, the smell of its exhaust and the sound of its engine. These inputs are processed by the brain in corresponding areas such as the visual cortex and the auditory cortex [9]. Once inputs are processed, they are combined in neural “convergence zones” that store schematic information of the experience in long term memory, which Barsalou calls “simulators ”[10]. Once an individual has this information encoded, the simulators are referenced when thinking about the experience, drawing back upon the bodily sensations of the original experience [10]. In this process, cognition is considered embodied and as such, for a metaphor to be considered embodied the corresponding neural processes must be present.
Barsalou’s theory does explain perceived concepts quite well but abstract concepts such as metaphors do not necessarily fit within the embodied theories. In cases of abstract concepts that we cannot perceive and thus “simulate” by Barsalou’s theory, there is minimal evidence for embodiment [9]. Many researchers claim to have support for embodiment of metaphors, particularly orientational metaphors but fail to satisfy the neural processes proposed by Barsalou. For example, one of the earliest studies to examine this phenomenon had students estimate the halfway point of a square after receiving news that they either failed or passed an exam. The experiment concluded that positive affect resulted in higher estimation of a horizon point than the low affect (failing exam) group [11]. This experiment is one of many that attempts to show a physical dimension of the up/down orientational metaphor also referred to as space-valence associations [9]. One explanation for such results is habitual modeling of bodily posture, but this still does not meet Barsalou’s neural simulation model [9]. Despite the apparent lack of empirical evidence for embodied metaphor in research, physical connection to abstract concepts and metaphoric language seems to still exist. Physical basis of metaphor and abstract cognition remains a controversial albeit important topic for future research.
Other theories of abstract cognition include the work of leading metaphor therapist Dr. Richard Kopp. Kopp suggests there are three primary forms of cognition that relate to metaphor, logical/propositional, imaginal and metaphoric [5]. The first, logical or propositional cognition, which allows for processing of logical statements from premise to conclusion. For example, syllogisms such as, all people are mortal, socrates is a mortal, therefore, Socrates is a mortal..This form of cognition is a popular target for change in cognitive therapy in which dysfunctions in this logical thought are targeted and transformed. The second form of cognition proposed by Kopp is imaginal cognition. With this, images themselves are considered a form of cognition. Relationships between concepts are represented visually in an individual’s mental imagery. For example, the phrase, the dog is on the couch, represents a relationship between the dog and a couch as well as mental imagery of the situation. Finally, Kopp proposes metaphoric cognition, which combines the prior propositional and imaginal cognitive models. Metaphoric cognition is presented through verbal metaphors, “in which an image is employed as a word to convey meaning” [12]. A common example of metaphoric cognition is in client generated language of depression, such as “I feel like I am drowning”. In such an example, Kopp suggests that logic is found in the analogy while inviting imaginal relationships between depressive symptoms and the imagery of drowning. Kopp focuses on these three forms of cognition as a basis for cognitive therapy, in which the metaphoric language used by a client can be a target for sustained change. Kopp proposes metaphor therapy as a perspective on existing therapeutic techniques that focuses on metaphoric cognition [5].
Metaphor Therapy
Kopp’s metaphor therapy is proposed as a new perspective on existing therapeutic techniques such as cognitive therapy. It emphasizes client generated metaphors brought up in therapeutic sessions, such as depression is descent [3], and transforming them to solve cognitive dysfunction or stress. Additionally, metaphor therapy can focus on early childhood metaphors that may result in developmental challenges. The primary claim of metaphor therapy is that metaphor is a central process of change for psychotherapy rather than an additional tool for a clinician to use in their normal practice [5].
Kopp’s metaphor therapy is broken into stages that a clinician can follow to gain detail into a client metaphor and help guide the transformation process. First, the therapist must notice when a client uses metaphor in their language and engage with this. Second the therapist seeks to have the client engage with the metaphoric image. Following this the therapist guides the client into descriptive language of the senses and builds a more holistic image. Finally the therapist shifts focus to feelings invoked by the imagery and metaphor. After description reaches a natural conclusion, the focus shifts to reimagination and transformation of the imagery. The therapist invites the client to freely alter the situation and then the original metaphor. Finally, the therapist guides the client to go back to the original situation and reflect on how it differs with the new metaphor as a substitute [5].
Dwairy offers an extension of Kopp’s metaphor therapy with the inclusion of biological and sociocultural factors [6]. Dwairy’s biopsychosocial model of metaphor therapy (see figure 1) makes the case that behavior can be influenced at each level (bio-psych-social) and thus metaphoric imagery is also influenced by each as well.
Figure 1: Biopsychosocial model of metaphor therapy
Dwairy suggests that a number of biological pathways influence our behavior and even metaphoric imagery. For example, those in good health tend to have more positive imagery while those poor in physical health have negative imagery [5]. The limbic system also influences imagination via neurotransmitters, further emphasizing the importance of biological correlates of behavior. Additionally, Dwairy extends the cultural context of Kopps metaphor therapy. Non-western cultures tend to base their metaphoric imagery in larger cultural myths. Dwairy suggests adding this dimension to metaphor therapy helps to more accurately guide the transformation and understanding of client metaphor. Finally, as Kopp overviews, much of the work of imagery draws upon unconscious behavior and the clients interpretation of reality. Thus Dwairy re-emphasizes the importance of deep understanding of the clients descriptive language and viewing the imagery from the perspective of the client.
Conclusion (For context within portfolio)
The role of metaphor in therapeutic outcomes and understanding the full experience of depression is quite complex. Each area discussed in this work, from metaphor to therapeutic interventions, warrants further research . This works serves as a brief overview of the multifaceted nature of metaphor and techniques for working with client imagery in psychotherapy. With this foundation, a proposed immersive virtual environment for metaphorical exploration will be developed.
Works Cited
[1] Lakoff, G., & Johnson, M. (2008). Metaphors we live by. University of Chicago press.
[2] Bayne, R., & Thompson, K. L. (2000). Counsellor response to clients' metaphors: An evaluation and refinement of Strong's model. Counselling Psychology Quarterly, 13(1), 37-49.
[3] McMullen, L. M., & Conway. J. B.(2002). Conventional metaphors for depression. In Fussell S. R. (Eds.), The verbal communications of emotions: Interdisciplinary perspectives (pp. 167-181). Taylor & Francis.
[4] Legowski, T., & Brownlee, K. (2001). Working with metaphor in narrative therapy. Journal of Family Psychotherapy, 12(1), 19-28.
[5] Kopp, R. R. (2013). Metaphor therapy: Using client generated metaphors in psychotherapy. Routledge.
[6] Dwairy, M. (1997). A biopsychosocial model of metaphor therapy with holistic cultures. Clinical Psychology Review, 17(7), 719-732
[7] Strong, T. (1989). Metaphors and client change in counselling. International Journal for the Advancement of Counselling, 12(3), 203-213.
[8] National Institute of Mental Health (2020). Prevalence of major depressive episodes among adults. https://www.nimh.nih.gov/health/statistics/major-depression.shtml
[9] Casasanto, D., & Gijssels, T. (2015). What makes a metaphor an embodied metaphor?. Linguistics Vanguard, 1(1), 327-337.
[10] Barsalou, L. W. (1999). Perceptual symbol systems. Behavioral and brain sciences, 22(4), 577-660.
[11] Wapner, S., Werner, H., & Krus, D. M. (1957). The effect of success and failure on space location. Journal of Personality.
[12] Kopp, R. R., & Craw, M. J. (1998). Metaphoric language, metaphoric cognition, and cognitive therapy. Psychotherapy: theory, research, practice, training, 35(3), 306
[13] Buyukdura, J. S., McClintock, S. M., & Croarkin, P. E. (2011). Psychomotor retardation in depression: biological underpinnings, measurement, and treatment. Progress in neuro-psychopharmacology & biological psychiatry, 35(2), 395–409. https://doi.org/10.1016/j.pnpbp.2010.10.019