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In this paper, the presenter refined the definition of interpretation as the effort to organize and formulate, in a way meaningful to the patient, previously unacknowledged patterns of psychic functioning. He indicated that metaphor and similar rhetorical devices, framed in an attitude of skepticism, deserve to be considered helpful adjuncts in the interpretive effort. In addition to skepticism, construed as a form of psychoanalytic openness in which the analyst allows for a fundamental inaccuracy of the interpretive hypothesis, metaphors were shown to arise in the context of the intimacy of the therapeutic relationship and to be expressive of that intimacy. Ingram substituted intimacy, rigorously defined, for the less personal concept of the therapeutic alliance as a necessary condition for therapeutic gain.
To underscore the value of skepticism, Ingram related it to theory evolution. Karen Horney's deviation from the biological model of Freud toward one of cultural relativism was the product of a constructive skepticism. More recent revisions of focus indicate that, “In fundamental ways, social metaphors have shifted, and so must we.”
Ingram articulated the hermeneutical significance of metaphor in analysis: “it carries meaning across the boundaries that separate objects … it is the way meanings are transmitted.” He further linked it to empathy which was described as a special case of metaphor in which the analyst analogizes self to patient. Ingram delineated several cautions about the use of metaphor in psychotherapy, one of which received a high level of response from the discussant and the audience. This involved his contention that there are metaphors so rich and so powerful, so expressive of the intimacy between this patient and this therapist, that the therapist cannot legitimately apply metaphors of this class to other patients. This class of metaphor-laden interpretation that arise in one person's analysis are singular constructions borne of an intimacy in t