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To the Editor:
I hope Douglas Ingram's new paper (1996) will help us all see more clearly the importance of implicit metaphor in structuring the patient's communications. Now, our challenge is to learn to notice our patients' core metaphors and to explore them in a useful way in the analytic session.
Let me illustrate the way noticing the metaphorical underpinnings of the patient's words can shed light on the nature of the patient's predicament. Consider the patient who feels unable to act effectively, unable to do what she needs to do to get things going. Looking over her ineffectiveness, she might say, “I feel like I'm falling apart.” Conceptualizing her difficulties with this “falling apart” metaphor, we can expect her to to think of solutions in terms of “pulling herself together.” On the other hand, we can imagine another patient, feeling similarly ineffective, characterizing her ineffectiveness by saying she couldn't get things done because she was “all tied up in knots.” Thinking in her “all tied up in knots” metaphor, she would naturally think of solutions in terms of “loosening her mental constraints.” In other words, the metaphors of the first patient would lead her to think she should become more constrained while the metaphors of the second patient would lead her to try to accomplish the same thing by becoming less constrained.
It is not that either solution is inherently the better solution, of course. It is that a patient, or anyone, who is the captive of a particular metaphor will have a hard time thinking of solutions outside the metaphor. Moreover, a little listening to patients' metaphors will show an attentive analyst that patients often conceptualize large segments of their lives in terms of much the same metaphor, or in terms of families of related metaphors. The patient who thinks of ineffectiveness as “falling