Twelve transcripts, three from each of four patients, taken from the early, mid and late phases of open-ended, long-term psychoanalytic psychotherapy with the same therapist, were analysed for metaphor. Metaphors were categorized into key, novel and conventional. Using grounded theory metaphors were categorized by theme and function. It was found that all metaphors - novel, conventional and key - could be representative of key concepts such as the self, others/relationships and therapy/self transformation and diagnosis or psychopathology; chart change; indicate mentalization (Fonagy et al. 2004). In addition use of metaphors by different patients showed different patterns that co-occurred with good or bad outcome.