The Use of Metaphor When Working with a Severely Regressed Patient

The following case material represents an excerpt from the psychotherapy of a young woman facing a severe crisis—the first anniversary of her brother's suicide. It is intended to illustrate the usefulness of a metaphor in working with a person who was so depressed that the usual mode of “talking it out” was unavailable to her. The metaphor or dream image used enabled this patient to express psychological states too complex or too intense and threatening to be captured by ordinary speech.

Allyson, a 20-year-old college student, entered therapy for problems of long standing, but also for help in coping with an older brother's recent suicide. She was the youngest of three children. The brother who killed himself, Jay, was a year older. The oldest brother, Daniel, seemed to be the least troubled of the children; he was successfully self-employed. Her father is a physician, her mother a housewife. The family is Jewish, observant in the sense of attending services during the High Holy Days, and taking that observance seriously.

From Allyson's account, her mother came across as an odd and strange woman—out in space, to use the current term. She was very