The Clinical Power of Metaphoric Experience

Early in my career as a therapist, I inadvertently learned the power of metaphoric experience. I was a first-year resident in Spring Grove State Hospital and in charge of a closed ward of patients still considered “active” as compared to “chronic.” I decided to treat, that is, have regularly scheduled sessions with, one of the ward patients, a paranoid middle-aged woman who was the most continuously angry person I had ever seen. We would sit in my office with her pouring out a steady flow of venom at her husband, the nurses, and the hospital. I would listen, comment rarely, and occasionally ask a question when I thought she might possibly answer without being more upset. As she talked I would rock back and forth in my office chair. In retrospect, my rocking was a form of self-soothing that I was offering myself to enable me to be able to contain the poisonous affect she was pouring out. One day as I rocked I noted a sudden look of anxiety on her face. Intuitively, I assumed it had to do with my precarious chair movements. Spontaneously I said: “Don't worry, I won't fall. I'm an expert.” To my total surprise, she responded: “Oh, thank goodness. I've been so worried that I'd steal you from your wife.” As we each overcame our mutual startle, I noticed a change in her demeanor. Her face relaxed and her angry tone was replaced with a conversational exchange. On the ward, her tension-ridden intimidating behavior lessened and the nurses recommended extending her “privileges.” And although I was as yet too inexperienced to know how to apply it during our sessions, I now understood that infidelity was an important theme in her delusions.

Webster defines a metaphor as a figure of speech in which a word or phrase literally denoting one kind of object or idea is used in place of another to suggest likeness or analogy between them. In the “I won't fall” example, I did not intentionally use the phrase to suggest an analogy, but the patient recognized an analogy to a m