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Juicy Conceptualizations: Increasing Alliance Through Attending to Client Metaphoric Language
Abstract
Background:
There is increasing interest in the use of metaphor in cognitive behaviour therapy. Experts advocate bringing client metaphors into case conceptualizations, but there is little empirical research to support this.
Aims:
This study evaluated the effect of training 12 therapists to attend to client metaphors and bring them into case conceptualizations.
Method:
Pre- and post-training role-played therapy sessions were conducted and video-recorded. Alliance was rated by role play 'clients' and an external expert rated the quality of the sessions and of the shared conceptualizations.
Results:
There were significant increases in some ratings of alliance, based on role play 'client' ratings and external ratings of role plays of therapy sessions before and after training. The greater the difference between therapist and 'client' on a measure of preference for producing metaphor, the lower the rating of the session by the 'client' on the Bond factor score of an alliance measure, the Working Alliance Inventory. This result suggests that working metaphorically may be most effective when the therapist and client have a similar degree of preference for speaking metaphorically.
Conclusion:
This study provides preliminary support for the idea that attending to client metaphors during conceptualization can be beneficial for alliance.
... Therapists can also co-construct metaphors with the client to assist in formulation. 3,4 I will focus in this article on this elaboration and extension of client metaphor. ...
... There is some evidence that the therapeutic relationship is enhanced through the use of metaphor, especially if both therapist and client have a preference for metaphor. 3 A therapist who is in harmony with a client's metaphors can find that they help the client to discover new perspectives. They might feel more attuned to the client's issues and the client might feel more understood. ...
... Successful employment of shared metaphors in role-play situations was also found to positively impact client and therapist ratings of aspects of the therapeutic alliance, particularly in the subscales of case conceptualisation, collaboration, goals and topics. 3 However, the research also suggests that both therapists and clients differ widely in their responsiveness to metaphor. ...
Brief discussion of using client metaphor to build relationship and co-construct formulations primarily in a Cognitive-Behavioural Therapy context. Article published in Healthcare Counselling & Psychotherapy Journal (BACP) April 2021, pages 16-18.
... Second, neuroradiological research has shown that metaphors engage us emotionally in a way that literal language does not [6,7]. Third, metaphors can help build a therapeutic relationship [8,9]. Fourth, metaphors seem to motivate us in a way that literal language does not [10,11]. ...
... The CBT-therapists mention the benefits of a mutual language in strengthening the therapeutic relationship, but seldom mention the possibility of creating a metaphor together with the patient. Studies have shown that training CBT-therapists to co-create metaphors with patients and respond to patient metaphors can enhance the therapeutic alliance [8,9]. Studies have also shown that a good therapeutic alliance is associated with good outcome [40]. ...
Background
Research suggests that metaphors are integral to psychotherapeutic practice. We wanted to explore how 10 therapists reflect upon the use of metaphors in therapy, and how they react to some metaphors expressed by patients treated for of major depressive disorder (MDD).
Methods
Five therapists practicing psychodynamic therapy (PDT) and five practicing cognitive behavioral therapy (CBT) were interviewed with a semi-structured qualitative interview. Transcripts were analyzed using a thematic analysis approach.
Results
Our analysis resulted in two main themes: the therapeutic use of metaphors, and conflicting feelings towards metaphors used by depressed patients. Most therapists said that they do not actively listen for metaphors in therapy and many said that they seldom use metaphors deliberately. While PDT-therapists appeared more attentive to patient-generated metaphors, CBT-therapists seemed more focused on therapist-generated metaphors. Most therapists did not try to alter the patient-generated metaphors they evaluated as unhelpful or harmful. Some therapists expressed strong negative feelings towards some of the metaphors used by patients. PDT-therapists were the most critical towards the metaphor of tools and the metaphor of depression as an opponent. CBT-therapists were the most critical towards the metaphor of surface-and-depth.
Conclusions
These results remind us of the complexity of using metaphors in therapy, and can hopefully be an inspiration for therapists to reflect upon their own use of metaphors. Open therapeutic dialogue on the metaphor of tools, surface-depth and depression as an opponent may be necessary to avoid patient-therapist-conflicts.
Trial registration
Clinical Trial gov. Identifier: NCT03022071. Date of registration: 16/01/2017.
... Across the literature, it would seem the most common purpose metaphors have served in therapy, is as a way of helping clients understand their experience and/or key concepts relevant to intervention, hence metaphor has had a strong psychoeducational role (Malkomsen et al., 2022). The proposed benefits of metaphor use within the therapy room typically include increasing client understanding by relating the complex or unfamiliar to something simple or familiar (Killick et al., 2016), greater emotional and motivational impact compared with more literal discussions (Malkomsen et al., 2022), significant memory benefits for recalling important therapy concepts (Blenkiron, 2005;Otto, 2000) and enhanced therapeutic alliance (Mathieson et al., 2017). Some research has focused on the natural frequency of metaphor use in therapy for both therapists and clients (Mathieson et al., 2016), whilst others have considered more deliberate metaphor use in the therapy setting (Martin et al., 1992;Mathieson et al., 2018). ...
The notion of cognitive detachment (i.e. the capacity to treat thoughts as just thoughts, with no greater significance or importance) is introduced in this paper. Its link to similar established terminologies (e.g. distancing, decentering, defusion/deliteralisation, detached mindfulness), importance within cognitive behaviour therapies and place within an adapted cognitive-behavioural framework is highlighted. The use of metaphor to facilitate cognitive detachment is then the primary focus of the paper. An overview of how metaphor has typically been used within psychotherapy is presented and reflects mostly the use of therapist-generated metaphor for psychoeducational purposes. While the use of metaphor in serving a therapeutic cognitive detachment function is not new, developing idiosyncratic client-generated metaphors in this regard has been largely neglected, despite the widely held view that client-generated metaphors are more potent. Practical guidance on how clinicians can collaboratively assist clients to intentionally generate their own personalised cognitive detachment metaphor is provided, and specific ways to elaborate metaphors during therapy to enhance metaphor application and hence effectiveness in enabling cognitive detachment is considered. Finally, clinical examples are provided to illustrate the varied, creative and rich metaphors that can emerge from this process.
Key learning aims
(1) To introduce the term cognitive detachment and understand this important therapy target within an adapted cognitive-behavioural framework.
(2) To appreciate the broader use of metaphors in therapy and frame metaphor as one method for facilitating cognitive detachment.
(3) To motivate therapists to pursue idiosyncratic client-generated metaphor.
(4) To provide an instructional script to support therapists to help clients develop a personalised cognitive detachment metaphor.
(5) To provide specific guidance to therapists regarding methods for metaphor elaboration.
... The findings of this research have important implications for mental health practitioners who work with men. Attending and responding to the metaphoric language men use and bringing it into the relationship between a clinician and client could be beneficial for therapy alliance (Mathieson et al., 2017). Although alliance is created by the work the practitioner and the client do together, that is, it is dyadic; research evidence suggests that the benefits of alliance are mostly due to the practitioner's contribution (Wampold & Flu¨ckiger, 2023). ...
The use of tailored language, which involves a clinician’s ability to adapt communication styles and employ accessible terms and concepts, has long been touted as key to engaging men with mental health services. Metaphors are one communication device that can provide men with ways through which to meaningfully express themselves and communicate their mental distress experiences. Using qualitative photovoice research, the current study examined how New Zealand-based men (n = 21) communicatively constructed their meaning of mental distress through metaphors. Analysis of interview data was used to derive three metaphor groupings men consistently drew on to articulate their lived experiences: metaphors of emotions (darkness and weight), metaphors of survival (battle and entity), and metaphors of disembodiments (debility and entrapment). The findings highlight the power of metaphors as a tool for men in communicating their experiences of mental distress and are valuable for health professionals to contemplate across an array of contexts. The implications and importance of a metaphor-enriched perspective for engaging men in professional health care settings and services are discussed.
... In psychotherapy, a significant emphasis is placed on the collaborative construction of metaphors between therapists and clients, a process known as co-construction [135][136][137][138][139][140]. Research suggests that the effectiveness of metaphors is heightened when both the client and therapist share a similar preference for metaphoric language [136]. ...
Background
Despite the demonstrated efficacy of psychotherapy, the precise mechanisms that drive therapeutic transformations have posed a challenge and still remain unresolved. Here, we suggest a potential solution to this problem by introducing a framework based on the concept of mental navigation. It refers to our ability to navigate our cognitive space of thoughts, ideas, concepts, and memories, similar to how we navigate physical space. We start by analyzing the neural, cognitive, and experiential constituents intrinsic to mental navigation. Subsequently, we posit that the metaphoric spatial language we employ to articulate introspective experiences (e.g., “unexplored territory” or “going in circles”) serves as a robust marker of mental navigation.
Methods
Using large text corpora, we compared the utilization of spatial language between transcripts of psychotherapy sessions (≈ 12 M. words), casual everyday conversations (≈ 12 M. words), and fictional dialogues in movies (≈ 14 M. words). We also examined 110 psychotherapy transcripts qualitatively to discern patterns and dynamics associated with mental navigation.
Results
We found a notable increase in the utilization of spatial metaphors during psychotherapy compared to casual everyday dialogues (U = 192.0, p = .001, d = 0.549) and fictional conversations (U = 211, p < .001, d = 0.792). In turn, analyzing the usage of non-spatial metaphors, we did not find significant differences between the three datasets (H = 0.682, p = 0.710). The qualitative analysis highlighted specific examples of mental navigation at play.
Conclusion
Mental navigation might underlie the psychotherapy process and serve as a robust framework for understanding the transformative changes it brings about.
... Mathieson et al. has developed a metaphor workshop shown to improve therapists' metaphor awareness and confidence [15]. This research group also examined whether better attention to metaphoric language by CBT therapists increased client ratings of alliance [16]. They did this by training 12 therapists to better attend to patient metaphors and bring metaphors into case conceptualizations, which resulted in a significant increase in ratings of therapeutic collaboration, session satisfaction (measured by Session Rating Scale) and a non-significant increase on the working alliance (measured by Working Alliance Inventory). ...
Background
In the present study, we wanted to explore which metaphors patients suffering from major depressive disorder (MDD) use to explain their experience of being in therapy and their improvement from depression.
Methods
Patients with MDD ( N = 22) received either psychodynamic therapy (PDT) or cognitive behavioral therapy (CBT). They were interviewed with semi-structured qualitative interviews after ending therapy. The transcripts were analyzed using a method based on metaphor-led discourse analysis.
Results
Metaphors were organized into three different categories concerning the process of therapy, the therapeutic relationship and of improvement from depression. Most frequent were the metaphorical concepts of surface and depth, being open and closed, chemistry, tools, improvement as a journey from darkness to light and depression as a disease or opponent.
Conclusions
Patient metaphors concerning the therapeutic experience may provide clinicians and researchers valuable information about the process of therapy. Metaphors offer an opportunity for patients to communicate nuances about their therapeutic experience that are difficult to express in literal language. However, if not sufficiently explored and understood, metaphors may be misinterpreted and become a barrier for therapeutic change.
Trial registration
Clinical Trial gov. Identifier: NCT03022071 . Date of registration: 16/01/2017.
... The third study (Mathieson, Jordan, Merrick, & Stubbe, 2017) explored the effect of training CBT therapists to intentionally respond to client metaphors and bring them into case conceptualisations. Case conceptualisation is a collaborative process between therapist and client where key problematic beliefs and unhelpful psychological maintaining strategies are discussed and often illustrated using diagrams. ...
Metaphors are common in psychotherapy. The last decade has seen increasing interest in the use of metaphor in cognitive behaviour therapy (CBT), with attention to client metaphors being asserted as a way of enhancing CBT. However, prior to this current research there was very little research on the use of metaphor in CBT sessions, and no studies have examined how to train therapists in this skill.
This article discusses four studies that provide a preliminary empirical basis for the exploration of metaphors in CBT. The first study evaluated the reliability and utility of an approach to metaphor identification. The second study explored how clients and therapists co-construct metaphors, contributing to development of a shared language in early therapy sessions and identified a range of responses to each other’s metaphors. The third study explored the effect of training CBT therapists to intentionally bring client metaphors into case conceptualisations in terms of building therapeutic alliance and collaboration, along with an exploration of preference for metaphoric language. The fourth study explored the impact of the metaphor training on therapist confidence, awareness and use of metaphors, based on therapist self-report ratings and reflections on their ongoing application of learning over a three month period. These findings suggest that it is possibly to conduct empirical research on metaphor in CBT, with metaphor having potential as an important therapy process 1 variable.
This study highlights metaphors as ways of articulating the nature of spiritual experiences. A secondary analysis of data from a previous study revealed that spiritual experiences were described using metaphors. A sample of six participants was selected. The study aimed to describe metaphors of inpatients’ spiritual experiences in mental health care. The study had a qualitative design. The metaphors were interpreted as individuals’ embodied meanings of spirituality. These meanings were identified through a hermeneutic phenomenological framework, informed by the approach of interpretative phenomenological analysis. The analysis identified three superordinate themes, to capture the embodied lived experiences of spirituality: the meaning of the immortal diamond, the meaning of the lion-hearted warrior and the meaning of navigating by divine compasses. By acknowledging metaphors as important sources of subjective knowledge, this study reflects on how mental health professionals can use metaphors to gain insight into inpatients’ spiritual universe to facilitate relationships of resonance within a Relational Recovery perspective.
Background: In the present study, we wanted to explore which metaphors patients suffering from major depressive disorder (MDD) use to explain their experience of being in therapy and their improvement from depression.
Methods: Patients with MDD (N = 22) received either psychodynamic therapy (PDT) or cognitive behavioral therapy (CBT). They were interviewed with semi-structured qualitative interviews after ending therapy. The transcripts were analyzed using a method based on metaphor-led discourse analysis.
Results: Metaphors were organized into three different categories concerning the process of therapy, the therapeutic relationship and of improvement from depression. Most frequent were the metaphorical concepts of surface and depth, being open and closed, chemistry, tools, improvement as a journey from darkness to light and depression as a disease or opponent.
Conclusions: Patient metaphors concerning the therapeutic experience may provide clinicians and researchers valuable information about the process of therapy. Metaphors offer an opportunity for patients to communicate nuances about their therapeutic experience that are difficult to express in literal language. However, if not sufficiently explored and understood, metaphors may be misinterpreted and become a barrier for therapeutic change.
Trial registration: Clinical Trial gov. Identifier: NCT03022071. Date of registration: 16/01/2017.
Attention to client metaphors has been asserted as a way of enhancing cognitive behaviour therapy. Metaphors can be part of the shared language that is co-constructed between clients and therapists. Recent advances in cognitive linguistics have provided the most clearly operationalized method yet to identify metaphors in conversations, allowing analysis of how shared language develops. This study aims to explore how metaphoric shared language develops in early cognitive behaviour therapy sessions. Based on 12 transcripts of early cognitive behaviour therapy sessions, an iterative process led to the identification of a range of therapist and client responses to each other's metaphors, and identification of whether therapists or clients initiated metaphoric exchanges. Types of responses to therapist or client metaphors within three speaking turns were found to be: repetition, rephrasing, exploration, elaboration/extension, or agreement. Bursts of metaphoric exchange were initiated and taken up by therapists and clients at a similar rate. To conclude, therapists need to attend to the occurrence of metaphors and be aware of the range of potential responses that can engage the client in the ‘metaphoric dance’ (co-construction of shared metaphors). This has the potential to enhance engagement and outcomes though more salient reformulating of the problem for the client.
Metaphors are common in psychotherapy and have potential to enhance therapy in numerous ways. However, the empirical study of metaphors in cognitive behaviour therapy (CBT) has tended to be put in the "too hard basket", confined to being part of the art rather than the science of therapy. The lack of research is largely due to problems with definition, lack of a consistent, reliable approach to metaphor identification and the challenges of finding appropriate methodology to study this language-based activity.
This study aimed to assess the frequency of metaphors in CBT in a large sample of therapy sessions and to evaluate the reliability and utility of the discourse dynamics approach to metaphor identification.
The discourse dynamics approach, recently developed by linguists, was used to identify metaphors in 48 CBT session transcripts (from 12 clients and 3 therapists) and the reliability of this approach was evaluated, using an independent rater.
The total frequency of metaphors was 31.5 (range 17-49) per 1000 words of therapy conversation. Therapists produced metaphors twice as often (21.2, range 7-36) as clients (10.3, range 3-24). Reliability of the Discourse Dynamics approach was adequate.
Metaphors clearly occur in CBT sessions, with therapists using them at a higher rate than clients. While Discourse Dynamics is currently the most detailed identification approach available for investigating metaphor in CBT sessions, it is challenging to acquire skill in it and we found only adequate reliability. Ways to improve reliability and future research possibilities are discussed.
The abstract for this document is available on CSA Illumina.To view the Abstract, click the Abstract button above the document title.
Background:
Case conceptualization is assumed to be an important element in cognitive-behavioural therapy (CBT) because it describes and explains clients' presentations in ways that inform intervention. However, we do not have a good measure of competence in CBT case conceptualization that can be used to guide training and elucidate mechanisms.
Aims:
The current study addresses this gap by describing the development and preliminary psychometric properties of the Collaborative Case Conceptualization - Rating Scale (CCC-RS; Padesky et al., 2011). The CCC-RS was developed in accordance with the model posited by Kuyken et al. (2009).
Method:
Data for this study (N = 40) were derived from a larger trial (Wiles et al., 2013) with adults suffering from resistant depression. Internal consistency and inter-rater reliability were calculated. Further, and as a partial test of the scale's validity, Pearson's correlation coefficients were obtained for scores on the CCC-RS and key scales from the Cognitive Therapy Scale - Revised (CTS-R; Blackburn et al., 2001).
Results:
The CCC-RS showed excellent internal consistency (α = .94), split-half (.82) and inter-rater reliabilities (ICC =.84). Total scores on the CCC-RS were significantly correlated with scores on the CTS-R (r = .54, p < .01). Moreover, the Collaboration subscale of the CCC-RS was significantly correlated (r = .44) with its counterpart of the CTS-R in a theoretically predictable manner.
Conclusions:
These preliminary results indicate that the CCC-RS is a reliable measure with adequate face, content and convergent validity. Further research is needed to replicate and extend the current findings to other facets of validity.
The current article argues that the conceptual analysis of metaphor as offered by relational frame theory (RFT) illustrates one way in which the theory may be integrated with, and have a constructive influence on, acceptance and commitment therapy (ACT). The article walks through the basic account of metaphor as the relating of relations and summarises the empirical evidence in support of this conceptualization. This understanding is then applied to a number of metaphors that are common to ACT in an attempt to illustrate how the RFT account of metaphor may be useful in aiding ACT practitioners to construct and deconstruct clinical metaphors.
The existing scale for assessing competence in cognitive therapy (CTS) dates from 1988 and only the previous version of 1980 has been validated to any extent. A revised version, the CTS-R, was devised to improve on the CTS by: eliminating overlap between items, improving on the scaling system, and defining items more clearly. Kolb's well-known educational model was used as a guideline. In the new 14-item scale, three new items measure general therapeutic flair, the facilitation of emotional expression, and therapist's non-verbal behaviours (optional). We hypothesized that the CTS-R would prove more user friendly and demonstrate satisfactory reliability and validity. Twenty-one mental health professionals undergoing training in cognitive therapy provided 102 video-tapes of therapy with 34 patients, reflecting three stages of therapy. The tapes were rated by four expert raters, in a balanced design. The CTS-R showed high internal consistency and adequate average inter-rater reliability. Reliability for individual items varied widely among pairs of raters. Validity was demonstrated by improved ratings of competence for trainees who saw patients early and later during the course of training. Although raters found the CTS-R a more useful tool than the CTS and satisfactory reliability and validity were demonstrated, more refinement is needed in item definition. The study has led to modifications in the CTS-R, which are in the process of evaluation.
Over 1,000 research findings (Orlinsky, Rønnestad, & Willutzki, 2004) demonstrate that a positive alliance is one of the best predictors of outcome. Paradoxically, despite the robust connection between the alliance and outcome, no alliance measures have been developed specifically as clinical tools for therapists to use on a day-to-day basis with their clients. This article describes the development and validation of an ultra-brief alliance measure, the Session Rating Scale Version 3 (SRS). The instrument’s psychometric properties are examined and reported. Based on experience with the instrument at the various sites in the study, the feasibility of the scale is also considered. Results indicate that the SRS, a clinical rather than research tool, represents a balanced tradeoff between the reliability and validity of the longer research measures, and the feasibility of this brief scale. Results and implications for clinical practice and future research are discussed.
A look at National Institute for Health and Clinical Excellence (NICE) guidance for treatment of anxiety disorders reveals a revolution: first-line treatment for anxiety disorders is cognitive-behavioural therapy (CBT) and some other psychological interventions. Cognitive-behavioural therapy of
This book represents a bold attempt to address contemporary issues in both metaphor and psychotherapy research. On one hand, metaphor research is increasingly concerned not just with describing metaphors in discourse, but how they could be used more adroitly in purposive ‘real world’ contexts such as psychotherapy. On the other hand, while a growing number of mental health professionals believe that metaphors contribute in some way to the psychotherapy process, their ability and willingness to use metaphors might be compromised by a relative unfamiliarity with the various nuanced aspects of metaphor theory. The present analysis of metaphors in authentic psychotherapeutic talk brings these theoretical aspects to the forefront, and suggests how they can be applied to enhance the use of communication of metaphors in psychotherapy. It should be of interest to metaphor researchers, mental health professionals, and discourse analysts in general.
Recently, cognitive approaches to therapy have been facing an increasingly constructivist orientation, in which persons are viewed as actively constructing their own reality from their deep/tacit/unconscious knowledge representation. This paper begins with the presentation of the main assumptions of the constructive movement in cognitive therapy on the nature and change of cognitive representations. It is asserted that at the deep/tacit/unconscious levels, knowledge is represented in analogical and metaphorical ways. The use of metaphors is suggested as a therapeutic tool to access and change tacit/unconscious levels of cognitive representation. A cognitive adaptation of the multiple-embedded-metaphor strategy is presented and illustrated.
Present stages of development and preliminary validation of a self-report instrument for measuring the quality of alliance, the Working Alliance Inventory (WAI). The measure is based on Bordin's (1980) pantheoretical, tripartite (bonds, goals, and tasks) conceptualizaton of the alliance. Results from 3 studies were used to investigate the instrument's reliability and validity and the relations among the WAI scales. Data suggest that the WAI has adequate reliability. The instrument is reliably correlated with a variety of counselor and client self-reported outcome measures. Nontrivial relations were also observed between the WAI and other relationship indicators. Results are interpreted as preliminary support for the validity of the instrument. Although the results obtained in the reviewed studies are encouraging, the high correlations between the 3 subscales of the inventory bring into question the distinctness of the alliance components. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Results of 24 studies (based on 20 distinct data sets) relating the quality of the working alliance (WA) to therapy outcome were synthesized using meta-analytic procedures. A moderate but reliable association between good WA and positive therapy outcome was found. Overall, the quality of the WA was most predictive of treatment outcomes based on clients' assessments, less so of therapists' assessments, and least predictive of observers' report. Clients' and observers' rating of the WA appear to be more correlated with all types of outcomes reported than therapists' ratings. The relation of WA and outcome does not appear to be a function of the type of therapy practiced, the length of treatment, whether the research is published, or the number of participants in the study. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The Working Alliance Inventory (WAI; Horvath & Greenberg, 1989) and the Working Alliance Inventory-Short (WAI-S; Tracey & Kokotovic, 1989) are widely used measures of alliance in therapy. This study evaluated the factor structure of the WAI and WAI-S with confirmatory factor analysis in two samples (Ns=231 and 235). The hypothesized structures were not confirmed. An alternative 12-item WAI (WAI-SR), consistent with Bordin's (1979) model of alliance, was developed in one sample and cross-validated in the other. The WAI-SR better differentiated Goal, Task, and Bond alliance dimensions and correlated well with other alliance measures. The Task dimension was particularly salient, as expected based on Bordin's original theory. Additional psychometric properties and item response theory analysis of the WAI-SR are presented. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A model of cognition is presented that includes propositional cognition together with imaginal and metaphoric cognitive modalities. It is posited that metaphor is a distinct form of cognition that appears to combine propositional and imaginal cognition. Client-generated linguistic metaphors appear to represent deep, tacit, metaphoric knowledge that can be directly accessed, explored, and ultimately transformed by the client using a step-by-step interview protocol. Two case examples, involving a 38-yr-old male and a 43-yr-old female, illustrate how this brief intervention can access and change imaginal and metaphoric cognition not readily accessed by traditional cognitive methods. This approach is compared and contrasted with constructivist theory of cognitive therapy and with Ericksonian interventions using embedded metaphors. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The purpose of this study was to ascertain whether and how alliance and specific cognitive process may interact to influence outcome. Eighty social phobic patients were randomized to 10-week residential cognitive or interpersonal therapy, conducted mostly in groups. They completed process and outcome measures weekly. The ratings were analyzed with mixed models. It was found that initial patient-rated alliance predicted the course of social anxiety throughout therapy and that this effect was indirect through the cognitive process. However, this indirect effect did not interact with treatment. There was a trend toward an indirect effect of weekly variations in alliance rated by the individual therapist through weekly variations in subsequent cognitive process on weekly variations in subsequent social anxiety. Thus, the results support a facilitative rather than an active ingredient perspective on the role of alliance.
The Working Alliance Inventory‐Short Revised (WAI‐SR) is a recently refined measure of the therapeutic alliance that assesses three key aspects of the therapeutic alliance: (a) agreement on the tasks of therapy, (b) agreement on the goals of therapy and (c) development of an affective bond. The WAI‐SR demonstrated good psychometric properties in an initial validation in psychotherapy outpatients in the USA. The generalizability of these findings is limited because in some countries a substantial portion of individual psychotherapy is delivered in inpatient settings. This study investigated and compared the psychometric properties of the WAI‐SR in German outpatients ( N = 88) and inpatients ( N = 243). In both samples reliability (? ? 0.80) and convergent validity with the Helping Alliance Questionnaire were good ( r > 0.64). Confirmatory factor analysis showed acceptable to good model fit for the proposed Bond‐Task‐Goal model in both samples. Multi‐group analysis demonstrated that the same constructs were measured across settings. Alliance ratings of outpatients and inpatients differed regarding the overlap of alliance components and the magnitude of the alliance ratings: The differentiation of the alliance components was poorer in inpatients and they reported lower alliances. Unique aspects of the alliance in inpatient treatment are discussed and a need for further research on the alliance in inpatient settings is pointed out. Overall, the WAI‐SR can be recommended for alliance assessment in both settings. Copyright © 2009 John Wiley & Sons, Ltd.
Key Practitioner Message The Working Alliance Inventory‐Short Revised (WAI‐SR) is a 12‐item measure for the assessment of the therapeutic alliance.
The WAI‐SR is pantheoretic and captures three key alliance aspects: (a) agreement on the tasks of therapy, (b) agreement on the goals of therapy and (c) development of an affective bond.
This study demonstrates good psychometric properties of the WAI‐SR in outpatients and inpatients.
The WAI‐SR is ready to be used by psychotherapists interested in the therapeutic alliance, for supervision and process research.
To identify underlying patterns in the alliance literature, an empirical review of the many existing studies that relate alliance to outcome was conducted. After an exhaustive literature review, the data from 79 studies (58 published, 21 unpublished) were aggregated using meta-analytic procedures. The results of the meta-analysis indicate that the overall relation of therapeutic alliance with outcome is moderate, but consistent, regardless of many of the variables that have been posited to influence this relationship. For patient, therapist, and observer ratings, the various alliance scales have adequate reliability. Across most alliance scales, there seems to be no difference in the ability of raters to predict outcome. Moreover, the relation of alliance and outcome does not appear to be influenced by other moderator variables, such as the type of outcome measure used in the study, the type of outcome rater, the time of alliance assessment, the type of alliance rater, the type of treatment provided, or the publication status of the study.
Most people know that therapists listen to people discuss their problems, and that they are paid for their services. Yet few people who have not undergone therapy know what actually goes on in these sessions, or have any idea about how talking to a stranger can be beneficial to one's mental health. What is therapeutic about therapeutic discourse? Why is the therapy hour such a powerful influence in peoples' lives if all they do is talk? Who talks, and what about? To answer some of these questions from a linguistic stand-point, Kathleen Ferrara analyses samples of psychotherapeutic discourse between several therapists and their clients. She focuses on cohesion and the joint construction of digalogue to get at her main concern of just how talk can be therapeutic, and at the same time addresses recent concerns in the study of conversation. Her thesis is that repetition and continuity are resources of language which speakers can recombine in various ways to create meaning within a given social context, and she looks at the many ways these cohesive devices are used in therapy speech. Therapeutic Ways with Words should appeal not only to linguists and people concerned with language in the professions, but to the large audience connected to psychotherapy. 'The scholarship reflected in the manuscript is not just sound, but creative; not just up-to-date, but up to the minute. Ferrara offers insightful treatments of data just begging for attention in light of recent developments in discourse analysis, and thus contributes cutting-edge results ... It represents the kind of research we need much more of in linguistics today." Neal Norrick, Professor of English-Linguistics, Northern Illinois University
This online resource shows how metaphors can be used productively in CBT as an integral part of the treatment. It describes the use of metaphors for a wide range of problems, including anxiety and depression, and provides countless examples of metaphors that have been used by others in CBT. It brings together in one place hundreds of metaphors that experienced therapists have used to great success, and will be a valuable resource for all cognitive behaviour therapists, as well as those training in CBT.
Interpreting Figurative Meaning critically evaluates the recent empirical work from psycholinguistics and neuroscience examining the successes and difficulties associated with interpreting figurative language. There is now a huge, often contradictory literature on how people understand figures of speech. Gibbs and Colston argue that there may not be a single theory or model that adequately explains both the processes and products of figurative meaning experience. Experimental research may ultimately be unable to simply adjudicate between current models in psychology, linguistics and philosophy of how figurative meaning is interpreted. Alternatively, the authors advance a broad theoretical framework, motivated by ideas from 'dynamical systems theory', that describes the multiple, interacting influences which shape people's experiences of figurative meaning in discourse. This book details past research and theory, offers a critical assessment of this work and sets the stage for a new vision of figurative experience in human life.
An ACT Approach Chapter 1. What is Acceptance and Commitment Therapy? Steven C. Hayes, Kirk D. Strosahl, Kara Bunting, Michael Twohig, and Kelly G. Wilson Chapter 2. An ACT Primer: Core Therapy Processes, Intervention Strategies, and Therapist Competencies. Kirk D. Strosahl, Steven C. Hayes, Kelly G. Wilson and Elizabeth V. Gifford Chapter 3. ACT Case Formulation. Steven C. Hayes, Kirk D. Strosahl, Jayson Luoma, Alethea A. Smith, and Kelly G. Wilson ACT with Behavior Problems Chapter 4. ACT with Affective Disorders. Robert D. Zettle Chapter 5. ACT with Anxiety Disorders. Susan M. Orsillo, Lizabeth Roemer, Jennifer Block-Lerner, Chad LeJeune, and James D. Herbert Chapter 6. ACT with Posttraumatic Stress Disorder. Alethea A. Smith and Victoria M. Follette Chapter 7. ACT for Substance Abuse and Dependence. Kelly G. Wilson and Michelle R. Byrd Chapter 8. ACT with the Seriously Mentally Ill. Patricia Bach Chapter 9. ACT with the Multi-Problem Patient. Kirk D. Strosahl ACT with Special Populations, Settings, and Methods Chapter 10. ACT with Children, Adolescents, and their Parents. Amy R. Murrell, Lisa W. Coyne, & Kelly G. Wilson Chapter 11. ACT for Stress. Frank Bond. Chapter 12. ACT in Medical Settings. Patricia Robinson, Jennifer Gregg, JoAnne Dahl, & Tobias Lundgren Chapter 13. ACT with Chronic Pain Patients. Patricia Robinson, Rikard K. Wicksell, Gunnar L. Olsson Chapter 14. ACT in Group Format. Robyn D. Walser and Jacqueline Pistorello
Figurative language, as the linguistic expression of metaphoric thought, occupies a central place in the study of human cognition and creativity. This article describes four initial investigations of the reliability and validity of a measure of affinity for figurative language. In Study 1, a factor analysis of the Language Preference Report (LPR) yielded three orthogonally rotated components of affinity for figurative language: Liking to Produce Figurative Language, General Dislike of Figurative Language, and Liking to Study Texts Which Include Figurative Language. The factors, based on 540 responses, accounted for 73% of the total variance and were correlated with each other (absolute values between .55 and .36). Study 2, based on repeated administrations to 103 students at 2‐week intervals, investigated the reliability of the LPR Internal consistency estimates ranged from .92 to .84, and test‐retest reliability estimates ranged from .86 to .69. In Study 3, 39 students responded to both the LPR and the Similes Test. Participants’ Similes Test scores were significantly correlated with the LPR Production factor (r = .53, p < .001) and the Study factor (V = .36, p < .05). In Study 4, 79 students completed the LPR and later read 3000 words of text in which they were presented with 20 opportunities to choose figurative or literal sentence completions. The number of figurative completions chosen was significantly correlated with the LPR Dislike factor (r = ‐.65, p < .0001), the Study factor (r = .63, p
Observations of decision making of single human beings have shown the existence of frequent violations of Savage's independence axiom (the Allais and Ellsberg paradoxes). It is suggested that these violations result from the fact that under some situations of choice under uncertainty the independence axiom is necessarily violated by rational decision makers, which prevents them in all cases from including compliance with this axiom as a goal. By considering situations of partial ignorance and defining rational behavior in these situations as respecting both universal principles and rules specific to the particular situation encountered, necessary violations of Savage's axiom by all decision makers are exhibited. Thus the claim to universal observance of this axiom is denied and the explanation of violations by its simply being discarded as a goal is supported.
In this paper, we discuss a number of methodological problems we have encountered in identifying and analysing metaphors in a corpus of conversations about cancer. These problems relate particularly to: (i) the boundary between the literal and the metaphorical in the identification of linguistic metaphors; (ii) the precise identification of tenor and vehicle in relation to each linguistic metaphor; (iii) the extrapolation of conceptual metaphors from linguistic metaphors; and (iv) the extrapolation of conventional metaphors from patterns in the data. We begin with a discussion of the way in which metaphors are commonly analysed within the cognitive paradigm, and introduce in detail Steen’s [From linguistic to conceptual metaphor in five steps. In: Gibbs, R., Steen, G. (Eds.), Metaphor in Cognitive Linguistics. John Benjamins, Amsterdam, p. 57, 1999] proposal for an explicit and rigorous procedure for metaphor analysis. We then present a range of examples from our corpus that pose problems at different points in Steen’s procedure, and demonstrate how different decisions in the process of analysis lead to dramatically different conclusions as to the way in which cancer appears to be metaphorically constructed in our data. In light of our discussion, we propose some adjustments to Steen’s procedure and highlight areas in which further research is needed.
This article presents a step-by-step approach to working with family-generated metaphor in family therapy. Although the use of therapist-generated "therapeutic metaphors" has been widely advocated and practiced for many years now, less attention has been paid to the metaphors used by family members. We argue that the family's metaphors are a neglected linguistic resource in family therapy. Highlighting and validating these metaphors produces a therapeutic conversation in which the voices of family members are heard more clearly by the therapist, and the families' own imaginative energies are engaged in defining and pursuing the goals of therapy. Several case examples illustrate the use of this approach with children of various ages.
Single-Case Research Designs: Adaptations for the Analysis of Group Data. Paper presented at the Association for Behavior Analysis International Conference
- N M Blampied
Blampied, N. M. (2007). Single-Case Research Designs: Adaptations for the Analysis of Group Data.
Paper presented at the Association for Behavior Analysis International Conference, August 2007,
Sydney, NSW, Australia.
Cognitive sets, speed and accuracy of performance in the elderly
- J F Brinley
Brinley, J. F. (1965). Cognitive sets, speed and accuracy of performance in the elderly. In A. T. Welford
and J. E. Birren (eds), Behavior, Ageing, and the Nervous System: Biological Determinants of Speed
of Behavior and its Changes with Age, pp. 114-119. Springfield, IL: Charles C. Thomas.
Becoming a virtuoso in CBT: learning and interpreting the score with technique and artistry
- C F Newman
Newman, C. F. (2015). Becoming a virtuoso in CBT: learning and interpreting the score with technique
and artistry. Paper presented at the BABCP 2015 43rd annual conference, University of Warwick.
Collaborative Case Conceptualization Rating Scale and Coding Manual, version 5
- C Padesky
- W Kuyken
- W Dudley
Padesky, C., Kuyken, W. and Dudley, W. (2011). Collaborative Case Conceptualization Rating Scale
and Coding Manual, version 5, 19 July.