Digging down or scratching the surface: how patients use metaphors to describe their experiences of psychotherapy

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.

What Can We Learn About Therapeutic Change From Case History Data? The Research Jury Method with the Couple Case of "Carl" and "Sandra"

The purpose of this study was to explore the usefulness of using case history data to assess change in psychotherapy. This was a follow up to previous investigations utilizing a "research jury method" to evaluate psychotherapy outcome. Three judges studied the critical first five sessions of a ten session video of emotionally focused therapy with a couple, Carl and Sandra. They took intensive notes and then functioned as a "jury"” to evaluate the evidence. They concluded that the evidence from within the case history is strong that the couple changed for the better. The evidence also supported the conclusion that therapy contributed to the change, although, by their judgment, at the "preponderance of evidence" level. Finally, the evidence was used to evaluate how therapy contributed to change. It was concluded that the most likely factors contributed by the therapist were her helping the couple see that each other’s underlying intentions were positive, and by fostering their hope. Evidence also supported the contributions the clients themselves made through their taking responsibility for themselves, through their exploring their past experiences, and through their creativity. Limitations are discussed and conclusions for the evaluation of psychotherapy are drawn.