Juicy Conceptualizations: Increasing Alliance Through Attending to Client Metaphoric Language

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.

This study evaluated the effect of training 12 therapists to attend to client metaphors and bring them into case conceptualizations.

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.

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.

This study provides preliminary support for the idea that attending to client metaphors during conceptualization can be beneficial for alliance.