The use of metaphor by an artless first-time psychotherapist

The experience in a psychiatric residency of being a psychotherapist for the first time can be overwhelming and anxiety-provoking. This paper examines a first psychotherapy case which utilizes a theory-distant approach based on the use of metaphor. Metaphorical theory is reviewed, and potential benefits and pitfalls of using metaphor are examined. An in-depth case study is done, focusing on the following six metaphors: Art as Psychotherapy; Psychotherapy as Art; The World Is a Trap; Mothers Are Martyrs; StepMothers Are Evil; and Artists Are Crazy. Each metaphor was utilized in multiple layers through the course of the therapy. Some of the current research in the use of metaphor in psychotherapy is reviewed. Through this approach, I was able to develop necessary psychotherapeutic skills without being overwhelmed by traditional theories such as Freudian, Object Relations or Self Psychology. I conclude that the use of metaphor with my first psychotherapy patient strengthened the therapeutic alliance, allowed an idiosyncratic language to develop in the therapy, structured recurrent themes, and permitted me to respect the patient's defenses.