Monday, 7 February 2011

Using Language for Leverage: Metaphors in Integrative CBT

Metaphors are something we all use in our communication, to describe, to convey subtle meanings, to give a different perspective on something, and they are therefore found in all approaches to psychotherapy. We would expect them to be particularly central to CBT, as it is fundamentally about clarifying and changing views, perspectives and meanings. The cover of a recent book by Stott. R., et al (2010), Metaphors in CBT: Building Cognitive Bridges (Oxford: OUP), puts it well: “The business of Cognitive therapy is to transform meanings. What better way to achieve this than through a metaphor?”

For more information on this book see

There are many examples of metaphors which we all use in therapy, both deliberately and unconsciously. To get a feel for some of them, we can look at them in the context of mental health problems such as depression, anxiety and addiction (further below I will explore metaphors in the context of the 5 levels of Integrative CBT).


Some metaphors commonly used by both client and therapist to convey the lack of reward and motivation experienced in depression are:

“Swimming through treacle”

“Living in darkness”

“Carrying a heavy weight”

“Being surrounded only by cold, no sign of warmth, endless winter”

“Digging yourself deeper into a hole”

“Turning your face away from life”

“Letting go of the grip you have on the ledge”

The last three are relevant for understanding the self-perpetuating nature of the problem, and for indicating possible ways out, i.e. by not digging, but turning around, by hanging on until help comes…


In talking about anxiety and fear, the metaphors will naturally be threat-oriented and risk-oriented, for example:

“Like living in a war zone”

“The burglar alarm is too sensitive, always getting triggered”

“Always on red alert”

“On stage, under the spotlight”

“Feeling paralysed, unable to make any moves”

The challenge for the client, in the context of metaphors like these, is to lower the level of alert, ignore and eventually recalibrate the burglar alarm, and learn that, even though life will always have risks and threats, the war is over.


The experience of addiction has of course many metaphors attached to it:

“The monkey on your back”

“Selling your soul to gambling/alcohol/porn etc”

“Being eaten away by addiction”

“Living in the shadows”

“A garden being overgrown by weeds”

The good news, of course, is that addicts can gradually come out of the shadows, start pulling up the weeds and planting something better, and even reclaim their soul.

We can also look at the metaphors we use when discussing the process of therapy with our clients. While we may be comfortable with professional language such as “Behavioural Experimentation”, clients usually relate more easily to more everyday language such as “Reality-testing”, or better still to metaphors such as “Sticking your toe in the water”.

For the therapeutic process in general, we use images such as

Building a house - digging foundations, putting up walls and roof

Gardening - weeding, planting, watering

Sports injury - rest, physiotherapy, small steps

More specifically, we can look at what metaphors might be useful in discussing the 5 levels of the Integrative CBT model:

Level 1: Therapeutic Relating

Creating a safe space


Unpacking our baggage

Leaning on someone else for support

Creating the best conditions for growth, like with a plant

Level 2: Practical Problem-Solving

Putting petrol in the car

Making a map of the territory

Getting a clearer picture of where we want to get to

Checking our stock of resources for the challenge ahead

Profit and loss account in relation to motivation for and against change

Checking whether our investments are still worth the effort, cutting our losses if necessary

Level 3: Cognitive-Emotional Re-learning

Stuck in a rut, going around in circles

Opening the bonnet to see what’s happening inside

Untangling knots in our thinking

Looking at the bigger picture

Getting out of our own way

Reclaiming lost territory

Getting back up on the bike

Experimenting with a different style of serve, golf swing etc

Level 4: Schema Change

Seeing life through coloured glasses

Digging deeper

Undergoing an operation

Checking our operating systems for bugs

Scripts, models, programmes etc

Acting out old scripts (including between client and therapist)

Schemas as committee members – some may have a loud voice, but they only have one vote each

Level 5: Embracing the Human Condition

Human life as a journey

Challenges as adventures

Climbing a mountain – hard work, but great view, best not done alone

All in the same boat

And finally, the weather! – it comes and goes, we can’t influence it, only prepare for it

There is no doubt that such metaphorical language benefits both therapist and client, adding a richness and energy (more metaphors there) to the therapeutic dialogue, which can then be harnessed (and again!) for positive change.

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