Metaphor And Imagery In Psychotherapy

Introduction:
Metaphor and imagery have a long time history in psychotherapy, metaphor building up the relationship between the client and the psychotherapist (building trust, empathy and understanding). Metaphor is very powerful and can raising self- awareness and helps clients to see more and less the full picture of the client inner world. Metaphor and imagery as use in the therapeutic relationship to building up the link between the inner world and external world it abstract but very powerful to help the client to link between here and now and the past (the echo of the significant event or situation that the client feel stuck, impasses or dilemma solved). Metaphor and imagery help the client to move in the positive way and helps the client

and the psychotherapist to understand how to deal with the issues, its fascinated tolls and very useful to see in different angles (it involve body, mind, emotional) the client inner/ external worlds (helps to break down this issue of the client in depth way, and building up different positive strategies to deal and to make the penny drop (Semino, E. 2008, Tay, D. 2012, Beck, J. S. 1995, Neimeyer, R. A., & Mahoney, M. J. 1995, Lakoff, G. & Johnson, M. 1980, Sims, P. A. 2003).

The research examines the metaphor and imagery for therapeutic research and how it can help to the promoted behavioural changes and raising self-awareness (building bridge between unconsciousness to consciousness). The research demostrated analysis of a counseling and involve: transcript, pictures/images, balloons and drawing on paper is provided to illustrate the recommended steps in applying imagery and metaphor types. The research used some theories approached of Gestalt creativity (Zinger, J. 1977, Mann, D, 2010), Phenomenological (questions and description, e.g. transcript) (Spinelli, E. 1989), and TA (Berne, E. 1961) impasses (Mellor, K. 1980, Goulding, R & Goulding, M. 1975), ego state and script (Berne, E. 1961, Steiner, C. 1974) to understand in a depth way the client issue. However the client left- brain have the capacity for cognitive process (thoughts and analysis) and the right –brain have the capacity for the emotional process (Withers, R. 2006).
1. Identifying client and intervention:
I demonstrated the use of imagery and metaphor by presenting recording/transcript of an image (postcard/pictures) intervention to my supervisor that I focused on the client, I used in the therapeutic room in one of two sessions (session 16, 17).
Case formulation: (Lister-Ford, C. 2002) (see also section 4 analysis)
Description of presenting problems:
The client was suffering from low mood, depression and anxiety (panic attack sometimes), he has felt this way for the last 6 years (since he was 19 years old). He asked for help to reduce the, depression and anxiety and to enjoy everyday life.

Why intervention (case formulation):
➢ To help the client to understand his depression and anxiety through metaphor and imagery, and building bridge between unconscious and conscious. To raise self-awareness and understand his internal/external world (e.g. conflicts, confusion, loss and so on). Increase client awareness and feeling of control over these symptoms (sleepless, loneliness, powerless, low mood, hopeless).
➢ To decrease depression, anxiety and low mood symptoms. Solve the impasse of ‘please other’ (level 1). ‘Don’t be important, ‘don’t belong’, ‘don’t exist’, you’re not good enough’ (level 2). Level 3 symbolic image and language ‘I feel as if I am in a fog, lost, cold and alone’, ‘Prisoner of my thoughts’ (metaphor) (Lister-Ford, C. 2002, Steiner C. 1974).
➢ To strengthening /integrated his Adult ego state and developed his Free Child. In this case I used TA theory (Berne, E. 1961) in order to analysis and understand the clients needs and to help understand his depression anxiety and low mood through creativity methods (Gestalt theory; creativity, see Zinker. J.1977).The objective of session 16 and 17 is to gain a better understanding of the clients situation, to raise his self awareness and also to get a better understanding of his internal/external worlds.
➢ The creativity process helps the client to connect to his emotions and thoughts and accept himself as an individual/person (‘being in the world’)(reference)
➢ Other objectives for this client in these sessions are to be sure the client has enough strength in his adult ego state in order to work with the creative process. (Sills, C. & Hargaden, H. 2003) (See also ethical and permission from the client (see Bond, T. 2004)
The client Attachment: Anxiety Ambivalent (Bowlby, J. 1977)
Psychological games: Why don’t you try, NL as Victim position Feed by the
R and P ‘Kick me out’, ‘Do this for me’ (Berne, E. 1961,1964)
Ego quality: sadness (Lister-Ford, C. 2002)
Ego Condition: Hopeless (Lister-Ford, C. 2002)
Ego image (Lister-Ford, C. 2002): The client used to be scared of the darkness when he was a child, he was not like a ‘Normal’ child, he was a tense and anxious child and tried very hard not to have wants and needs, he’s the Family baby, he lacked sufficient experience of unconditional love he doesn’t trust his own wants and needs without becoming anxious and tense.
Life Position: I’m Not Okay You are OK. I’m OK you are not OK (move on and off with the same position for example: something wrong with me, everybody else looks normal) (Berne, E. 1961,1964)
Child Contamination: There is something wrong with me (see figure 2: double, Parent and Child contamination(Berne, E. 1961,1964).
Double contamination: Distortion of the reality, here and now difficult to cope with the situation in everyday life (I’m not good enough, Don’t important, Don’t exist) (Berne, E. 1961,1966)
Parent Contamination: The world is a bad place (don’t exist) (Berne, E. 1961,1964).
Client script matrix: (Lister-Ford, C. 2002, Steiner C. 1974) see figure 2

Understand of research ethic and complexities of research in therapeutic relationship:
Ethical consideration:
I asked the supervisor’s permission before I started the creativity process/research. Confidentiality contract research: I asked client’s permission before I started the creativity research process. We, (the client and I) signed a new confidentiality contract for research (client agreed with the creativity research process)
1. Client safety: To ensure anonymity and permission for use of transcript in research.
2. Non-maleficence: Commitment to avoiding harm
3. Benefit: Commitment to the client’s well-being
4. Autonomy: The client was willing to participate in data collection and if the client refused to cooperate, I will respect the client decision
5. Self-respect: Respect the decision of the client. Hear the voice of the client and what the client needs.
6. Work with the ethical guidelines for researching (BASCP)
7. Give the potential legal implication of client material. The researcher works to a strict confidentiality code, clearly indicating the boundaries of this at the beginning of any interview/sessions
8. Respect for client self determination
9. Name and identifiable details will be changed.
10. In keeping with the Data Protection act 1998, all recorded data will be stored in lockable and secure cabinet (Bager-Charleson, S. 2014, Bond,T. 2009).

Before I started my creativity process I asked my client for permission. I decided to do creativity intervention at this time because I have to be sure that my client has enough Adult ego state to cope with this process, also I explained to the client the purpose of this creativity play in the clinic room, what we need to do, e.g. raising self awareness, and if the client is still not comfortable or does not feel not safe with this process he can let me know if he’s want to continue or not, even if he is in the middle of the creativity process the client can let me know and I will respect his word and ask my client to clarify what the reason is he wants to stop. How the client’s feels and describe his feelings and thoughts (Bond, T. 2009). Ones of the reasons to work with TA approached (Berne, E. 1961) is because I need to hear the clients voice in to his Child ego state and what the client really needs, empower the client, strengthen his Adult ego state (integrated Adult ego state).

2. Engaging with literature (metaphor and research methods):
Creativity process influence on the body, mind emotionally and cognitive, it helps the mind to reflective the unconscious to conscious processing into the ‘form’/’shape’, that helps the client to think about this and helps to building up insights, its like to bring ‘light’ into the soul (Learmouth, M.& Huckvale, K. 2008).
Bowlby’s describe from the prospective of attachment theory the creativity process helps the client to bring meaning and understanding into the therapeutic room working with association and helps the client in authentic way and helps the relationship to be closer between client and psychotherapist (Bowlby, J. 1977, Holmes, J 1993).
(Learmouth, M. & Huckvale, K. 2008), argues that creativity process can helps the client to achieve the full picture from unconscious to conscious when the client express his feeling is can be very powerfull and if the have the rights condition in the therapeutic room for example: the right support and use by the psychotherapist; empathy, trusting, non judging, safety and unconditional positive regards, good relationship between therapist and client it can helps the client to raising self awareness and also encourage the client to change some patterns of the his behavior (like “green hose” very safety) (Learmouth, M. & Huckvale, K. 2008). Metaphor and imagery is like a light for the soul to building the bridge between internal/external worlds between the script and what we feel, between unconsciousness to consciousness by effective way to helps the client to understand himself better and helps to the ‘penny drop’, the clients clarify in depth the relationship between “object event and subjective” (Winnicott, D.W. 1971), between “mind and body”, (Lakoff, G., & Johnson, M. 1980) between internal/external worlds between “unconscious to conscious”(Freud, S. 1914,1915)
“Creativity and imagination are often undervalued as human resources yet without imagination we could not remember, anticipate, empathize, or make choices. Our adaptability as a species is dependent on these functions. To bring them to the service of psychotherapy whose business is so much to do with adaptation, resilience, and survival is therefore only a modern manifestation of one of our oldest and deepest resources” (Chadwick, P, 2000, P19).
3. Designing the intervention and collecting data:
Methodology: Types of data and collected data:
This research uses inductive thematic analysis of metaphor and imagery to show how metaphor and imagery have the powerful and useful tools to helps the client in the therapeutic room. I used: Pictures, transcript, balloon Technique and drawings on paper. The research use qualitative approached (McLeod, J. 2001).
The creativity process took 2 sessions to evaluate the process with metaphor and imagery (McLeod, J.

2001). Before I started the creativity process I asked my client how do you feel now? Measure between 0 (worst) and 10 (excellent) in order to measure the changes (see graphs and pies). I used two elements to evidence if the metaphor and imagery helped my client to raise his self -awareness and to see what influence it had on his feelings (mood). Before I started the process I explained to my client the process of this creativity and the goal. I asked his permission to be sure the client was willing to be involved with the creativity process (Bond,

T.2009).
Session 1: Postcard/pictures: I put 20 pictures on the floor and asked the client to chose ones of the pictures that reflected his situation here and now, a picture that he doesn’t like or found difficult. The client chose one of the pictures, and reflected on his thoughts and feeling. Later on I asked the client through the image to building metaphor continue the process with questions (see transcript).
Different research show that pictures/ images helps the client’s to speak on his difficult issues (for example childhood trauma, sexual abuse and so on) because the creativity process helps the client to work with association that the client can’t hiding or control this feelings and thoughts and the client can find himself explore to the image and express his issue in the creativity process (Martin, R. & Spence, J.1987, 1988, Spence,J.1986, Weiser, J. 1999, 2001,2002, 2004).
The process started with unconscious process bring into the therapeutic room any association and later on the process started to building up the bridge between unconscious to conscious,.

The client projecting is issue into the picture/image and represented his emotional and thought into the image, particular when the client can’t deal with the issue in everyday life. In different words, the image helps the client to reflective his problems for example; depression into the image (see client chose image 1 below).
The following weeks: session 2 of creativity process: I asked the clients to inflate balloon which helps the client to relieve himself of negative thoughts, feelings and somatic symptoms such as anxiety, depression, fear and so on. The client’s inflate the balloon and written down all his negative feelings and thoughts and when the client finished to written down the client rid of all negative thoughts, feelings and in the end I asked the client to impale, smash the balloon and throws the balloon into the bin see image 2 Balloon technique below) (Friedman, B. Van der Hart, O, Witztum, E. 1988 p

7).

Image 1: The Fog

Image 2: Balloon Techniques

At the same session I asked my client to draw his feeling as a reflective of his process what he felt, what makes him change and draw his feelings on the paper, later on we reflect together our feelings, thoughts and behavior (see draw 1 below).
Draw 1: The client draw is Metaphor: ‘Prisoner of his thoughts’
Drawing therapy: in order to helps the client to raising awareness and help the client to understand his feelings and thoughts I asked the client to reflective his words (metaphor and image) into the paper to be more activated and helps the client to demonstrate his thoughts and feelings to understand his conflicts through out visual language and hope the client can understand his conflict in different angle and helps the client to raising self-awareness and insights (Withers, R. 2006).

4. Analysis interpretation and finding:
The objective of the analysis is to understand two questions of the client situation:
1.What images represent the client conflict in his life?
2. What images represent the client internal/ external worlds in here and now in the therapeutic room?
Checked the internal world (subjective way; depression, fear, anxiety) and how it projects to the external worlds (the object: photos/image, balloon, drawing on paper), it always dialectic between internal/external worlds and so forth, the same system with mind -body who influence and feed each other). The client chose the picture as a reflection of his internal world into the external world. Projected into the picture, client felt a lonely and dark (internal world) ‘Prisoner of his thoughts’. I found to use of image/picture to helps the client in effective and positive way to engage the client and move on mean to explore meanings, solve his conflicts by understanding more clearly the issue and raising self -awareness between the triggers that started (trauma and move to post trauma) the symptoms and the reasons of his conflicts (like spider-web). Creativity process challenging the client and helps the client to understand himself in effective way and in different way. Helps the client to contain the process by created metaphor and reflective into the image that the clients build up in positive way and I mean helps the client to see his conflict by his value, meaning and respect, to connected and accepted his feelings, without to be shame or disrespect.
When my client built his metaphor ”Prisoner of his thoughts” (explicit metaphor) he started to raise awareness and strengthened his Adult ego state, the client perceive his inner/external world more clearly in very powerful meaning.
The Metaphor ‘prisoner of his thoughts’, It is one of the principal means by which client understand his experience and reason on the basis of that understanding, I mean the client add colourful, form, shape and texture to his communicated (meaningful) in doing so build an bridge between client subjective (inner world) and objects (external world), resolving unfinished business to finished business. The metaphor can be very powerful because that helps the client to see the process from abstract and move to concrete. Particular when the metaphors express in explicit way and helps to explore the meaning of the words (metaphorically) and his life experience in most useful way (visual language, concrete mind picture in authentic way) and this helps the client to see in different angle his issues (in this cased the creativity process involved two elements the unconscious= darkness, painful and the conscious= lightness)
The image of ‘Balloon techniques’ and drawing his thoughts and feelings on the paper helps the client’s to started to understanding himself by express his feelings and thoughts and Image these experiences have contributed to the client construction of a world in which positive change is possible, and in which he is capable of creating those positive changes (the mental and emotional capacity).
In the TA (Transactional Analysis see Berne, E. 1961) approach the client and me understand the impasse (Mellor,K. 1980) level 1 of the conflicts between the driver “please others”, “try hard” and the impasse level 2 (Mellor, K. 1980) “don’t grow up”, “don’t be important” don’t exist, “don’t belong” (Berne, E. 1961) (see transcript line 5 “darkness affect my mood”). Impasse level 3 (Mellor, K. 1980) show clearly the (see transcript line 11” loneliness and isolation really) ”I feel as I’m in a fog, alone”(Lister-Ford,C. 2002, p 164) (see image/picture 1 the client choose) metaphor “prisoner of his thoughts” (see transcript line16). The client understood that if he’s not going to be very busy he would be tramps into his “prisoner of his internal world” (see transcript line 21, “stuck”, “panic” disappear”). Client can described the intra-psychic conflict between Parent and Child ego states level 3 (Mellor,K. 1980) is at the somatic (the client body language, ‘pain in my stomach, my chest, my neck’) level P0 to Co ‘stuck place’ the clients experience in script stuck also, the conflict between the Parent ego state and the Child ego state once the Child begins to experience a different energy (due to a permission) in opposition to the Parent ego state. And that what the client express himself and reflect himself through the picture (see also balloon, drawing on paper) “I feel as if I am in a fog, lost, sad cold and alone” (Lister-Ford,C. 2002, p 164) the client also stuck between the driver ‘Please others’ please his father and this “please other” driver (the relationship between Client (please his father) and his this please his father reflective in different way with his girlfriend and with me in the therapeutic room, and this made the client to be stuck in different way, made himself in the position of self- sacrifice (Programme see script figure) himself and put his need in the last priority with any relationship with; psychotherapist, girlfriend, and particular with his parent-father (Lister-Ford, C. 2002, P 72. Mellor, K. 1980).
Client racketing: express fear of darkness (link to the ego image childhood trauma left alone in the school holiday, developed fear of dark) … sadness, loneliness (Erskine, R. and Zalcman, M. (1979, Zalcman, M. 1987).
Script matrix: Injunction don’t be important, don’t belong (alone by himself) “don’t grow up” “ don’t exist”. Driver “please others” “try hard” and “be strong”(see transcript) don’t exist (Prisoner of his thoughts client felt negative about his life (see Lister-Ford, C. 2002, Steiner, C. 1974)

Measures the research:
I measured the creativity process by checking two elements: Feelings (mood) and self-awareness. Before I started the creativity process with the client, I asked my client how do you feel? 0 (worst) and 10 (excellent), I also asked my client what is your awareness of yourself here and now in the room. Below are the results express by graph and pies:

Graph1: Measures of feelings (mood). Before the creativity process client felt 4 after client felt 7

Pie 1: before the process

Pie 2: After the creativity process

Pie 3: Measures self- awareness (before the creativity process)

Pie 4: After the creativity process measured self - awareness

5. Reflecting on the process: My client and I reflected together the process in sessions 2 (session 17) I gave my client the opportunity to reflect on the process through questions: Before I started the creativity process I asked my client How do you feel? 0 (worst) 10 (excellent), the same with the self –awareness, the Client answered that he felt 5 before started the creativity process after the creativity process, I asked my client how do you feel (see graphs measures self awareness and feels). I asked my client if he enjoyed do the creativity, and my client said that he enjoyed very much. I asked my client also if he tried to ‘please me’ when he said this and my client said not, he really enjoyed and he feel much better and happy and very positive. My client said that he felt much better after the creativity process than before, he felt more self- awareness and felt his mood getting better. I can see my clients body language: Crossed legs and arms before he started the creativity process and through the creativity my client stop to crossing his arms and legs and appeared more relaxed. My client and I felt the positive energy in the room, the creativity process made my client to feel like ‘the penny had dropped’ that unfinished business come to finished, emotionally and cognitively he felt better, after two weeks my client said that all the creativity made him feel great and he really appreciated this approach. He asked me to do more creativity process in the future. I can understand and used my intuition and I believed that my client had progressed and felt much better. I asked my client to draw his feelings on the paper about how he felt before the process and how he felt afterwards (please see drawing 2)

Draw 2: Before the client started the creativity process (Reflective process) we can see more black colour on the page and a tiny yellow, orange bright colours.

Draw 3: After the client finished the creativity process (Reflective process), see more almost full of the page by bright colours and a tiny dark/black colour.

Conclusion:
• To used metaphor and image in the therapeutic room it very powerful and helps the client to raising self- awareness and clarify his conflict in visual language. It’s working as a bridge between body-mind and between unconscious to conscious.
• Working with metaphor and imagery helps the client to reflected himself and bring to his meaningful life and insights, building the bridge between internal/external world, between unconscious to conscious, between psychotherapist and client relationship and between the client feeling and thoughts and also helps to strengthen client’s Adult ego state.
• My future research will research and use Gestalt theory in particular two characteristics the creativity and the phenomenology approach. I will use the phenomenology approach in order to break down through questions and description ‘here and now’ and cover different angles of the client experiences, for example I would used the ‘Factorization’ from the mathematic approach to break down ‘here and now’ and helps the client in the depth way to understand his internal/external world and to achieve the clients goals.
This Factorization, like in mathematics, helps to understand the triggers and the resources of the full picture (for example, depression, anxiety and so on). And the phenomenology approached helps me to check the ‘here and now’ and building the bridge between unconscious to conscious to hear the echo of the past (history experience of the client) present (how the client feel in the room, body -mind) and future (what will be the implication from the ‘here and now’, how the client understanding and raising self -awareness what change and what responsibility he will take with him and how its helps the client to achieving his autonomy.