Table 2 The identified themes and subthemes with quotes from the therapists
Themes | Subthemes | Examples of quotes |
|---|---|---|
The therapeutic use of metaphors | Self-criticism concerning limited awareness and lack of listening | “I don’t explore metaphors specifically. I usually listen to the patient’s own language, but not regarding their metaphors specifically.” (CBT) “I don’t think I have a very conscious awareness of these things (metaphors).” (PDT) |
An arsenal of metaphors or a personalized approach | “I have some metaphors which suit particular situations. I often repeat them because they describe what the patients are struggling with in a nice way.” (CBT) “I wait, I don’t use many metaphors, it’s not like I throw them forward at the first opportunity.” (PDT) | |
Strengthening the therapeutic relationship | “It creates a sense of fellowship, our own coded language … It’s something that exists just within our relationship.” (PDT) | |
Finding new perspectives and insight | “It can open up a whole other dimension.” (PDT) “I think metaphors can help the patient get out of a rigid way of thinking”. (CBT) | |
Exploring metaphors: literal meaning or emotional subtext | “I try to find out if I understand correctly what he is expressing by using a metaphor.” (CBT) “I think it (a metaphor) paves a way into a lot of feelings.” (PDT) | |
Unhelpful metaphors: Substituting or reframing | “Some patients hide behind their metaphors.” (PDT) “I seldom correct them, but I may not use their expressions.” (CBT) | |
Conflicting feelings towards metaphors used by depressed patients | Tools: Reassurance or resistance | “It’s an insurance for the patients when you tell them that ‘we have tools, a lot of different tools’”. (CBT) “I can sometimes feel that it invalidates me as a therapist.” (PDT) |
Surface/depth: Different definitions of depth | “I think it’s more about prejudice, that going deep is something they have to do, without realizing what it actually means.” (CBT) “Depth is turn the gaze inward, towards the reactions and feelings.” (PDT) | |
Chemistry: Engagement and curiosity | “It’s easier to get good chemistry with people who are interested in therapy.” (PDT) ““That they work in-between the sessions, and don’t just think we can push a button – ‘click!’ – and then it’s over.” (CBT) | |
Opponent: Externalizing through metaphors | “It’s a way to externalize some of your own inner forces. (…) It’s easier to blame the depression.” (PDT) “This monster is a metaphor … a way to externalize the depression that can be very fruitful.” (CBT) |