Metaphor and emotional-cognitive regulation in psychotherapy: A single case analysis

The present study investigates the role of unconventional metaphors in relation to the emotional-cognitive regulation within Metacognitive Interpersonal Therapy (MI Therapy). This study deals moreover with the application of a new instrument of metaphor analysis within psychotherapeutic transcripts, and with the analysis of MI Therapy by means of computer assisted text-analytic measures. An introduction to the role of metaphor in cognition and psychotherapy is presented. A theoretical model for the identification of metaphorical language within therapeutic transcripts (Metaphor Analysis in Psychotherapy – MAP) with a related operational identification procedure is then described. Following this, the Therapeutic Cycle Model (TCM) is introduced. Finally, guidelines about the conceptual model and the therapeutic treatment of Narcissistic Personality Disorder (NPD) within Metacognitive Interpersonal Therapy are offered. The first entire year of a treatment (42 sessions) with a patient affected by a NPD and treated with a MI Therapy has been recorded and entirely transcribed. The TCM’s computer assisted text-analytic measures made possible the clinical analysis of the case; the MAP allowed the identification of unconventional metaphors within the therapeutic transcripts. The relationship between the production of novel metaphorical language and the computer assisted text-analytic measures allowed the investigation of different clinical functions of metaphors within the therapeutic process analyzed. Metaphor production showed a different distribution along the phases of the treatment, with a lower frequency in the last phase for each text-corpus considered (H1). Metaphor occurrence, contrary to our expectations, did not show any significant relationship with Emotional Tone and Abstraction for any text-corpus considered (H2). As expected it was possible to show a significantly different metaphor distribution both in relation to the different EAPs (H3) and to the Therapeutic Cycles (H4). The dyad presented a significantly higher amount of metaphors in phases of the therapy characterized by Reflecting and Connecting. On the contrary, dyad’s metaphors showed a lower frequency within Relaxing and Experiencing. Finally, the metaphorical language of the dyad presented a higher frequency during their Cycles. This pattern of results differentiated itself if we considered separately the patient and the therapist. Patient’s metaphors countersigned phases of his speech characterized by Connecting and by Cycles. In relation to the therapist, his metaphors occurred prevalently during Reflecting, while a lower occurrence was observed within Relaxing. Moreover, therapist’s metaphors did not present a higher frequency within the Cycles. It was possible to partially verify the hypothesis of a different pattern of emotional-cognitive functions of metaphors both within and outside the Cycles (H5). Outside them, metaphorical language did not show significant differences across the EAPs for the dyad, while patient and therapist presented two different patterns of results. The patient used more metaphors within Relaxing than within Reflecting and Experiencing, while the therapist showed an almost complementary use of metaphors, which are less frequent during Relaxing and more frequent during Reflecting. On the contrary, metaphor production within the Cycles did not present significant differences across the EAPs for both the patient and the therapist, while for the dyad we could observe a higher frequency of metaphorical language within Reflecting and a lower one during Experiencing. Finally, the hypothesis of a different distribution of metaphors associated respectively with Reflecting and Experiencing across the Cycles (H6) was verified only for the patient. Patient’s metaphors occurring within Reflecting and Experiencing presented both a significantly higher occurrence within the Cycles than outside them. In relation to the text-analytic measures, it was possible to observe a higher amount of Emotional Tone and Abstraction in the final phase of the therapy. Abstraction increased significantly for each text-corpus considered, while Emotional Tone and negative Emotions did not when considering the therapist’s speech. The analysis of the EAPs presented a different distribution between the first two phases of the treatment and the third one. More precisely, we observed a significant reduction of Relaxing and a significant increase of Connecting. No significant modifications of Reflecting and Experiencing were detected. This held for each text-corpus considered. Finally, it was possible to observe a higher occurrence of the Cycles in the last phase of the therapy for each text-corpus considered. The results were interpreted within the theoretical framework provided by the two different methodologies (TCM and MAP), with reference to the MI Therapy. It was possible to conclude that the investigation of metaphor production at a purely frequency level can reveal important clinical features of treatment under analysis and the modification of these features. Moreover, clinical functions of unconventional metaphors were identified in relation to emotional-cognitive regulation processes occurring during the treatment and measured by means of computer assisted text-analysis. Finally, the applicability of computer assisted text-analytic measure for the clinical analysis of the case was demonstrated. These results can not be generalized due to the single-case nature of the study. However, our findings would advocate the opportunity of replicating this study with a bigger sample, and also in relation to different therapeutic orientations, in order to increase our empirical knowledge about the functions of metaphor in regulating emotional and cognitive process during psychotherapy.