Metaphors are a central tool for therapists of many therapeutic modalities. They are central ways in which we understand the world, and particularly, our own inner experiences. Our inner life of thoughts and feelings are described by relating to physical properties of the world. A metaphor can be defined as a figure of speech that denotes a similarity between two unlike entities (Stott et al. 2010).
Metaphors help us see thoughts – their nature and role – in a different light. Just that alone, seeing thoughts differently, helps to create a space, a distance, between us and our thoughts, which helps us to stand back a little, see things a bit more objectively, and make wiser and more helpful decisions about how to react effectively (Killick, Curry & Myles, 2016).
In personal injury this is particularly important as individuals’ and their families often struggle to make sense of what has happened to them and to explain the changes between their pre and post-injury selves. This struggle can lead to mood disorders, isolation and shame.
To facilitate an understanding of the process survivors are going through, it is useful to look at the grief literature.
It also impacts each individual and their families in different ways. One of the things that might be difficult to understand is that for most people, the grief of what was lost never leaves a person completely. The loss stays with most of us forever. This idea was supported by Tonkin (1996).
This concept was helpful capture in the following analogy:
The box and the ball analogy (Lauren Herschel)
In this analogy the individual is encouraged to imagine life as a box and the grief experienced as a ball inside of the box, also inside the box is a pain button. At the start when the loss is so fresh and new, the grief that many people feel can be overwhelming and large. Large enough that every time one moves the box (trying to get on with life) the grief ball can’t help but hit the pain button. It cannot be controlled.
The pain may feel unrelenting and never-ending. Over time, however, the ball starts to shrink on its own, as carries on with life. Occasionally the ball hits the pain button, but this is not as frequently as at the start.
Grief is never experienced the same way for any two people. Most of us walk through life, carrying our own box with a ball of grief inside of it.
In a similar way to grief, adjustment to personal injury can be like the ball in the box, the initial shock to what has happened and the consequential changes to life it brings can cause psychological pain and disbelief to the individual and their families. In some cases, the initial shock is prolonged due to denial (poor insight) of any changes that have occurred. In time and with support the pain does decrease but it never goes away completely as loss of one’s previous life can be a trigger for the pain button.
Destination analogy for goal setting
In helping clients with personal injury set goals in keeping with their values, it is often helpful to use the destination analogy.
Picturing life as a destination and goals as a series of steps in that journey can be useful in organising and structuring those conversations.
The questions below are common in these conversations
- Where exactly are you going?
- What do you want to achieve?
- What route do you need to take in order to get there?
- How will you know when you get there?
- How will your life be different?
- What will you be doing differently at that time? What will others notice about you?
- Can you get there in one go, or do you need to do it in stages–take rest stops? Is it achievable?
- How long do you anticipate it will take
There are many unseen effects of personal injury which includes anxiety, depression, post-traumatic stress disorder, difficulties sleeping and so on. Some individuals’ may struggle with self-esteem issues.
The £20 Note Analogy
The £20 note analogy may be helpful in a therapeutic context. Here, you ask the individual if the value of a £20 note changes if it is found scrunch up after being placed in a washing machine.
Usually the answer is no, again the question is asked if the value of the £20 note changes if it falls to the ground and trodden on, usually the answer is no. In a similar way despite all the circumstances in life we find ourselves, our value as human beings never changes.
References
Kilick, S., Curry, V., & Myles, P. (2016). The mighty metaphor: A collection of therapists’ favourite metaphors and analogies. The Cognitive Behaviour Therapist, 9, E37. Doi: 10.1017/S1754470X16000210
Lois Tonkin TTC, Cert Counselling (NZ) (1996) Growing around grief—another way of looking at grief and recovery, Bereavement Care, 15:1, 10, DOI: 10.1080/02682629608657376
Stott, R., Mansell, W., Salkovskis, P. M., Lavender, A., & Cartwright-Hatton, S. (2010). Oxford Guide to Metaphors in CBT: Building Cognitive Bridges. (Oxford Guides to Cognitive Behavioural Therapy). Oxford University Press.
Need any further information?
We at The Psych Practice offer support to individuals, couples and families living with brain injury.
For more details please contact us on:
Telephone: 020 8058 4060
Email: admin@thepsychpracticetpp.com
Website: https://www.thepsychpracticetpp.com
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