Metaphors Offer Meaning

 

“I had a black dog, his name was depression” is a video which make so much sense to so many people across the world. Depression does not discriminate and it comes in all shapes and sizes. Some may call their depression a black dog, others a slug or demon on their shoulder. The metaphor that someone uses for their depression can also be the thing which brings them closer to managing their symptoms. Metaphors can also be used within therapy to support changes in thinking. Steve Killick, Vicki Curry and Pamela Myles (2016) have collated some of the metaphors which clinicians  have used or have developed with clients to help overcome their difficulties, have a read of this one or the others in the paper and tell me which is your favourite.

This is my favourite;

Folding up paper to put in the bin- Young people and trauma

I was working with a 14-year-old boy with PTSD following some very traumatic events. We were about to embark on our third session of trauma-focused CBT and I wanted to remind him why it could be helpful to go through what happened and talk about the very thing that he had avoided talking about for 18 months.

I tried to explain that I wanted to help him to take the sensory information of the memories and ‘wrap them up in words’. I reminded him of two common metaphors that I had used in earlier sessions to explain how this processing of memories can lead to a reduction in symptoms: the wardrobe (Ehlers & Clark, 2000) and the factory (Richards & Lovell, 1999).

These two metaphors had been adapted and elaborated following the feedback from many clients (the revised versions are described in Trickey, 2013). The client listened patiently, nodding and encouraging me as I told him the stories. He then said ‘It’s a bit like that David, but actually, it’s more like this’. He filled up the waste paper bin with scrunched up pieces of paper until it was overflowing and said ‘These are all the bad things that have happened to me, and as I walk along the road to school [he made the bin walk along and bits of paper fell out of the top] they fall in front of my eyes. And as I go to sleep [he lay the bin down and more pieces of paper fell out] they fall into my dreams. But when I come here and talk to you, we take each piece of paper out [he took each of the pieces of paper out], un-scrunch them [he un-scrunched them], and we read them through carefully. Then we fold them up neatly and place them back in the bottom of the bin [he folded up each piece of paper neatly and placed it in the bottom of the bin]. This means that they don’t fall out the top, and I have more room in my head to think of different things’.

Not only is this a remarkably helpful metaphor, I love using it because it came from a client in the middle of trauma-focused therapy to explain his own experience of how it was helping. I have used this story many times since, and because it comes from a ‘fellow-client’ it has much more credibility. I am so grateful to the client for his help.

By DAVID TRICKEY

You can read the whole article here:

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/A2FDDEB0C9BA9B4FE7103A73C0455B6D/S1754470X16000210a.pdf/div-class-title-the-mighty-metaphor-a-collection-of-therapists-favourite-metaphors-and-analogies-div.pdf

The STIGMA of Mental Health Difficulties “We have come a long way but we still have a long way to go”

“Psycho” “Mad” and “Crazy” are just a few of the words that are pushed around when talking about mental health issues. Children, adolescents and adults, will often not speak of their difficulties due to the stigma that society has created around mental health. Resulting in many people suffering and battling with their difficulties alone. With increased access to google, ‘WebMd’ and Wikipedia children, adolescents and adults often misdiagnosis themselves or become haunted by the possibility of their symptoms never being alleviated. It is down to professionals to help to destigamise mental health illness.

But, we must also reflect on how far society has come in changing the perceptions of mental health issues. Scientific developments, social understanding and a reduction of discrimination led to de-institutionalization in the 19th century, when asylums like the notorious Bethlehem Hospital a.k.a. “Bedlam”, were transformed. Those who suffered, in what Foucault called, ‘the great incarceration’ of people with mental health issues, would not believe the progress that society has made in such a short amount of time. Lord Shaftesbury in 1851 spoke about how “madness constitutes a right … to treat people as vermin.” The historic abuse, neglect and inhumanity that people with mental health issues were victim to within society emphasises how far we have come.

Yet we still have a long way to go, as can one truly say that in modern society people with mental health difficulties are not still treated differently, and continue to be view as being weaker, less able and feeble individuals. Although much has change in how people with mental health issues are clinically treated, people are still challenged by the stereotypes and prejudice that result from misconceptions about mental illness. As a result of this people with mental illness are robbed of the opportunities that define a quality life: good jobs, safe housing, satisfactory health care and support, and their voice is often left unheard. It is hard to think about how these prejudice are still prominent within our society as it is estimated that 1 in 4 people in England will experience mental health problems in any given year. Corrigan and Watson spoke about how far we have come in developing our understanding of the brain, neurological development, cognitive functioning and ways to treat mental health issues, but research has only recently begun to explore stigma of mental illness.

Much work needs to be done to fully understand the breadth and scope of prejudice against people with mental illness. It is at this point professionals, teachers, families and society as a whole must work to understanding and change the prejudice and discrimination of people with mental health issues. It is important to consider how many children, adolescents and adults within modern society shy away from seeking help with their mental health difficulties due to the on-going stigma.

Steps are starting to be made to reduce prejudice, ensuring that people with mental health difficulties can receive the help and support they need without being shunned within society. Mental health professionals have begun to understand the paramount importance of early intervention in helping children and adolescents with mental health issues, reducing stigmatisation in the next generation. Many schools within the UK now have links with their local Child and Adolescent Health Service (CAMHS) who offer help and interventions for those children and adolescents with mental health difficulties. Moreover, they offer vital psycho-education to teaching staff and other local services to ensure that as key role models within society and educators of the next generation, they to can spread the message of destigmatising mental health difficulties. Celebrities and the Royal Family have begun to show their support for speaking out about mental health difficulties and reduce prejudice within society. Kate Middleton is the patron of the Anna Freud National Centre for Children and Families, whilst Prince Harry and Prince William have shown their backing for the charity ‘Heads Together’ who aims to eliminate stigma and change the conversation about mental health.

Recently Prince Harry spoke to some of Great Britain’s best athletes to hear about their own mental health difficulties. This work sparks the drive to increase awareness about mental health issues and help support society to promote a positive conversation about mental health. Watch the link below and tell me what you think:

 

Getting It Down On Paper

cropped-winnie-the-pooh-writing.jpg

 

To think, to wonder, to learn, to make a change, we need to have something to grab hold of. An idea or a thought can become so much more once it is written down on paper.

Within clinical practice, psychologists often use drawings, timelines and genograms (family trees) to help their clients see their context and difficulties in a visual way. But why is this technique so helpful?

Gerald Oster’s recently published book- Using Drawings in Clinical Practice, emphasises some of key reasons why drawing is useful when working with children, families and adults.

He stresses that often drawings are an easy way to engage clients, especially those who are nervous or find it difficult to share some of their deeper concerns.

Oster’s book speaks about the benefits of using drawing in an initial session or assessment session with a client. As drawings and pictures can reveal so much about the intricacies of a person’s view on the world and their relationships with those around them.

By simply asking a client to draw their family, any difficulties or strained relationships soon become apparent. They might have drawn themselves very distant from their family, or made their partner look like the devil- whatever is put down on the page is valuable.

Having drawn a picture, clients will be able to see themselves that they have created a solid image in their mind. By having their own views on the world and their relationships with others, down on paper it can help a person become more reflective.

Their ideas, beliefs, emotions and thoughts become concrete when they are on the page. This means that they can be explored and looked at from lots of different ways. Fleeting thoughts can be held and looked at, stressful and scary images can be explored and altered. By seeing something in black and white (and colour if the NHS can afford pencils), you no longer have to be puzzled or pestered by intrusive thoughts.

Children find drawing and writing down thoughts particularly helpful. Oster writes about the importance of being able to help a child make connections between their drawings, and their emotions and thoughts.

Drawings, timelines, family trees, poems, stories, comic books, sculptures, paintings… all represent something about their creator. By seeing our own perspective on the world and relationships in front of us in a concrete and tangible way, we can begin to connect how our view of impacts our thoughts, emotions and behaviours.