When is a Metaphor? Art Psychotherapy and the Formation of the Creative Relationship Metaphor

It is a widely debated subject whether a patient with a diagnosis of major depression and a history of psychosis is able to use and comprehend metaphors. There are a number of studies that indicate that metaphor comprehension with this population is very reduced. However, within the context of psychotherapy metaphor is poorly defined and the concept is often applied inconsistently in academic literature. This thesis examines a commonly reported occurrence of metaphor formation in art psychotherapy and in particular, examines a type of metaphor that offers a novel perspective about interpersonal relationships called the creative relationship metaphor. This thesis aims to develop a definition of a form of metaphor that is helpful in clinical practice and understand the clinical formation of this metaphor in art psychotherapy. The first part of the thesis develops a new metaphor type, called the ‘creative relationship metaphor’ (CRM), beginning with a psycholinguistic perspective. 2 3 In summary, the key characteristics of the CRM being developed is that it is: • An interpersonal event • An image based representation which is cognitively mapped • Context dependent • A novel way of perceiving the person, thing or event The hypothesis that patients diagnosed with severe mental health issues can produce CRMs is tested through two analyses. The first analysis focuses on the defining features of the creative relationship metaphor and the second analysis focuses on the therapist’s influence on metaphor formation. In the clinical examples, the increased capacity to reflect on significant relationships is linked to the formation of the CRM. These results offer preliminary evidence suggesting that there are specific in-session interventions that support the development of the CRM in the assessment context.