Pragmatic Case Studies in Psychotherapy

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February 24, 2018 -- From the Editor 


Metaphoric Tasks in Psychotherapy: Case Studies of "Margie's" Self-Image and "Amy's" Pain 

*** Sam Hamburg, Private Practice, Chicago, IL; and Family Institute of Northwestern University, Evanston, IL 


*** Linda McMullen, University of Saskatchewan, Canada 

*** Robert Karlin, Rutgers University-New Brunswick, NJ

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            Since human verbal language and nonverbal behavior are permeated with potential metaphor, it is not surprising that metaphor plays a major role in psychotherapy, even when, as frequently happens, we don't pay explicit attention to it.  In this issue, the potential clinical  power of metaphor in psychotherapy is illustrated by Sam Hamburg in two of his cases. 

          Specifically, Hamburg used simple tasks, assigned as homework, as metaphors to facilitate deep therapeutic change. The first client, a 45-year-old, single woman named "Margie," was an individual with  pervasive depression. With Margie, Hamburg used the structured completion of a jigsaw puzzle as a metaphor for the central problem that plagued her: a self-defeating self-image of incompetence that prevented her from functional accomplishments and from experiencing any enjoyment in life. Margie's mastering the concrete tasks involved in the sequential completion of the jigsaw puzzle, in the context of a deeply positive therapeutic relationship, generalized to mastering the larger challenges in her life.  

          Hamburg's second client is "Amy," a socially, educationally, and professionally successful 26-year-old woman with severe bouts of abdominal pain with no identified medical cause. With Amy, Hamburg employed a variety of metaphors that were embedded in the service of hypnotherapy for the alleviation of her pain. For example, Hamburg metaphorically connected Amy's concrete experience of the pain to a physical device that can be systematically controlled, namely, to that of a metronome that allowed for the use of a 300-point pain rating scale. Hamburg helped Amy to connect variation in the speed and sound intensity of the metronome to the metaphor of pain as a loud alarm, e.g., an alarm that can ring at different speeds, at different decibels, and can be turned on or off like a metronome. 

          In both Margie's and Amy's cases, Hamburg achieved dramatic success in addressing their presenting problems. Hamburg's theoretical model consists of the integration of client-centered, experiential, and hypnotherapy principles within a behavior therapy framework. Because of the value of understanding the specific metaphors and techniques Hamburg used in his therapy in the context of his broader integrative model honed over many years of clinical experience and reflection, an autobiographical statement documenting the development of Hamburg's integrative model is presented as an appendix to his case studies. 

          In commenting on Hamburg's case studies, Linda McMullen—an expert in qualitative research on the use of metaphor in psychotherapy—deeply analyzes Hamburg's cases in the context of the scholarly and research literature on this topic. Then Robert Karlin—a highly experienced and reflective CBT therapist and an expert in psychotherapeutic hypnosis—connects Hamburg's work both to the research literature in the use of hypnotherapy for pain and to related issues, such as how to understand the placebo effect and the difficulty of more generally separating out specific from nonspecific factors in accounting for the effectiveness in psychotherapy.


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Vol 13, No 4 (2017)

Table of Contents

Case Study

Metaphoric Tasks in Psychotherapy: Case Studies of "Margie's" Self-Image and "Amy's" Pain Abstract PDF
Sam R. Hamburg 284-328
When Skill and Wisdom Merge Abstract PDF
Linda M. McMullen 329-337
Metaphor, Verstehen or Neither: A Reflection on Hypnotic Analgesia and Active Ingredients in Psychotherapy Abstract PDF
Robert A. Karlin 338-347
What Are Case Studies Good For? A Response to Commentaries by McMullen and Karlin Abstract PDF
Sam R. Hamburg 348-352