How Metaphor Can Free Us From Therapy-Speak
reflections from existing online as a writer and psychiatrist
Metaphors are a beautiful part of my writing life, but they are equally important in my work as a psychiatrist and psychotherapist. Metaphors open the gates for us to be able to express what is very difficult to speak to in literal terms. Like poetry, metaphor helps us place words around the edges of something is mysterious without being forced into collapsing or reducing it. When we speak in metaphor, the rules of the game are that we know we are not capturing all of it.
For Mary Oliver May, I’m drawing this week from Upstream, which is a collection of essays by Mary Oliver on life, writing, and other thinkers. In her essay on Ralph Waldo Emerson’s work, she writes this:
“The best use of literature bends not toward the narrow and the absolute but to the extravagant and the possible. Literature, the best of it, does not aim to be literature. It wants and strives, beyond that artifact part of itself, to be a true part of the composite human record—that is, not words but a reality.”
In various forms of therapy training, metaphor is emphasized as a clinical tool in view of helping folks create narrative connecting their past, present, and future. This is true to the extent that different schools of therapeutic thought have books entirely dedication to metaphors that are commonly used in that therapy. As someone who works in psychoanalytic and Acceptance and Commitment Therapy models, I too have my favorite borrowed and made metaphors I often use with my patients. Like literature, I often think that good therapy bends towards opening us up & allowing new meanings to exist. This doesn’t just mean a “reframe,” but often means a deepening that broadens our ability to hold all that is true in life and good in ourselves without combusting.
In the past decade, the rise of “therapy speak” has changed the way that we (me included) think about our emotions and relationships as a culture. In 2015-2018, mental health professionals showed up in the commons of social media with the goal of increasing access to psychoeducation and reducing stigma around mental health diagnosis and treatment. Therapy has long been shrouded as a mysterious process meant for those who were “sick enough” to warrant it. The change of culture both by therapists and by those being vulnerable enough to share their struggles is in many ways a positive thing.
In the last few years, though, criticism has emerged over what many now dub as “therapy speak.” To be sure, I remember being in medical school and being pulled into various rabbit holes or communities that, in hindsight, had mixed impacts on me at the time. I was anxious, I was scrolling, and posts that seemed like they might help me figure that out or feel better caught my attention. This trained the algorithm, and suddenly more and more information and groups and online communities were marketed to me. I learned a lot from these spaces, and still follow a few today. However, I, like many, also was given almost-right information often to an extent that was not helpful and was out of scope of what the science or clinical practice guidelines might have said at the time. This still happens on social media.
My experience with this combined with my socialization as a psychiatry trainee has lead me to being very hesitant to talk about mental health online. I’m aware of what it means to try to do therapy or psychiatry well for just one person, and it is an endlessly interesting, complex, nuanced task. And that’s just for ONE person in front of me who is asking a very specific, contextual question. How could I possibly do that well for a group of folks? How can anyone do that well, even with great learning, experience, and an ethical mind? How can mental health information or clinicians put out answers that are more helpful than harmful into the general chaos of social media?
Yet, people go online for answers. If you have insurance, access, and a good connection with a clinician, you’re lucky. If the question pertains to medications, side effects, and what it might mean for you as an individual to be on this particular med, then you’re lucky if you can get off a waitlist and see a psychiatrist more than every 6-12 weeks.
I think it is needed and possible for scientists, researchers, and clinicians to show up online, advocate, and educate. I think it needs to be done with an eye towards how different people and our own patients might experience both the information and our opinions being in public. If we don’t, we are left with the brutal combination of lack of access to care for many in need and all too many folks willing to benignly speculate or, at worst, capitalize on pain and illness when a vacuum for care exists.
What I’ve come to, at least for now, is that staying with metaphor can help. While I do long-form content on medication questions on the podcast I co-host, one of the things that opens folks up in poetry and in clinic may also be the solution in a polarized, urgent online world: metaphor. In therapy, we often lead with more open questions, like:
“I wonder what it might be like to imagine that relationship if it had more kindness in it.”
“What could we imagine together that might feel supportive to you?”
“I can sense there being many feelings about this. Can we let each speak their part for a moment?”
When it comes to my own consumption online, if it’s too literal, it’s too narrow. I often go back to a statement I learned in med school: If it’s sexy, it’s probably not true. Here, I mean sexy as in marketed well. The product or idea will work immediately, is a secret, has never been thought of before, and is something that others want to keep from you. Is it possible one or all of these things could be true, and I’ve missed out in ignoring them? Yes. But what is also often true is that the truth will out, and I can believe them the third or eighth or twentieth time I hear them. Maybe it will need to be the 50th time if they’re selling a webinar and group community online (don’t ask me how many times I fell for that…I’ve now learned coping skills and that emotion is okay).
Today’s Poem of The Day: Spring, linked here
Today’s Writing Prompt: What are your favorite metaphors that help you navigate life? Who or where did they come from?
Today’s Tiny Challenge: This is the first time of seven in which we will explicitly focus on mindfulness this month. Mindfulness is a core spiritual tenet by a different name in many religions and in the transcendentalist train of thought.
Today, I want you to notice something in food. This could be watching the details of the slow drip of coffee from the spout to the pot, the fleck of grounds making through the filter. It could be the divisions in the tomato you cut, the firmness of the skin, the way it stings that cut on your hand. I want you to set a timer for two minutes, and notice. The point is not the make you feel any certain feeling. The point is building the muscle of attention—the ability to see complexity and detail despite living in a world that wants us to go fast and consume everything, all the time. We will build this muscle over the month, so be nice to yourself and recognize this might be hard!
Take care, and I’ll see you again tomorrow.
Margaret of Bad Art Every Day