Turner, James

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Sheffield Hallam University Research Archive

Develoment and evaluation of a pictorial metaphor technique in the therapeutic encounter: A Delphi StudyTURNER, James <http://orcid.org/0000-0002-8360-1420>Available from Sheffield Hallam University Research Archive (SHURA) at:http://shura.shu.ac.uk/26212/This document is the author deposited version.  You are advised to consult the publisher's version if you wish to cite from it.Published versionTURNER, James (2019). Develoment and evaluation of a pictorial metaphor technique in the therapeutic encounter: A Delphi Study. In: RCN International Nursing Research Conference and Exhibition 2019, Sheffield Hallam UnIversity, 03-04 Sep 2019. (Unpublished) Copyright and re-use policySee http://shura.shu.ac.uk/information.htmlSheffield Hallam University Research Archivehttp://shura.shu.ac.ukDr James B. Turner  HND, RMN, BA (Hons), MA, Dip CAT Practitioner, PG Dip Ed, RNT. SFHEA, PhD Principal Lecturer, Sheffield Hallam University/Cognitive Analytic Therapy Practitioner Clients perspective:  ‘I was attracted to (CAT) therapy  due to its practical nature. It looked like a  method with a procedure. I was hoping to get actual results  and understanding. I wanted to gain a set of  actions for continuing future use. The  investigations during my therapy lead to some important points. Knowing these and their background allows me to act accordingly when situations arise. Jim summarised these points with a picture, having three areas. A glance at the picture reminds me of all the major points and the relevant thought behind them. It summarises the important findings that I need to keep fresh, clear and forward in my mind.  The picture gives me a precise, practical view of the therapy, why it was required and the outcomes it produced.’ Development and Evaluation of a Pictorial metaphor technique : A Delphi Study A review of the literature offered extensive guidance for the use of metaphor in therapy. Often therapies are very focussed on cognitive processes, especially cognitive and behavioural therapies, and yet the use of metaphor is well documented (Kopp 1995, Abbatiello 2006, Barker 1996, Welch 1984 and Palmer 2006) and is an often used utterance (Leiman 1994) in all therapeutic and social encounters. Holmes and Bateman (2002) consider metaphors ‘inherently integrative as they coalesce a number of complex strands of thought into a single memorable image. Mio and Katz (1996) found that positive outcomes are achieved if therapists  utilise metaphor with their patients but a lack of confidence or expertise can restrict their use (Barker 1999).  When the metaphoric mind is acknowledged, accepted and  celebrated there is no longer a distinction between rational and metaphoric minds there is only mind’  (Samples 1976 in Welch 1984)... Strong’s three responses explicating what is implicit in a metaphor and therapeutically extending or modifying it the counsellor creating and delivering a ‘therapeutic metaphor’ (Bayne et al 2000)... Mio and Katz (1996, p76) ‘therapists in  good outcome studies develop and  carry forward metaphor phrases initially generated by their clients’.      Initial Findings Analysis of these figures show that 86% of  participants noticed metaphors in their work  with 72% often or always noticing/working  with them. Qualitative comments ...  •I do not use metaphor unless it comes from  the client then I might adopt what they suggest •I like metaphors and find them very useful but  at the same time I am sometimes concerned  that my lack of expertise means that I am  likely to impose them rather than develop  them collaboratively •It feels like a fundamental part of finding a  shared language •I am trained in a method that utilises metaphor                                 Delphi Findings 7 themes and arose from the 76 Delphi statements... A) Qualities of the Therapist: being attuned,  willing to work  with metaphor, confidence.  B) Training and Supervision: 'Ive realised I  used  metaphors more frequently in supervision.   This I am now very aware of.  I am now aware  how useful this would be in clinical work.' C) Therapeutic encounter: clients own words   develops a shared language. But therapist can  offer an image collaboratively. D) In session process: art materials to hand,  willingness, confidence, checking out.  E) Potential of metaphor: can help manage  affect, one step removed, central theme.  F) Pictorial metaphor: If it works use it, non- judgemental, simple not perfect drawings, less  threatening.  G) Cautions and barriers: pejorative art  experiences, keep checking out agreement with client.                                                  Training Programme Findings 90% of responders were ‘attuned’ to metaphor  having scored their metaphor experience as ‘Yes’...‘I  almost can't help using them! I think that they can  be a very powerful tool to encourage the patient to  understand something/see from a different  perspective’ .  The ‘no’ or ‘limited use’ responders clarified their  position as lacking confidence , ‘only just started to  experiment with them’ or ‘only with some patients’ .  There was a sense of not paying enough attention, not  being focussed to metaphor as if 'in passing' rather than an 'integrative part of therapy’ . Also there was a reflection on metaphors usefulness ‘as I have missed so many  opportunities’.  Case examples of patient-derived metaphors were  provided including use narrative, images, meaning  during clinical work’ within SDR’s: A smashed up TV,  a top dog, a rickety ladder, opening and closing doors.                  Focus groups Opportunistic sample of CAT  therapists at 4 conferences.  general support for approach and key concerns to take forward, like  the role of art and the therapist as art maker in collaboration.    Study 1 has been reported  (Turner 2011, 2012 and 2014)   Delphi Study Consensus methods are based on the belief that sufficient widespread agreement from a group  of experts generates an empirical generalisation (Powell 2003 in Cook and Birrell 2007) Delphi employs a series of iterative questions (rounds) in order to poll and organise opinions  of a sample of expert individuals (panellists) enabling a decision making process to occur  among a sample (Delbecq 1975).    Training programme   Focus group evaluation using  questionnaire. Developed from  findings in Study 1 and Study 2. Five 'pilot' workshops delivered with data capture from 3 fields ; CAT therapists, CRUSE counsellors and MH  counsellors.    Action research      Self Rating Scale The MaP-SELF: Self assessment developed from the  Delphi consensus exercise and  tested in practice.  Participants found the scale helpful to support key  aspects of metaphor and art metaphor practice. James.turner@shu.ac.uk   

Develoment and evaluation of a pictorial metaphor technique in the therapeutic encounter: A Delphi Study

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Develoment and evaluation of a pictorial metaphor technique in the therapeutic encounter: A Delphi Study

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