Facets of the psychotherapy relationship: a metaphorical approach

Submitted: June 23, 2020
Accepted: September 12, 2020
Published: January 14, 2021
Abstract Views: 1014
PDF: 432
HTML: 16
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.


Although many separate aspects of the psychotherapy relationship have been studied, including empathy, working alliance, and self-disclosure, a metaphorical approach has the potential to generate a more holistic perspective of this phenomenon. Hence, the goal of this study was to explore the nature of the psychotherapy relationship from the psychotherapists’ perspective using a metaphorical approach. In an online survey, a sample of N=373 Czech psychotherapists and counselors rated a set of relational metaphors in terms of how accurately they depicted their roles in their relationships with their clients. The single most endorsed metaphor for the practitioner’s role was a guide. Furthermore, the principal component analysis identified three relational components, namely, Mentor, Resource Supplier, and Remedy Distributor. The associations among these components and multiple practitioners’ variables, including demographic and practice-related variables and theoretical orientation, were explored. These three components represent general dimensions of the psychotherapy relationship that cut across various theoretical orientations and, thus, define psychotherapy relationships in a general sense.



PlumX Metrics


Download data is not yet available.


Angus, L. E., & Rennie, D. L. (1988). Therapist participation in metaphor generation: Collaborative and noncollaborative styles. Psychotherapy: Theory, Research, Practice, Training, 25(4), 552-560. doi: https://doi.org/10.1037/h0085381
Angus, L. E., & Rennie, D. L. (1989). Envisioning the representational world: The client’s experience of metaphoric expression in psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 26(3), 372-379. doi: https://doi.org/10.1037/h0085448
Austin, W., Bergum, V., Nuttgens, S., & Peternelj-Taylor, C. (2006). A re-visioning of boundaries in professional helping relationships: Exploring other metaphors. Ethics & Behavior, 16(2), 77-94. doi: https://doi.org/10.1207/s15327019eb1602_1
Beisecker, A. E., & Beisecker, T. D. (1993). Using metaphors to characterize doctor-patient relationships: Paternalism versus consumerism. Health Communication, 5(1), 41-58. doi: https://doi.org/10.1207/s15327027hc0501_3
Beutler, L. E., & Harwood, T. M. (2000). Prescriptive psychotherapy: A practical guide to systematic treatment selection. Oxford: Oxford University Press.
Burlingame, G. M., McClendon, D. T., & Alonso, J. (2011). Cohesion in group therapy. Psychotherapy, 48(1), 34-42. doi: https://doi.org/10.1037/a0022063
Cain, D. J. (2002). Defining characteristics, history, and evolution of humanistic psychotherapies. In D. J. Cain & J. Seeman (Eds.), Humanistic psychotherapies: Handbook of research and practice (1st ed., pp. 3-54). Washington, DC: American Psychological Association.
Carter, A. H. (1989). Metaphors in the physician-patient relationship. Soundings: An Interdisciplinary Journal, 72(1), 153-164.
Castonguay, L. G., Janis, R. A., Youn, S. J., Xiao, H., McAleavey, A., Boswell, J. F., O’Leary Wiley, M. (2017).
Clinicians’ prediction and recall of therapeutic interventions: Practice research network study. Counselling Psychology Quarterly, 30(3), 308-322. https://doi.org/10.1080/09515070.2017.1334628
Cooper, M. (2008). Essential research findings in counselling and psychotherapy: The facts are friendly. Los Angeles, CA: Sage.
Cooper, M., Norcross, J. C., Raymond-Barker, B., & Hogan, T. P. (2019). Psychotherapy preferences of laypersons and mental health professionals: Whose therapy is it? Psychotherapy, 56(2), 205-216. doi: https://doi.org/10.1037/pst0000226
Corsini, R. J. (2008). Introduction. In R. J. Corsini & D. Wedding (Eds.), Current psychotherapies (pp. 1-14). Belmont: Thompson.
Crits-Christoph, P., Gibbons, M. B. C., & Mukherjee, D. (2013). Psychotherapy process-outcome research. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (6th ed., pp. 298-340). Hoboken, NJ: John Wiley & Sons.
Curtin, J. (2017). lmSupport: Support for Linear Models. R package version 2.9.8. https://CRAN.R-project.org/package=lmSupport
Elkins, D. N. (2009). The medical model in psychotherapy: Its limitations and failures. Journal of Humanistic Psychology, 49(1), 66-84. doi: https://doi.org/10.1177/0022167807307901
Fernández-Álvarez, H., García, F., Lo Bianco, J., & Corbella Santomá, S. (2003). Assessment questionnaire on the personal style of the therapist PST-Q. Clinical Psychology and Psychotherapy, 10(2), 116-125. doi: https://doi.org/10.1002/cpp.358
Fox, J., & Weisberg, S. (2011). An {R} companion to applied regression (2nd ed.). Thousand Oaks, CA: Sage.
Gelso, C. J., & Carter, J. A. (1985). The relationship in counseling and psychotherapy: Components, consequences, and theoretical antecedents. The Counseling Psychologist, 13(2),155-243.
Gelso, J. C., & Hayes, J. A. (2007). Counter-transference and the therapist’s inner experience: Perils and possibilities. London: Routledge.
Grencavage, L. M., & Norcross, J. C. (1990). Where are the commonalities among the therapeutic common factors? Professional Psychology: Research and Practice, 21(5), 372-378. doi: https://doi.org/10.1037//0735-7028.21.5.372
Henson, R. K., & Roberts, J. K. (2006). Use of exploratory factor analysis in published research: Common errors and some comment on improved practice. Educational and Psychological Measurement, 66(3), 393-416. doi: https://doi.org/10.1177/0013164405282485
Horn, J. L. (1965). A rationale and test for the number of factors in factor analysis. Psychometrica, 30(2), 179-185. doi: https://doi.org/10.1007/BF02289447
Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48(1), 9-16. doi: https://doi.org/10.1037/a0022186
Huang, F. (2015). hornpa: Horn’s (1965) test to determine the number of components/factors. R package version 1.0. https://CRAN.R-project.org/package=hornpa
Keefer, L. A., & Landau, M. J. (2015). Frighteningly similar: Relationship metaphors elicit defensive information processing. Social Psychological and Personality Science, 6(8), 931-939. https://doi.org/10.1177/1948550615597975
Kopp, R. R. (1995). Metaphor therapy: Using client generated metaphors in psychotherapy. Bristol, PA: Brunner/Mazel.
Kuhn, T. S. (1996). The structure of scientific revolutions (3rd ed.). Chicago, IL: University of Chicago Press. doi: https://doi.org/10.7208/chicago/9780226458106.001.0001
Lakoff, G., & Johnson, M. (2003). Metaphors we live (2nd ed.). Chicago, IL: The University of Chicago Press.
Leary, D. E. (Ed.). (1990). Metaphors in the history of psychology. Cambridge, UK: Cambridge University Press.
LimeSurvey Project Team. (2015). LimeSurvey: An open source survey tool. LimeSurvey Project Hamburg, Germany. Available from: http://www.limesurvey.org
Norcross, J. C. (2011). Psychotherapy relationships that work: Evidence-based responsiveness (2nd ed.). New York, NY: Oxford University Press.
O’Connor, B. (2000). SPSS and SAS programs for determining the number of components using parallel analysis an Velicer’s MAP test. Behavior Research Methods, Instruments, & Computers, 32(3), 396-402. doi: https://doi.org/10.3758/BF03200807
Orlinsky, D. E., & Rønnestad, M. H. (2005). How psychotherapists develop: A study of therapeutic work and professional growth. Washington, DC: American Psychological Association.
R Core Team. (2017). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. Available from: https://www.R-project.org/.
Revelle, W. (2016). psych: Procedures for Personality and Psychological Research. Evanston, IL: Northwestern University. Available from: http://CRAN.R-project.org/package=psych Version=1.6.4.
Řiháček, T., & Roubal, J. (2017a). Personal therapeutic approach: concept and implications. Journal of Psychotherapy Integration, 27(4), 548-560.
Řiháček, T., & Roubal, J. (2017b). The proportion of integrationists among Czech psychotherapists and counselors: A comparison of multiple criteria. Journal of Psychotherapy Integration, 27(1), 13-22. https://doi.org/10.1037/int0000069
Řiháček, T., & Roubal, J. (2019). Využívání psychoterapeutických technik v praxi [The use of psychotherapy techniques in practice]. E-psychologie, 13(1), 1-17. https://doi.org/10.29364/epsy.335
Řiháček, T., & Roubal, J. (2020). Common principles of psychotherapeutic change: Patterns of use. British Journal of Guidance and Counselling, 48(4), 489-499. https://doi.org/10.1080/03069885.2018.1503230
Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consultin Psychology, 21(6), 95-103. doi: https://doi.org/10.1037/h0045357
Rowat, R., Stefano, J. De, & Drapeau, M. (2008). The role of patient-generated metaphors on in-session therapeutic
processes. Archives of Psychiatry & Psychotherapy, 10(1), 21-27. doi: https://doi.org/10.1007/BF00120585
Safran, J. D., Muran, J. C., & Eubanks-Carter, C. (2011). Repairing alliance ruptures. Psychotherapy: Theory, Research, Practice, Training, 48(1), 80-87. doi: https://doi.org/10.1037/a0022140.
Santa Ana, E. J., Martino, S., Ball, S. A., Nich, C., Frankforter, T. L., & Carroll, K. M. (2008). What is usual about “treatment-as-usual”? Data from two multisite effectiveness trials. Journal of Substance Abuse Treatment, 35(4), 369-379. http://doi.org/10.1016/j.jsat.2008.01.003
Scaturo, D. J. (2002). Technical skill and the therapeutic relationship: A fundamental dilemma in cognitive-behavioral and insight-oriented therapy. Family Therapy, 29(1), 1-21.
Schlippe, A. von, & Schweitzer, J. (1998). Lehrbuch der systemischen Therapie und Beratung. Göttingen: Vandenhoeck & Ruprecht.
Wampold, B. E. (2001). The great psychotherapy debate: Models, methods, and findings. Mahwah, NJ: Lawrence Erlbaum Associates.
Young, J. S., & Borders, L. D. (1999). The intentional use of metaphor in counseling supervision. The Clinical Supervisor, 18(1), 137-149. doi: https://doi.org/10.1300/J001v18n01_09
Ziv-Beiman, S. (2013). Therapist self-disclosure as an integrative intervention. Journal of Psychotherapy Integration, 23 (1), 59-74. doi: https://doi.org/10.1037/a0031783.

How to Cite

Řiháček, T., Roubal, J., & Motalová, K. (2021). Facets of the psychotherapy relationship: a metaphorical approach. Research in Psychotherapy: Psychopathology, Process and Outcome, 23(3). https://doi.org/10.4081/ripppo.2020.468