Comment on James Turner’s article on Verbal and Pictorial Metaphor in CAT

Hughes, R., 2011. Comment on James Turner’s article on Verbal and Pictorial Metaphor in CAT. Reformulation, Winter, pp.24-25.


I read with interest James Turner’s introduction to his research project in the last edition of Reformulation.1

The Delphi research method offers a quantifiable means by which practice based skills, applications and understanding can be thought about and presented within the current hegemony of evidence-based practice. Delphi lets us present our evidence without the millions of pounds available to the pharmaceutical industry. Delphi gives a cross-cultural voice to the art that is therapy and to the ‘science’ of psychology. That said, I was left with some questions about the study.

There seemed to be little explanation of what was meant by the central concept, ‘metaphor’. Furthermore, the concept was then discussed in two distinct categories - verbal metaphor and visual metaphor, the latter referred to as ‘pictures’. To my mind, a verbal metaphor is when something is described in a kind of shorthand, where something is signposted in a condensed way that is culturally identifiable. The Oxford English Dictionary describes verbal metaphor as “application of name or descriptive term or phrase to an object or action to which it is not literally applicable”. This would suggest that what James is in fact doing, at least some of the time, is pictorial representation or illustration, rather than pictorial metaphor.

Metaphor is hugely acculturated and metaphors used in one social coterie acquire different signifiers than they do in another. Metaphors are generated by particular social groups and their meanings are not necessarily homogenous. This needs to be considered in collaborative work, especially if, as is proposed, the therapist makes a visual representation of a metaphor for the patient.

I was wondering what James actually meant by the term “visual metaphor/picture”  – because it seemed to be something separate from ‘art’ in that although self-expression and joint expression in pictures seemed an important component, James’ figures were of a linear, illustrative style and very much open to interpretation as to what they represented and what they revealed unintentionally. I also wonder what is meant by ‘pictorial metaphor’ that makes it different from a drawing of a verbal description. Perhaps this is James’s aim -  to hold meanings in the visual memory and not simply in words. But if, as I think is implied in some of the comments from the workshops James conducted, where there is language of a more esoteric, subconscious evocation and something revealing and expressive in the art-making, then the representational style referenced in the figures is but one of the many visual languages that art makers can use. It may be that more understanding of art and image-making would add to this research, if more than representation is intended by the use of pictures. Speaking as an Art Psychotherapist, I believe art making and the images produced inevitably speak beyond words.

The late Art Psychotherapist Rita Simons wrote a number of books about the meaning of various artistic styles in pictures. Joy Schaverien, Art Psychotherapist and Jungian analyst, also writes about the “revealing and embodied” image. As with music, the whole is more than a sum of its parts. To reduce the use of pictures in CAT to linear narrative metaphors may be useful, but it is also limiting.

The use of art in therapy is well-documented, with practice-based evidence going back to Adrian  Hill’s use of art in tuberculosis sanatoria in the early 1900’s and the observations that personal creative expression can help soothe the soul, and later Edward Adamson’s first-ever Art Therapy department at Netherne Hospital in Surrey for sufferers of shellshock (now PTSD) and other mentally distressed people.

Art can increase the sense of presence, can add depth, clarity and be unfolding in its revelation, like poems to be returned to. It can be cathartic – it is a personal expression. The transference issues involved in joint picture making are not something that can be straightforwardly paralleled with joint formulations in other aspects of CAT.  Once the paper and pencils are shared, the image is no longer only the client’s free expression. Shared image making has all the potential to regress, to impinge, to control, to undermine and to seduce!  Sharing paper and pencils to draw together and attune to the experiences of the client  would be problematical and deceptive if pictures are assumed to be, as seems implicit, a poignant ‘illustration’ and not the potent embodiment of all manner of personal and interpersonal experiences and feelings. Also, the therapist’s own unconscious and unintentional revelations could be on the paper and in the enactment too!

I am very much in favour of this research project, but its aim of defining “the CAT creative approach” and leading to “training programmes” seems based on a belief that there is just one way and that this will be it -  and this just is not so in my view. In Art Psychotherapy, there is a long and carefully thought about tradition of ‘non-directive’ art making. This means that the maker of the art is not told what to draw, how to draw it, or with what to make their image. The underpinning is the immersion of the art maker into the creative process, in the containing but not intervening presence of the therapist, allowing emotional resonances and elaboration in thought and sensation to be experienced by the art maker, to be shared with the therapist by choice. Some art psychotherapists do share image making, e.g in some group work and with some client groups where disability or isolation make shared work efficacious. Otherwise it is not an approach that is considered helpful to the self-discovery that artistic self expression can facilitate. Themes may be made conscious and exploration encouraged, but these should be the individual’s images and not the therapist’s. (Similar points were made by Freud  on free association. Also, see Jung’s descriptions of art in therapy2).

If CAT is developing a practical dialogical approach to art, there is much to consider. There are quite a number of CAT trained Art Psychotherapists , as well as  Dramatherapists and Music Therapists, who can help to develop a theory of the creative use of art in CAT, to add to James’ research.

I recall Mikael Leiman at an ACAT annual conference using himself to mime a  client’s core pain -  a very powerful and direct approach. Where reformulation requires an immediacy other than words – such as Leiman’s miming – to mirror the core pain, pictures cannot do this by cartoon illustration alone.

I look forward to hearing about the developments in James' research and I hope my comments are useful as a perspective on art making in CAT.

Rose Hughes
CAT Psychotherapist and Supervisor
Art Psychotherapist and Supervisor
21.09.2011

1 Reformulation (36) p37 - 41 …..

2 in Edwards, Michael, A Jungian Circumambulation of Art and Therapy: Ornithology for the Birds, Insider Art, 2010

Full Reference

Hughes, R., 2011. Comment on James Turner’s article on Verbal and Pictorial Metaphor in CAT. Reformulation, Winter, pp.24-25.

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