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A postmodern metaphor: Psychotherapy as rhetoricTanya DiTommaso aa Department of Philosophy, University of Ottawa, Canada K1N 6N5

Online Publication Date: 01 July 2005

To cite this Article DiTommaso, Tanya(2005)'A postmodern metaphor: Psychotherapy as rhetoric',The European Legacy,10:4,349 357

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The European Legacy, Vol. 10, No. 4, pp. 349357, 2005

A Postmodern Metaphor: Psychotherapy as Rhetoric

Tan ya DiTommaso

Abstract What is the non-objective/non-empirical nature of the psychotherapeutic discourse that heals? In

general, to what extent must non-objective and non-empirical strategies be used in psychotherapeutic dialogues?

In particular, to what extent must rhetoric be used to alleviate the symptoms of depression and anxiety? We

shall examine the various rhetorical strategies in psychotherapy, and question the nature of the therapistpatientrelation that pervades psychotherapeutic discourse.

I. Postmodern Depression and Anxiety

It is not a coincidence that the prevalence of depression and anxiety in North

America comes at a time when philosophy itself has reached a desperate point ofuncertainty. In the age of postmodernismwhere here foundationalism/essentialism/

realism are rejected, the sovereignty of reason is critiqued, the notion of an autonomous

and objective subject is destroyed, and all metanarratives are questionedwe are

continually advised to focus on the language-game character of all thought and action. All

the while we try to understand the particular language-game of this theory or that

practice, nestled within this exercise is the realization that upon accepting the

deconstruction of core identities, metaphysical truths, and normative values, we have

ushered in a frustrating and anxious state of uncertainty. This unsettling awareness may

or may not be conducive to our particular theoretical and practical goals. In the case

of psychotherapy, the prognosis is mixed. While the goal of psychotherapypatching

together a disintegrated, disharmonious, demoralized self1 is thwarted by the

predominant postmodern ideas that promote the very disharmony and disintegration

that psychotherapy tries to mend, psychotherapy has successfully integrated postmodern

ideas into its practice by focusing on the non-objective language games inherent

in discourse. To succeed, however, the psychotherapeutic enterprise must work within

the postmodern glorification of ambiguity and uncertainty, and find new ways of healing

the selves that consist of and exist within this uncertainty.

Department of Philosophy, University of Ottawa, Canada K1N 6N5. Email: [email protected]

ISSN 10848770 print/ISSN 14701316 online/05/043499 2005 International Society for the Study of European Ideas

DOI: 10.1080/10848770500116481


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While psychotherapy has largely accepted a more de-centered, deconstructed,

non-objective interpretation of the self, little emphasis has been placed on the role of

rhetoric and metaphor in psychotherapeutic discourse. While the role of rhetoric in

psychotherapy has been noted,2 we find only the faintest of suggestions that this might

be an appropriate topic of research when, for example, in the final pages of Persuasion

& Healing: A Comparative Study of Psychotherapy, it is suggested that as a type of

persuasion, psychotherapy might be more closely allied to rhetoric and its close relative,

hermeneutics, than to behavioral science.3

In philosophy, on the other hand, the postmodern move away from the language of

metaphysics has translated into the acceptance of rhetoric and metaphor as the foundation

of human thought and practice. Current continental theories of the self are commonly

interpreted as only one interpretation that emerges in the course of dialogue; a dialogue

where conflicting ideas compete for dominance or acceptance. Any current and

dominant theory of the self is dominant only insofar as it has risen to power by persuasion

and force (linguistic or otherwise). What is more, the postmodern recognition andendorsement (and perhaps condemnation) of any thought or practice as inherently other-

than-self encourages us to anticipate the day when our current notions or practices will be

overthrown by other, more persuasive, notions or practices. It certainly seems that we live

on the brink of anticipation, where we have come to expect that our thoughts and

practices will sooner or later be modified or replaced.

But what becomes of our sense of self when we learn to speak or act with this

anticipation in mind? How can we ever speak and act with confidence? Can we still take

our own, or anyone elses, ideas or practices seriously, or will we quietly withdraw from

dialogue because it only leads to endless possibility? Will we tremble with anxiety beforethis uncertainty, fearing the never-ending kaleidoscope of change? Little attention has

been placed on the paralyzing psychological effects of the postmodern agentthe

interpreter who speaks and acts. In response to this, I shall suggest that we reconsider the

current psychotherapeutic dialogue from within this general state of uncertainty, and

consider the possible remedies that a postmodern world-view might present. With this

in mind, I suggest that rhetoric and metaphorthe foundations of hermeneutic

interpretationbe acknowledged by psychotherapeutic practice as vital keys to

understanding and healing depressed and anxious selves.

II. Rhetoric and Metaphor in Psychotherapy

Curiously, while the postmodern emphasis on rhetoric and metaphor in

interpretation plays a central role in the cognitive-behavior therapies and linguistic

therapies of psychoanalysis, there has been little overt acknowledgment of the use of

metaphor or rhetoric from within psychoanalysis, and what is more, there has been no

recognition of a need to train therapists in this art. This inattention hinders attempts to

interpret and treat depression and anxiety. Without an acknowledgement of the central

role that metaphor and rhetoric play in self-interpretation, and without an emphasis on

training therapists in this art, therapy cannot succeed in interpreting, translating, and

healing the anxious and depressed selves who populate the postmodern world.

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Rhetoricthe art of persuasionis a powerful tool that allows interpreters to

transcend rational boundaries by merging together what reason would dismiss as a logical

paradox. Through rhetoric, therapists in effect accomplish what is logically impossible;

they can create something from nothing, good from bad, happiness from depression, and

peace from anxiety. In other words, to transform the perception of something (e.g. the

patients perception of a burden) into nothing (e.g. the lack of a burden), to turn the

perception of nothing (e.g. the patients perception of a lack of love) into something (e.g.

the presence of love), and to turn the perception of what is bad and painful (e.g. a

disturbing event or idea) into that which is goodand pleasant(e.g. a helpful event or idea),

the psychotherapist must engage in the practice of rhetoric.

Metaphor underlies all our attempts to communicate. In using metaphors, we

transfer, transform, and translate the meanings of our existence and the world around us.

To interpret a troubling event or feeling into one more pleasant or meaningful, metaphor

is essential. To interpret something as, is to invoke the use of metaphor, and thereby

to alter the meaning of that something. Not surprisingly, metaphor and rhetoric holda central place in contemporary hermeneutic philosophy. What is surprising is the

diminished role that metaphor and rhetoric continue to play in the theory and practice

of psychotherapy.

III. Narrative Therapy: Cure or Care?

The self conceived as a linguistic being who creates, establishes, and breaks its own

linguistic boundaries is precisely the idea behind narrative therapy.4 The practice of

psychotherapy hinges on the idea that an ongoing discourse between therapist and client

is necessary to understand the maladies which plague the self. In general, narrative therapy

and cognitive-behavior therapy both aim at developing a trusting dialogue between the

therapist and patient where the therapist attempts to talk through the patients problems

and establish or restore the patients sense of worth, self-love, balance, and self-possession.

In talking to the patient, the therapist must translate and replace the patients troubled

interpretation with another more workable one. Essentially, our self-narratives attain

workability in the dialogical setting of narrative therapy. The workability, or lack thereof,

of ones narrative is judged against the expectations and interpretations of the therapist.5

The power of the word is a presumption that guides the great care our society takesin choosing the very words used to describe psychotherapy. The move to replace the

words analyst and patient with therapist and client, illustrates the commonly

held belief that words evoke powerful messages and affect how we perceive ourselves.

This linguistic shift signals the move away from the medical model of analystpatient

toward a less objective, less scientific, and less authoritative therapistclient dialogue.

More recently, and perhaps more disturbingly, the word cure has come under attack.

This shift towards describing the dynamic that occurs in psychotherapy as a caring and

healing through love, rather than as a cure,6 is premised upon the assumption that

the word care (as opposed to cure) places the therapist on an equal footing with

the patient-as-client and, further, that the activity of therapy consists of a mutual

empowerment in which power-with replaces power-over or power-under.7 This

change signals a rejection of the conception of the passive patient and the analyst as expert

A Postmodern Metaphor 351


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who asserts critical authority over the former. Freuds characterization of the

psychoanalyst as a mirror has dominated contemporary psychotherapy to the extent

that therapists of psychoanalytic and other nondirective types of therapy have claimed

that they do not influence the patient.8 Psychotherapy is increasingly regarded as a joint

effort where the therapist, no longer the master of the dialogue, is now a co-contributor,

among other possible contributors, in the reconstruction of the patients self.9 This move

towards replacing the notion of cure with care is unsurprising given the postmodern

dissolution of certainty and authority.

If the goal of diminishing the symptoms of depression and anxiety is thought of as a

result of care, as opposed to a cure, then how are we to understand the notion of an

ill or unhealthy self? If we forego cure for care, should we then replace ill

with careless when describing the self who suffers from depression and/or anxiety? We

could say that it is the selfs adaptabilitythe sense of ease with which one modifies ones

narrativethat is the essential aspect of a healthy self. The ill self, the self who clings

to sad, troubling, and anxious thoughts, is helped by the therapists suggestions for newnarrative configurations and less troubling thought patterns. In other words, the therapist

works to modify the patients self-defeating narrative. How is it that such a troubled self,

a self who cannot adapt itself with ease and efficiency, could be thought of as an equal

and co-creator in the psychotherapeutic dialogue? Certainly while the patients efforts

and participation in change are necessary for this dialogue to occur, it is equally necessary

that the therapist play a dominant role as healer. The postmodern watering-down

of authority effectively undermines the authority of the analyst as a specialist who can

offer something above and beyond what others can provide. Essentially, the linguistic

implications of care undermine the efficacy of psychotherapy by ignoring the powerful

rhetorical dynamic that grounds the discourse between analyst and patient.

Within postmodernismwhere the self is taken to be a linguistic narrative that can

be altered and reconstructed through conversationwhat concerns the psychotherapist is

the self who cannot make an ordered sense or workable narrative out of her conflicting

ideas and feelings. When these conflicting ideas and feelings are left unordered (because,

for example, they might be too overwhelming or painful for the patient), they fester and

create feelings of inadequacy, frustration, anger, anxiety and dread. Depressed and/or

anxious individuals interpret their lives with disruptive and demoralizing self-narratives.10

The process of transforming these self-narratives requires addressing the particular

narrative events, feelings, and ideas that, for one reason or another, the patient has notbeen able to organize without troubling her larger narrative self. If the object of

dialogical therapy is the patients narrative-linguistic self , then aiming at a new interpretive

organization of a self which is mediated through narration requires that the therapist

alterthe selfs narrative by asking different questions and, thereby, changing the ill story

into a healthier one.11 What is evident in this description of dialogical therapy,

we should note, is that the role of the analyst is not depicted as a co-contributor.

The tendency in psychotherapy today is to infer from the deconstruction of

permanent and identical truths and realities a paralysis where therapists who care

are unable to exercise power and persuasion, and are unable to turn false narratives into

true ones. In understanding that the re-ordering of the patients ideas, feelings, and

values is always only one possible ordering, the talking care operates under the illusion

that very little, or no, power or persuasion should be exercised by the therapist, while the

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patient is prompted to revise for herself an interpretation dialectically until an internally

consistent picture emerges.12 While postmodernists in general are convinced that the

self has no altogether unified or true narrative, what is not generally agreed upon is

the extent to which some self-interpretations can be more persuasive and powerful

than others.13 The dissolution of authority and certainty need not entail powerless and

non-authoritative therapy.

Even within the realm of care, some small amount of authority and persuasion

must be used in order to prompt the patient towards changing troubled thought patterns.

The fact that the patient seeks out the services of a therapist already suggests the

patients readiness to submit to an authority. In fact, within psychotherapy, it is widely

acknowledged that a patients simple readiness to enter into therapy generates a placebo-

like effect for that patient. On this, Frank writes:

We shall start with a universal feature of successful psychotherapies, their ability to

arouse the patients expectation of help. Humans are time-binding creatures, so

assumptions about the future have a powerful effect on their present state.. . .

Physicians have always known that their ability to inspire expectant trust in a patient

partially determines the success of treatment. . . . Placebos exert their effects primarily

through symbolization of the physicians healing powers . . . [A] placebo is itself a

form of psychotherapy . . . [P]sychotherapeutic success depends in part on patients

confidence that the therapist possesses healing knowledge and skills.14

As is evident in Franks research, the therapists power extends beyond the thera-

peutic session, and it is precisely this power that is an invaluable dimension of the

psychotherapeutic discourse.

IV. The Patients Desire and Belief

Logically prior to the activity of narration is the impulseto narrate. What is expressed

in narration is the self as a linguistic impulse, a self that seeks to express itself, order itself,

and find meaning for itself. The primordial search for meaningthe meaning and sense

of ones self, existence, history, and purposeis what drives our desire to narrate and

re-narrate our selves. Viktor Frankls Logotherapy recognizes this point, and focuses on

the patients underlying quest for finding and creating meaning. In perhaps the most

explicit example of the close relation between rhetoric and psychotherapy, Frankl arguesthat the therapist should focus on the meaning of human existence as well as on mans

search for such a meaning . . . [for] this striving to find a meaning in ones life is the

primary motivational force in man.15 We could say that the healthy self desires and

continually believes in the possibility of future meaningful narrations. In contrast, the

depressed self may not see her current narrative as entirely meaningful and may no longer

believe in the possibility of future meaning. An anxious self, furthermore, might be

overwhelmed with her role as a meaningful self; she may believe that too many narrative

details rest on her shoulders. For the anxious self, too many insignificant events, ideas,

or feelings may spill into her self-narrative, creating the sense that she cannot escape the

demands and noise that the world places on her. In both cases, these patients need to

reorder their narrative stories with the goal of transforming and creating new meanings

which can in turn be attributed to aspects (small or large, real or imagined, hidden or



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obvious) of their narrative stories. To alleviate both anxiety and depression, the therapist

must focus on modifying the patients narrative self, so that current events, ideas, feelings,

memories, and goalswhich might seem hopeless, burdensome, or traumaticcan be

woven together into a new narrative story which alters both the color of these events

or feelings and also their meaning. As Frankl astutely notes, emotion, which is suffering,

ceases to be suffering as soon as we form a clear and precise picture of it.16

While the art of reconfiguring anothers narrative story depends upon a reasoned

discourse, the postmodern disintegration of objectivity signals that desire and belief have

overthrown the tyranny of reason. The postmodern therapist cannot search for the

uncontested ultimate and objectively true meaning of the patients actions, thoughts,

and purpose in life. Any search for meaning cannot rest solely upon an appeal to reason.

When we ask the question: what is it exactly that makes people feel happy? we find no

absolute or universal answer. The goal of helping people feel happy or content is not

objective, but rather it is an aim that lies within the realm of subjective fancies, beliefs,

dreams, and desires. The object of psychotherapy is not the true or objective self,but rather the imagined or believed self. While reinterpretations of a narrative self

are neither true nor false in a metaphysical sense, they are nonetheless believable

or unbelievable. Indeed, a condition for the very possibility of narration is the belief that

meaning, order, and sense can exist. The authority of belief is a necessary authority in

a world where deconstruction has taken its toll. In effect, the matter of a person

feeling happy, content, or satisfied rests upon the single authority of that persons

subjective belief.

In a recent workWhat is a Relevant Translation?Jacques Derrida addresses

the lack of an objective authority in determining the relevance of an interpretation. Here,the good interpretation is described as one that is believable and satisfying, rather than

one that is true and real:

What is most often called relevant? Well, whatever feels right, whatever seems

pertinent, apropos, welcome, appropriate, opportune, justified, well-suited or adjusted

. . . [A] relevant translation would therefore be, quite simply, a good translation, a

translation that does what one expects of it, in short a version that performs its mission,

honors its debt and does its job or its duty.17

In an earlier interview, Derrida also states: I would not say that some interpretations

are truer than others. I would say that some are more powerful than others. The hierarchyis between forces and not between true and false.18 What Derridas deconstruction

highlights is the rhetorical force that underlies the interpretations that we believe and

take-to-be-true.19

The effective therapist is one who recognizes this subjective contingency of truth,

and in this light, reconstructs a narrative self that is both persuasiveand convincing. In effect,

the therapist should be a master of rhetoric. Rather than speaking of elusive truths, the

therapist must construct a reinterpretation of a narrative self that is believable. The

therapists ability to construct a persuasive and believable re-interpretation of the patients

memories, thoughts, feelings, and goals is the means through which narrative therapy is

successful. To be effective, the therapist must not only construct a new sense and narrative

order for the patient, but more importantly, these constructions must be provided in such

a way as to make them believable by the patient.

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V. Some Implications of Rhetoric in Psychotherapy

The trend to see the therapist and patient on an equal footing is, when taken to its

extreme, debilitating. While it is true that the therapist must always care about what

happens to the patient, and while it is necessary that the patient actively participate in the

recreation of a new narrative self, focusing solely on care would spell the demise ofpsychotherapy. We can, after all, receive care from just about any person willing to talk

to us. To go so far as to remove the cure from therapy would amount to pulling the

plug on the rhetorical effectiveness of dialogical therapy. In order to interpret and modify

a linguistic self who is comprised of ideas, dreams, wishes, beliefs, and desires,

psychotherapy must rely on the use of metaphor and fully exercise the art of rhetoric.

Only with metaphors and through rhetoric can a therapist convince the depressed self of

a new meaningful and optimistic narrative or convince the anxious self of a new narrative

order that makes events, feelings, and ideas appear less burdensome. The use of metaphor

consists in making things become other than what they seem. The art of rhetoric consistsin the power to persuade others. Combined, powerfully presented metaphors can succeed

in convincing the patient to believe in and adopt a new narrative story.

If the act of reconfiguring a patients narrative self is to be effective and fruitful,

a therapist must be convincing. To be convincing, the therapist must exercise the power

of persuasion. Frankls therapeutic goal of confronting the patient with things which

sometimes are very disagreeable to hear,20 and the ability to reorient a patient toward

a new meaning, is impossible if the therapist does not persuade by steering the

conversation, asking particular (often leading or rhetorical) questions and offering

connections. To reach through to, and to modify, a self who is embedded within a web

of disorganized and troubling beliefs, the therapist must practice the art of persuasionby presenting compelling, authoritative, and believable narrative connections.

Another important reason to emphasize the rhetorical power of the therapist is the

fact that patients not only anticipate, but want to believe, that therapists can remedy their

problems. As Freud recognized, expectation colored by hope and faith is an effective

force with which we have to reckon . . . in all our attempts at treatment and cure.21

Patients implicitly look to therapists as specialists, experts, and authorities who can put

an end to their symptoms. Patients seek the advice of therapists with an optimistic

willingness to believe both what the therapist says and that what he or she says will be

instrumental in affecting their depression/anxiety. While patients will choose to believeone particular narrative story over another, a patient is unlikely to accept a narrative

presented by a therapist who lacks credible authority.

While the therapists impressions must remain fluid, open, and sensitive to the

nuances in a patients narrative re-telling, it is counter-productive to think of the therapist

merely as a co-narrator. The vulnerability of the patient, often accompanied by a distorted

perspective and impaired judgment, is characteristic of psychotherapy in general and is

what originally places the patient in the therapists charge. While therapy involves an

exchange or convergence of the therapists and patients perspectives, this dialogue

involves a greater shift in the values of the patient than in those of the therapist.22 With

this in mind, we could say that the goal of the therapist is to respect the patients

vulnerability as well as his or her possibly impaired judgment. . . . [T]he therapist must

be paternalistic, but only to maximize the patients potential for autonomy.23



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As disagreeable as it might be to speak of authority and power in a postmodern age, we

must admit that to be successful in narrative therapy, the therapist must exercise power,

persuasion, and influence over the patients narrative self. Only as a metaphori.e. a

person as an authoritative specialist does the therapist possess the persuasive position

necessary to succeed in a discourse that is directed towards convincing a patient (a patient

who is already willing to believe the therapist) to believe in a new, less troublesome,

narrative self.

In listening to and weeding out the troubling connections or lack of connections

within a patients story, the therapist cannot help but exercise power. If a new set of

narrative connections is to be accepted by the patient, it must be made in and through

the analysts authority and conviction. Even if the patient is schooled in postmodernism,

she nevertheless accepts her current meaningful or meaningless fate as being true and

real. Patients cling to their problematic and troubling narratives precisely because they

believe these stories to be true and real. The patient will not willingly adopt what

she considers to be a fabrication of her situation. Instead, the patient will only replacewhat she believes to be her true and real situation with another perspective (another

metaphor) that she believes to be true or real. It is the responsibility and goal of a

psychotherapist to present new narrative perspectives (transformative metaphors that alter

the patients reality) in such a persuasive and believable way that these new perspectives

become true and real for the patient.

To be persuasive, then, the therapist must present a new narrative order to the

patient metaphoricallyas if it were true. While Frank did not offer an answer to his

question: If the therapists healing powers depend more on personal qualities such as

persuasive talent. . .

how should therapists be selected and trained?,

24

we can provide apartial answer here by suggesting that in addition to their current curriculum, therapists

must also be schooled in the art of rhetoric. Therapeutic success will depend on the

degree to which new narrative orders are presented with confidence, believability, and

authoritativeness. If the new narrative order is not presented in such a fashion, and if the

patient is left to wander in through merely potential and marginally possible narrative

suggestions, then the therapist does nothing to cure the patients condition, and may

inadvertently contribute to prolonging the postmodern malaise and ambiguity that

currently grips our society.

Notes

1. See Jerome D. Frank & Julia B. Frank, Persuasion & Healing: A Comparative Study of Psychotherapy, 3rd edn (Baltimore: The Johns Hopkins University Press, 1991).

2. S. Glaser, Rhetoric and Therapy, in Psychotherapy Process: Current Issues and Future Directions,ed. M. J. Mahoney (New York: Plenum Press, 1980), 31334.

3. Frank and Frank, Persuasion & Healing, 300.4. See Daniel C. Dennett, The Origins of Selves, in Metaphysics: Classical and Contemporary

Readings, ed. R. C. Hoy and L. N. Oaklander (Belmont, CA: Wadsworth Publishing Co.,1991), 35564.

5. See Michel Foucault, Madness and Civilization, A History of Insanity in the Age of Reason (New York: Vintage Books, 1988); and Thomas Szasz, The Manufacture of Madness: A ComparativeStudy of the Inquisition and the Mental Health Movement (New York: Harper & Row Publishers,1970).

356 Tanya Ditommaso


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6. See James H. Olthuis, The Beautiful Risk: A New Psychology of Loving and Being Loved(Michigan: Zondervan, 2001).

7. Ibid., 37.8. Frank and Frank, Persuasion & Healing, 178.9. See Roy Schafer, Narration in the Psychoanalytic Dialogue, in On Narrative, ed. W. J. T.

Mitchell (Chicago: University of Chicago Press, 1981), 2549. See also Roy Schafer, Retellinga Life: Narration and Dialogue in Psychoanalysis (New York: Basic Books, 1992); and RoySchafer, Authority, Evidence, and Knowledge in the Psychoanalytic Relationship,Psychoanalytic Quarterly 65 (1996): 23653.

10. See Frank and Frank, Persuasion & Healing.11. See Schafer, Narration in the Psychoanalytic Dialogue; Schafer, Retelling a Life; Schafer,

Authority, Evidence, and Knowledge in the Psychoanalytic Relationship.12. Paul Fairfield, Truth Without Methodologism: Gadamer and James, American Catholic

Philosophical Quarterly 67 (1993): 28597.13. See Tanya DiTommaso, Contradiction and Confirmation: Validity as Persuasiveness,

Symposium 6 (2002): 2335.14. Frank and Frank, Persuasion & Healing, 1329, 155, 176.

15. Viktor E. Frankl, Mans Search for Meaning (New York: Washington Square Press, 1984), 121.16. Ibid., 95.17. Jacques Derrida, What is a Relevant Translation? Critical Inquiry 27 (2001): 174200.18. An Interview with Jacques Derrida, The Literary Review 14 (1980): 21.19. In his latest writings, Hans-Georg Gadamer also made a significant point of emphasizing the

rhetorical underpinnings of all that we take to be true in the natural and social sciences. See,for example, Hans-Georg Gadamer, A Century of Philosophy: Hans-Georg Gadamer inConversation with Riccardo Dottori, trans. Rod Coltman and Sigrid Koepke (New York: TheContinuum International Publishing Group, 2003).

20. Frankl, Mans Search for Meaning, 120.21. S. Freud, From the History of an Infantile Neurosis, The Complete Psychological Works of

Sigmund Freud, ed. and trans. J. Strachey, vol. 7 (London: Hogarth Press and Institute ofPsychoanalysis, 1953), 289.

22. Frank and Frank, Persuasion & Healing, 184.23. Ibid., 180.24. Ibid., 300.


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