Once upon a time:In what ways does the use of metaphor and story in counselling sessions help those with PTSD to reframe their trauma narratives?

Metaphor is a way to see or experience one thing as something else (Grady, 1997a&b) allowing us to reason and communicate abstract concepts. It has long been used in psychotherapy where it has shown to enhance conceptualisation, expression of emotion and transforming meaning (Lakoff and Johnson, 1999: Mathieson et al., 2018). Existing research has shown that 'disclosure', that is revealing a trauma, using expressive writing, metaphor and creative activities, results in improvement in physiological and psychological health (Pennebaker and Beall, 1986; Connolly Baker & Mazza, 2004; Brewin,2005). But no studies to date have investigated how these features work in combination.
The primary aim of the study is to test the effectiveness of psychological interventions using metaphor and story in writing and creative activities, to help reframe the trauma narrative of clients, especially for those suffering from PTSD. Different ways of incorporating metaphor and story into creative activities will be analysed to see which work best with PTSD. The study will also explore whether the effectiveness of the metaphor is dependent on the activity or on how the therapist or workshop leader embodies the activity.
The project will be interdisciplinary, based on cognitive linguistics drawing on psychology, metaphor, writing and trauma theories. Creative activities will be designed and run with two groups to compare and analyse what components in the activities are more effective for people with PTSD. Participants for one group will be recruited from English and Counselling/Psychology undergraduates. The workshop will be promoted as a stress relieving activity. A preliminary questionnaire adapted from trauma-informed screening tests will be used to test for PTSD. The other group will be clients from an eating disorder clinic at The Birmingham and Solihull Mental Health NHS Foundation Trust (BSMHFT). The clinical staff triage will screen the clients for PTSD. The workshops will be held over six weeks, with 6-8 people.
The experimental activities will be conducted with both groups and their effectiveness will be compared with activities within the expressive writing paradigm used in Pennebaker and Beall's (1986) research on writing about traumatic events. This study will focus on activities which include different combinations of metaphor and story, for example, writing as if a character from a fairy tale. Participants will be invited to reflect in their journals and will be assessed by questionnaires on how they felt before, during, and after the activities. After two months they will be asked to complete a short expressive writing task and to answer a questionnaire to identify any changes in their narratives. The focus of the analysis will be in their use of words that indicate changes in cognition, words that connect ideas and words that show a deeper or more considered understanding of an event. A word emotion chart will be used to register changes in emotions. Evidence of any reframing from the eating disorder client group will be reported from the nurse staff based on their attitudes and behaviour.
The primary research question is:
How effective are interventions involving metaphor and story in helping clients reframe their trauma narrative?
Secondary questions include:
Does the combined approach of metaphor and storytelling help people reframe their trauma safely within a group setting?
What cognitive changes are provoked in clients when they and the therapist use metaphor and storytelling, to access and reframe their trauma narratives?
What else is required with language?

The project will have a wide- reaching impact, benefiting academics and practitioners by contributing to theoretical understanding in how metaphor and story can help reframe the trauma narrative. The hope is that the findings will influence and improve the design and implementation of psychological programmes with creative metaphor interventions.