Using metaphor to facilitate cognitive detachment in cognitive behaviour therapies

The notion of cognitive detachment (i.e. the capacity to treat thoughts as just thoughts, with no greater significance or importance) is introduced in this paper. Its link to similar established terminologies (e.g. distancing, decentering, defusion/deliteralisation, detached mindfulness), importance within cognitive behaviour therapies and place within an adapted cognitive-behavioural framework is highlighted. The use of metaphor to facilitate cognitive detachment is then the primary focus of the paper. An overview of how metaphor has typically been used within psychotherapy is presented and reflects mostly the use of therapist-generated metaphor for psychoeducational purposes. While the use of metaphor in serving a therapeutic cognitive detachment function is not new, developing idiosyncratic client-generated metaphors in this regard has been largely neglected, despite the widely held view that client-generated metaphors are more potent. Practical guidance on how clinicians can collaboratively assist clients to intentionally generate their own personalised cognitive detachment metaphor is provided, and specific ways to elaborate metaphors during therapy to enhance metaphor application and hence effectiveness in enabling cognitive detachment is considered. Finally, clinical examples are provided to illustrate the varied, creative and rich metaphors that can emerge from this process.Key learning aims(1) To introduce the term cognitive detachment and understand this important therapy target within an adapted cognitive-behavioural framework.(2) To appreciate the broader use of metaphors in therapy and frame metaphor as one method for facilitating cognitive detachment.(3) To motivate therapists to pursue idiosyncratic client-generated metaphor.(4) To provide an instructional script to support therapists to help clients develop a personalised cognitive detachment metaphor.(5) To provide specific guidance to therapists regarding methods for metaphor elaboration.