Metaphors Built On Therapeutic Strategies

One thing that therapists can be very thankful for is that our discipline is blessed with many strategic tools. For therapists who are willing to explore the literature, seek training in different modalities, and expand their knowledge, there will never be a lack of useful interventions. With some 400 different types of therapy and dozens of different interventions within each school of thought, the question for the informed therapist is, "Which of the tools in my kit will be most helpful for this particular child?" The next question is likely to be, "How do I most effectively communicate that intervention or strategy to this particular child?"

Two of the stories that I have developed to illustrate this communication of strategies through metaphor are Chapter 12's opening metaphors about managing pain, major illness, and the anxieties associated with medical treatment. The strategies behind Story 81, "Blowing Away Pain," are based on the use ofEricksonian hypnosis approaches with pediatric hematology oncology patients (Jacobs, Pelier, & Larkin, 1998). They begin by stating:

When children are diagnosed with cancer they are thrust into a world filled with uncertainty.

Pain and treatment separates them from the routine ofdaily living; the possibility of death looms.

Children employ necessary defenses to psychologically negotiate the various stresses of illness, to help them feel more secure while integrating their experience of cancer and healing potentials. (1998, p. 139)

From a review of the literature, they claim the data are "well established and illustrate how children are highly susceptible and are naturally imaginative" (1998, p. 140). These factors of suggestibility and natural imagination contribute to the potency of metaphor therapy with kids.

Jacobs, Pelier, and Larkin (1998) explore the question of what we know developmentally about kids and how we can adapt strategies that will access those developmental competencies for managing situations such as life-threatening illness. Preschool children, for example, are growing in autonomy and tend to be highly imaginative. They believe in Santa Claus and the Tooth Fairy, participate in imaginative play with dolls or rocket ships, and have the ability to drift easily between fantasy and reality. This richness of fantasy combined with a high level of self-focus has both an upside and a downside. On the downside, it could be easy for a child's fantasies of danger, vulnerability, and separation from parents to be validated by admission to a hospital, the diagnosis of cancer, and traumatic treatment procedures.

On the upside, it is possible for the therapist to join the child's imaginative world, playfully and informally, through the creation of healing stories. Jacobs, Pelier, and Larkin (1998) talk of helping to assist a child with procedures such as chemotherapy by absorbing them in play and imagination — an intervention remarkably similar to the storytelling offered to nine year old Jacob Grimm for the surgical removal of a tumor in 1794 (discussed at the end of Chapter 1). A case example they give of working with one preschool child was for a therapist to sit on the floor with him, blowing bubbles. This strategy utilizes the characteristics of this developmental age and is incorporated into Story 81, "Blowing Away Pain: A Kid Story."

Story 82, "Managing Pain: A Teen Story" is a hero story based on an adolescent client's favorite sports hero. For the sake of the written story in this book I chose a basketball player, but it could include any game and any athlete. As with all metaphors, it is the therapeutic characteristics of the story rather than the content that matters most. Here, the story again follows the developmental characteristics described by Jacobs, Pelier, and Larkin (1998). The therapeutic strategies incorporated into the story tap into adolescent metaphoric thinking, while seeking to build skills of empowerment, mastery, and pain management.

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