Intentional Choices of Metaphors for Psychedelic-Assisted Therapy

Metaphors used in psychedelic-assisted therapy (PAT) shape client expectations and outcomes, yet few publications address their deliberate use within a cognitive-behavioral framework. Common metaphors like journeys, brain rewiring, and medicines may not suit all clients or align with learning-focused interventions. This paper introduces baseball's "batting practice" as an alternative metaphor, emphasizing autonomy, agency, responsibility, and the incremental skill-building nature of PAT. Depicting the therapist as a coach reimagines therapy as active engagement, ongoing effort, gradual improvements, and periods of progress and stagnation, paralleling integration processes. The metaphor highlights process over outcomes, persistence, patience, mindfulness, and teamwork. Potential shortcomings are noted to encourage flexibility and collaborative metaphor selection for optimizing outcomes in psychedelic-assisted CBT.

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Abstract

Metaphors applied in psychedelic-assisted therapy (PAT) influence expectations and outcomes. They might help minimize therapist burnout as well. Nevertheless, relatively few publications address their conscious application, especially within a cognitive behavioral framework. Metaphors in PAT related to journeys, rewiring the brain, and medicines are prevalent, but these approaches may not appeal to all clients and might not provide an ideal focus for interventions devoted to learning and cognition, such as those used in cognitive-behavioral therapies. This paper introduces “batting practice” from the sport of baseball as an alternative metaphor. Batting practice emphasizes autonomy, agency, and responsibility, as well as the incremental and skill-building nature of PAT within a cognitive-behavioral perspective. Depicting the therapist as a coach also has advantages, reimagining the therapist-client interaction and time “in the cage,” emphasizing active engagement, ongoing effort, gradual improvements, and periods of progress and stagnation. The batting practice metaphor also emphasizes persistence, patience, mindfulness, and teamwork, paralleling the processes of ongoing integration present in PAT. Application of this metaphor can highlight a focus on the process (“practice”) rather than outcomes, as well as learning opportunities that improve skills across a season or lifetime. We also highlight potential shortcomings of this metaphor to encourage flexibility and enhance awareness as discussions of PAT metaphors continue. Ideally, clients and therapists can collaborate on metaphorical language to optimize outcomes in psychedelic-assisted CBT.