Metaphor and Meaning in a Clinical Interview Trudy Mallinson, Gary Kielhofner, Cheryl Mattingly Key Words: history caking • human occupa- cion model • interviewing This study examined the narrative features of20 life histo- ries gatheredfrom psychiatric patients with the Occupational Perftrmance History Interview. The aim was to identify how narrative features were present in the patient interview responses and to illustrate how such nar- rative features can be located. we found that the patients organized their interview responses with deep metaphors that served to "emplot, " or give meaning to, the life story. This article illustrates how patients used the deep metaphors to both circumscribe and frame possible solu- tions to the problems in their lives. Deep metaphors are consistent, recurring images ofa life story that give coher- ence to, and aid in, the interpretation of the events of that life. Moreover, we explored how metaphors can be located in patient life histories and their implications for occupa- tional therapy. T rudy Mallinson, MS, OTRJL, NZROT, is Research Specialisr in Behavioral Sciences, Deparrmenr of Occuparional Therapy, University of Illinois ar Chicago, M/C 811, 1919 Wesr Taylor Srreer, Chicago, Illinois 60612. Gary Kielhofner, DrPH, OTR, FAOTA, is Professor and Head, De- parrmenr of Occuparional Therapy, University of Illinois ar Chicago, Chicago, Illinois. Cheryl Maningly, PhD, is Assisranr Professor, Deparrmenr of Occuparional Therapy, University of Illinois ar Chicago, Chicago, Illinois, and Adjuncr Foreign Professor, Kavolinska Insrirure, Srockholm, Sweden. This article was acceptedfOr publication June 28, 1995. R ecenr literature has argued that persons make sense of their occupational lives through narra- tives and seek to behave within these narratives (Clark, 1993; Helfrich, KielhoFner, & Mattingly, 1994). On rhe basis of this argument, researchers recommend that occupational behavior be viewed as action that both emanates from and directs where a person's story is going (Kielhofner, Borell, Helfrich, Nygard, & Burke, 1995), The implication of this argument is that if therapists can grasp the narrarive wirhin which a parient makes sense of his or her experiences, they can better help that patient (Clark, 1993; Helfrich & Kielhofner, 1994; Mattingly, 1991, I994a, 1994b). Despite such calls for narrative understanding in occupational rherapy, there exists no fotmal method explicirly designed for garhering and interpreting patienr life srories, We decided ro create such a method byexam- ining the narrarive features of data collected by an already existing interview, the Occupational Performance History Interview (OPHI). The OPHI is a semistructured inter- view designed ro gather a person's life hisrory as it per- tains ro work, play, and self-care performance (Kielhofner & Henry, 1988), The inrerview covers five conrent areas: organization of daily living routine; life roles; interests, values, and goals; perception of ability and responsibility; and environmenr. To assist patienrs in relating their life histories, the therapist and patienr idenrify a turning poinr that divides the life history inro past and present. On the basis of the data gathered, therapists rate the 10 interview items with a 5-poinr scale that represenrs the patient's degree of adaptiveness or maladaptiveness. Studies of the OPHI have found modest test-retest and interrater reliability for these ratings (Kielhofner & Hen- ry, 1988; Kielhofner, Henry, Walens, & Rogers, 1991), Through categorization, the ratings reduce the amounr of data. Therefore, the rating scale does nor cap- ture everything that patienrs relate about their lives in the inrerview, and this is underscored by the fact that therapisrs who use the OPHI consistenrly report that rhe qualirative information gained in the inrerview is more useful than the scale ratings. Thus, although the rating scale captures something from the interview, ir also appears ro leave our critical information. When the OPHI was originally developed, Kielhof- ner, Henry, and Walens (1989) recognized that the scale needed ro be complemenred by another method of charac- terizing the data. Consequenrly, the OPHI asks therapists to wrire a brief life history narrative organized around the contenr of the interview. This portion of the OPHI was created more than a decade before the inrroduction of narrarive concepts into occupational therapy, Although May 1996, Volume 50, Numbfl' 5 338 Downloaded from http://ajot.aota.org on 06/01/2020 Terms of use: http://AOTA.org/terms