Metaphor is inherent in every patient hour, including the first one. There is always deep unconscious meaning. Understanding the deeper levels allows the therapist to know the developing relationship to the transference. The transference contains, among other things, anxiety that begins even as the patient thinks about making their first appointment.

Technical interventions can be made completely within the patient’s provided metaphor that both helps the therapist to increasingly understand its deeper layers but also will reduce patient anxiety, thus connecting the patient to the therapy endeavor and to the therapist. These interventions can be made at the patient’s level (patient's surface). This provides the patient with confirmation that the therapist understands the nature of the problems and is capable of working with those difficulties. Case material will be provided as well as suggested papers to read. Participants will be welcome to provide illustrations from their cases.