Using metaphors in the care of childhood sexual abuse: a review essay

Careful and intentional language use can improve healthcare outcomes for vulnerable populations. This essay critically analyses how metaphors shape clinical communication with childhood survivors of sexual abuse. Drawing on prior literature and insights from conversations with child abuse paediatricians and Trauma-Focused Cognitive Behavioural Therapy-certified psychologists, this essay discusses several key metaphors clinicians use when communicating with childhood survivors. Together, these perspectives inform our argument that metaphors-often treated as incidental in healthcare practice-are in fact fundamental to clinical interactions and are frequently employed without explicit awareness by practitioners. We also argue that helping clinicians become more aware of their implicit, often covert use of metaphors-and offering guidance on supportive versus harmful metaphorical framing-could be incorporated into medical education and trauma-informed care practices to better support patients who have experienced childhood sexual abuse. This essay also highlights the need for qualitative research that bridges medicine and linguistics to better understand how metaphors shape patient care experiences, particularly for this population.