The topic of this work is the alignment or non-alignment (accommodation) of verbal and gestural metaphors between patient and therapist in psychotherapy. The theoretical starting point is a cognitive-linguistic approach: Our perception of the world, how we think and act, how we relate to others or express ourselves towards others – all of this is based on metaphorical concepts. The author first presents the theoretical foundations and then applies the theory practically by conducting a conversation analysis of a case study. The case study involves the long-term psychotherapy of a patient with borderline issues. Six audiovisual recordings of therapy sessions from the beginning, middle, and end of the therapy are analyzed for metaphors in this volume. Additionally, the author conducts a gestural metaphor analysis for certain notable sequences. This work contributes to foundational and interdisciplinary research.