This study investigates the relationship between unconventional (i.e., creative) metaphors and emotional-cognitive regulation in a metacognitive interpersonal therapy (MIT). The occurrence of unconventional metaphor was identified using the Metaphor Analysis in Psychotherapy (MAP) model, and emotional-cognitive regulation was assessed by the Therapeutic Cycles Model (TCM). The results showed that the dyad's frequency of unconventional metaphors is significantly related to emotional-cognitive integration, reflective processes and moments of therapeutic engagement based on the quality of such regulation. More specifically, client metaphors were associated with emotional-cognitive integration and moments of therapeutic engagement, while therapist metaphors were associated with reflective processes. The results suggest that unconventional metaphors may be considered markers for different cognitive-emotional regulatory processes and moments of heightened therapeutic work and change in MIT.