Imagery Techniques in Psychotherapy

Schorr explains the rationale for using imagery in psychotherapy and hypnosis: "visual imagery or visual memory seems to be especially vivid and permanent… it is used in hypnosis and psychotherapy because it is easier to summon up a visual image than a tactile or olfactory one." (Schorr 1974) He divides these visual images into two types:

Non-symbolic – where a specific concrete answer is elicited to the therapist's question e.g., the image is known and integrated

Symbolic – images that are representational of certain people in the patient's life, or other intrapsychic elements that the patient cannot fathom what they mean e.g., the image is unknown or unrecognizable.

Symbols, then, "create meaning out of experience." Schorr observes that effective treatment "demands the integration of symbolic and non-symbolic imagery within the fabric of the therapeutic dialog" For example, using them as cogent metaphors for meaningful, highly affect-charged experiences.

Images are the product of the faculty of imagination. Assagioli sees imagination as the function of evoking and creating images." (Assagioli 1965) He categorizes it as a synthetic function, as it can operate at several levels concurrently–those of feeling, sensation, thinking, and intuition—both at conscious and unconscious levels of the mind.

In other words, elements of imagination can represent feelings, sensory experiences, concepts, and deeply intuitive meanings. These can be known or readily summoned from memory, or they can be out of the individual's awareness.

Schorr (1974) reviewed uses of imagery in psychotherapy. He states "imagery seems to play a role in nearly all of the proliferating new psychotherapeutic techniques." Schorr ends his review by citing his own system of psychotherapy that he calls "Psychoimagination Therapy."

Imagery is also used among the behaviorists. Stampfl introduced "emotional flooding" in his "implosive therapy" for phobias here a client is made to vividly imagine the thing he fears most and confront it—in effect, to stare down his nightmares.

Imagination is featured in Wolpe's "systematic desensitization." This is a kinder, gentler approach than flooding. Here the patient is led to imagine a series of increasingly anxiety-laden scenes, and to remain with each until his anxiety subsides. Progressively, he is led to confront more intense anxiety-laden material until he can be exposed to it without eliciting further anxiety.

European psychiatrists and psychotherapists developed a rich tradition of imagination techniques. Robert Desoille created the reve evielle, or guided daydream technique. Hanscarl Leuner practiced Guided Affective Imagery (GAI)… Roberto Assagioli utilized imagery to explore the domains of the human unconscious. We will explore in greater depth the rich, evocative techniques used by Leuner and Assagioli later in this paper.

Singer (1974) expands upon Schorr's review by pointing out more dramatic uses of imagery in other therapies, citing Jacob Moreno's Psychodrama acting out family roles. He also points to other examples of imagery in psychotherapy: Fritz Perls' Gestalt Therapy, where the participant takes the viewpoint of images in dreams to discover what they signify, or personifies both sides of an intrapsychic conflict; and Eric Berne's work, who used role-playing in his Transactional Analysis to identify the Parent, Adult, and Child Ego states to find more effective ways of interpersonal communication.

Martha Crampton (1969) answers this question by discussing her work with Psychosynthesis, a type of psychotherapy. She believes that mental imagery techniques may play a useful role "in establishing rapport with the patient, to assess his problems and potentialities, and to actively involve him in the therapeutic process."

How does this happen? Rapport is established through imagery because images are a way that the patient symbolically represents his meaningful experience. Evoking these images establishes rapport with the patient by entering into the client's unique frame of reference.

Images can be used for assessment, as well. A Psychosynthesis therapist might ask the client to imagine or draw a tree to assess the client's sense of self. A dwarfed or stunted tree may mean a person who has been unable to express his potential, whereas a tree in full bloom with much fruit may be a person who has achieved a high level of actualization.

Imagery can also actively involve a patient in therapy because he must interact with the image. He may be called upon to give the image a voice, draw it, dialog with it, and transform it in his imagination. All of this makes the image compelling and meaningful to the patient.

Schorr (1974) underscored the meaning-creating role of imagery. He felt that "the task in psychotherapy is for the patient and the therapist to assign meanings to these images, to relate the process to the possibility of new awareness, and hopefully, change."

Imagery techniques are also used in hypnotherapy. Fromm (1967) details many uses for imagery in hypnoanalysis, for bringing about dissociative states as well as integrative processes, and for "ego-strengthening."

Pelletier (1979) describes a typical induction in hypnosis to bring about ego-strengthening, where he recommends the hypnotherapist give active suggestion in a suitable trance state that the patient is like a mighty tree, "tall and strong, firmly rooted and grounded, made stronger by the vicissitudes of life."

Pelletier (1979) also describes another use of guided imagery in projective assessment. Subjects gave richer responses to the Thematic Apperception Test when guided to take the viewpoint of selected images on the cards in a hypnotic state. Pelletier felt this greater subjective immersion in the image helped "the patient ascertain the abundance of… choices possible" to the figures on the cards when subjects could more fully take that perspective.

Depending on the philosophical orientation of the therapist, he may assume more or less responsibility for directing the patient in imagery work.

At one end of the spectrum is the model of the directive hypnotic induction. Here the hypnotherapist actively gives suggestions to a supine, and fully passive patient. In this view, the patient is ill, and the doctor or therapist must cure him. The patient has minimal responsibility for his own condition.

Paul Sacerdote (1967) illustrates this approach with his use of "induced dreaming by hypnosis." He describes the process as follows:

1. The hypnotherapist induces a hypnotic trance in the patient
2. The trance is deepened to a predetermined level.
3. Suggestion is given to the patient that he will have "an interesting, possibly strange dream with a very pleasant conclusion, that will help you further with your past and present problems."
4. A post-hypnotic suggestion is given to the effect that the patient will wake up, relate the dream to the therapist, adding any meanings that occur to him, and then… "go back to sleep and have another dream." Any number of dreams can be produced during the therapy session through this means.

In directive hypnotic suggestion, the hypnotherapist decides how, what, and when, and the patient complies.

The "therapist as guide" model implies a more egalitarian relationship between therapist and patient. Here the therapist is seen as a guide, and the patient is viewed as a "traveler on the path to self-realization, or self-actualization." The patient does much of the work of gathering insight, while the therapist serves to clarify the material the patient brings to the surface and suggests methods for handling any frightening or unusual images that come up in the process of the reverie or guided daydream.

Crampton (1969) describes two styles of mental imagery techniques, the directed type or the spontaneous type.

In the directed type, the therapist presents predetermined images to the patient for contemplation. Schorr (1974) describes the patient's role in the directed mode: "The patient is required to react to images presented to him."

The spontaneous type is characterized by attending to the inner stream of consciousness… reporting on what appears on the inner mind screen. It may also take the form of asking questions of the unconscious and listening for an answer, requesting a symbol to represent a problem or a relationship, or carrying on a dialogue with a symbol of the Transpersonal Self, such as a wise old man.

The two styles of mental imagery techniques vary in the amount of externally imposed structure. However, in both styles of the "therapist as guide" model, the burden of the therapeutic labor is the patient's, not the therapist's.

At the other end of the spectrum is the patient-directed model, where the patient has full responsibility for his treatment. This is illustrated by Scagnelli's work with a "borderline schizophrenic patient," who was charged with handling his own dream images. A combination of hypnosis, dream therapy and a psychodynamic approach were used to treat this patient.

In this approach, the therapist trained the patient in self-hypnosis, and gave the patient a program of monitoring his own dreams. In an initial hypnotic session, it was suggested to the patient that "he has control over his dream images, that he can will them to do what he chooses." The patient was encouraged to develop this ability of "creator-control," and subsequently used it to confront the frightening aspects of the unconscious mind. (Scagnelli 1977)

In the course of his treatment, the patient identified multiple aspects of his personality, among them a bodiless dwarf, a wise old man, an Indian maiden, and a baby. Scagnelli believes that crucial to the successful use of this technique was the ability to delegate control to the patient through autohypnosis and over the dream material itself through creator-control of imagery…

Hanscarl Leuner

Hanscarl Leuner developed a system he called Guided Affective Imagery (GAI). He believed it was compatible with any system of "personality dynamics that acknowledges subconscious motivation, the significance of symbols, resistance, and the therapeutic importance of the mobilization of affect." (Leuner 1969)

GAI begins with suggestions of relaxation. The patient is encouraged to daydream on specific themes, which are offered by the therapist. Leuner explains, "the daydream process typically takes an autonomous direction. It evokes intense latent feelings relevant to the patient's problems."

He believes that "GAI techniques for the guiding and transformation of imagery lead to desirable changes in both affect and attitude toward life situations." He does not believe GAI is suitable for use with addicts or "full blown psychotics."

The patient is asked to imagine a specific image selected by the therapist. Leuner believes that the suggestion should be left as open and unstructured as possible so that the patient can develop his own image with its associated feeling qualities, unique to the individual patient. Leuner used the following ten images:

1. a meadow
2. climbing a mountain
3. following a brook to the ocean, or alternately, its source
4. exploring and describing a house
5. visualizing a close relationship, a relative or a friend
6. a situation designed to evoke sexual feelings and behavior ( for women he used a situation where their car has broken down in the middle of the country, and a man stops to pick them up on a highway; for men he used a rosebush image, from which men were instructed to select and pick a flower)
7. a lion
8. a living person who represents the patient's ego ideal
9. looking into a dark forest from a meadow, or alternately, looking into a cave from a meadow
10. a swamp, out of which a figure arises

Leuner believed that each of these symbols tapped the unconscious psyche. For example, (2) represented the patient's aspiration and career goals; (4) was a symbol of the patient's own personality, his self-concept; (7) was a symbol giving expression to the patient's aggressive feelings and behavior; and (10) represented repressed, instinctual (sexual) materials, similar to Jung's archetypal, "affect-laden animals."

During the course of the patient's reverie, the therapist could intervene in a series of active guiding or directing techniques. Among these was to have the patient free associate to the image, to confront a fearful image and dialog with it, and to bathe and anoint oneself with various magic fluids, e.g., the healing waters at the source of a brook. (Leuner 1969)

Roberto Assagioli

Roberto Assagioli was an Italian psychiatrist who developed a system of psychotherapy called Psychosynthesis. Central to the use of this system is the use of a wide variety of imaginative exercises.

Assagioli was influenced by the work of Desoille, Leuner and Happich in contacting material from the personal unconscious. He drew much inspiration from Jung, Maslow, and William James for contacting "the collective unconscious, the transpersonal realm, or higher realms of consciousness," by the use of symbols.

Assagioli believed that "symbols, properly recognized and understood possess great value; they are evocative and induce direct intuitive understanding." (Assagioli 1969) He cautions, however, that work with symbols has its dangers: "They can be taken literally and block the arrival at reality… they can express only a single aspect, a quality, a partial conception of a given reality."

After an initial assessment by a therapist, the patient may be directed to, among other techniques:

• imagine a particular symbol
• to meditate upon a "seed thought"
• to listen to a piece of music thought to evoke a certain quality (martial music was supposed to be helpful in developing the will, for example)
• to spontaneously draw a symbol representing an attitude or personality dynamic
• to dialog with a symbol

Martha Crampton lists a wide variety of techniques used in Psychosynthesis. She names dream analysis, spontaneous drawing, expressive movement, body awareness techniques, inner dialog, psychodramatic and role-playing approaches, evocative words of desired personal qualities, and other techniques, which are "combined in a synergistic way, so that each method will enhance the value of others." (Crampton 1969)

Progress in therapy is seen to pass through four stages:

• The first stage brings increased self-knowledge and insight into unconscious motivation.
• At the second stage, the patient discovers an inner controlling center (the Centered Self) and begins to direct energies of the psyche.
• At the third stage, the patient encounters a new, unifying sense of Self (the Transpersonal Self).
• At the fourth stage, the patient begins to reconstruct a new personality around this new unifying center. (Assagioli 1965)

In the third and fourth steps of therapy, the patient is led to explore and gain insight into the higher unconscious, also called the Superconscious mind or transpersonal realm. This aims to facilitate the patient having a "peak experience,"whereby he contacts the inner sense of wisdom, purpose and unconditional love of the Transpersonal Self.

Assagioli characterized 14 groups of symbols that characterized the transpersonal life. These symbols could be known directly by practicing a "psycho-spiritual exercise." This meditation had steps of relaxation; alignment with the Transpersonal Self; reflective meditation upon the symbol, and receiving the energies of intuition from it; then creatively radiating these energies to others.

The fourteen categories of symbols are:

1. Introversion
2. Deepening or descent
3. Elevation or ascent
4. Broadening or expansion
5. Awakening
6. Light or illumination
7. Fire
8. Development
9. Strengthening or intensification
10. Love
11. A Way, Path or pilgrimage
12. Transmutation or sublimation
13. Rebirth or regeneration
14. Freedom or liberation

An example of a meditation for (8) would be to visualize the development of an acorn into an oak tree, a seed into a mature plant, or a rose or lotus flower unfolding from a bud into full and radiant bloom.

For (11) he recommended meditation on Dante's journey through inferno, purgatorio, and paradiso, which he felt was evocative of the spiritual pilgrimage of the self.

His goal in the use of symbols was to foster "an increasing synthesis between the personal and transpersonal aspects or levels, to bring about the manifestation of the Whole Man." (Assagioli 1969)…

Assagioli, Roberto. Psychosynthesis: A manual of principles and techniques. New York, NY: Hobbs, Dorman and Company, 1965.

Assagioli, Roberto. "Symbols of transpersonal experience." Journal of Transpersonal Psychology, (1), 1969, 33-45.

Crampton, Martha. "The use of mental imagery in psychosynthesis." Journal of Humanistic Psychology (9). 1969, pages 139-153.

Fromm, E. "Dissociative and integrative processes in hypnoanalysis. American Journal of Clinical Hypnosis, (10), 1967, 174-177.

Leuner, Hanscarl. "Guided Affective Imagery (GAI), a method of intensive psychotherapy, American Journal of Psychotherapy, (23), 1969, 4-22.

Pettletier, A. M. "Three uses of guided imagery in hypnosis." American Journal of Clinical Hypnosis, (22), 1979, 32-36.

Sacerdote, P. "Therapeutic use of induced dreams." American Journal of Clinical Hypnosis, (10), 1967, 1-9.

Scagnelli, J. "Hypnotic dream therapy with a borderline schizophrenic: a case study." American Journal of Clinical Hypnosis, (20), 1977, 135-145.

Schorr, J. Psychotherapy through imagery. New York, NY: Intercontinental Medical Book Company, 1974.

Singer, J., L. Imagery and daydream methods in behavior modification. New York, NY: Academic Press, 1974.