"Guided imagery" is the sophisticated art of intentionally using key words,
sounds, and vocal dynamics to induce a desired response in a person or group.
The power and utility of using guided imagery and c/overt suggestions in many
situations has justified books, classes, and the arts of public speaking,
advertising, medicine, religion, clinical and self hypnosis, and
Average kids and adults are often unaware of the scope and degree of the effects
of their own responses to inner and external images, with and without other
sensory stimuli like sounds and odors. This section offers brief perspective on
using guided imagery in clinical work. Using imagery to help people recover from
psychological wounds is described seperately.
Goals - use this technique to
induce a desired situational or chronic response in a client or group.
Participants - the clinician
and a child or adult client or a family group.
Best time to do this - when
believes (a) a non-didactic experience is
appropriate to the work (e.g. to get past a "resistance" or shift an
inhibiting attitude or reflex), and that (b) the client/s have "enough"
visual ability and (c) are currently undistracted and receptive; and the
instinctively or intentionally chooses a direct
or indirect application of this technique.
Preparations - Results depend
on the clinician's...
ability to (a) conceive a desired clinical
outcome and (b) a viable strategy for using imagery to promote that outcome;
(c) knowledge of and (d) experience with
proactively providing guided imagery with a range of people and
circumstances, and the clinician's...
abilities to (e) attain and (f) maintain focused
objective environmental (me - you - us)
Clinicians need to be undistracted, self-aware, guided by their true Self, and
able to manage any unexpected client responses - i.e. provide a safe experience.
S/He may or may not ask the client's permission ("Are you open to doing some
safe guided imagery work now?") and describe the technique and its purpose
first. Ideally, the clinician will video the experience (with the client's
permission) for later study alone or with a supervisor or peers.
Technique - three broad
phases to this technique are: (a) mutual trance induction (optional), (b) an
intentional sequence of words, sounds, and vocal dynamics from the clinician,
who monitors and adjusts to the client's observed responses in real time to a
natural stopping point, and (c) processing the experience if and as appropriate.
Mutual Trance Induction
A trance ("going inside") is a momentary or sustained period of heightened focus
on personal thoughts, images, "senses," and bodily sensations; and reduced
awareness of external stimuli except for immediate danger. Trance states vary
between slight to moderate to deep. People differ in their (a) natural and
learned ability to experience full (vs. intellectual or pseudo) trances, and
their (b) self-perception of this ability ("I'm no good at going into trances.")
of childhood trauma are significantly adept at - or guarded against - sustaining
moderate to deep trance states, depending on which subselves govern their
personality in clinical situations. Many feel that fantasizing, imagining, day
dreaming, "musing," and the transitions into and leaving REM sleep states are
natural trance states.
Clinical hypnosis paradigms offer
various direct ("Your eyelids are becoming pleasantly heavy now...")
and indirect ("You can be
interested to learn how deep a trance you'll decide to relax into now...")
ways to induce a trance state in
a person or group. Methods usually include variations in...
physical relaxation, comfort, and sense of local
focusing on thoughts and breathing, and...
the clinician's instinctively or intentionally
pacing his/her words and speech dynamics to the client's dynamic changes in
breathing depth and rate, muscular relaxation or tension, eye closure and
movement, minute movements, etc.
Trance inductions can be a word, phrase or sentence,
and/or a conditioned body action like a gesture and/or sigh, or a longer
sequence of clinician behaviors.
induction success depends on the clinician going into their own trance with the
client or not is debatable. My experience is this is often natural and useful in
maintaining special focus on the dynamic real-time zones of me + you + us.
Note the option
of using client "resistance" to establishing and maintaining a significant
trance and/or inner imagery as a useful assessment and treatment-plan variable
("Seems like you have a well-intentioned subself who feels imaging and trances
are too dangerous for now. Would you like to explore and change that safely?")
Provide Strategic Guided Imagery
Strategic implies that he
clinician has (a) assessed the client system and (b) formed clear treatment
goals, (c) drafted a treatment plan (strategy) to reach the goals, and (d) has
decided that a planned or spontaneous guided-imagery experience is timely and
appropriate in this phase of the strategy. Premise - a safe, vivid
internal experience - with or without inner images - is just as powerful as
an actual physical experience at causing, changing, or inspiring client
awarenesses, motivations, and behaviors. How do you feel about this?
variable is whether the clinician (a) tries to elicit a specific response in the
client ("I want your Shamed Child to feel better about herself."), or (b) trusts
the client's Manager subselves to choose the best response to a guided-imagery
experience. I've experienced the latter as most effective for all involved, in
Guided means that the
clinician takes control of the dynamic process with the client, and offers a
brief or sustained verbal/nonverbal sequence of behaviors to direct the client's
inner experience toward some desired general ("Become more comfortable and
effective in identifying and asserting your needs") or specific ("Learn to
effectively confront your ex spouse on your child-support needs and
Imagery means verbally
descriptive, evocative words, phrases, sequences, and
from the clinician that cause or invite general or specific
images and associations in the client/s.
content and nature of useful guided images are beyond generalizing. One way to
choose appropriate situational imagery is to ask in the context of specific
clinical goals: "What imaginary (inner) experience can improve the
client/s' confidence to try real interactions (like confrontations, or new
esponses) with other family members or subselves?" In this context, guided
imagery can preview or complement client-clinician role plays as rehearsals and
learning experiences for new behaviors.
Process the Experience
ways to "process" (reflect on, discuss, and learn from)
guided-imagery interventions are (a) the client alone, (b) the clinician alone
and/or with colleagues, and (c) the clinician and client together. Process focus options include
examining the imagery experience in the context of ...
the client's presenting problems, and/or...
the clinician's treatment plan; and/or...
the apparent systemic results of the experience,
the technique itself- i.e. processing if, how,
and when the client can learn to (a) do his/her own imagery work, and/or
(b) model and teach it to other adults and kids.
Next - Follow up over time to
see if the imagery had any significant effect on the client's attitudes, values,
and behaviors. If not,
asses s alone or with a co-worker whether (a) the image was ineffective or misguided, and/or (b)
the client's protective false self is preventing the intended benefits of the
Reduce Excessive Guilts
is the automatic healthy neural/emotional/hormonal response to believing you have broken or violated someone's perceived or
behavioral "rule" - i.e. a should (not), must (not), ought to, have to, or can
not (e.g. "People shouldn't say "fart" or pass gas in public"). Guilts ("I did a bad thing") feel like
- and promote -
a bad thing"). These stressors are caused and
Unwarranted guilt occurs when a child or adult is unaware of feeling badly for breaking someone else's
rule which the person doesn't genuinely endorse.
Moderate guilts are helpful behavior guides and regulators.
local and chronic guilts cripple personal
self-esteem, relationships, and family nurturance levels. Members of typical
families and stepfamilies have
many causes for excessive
and unwarranted guilts - specially if one or more adults are unrecovering
Goals - to teach the client/s
differentiate shame and guilt, and excessive and
see moderate guilts and shame as normal and helpful; and
show the client/s how to (a) validate guilts, and
(b) reduce or
let go of excessive and unwarranted guilts; and...
motivate client parents to (a) prevent excessive guilts in
their dependent kids; and (b) teach their kids to notice, validate, moderate, and use
Participants - the clinician
and one or more adult and/or adolescent clients in any kind of family.
Best time to
do this - when (a) a client complains of significant excessive or chronic
guilt in themselves or in another person they care about, (b) other problems are not more pressing, and
(c) you have at least 30" or so for
the technique. Ideally, you and the client will also have covered basic
and techniques like respectful
Preparations - read these
articles about psychological (false self) wounds and
reducing excessive guilts for
perspective. Options - also scan or read (a) this article on
and (b) this sample Bill of personal Rights.
Consider having the client read and discuss one
or more of these as part of your intervention.
Technique - lay some
foundations first, and then demonstrate and use them with current excessive or chronic
Ask if the client would be interested in
learning an effective way to reduce their guilts to normal healthy levels.
Option - if the client is a parent, ask if they would like to learn a
practical way of teaching their child/ren how to effectively manage and use
normal guilty feelings and thoughts.
Ask the client to describe (a) their
definition of "guilt," and whether they think it is usually a helpful response
("good") or stressful ("bad"). Then ask "When you feel significantly
guilty, what do you usually do with it?" To make this concrete, ask for an
example, and validate it with empathic listening (a "hearing check") - "So when
your parent gets that look on her face, you feel guilty like you did as a
Describe and illustrate the concept of
behavioral "rules" (should (not)s, have to's, must (not)s, can nots,
ought to's, etc. Ask the client to describe several favorite rules s/he was
taught as a child, or rules s/he is teaching her/his own kids. Option -
describe several rules you were taught as a child. See if the client
agrees that behavioral rules are required to maintain order and security in
typical homes and families. Confirm that the client adopted the unconscious rule
"I must obey and please my
parents and other family adults", or equivalent. See if that rule also included
something like "...and I should
never question or (openly) disagree with my parent's rules." Stay focused on the
Ask if the client agrees that (a) guilty
thoughts and feelings range from mild to crippling, and that (b) guilt feels
similar to shame, but is different. Option - if appropriate,
suggest that you'll discuss some practical options for reducing chronic or
excessive shame ("low self esteem") at another time.
Propose that all emotions -
including guilt - are useful signals that the person needs to do
something. Implication: feeling guilty is potentially useful, not
"bad." Option - use any guilts the client described to illustrate this
("So your old guilt reaction to your parent's 'look' is telling you to act in
some way to fill a need.") Framing guilt
as useful is usually new and intriguing to typical clients.
Ask the client to validate that
guilt feelings usually have associated thought patterns, which may amplify
and/or prolong the feelings. A common example is this increasing guilt by
thinking something like "I shouldn't
feel so guilty about this." Option - ask "Who's rule is that - your own,
or someone else's?"
Suggest that all child caregivers dictate hundreds of behavioral rules to young
children, who (a) can't evaluate the validity of them or (b) assert and enforce
their own rules. "Growing up" involves reality-testing these original rules in
various situations, and deciding whether to keep them or evolve more fitting
rules. Thus any "broken" rule can be
judged to be "someone else's" or "my own." For example, most independent
adults unconsciously forge and act on their own rule like "I
may or may not agree and comply
with my parent's rules now. Either way, I'm OK - even if my parent/s
rules by telling a (true) story: A grown woman had unconsciously adopted
her mother's rule that you had to cut a turkey in half before cooking it. When
the woman's daughter asked why that was necessary, she said "Well, my Mom always
did - I've never thought about why." The Mom asked her Mother why, and learned
it was a custom dating from the time that her Mother's grandmother's oven was
too small to hold a whole turkey, so she had to cut and cook it in halves.
Validate this by asking if the client can identify someone else's rule that
causes current (misplaced) guilt. If s/he can, ask how it would feel to think
something like "That is ____'s rule, not mine.
I don't have to feel badly for breaking
other people's rules that I don't agree with." Option -
have the client say that forcefully to you, with steady eye contact, and notice
how that feels.
Verbally summarize these "guilt basics," or provide a printed
Premise: all emotions - including guilt - are
normal and useful indicators of unfilled needs.
In healthy kids and adults, guilty thoughts and
feelings occur when the person believes they have broken one or more
behavioral "rules" - shoulds, musts, ought to's, have to's, etc.
Guilt feels like - and promotes - shame, but is caused and
Guilty feelings usually occur with related
thoughts, which may prolong and/or amplify guilt.
"Growing up" includes validating or updating
parents' childhood rules about "correct," "proper," or "good" behavior and
attitudes. The implicit "meta-rule" (rule about rules) is "As
a unique, worthy adult, I have the
right to decide whether to obey other people's behavioral standards and
rules, or to define and use my own rules to guide my decisions and actions."
learn to let go of unmerited guilts by (a) defining what specific
rules I feel I've broken, and (b) deciding whose rule is it - my own or
someone else's. If the latter, I claim the right to decide on my own moral
and behavioral rules - without guilt or shame!
reduce excessive guilts by (a) identifying what needs my guilt is
trying to alert me to, and (b) acting to fill the needs to reduce my
legitimate guilts to normal levels. A common example is owning our behavior,
and sincerely apologizing to someone we've hurt.
Discuss any of these until (a) the client is
comfortable with all of them, or (b) you conclude that his or her ruling
subselves are not able to adopt these ideas now without ambivalence or
undue anxiety. The latter suggests inviting the client to do some personal
if they have hit
or else plant seeds for that, and let go of
responsibility for "fixing" the client.
Use the Foundations
Ask the client to identify three or four things that cause him or her
significant guilt, and to pick one s/he wants to end or "reduce to normal." Use
to check the accuracy of your hearing, without judgment. Then
ask the client to identify the specific rule or rules that s/he feels she is
breaking. For each identified rule, ask "Who's rule is that - yours, or someone
For each rule that the client feels is authentic (their own), then
are your guilty feelings and thoughts asking you to fill?"
If appropriate, explain and illustrate the
difference between surface and primary
and why distinguishing between
them is useful in important, conflictual, and stressful situations;
Review the concepts of personal dignity (self
rights, and ask if the client feels s/he
has the undeniable right to fill his or her primary needs as a dignified, unique person.
If the client is ruled by a false self, expect ambivalence,
intellectualizing, and/or pretense;
Ask the client to say out loud her/his personal
right to authenticate major behavioral rules - i.e. to differentiate personal
rules from other people's rules); and...
Brainstorm and rank-order viable options for
filling the client's relevant primary needs now.
Explore any barriers to acting on the best
option, and practical options for reducing (problem-solving) them.
For each rule the client feels is
someone else's value, ask "Is anything in the way of forming
and acting on your own rule to replace this one?" Two possible responses are (a)
internal (inner-family) blocks, and (b) external blocks - e.g. "If I c/overtly
reject my parent's rule, s/he'll
/ collapse / badmouth me to others / rage and scorn me / take it out on my kids
Encourage the client to define a new personal
rule to replace the old (other person's) rule, without imposing your own
values. Invite her or him to
experience their true Self saying the new rule out loud to you, with good
eye contact. Use empathic listening to validate what you hear and perceive.
Explore whether it's useful and practical for
the client to inform the rule-originator of adopting the new rule/s, and (b)
why s/he's choosing to do that now ("Dad, I choose to give up my traditional
guilt at not pleasing or agreeing with you now, and I need you to affirm my
adult right to do that respectfully.")
play responding with respectful
to old rule-owner's expected reactions like
anger, hurt, misunderstanding, blame, ridicule, threats, or withdrawal.
Watch for chances to identify and reduce habitual communication
Next - Follow up to see
whether the client tried to reduce their excessive guilts, and if so, what
happened. If not, explore what blocks them (usually a protective false self).
Reinforce the foundations and options above as appropriate, and affirm any
successes. With successes (as viewed by the client), note the implication
"You can change your basic
beliefs and behaviors, if and when you need to.":
I'm grateful to my Gestalt therapy instructor Dr. Ray Robertson, who suggested
that "There are two kinds of useful therapy - supportive and frustrating." This
technique is a version of the latter.
This technique paradoxically implies that the clinician is
responsible for helping the client solve their problems, and does so by
strategically "not helping." Veteran clinicians who rely on the traditional
medical model of "mental illness" and therapy - e.g. many psychiatrists -
automatically assume full responsible for solve their individual clients'
problems. Including "helping by not helping" in their paradigm may be a
(core attitude) change similar to replacing psychoanalytic therapy with
family-systems principles. Related techniques are paradoxical interventions,
like prescribing major symptoms. (You probably should get even more
Goals - to respectfully
frustrate and encourage the client to take responsibility for filling
her or his own needs, rather than depending on the clinician (or someone) to fill
them. Since overly-dependent and approach-avoid (I want to change / I
don't want to change) clients are usually (always?) ruled by a protective false
self, this interim technique also aims
to help motivate them to eventually do meaningful
by compassionately raising their local discomfort.
Participants - the clinician
and one or more wounded adult and/or adolescent clients - alone or in a group.
This technique is probably not appropriate with (a) a suicidal,
homicidal, or criminal client, (b) an addicted client and family, and (c)
client-family abuses and/or child neglect.
Best time to do this - when the
client's ruling subselves c/overtly hint, expect, or demand that the clinician
responsible for "solving my problem/s," and the clinician feels using this
technique is safe enough at this time.
Preparations - clinicians and
their supervisor or case manager need to (a) be steadily governed by their true
Selves, and fully accept that (b) mentally-competent adult clients are
responsible for their own needs, and that (b) it's ethically acceptable to
strategically "help by not helping." The clinician also needs (c) a long-range
view, and (d) to accept that frustrating the client may cause them to quit this
part of their preparing to hit bottom and eventually make second-order changes.
Addicted families and clients with toxic compulsions merit special perspective
Technique - Options:
Create some context by asking the client to
restate why they have sought professional help, what their key presenting
problems are, and what they need - specifically - from the clinician;
Recap the work so far, summarizing and affirming
progress the client has reported, if any.
Verbally summarize (a) the presenting problem
the client is depending on you to resolve, and (b) affirm each specific
attempt the client has made to resolve it so far.
Respectfully acknowledge that these attempts
have not solved the problem to the client's satisfaction.
Ask (a) if the client can tolerate finding no
solution to this presenting problem, and/or (b) "What may happen if you and
I can't find a way of making this better for you?" Discuss as needed.
appropriate, observe that the client has responded to your interventions on this
problem so far with some version of "Yes, but (here's why I can't do that, or
why that won't work." Use
to acknowledge their explanation or defense, and restate something like "So the
solutions I've suggested so far don't seem to work for you, do they?"
Say something like "I'm as frustrated as
you are, (name), and I need to be honest - I have no more suggestions for you on
this problem. I just don't know what you can do." Listen empathically to
any responses, and restate this as often as needed. Then with good eye contact,
be quiet and see what the client's subselves need to do. Options:
offer a referral to another professional for
this presenting problem; and/or...
summarize the client's remaining presenting
problems, and assure him or her that you do
have suggestions on reducing those problems (if
the client is stymied and depending on you
on this problem because s/he is probably controlled by a well-meaning
false self who doesn't trust his/her true Self to solve this problem,
you can offer specific, effective
ideas on affirming and resolving
this primary problem if the client is interested. Expect ambivalence,
disinterest, or polite (dutiful) interest, and "plant seeds." Avoid
trying to persuade the client to do parts work, referring to the
Do personal parts work if/as needed to maintain
serenity with your intervention, including processing this intervention and
the client's observed reaction as needed with your supervisor, consultant,
and/or case review group.
Describe factually what you're doing and why -
e.g. "In this case, I want to encourage you to assume responsibility for filling
your own needs, rather than postponing that by depending on outside helpers
like me. This is a normal, difficult step in helping your subselves to trust
your Self and other regular wise subselves to assume full adult
responsibility for the quality of your own life."
Next - with the client's
agreement, shift to another problem (unfilled need), and/or discuss
termination options. If s/he continues to
work with you, follow up in future sessions on her/his response to your "not
helping" with this presenting problem. If s/he does assume responsibility
for filling related needs, affirm that - regardless of the local outcomes! The
real target here is patiently facilitating the client to trust his or her own
judgment and competence.
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