The Official Publication of the
International Society of Schema Therapy
In This Issue
A Hierarchy of Confrontational Interventions Facing 8 Dysfunctional Parent Modes by Ofer Peled (Israel)
Schema Therapy with Children and Adolescents an Extract of Mode Work by Christof Loose (Germany)
Experiential Strategies in Group Schema Therapy by Dr. Rita Younan (Australia)
Memory Reconsolidation: Can we Unlearn Emotional Learning? by Dr. Bruce A. Stevens (Australia) & Dr. Pierre Cousineau (Canada)
Imagery Rescripting, Practical ways to Improve Skills by Chris Hayes (Australia)
Imagery Rescripting: Practical Way to Improve Skills
Senior Clinical Psychologist, Accredited Schema Therapist
Sexual Assault Resource Centre, Department of Health, Western Australia
Director - Schema Therapy Training Australia
“How about we do some imagery work today?”, I said to my client, expecting a predictable imagery rescript where I enter the image, stick up and protect the child, and provide the safety that they had long been deprived. My supervisor at the time had been encouraging me to “do more experiential work”. It had worked well in other clients and I was up for the challenge.
“Close your eyes and get an image of you as a child when you felt unsafe”, I said to my client. My client replied, “I’m walking into my house, I’m about 5, and as I walk in there are five big bikers who are drunk sitting in my lounge room…. I’m scared”.
Taken by surprise, I go through the imagery process trying my best to look calm and collected, but secretly thinking….“WHAT ON EARTH AM I GOING TO DO WITH FIVE BIKERS?!”. I looked around the room as if I was looking for an invisible guiding colleague to appear!
In my mind I have an image of me saying: “Hello chaps…. I’m wondering if you can get out of here, this child is afraid of you… I have a university degree you know!!”
Thankfully, over the years I’ve been able to continue to develop my skills using imagery rescripting....
Imagery rescripting is a powerful experiential technique that uses the power of imagination and visualisation to identify and change meaningful and traumatic experiences in the past, resulting in transformation in the present. Typically those who are developing skills in schema therapy specifically find imagery work an exciting, but often daunting clinical option. Accessing corrective emotional experiences that a client has often never experienced (such as XXXX) is often a powerful intervention. However, imagery rescripting is an intervention often postponed or deferred in favour of more “safer” options.
In this article, I hope to provide five practical ideas to help fine tune and develop imagery work within Schema Therapy.
1) Imagery Rescripting: “Messing with Meaning”
It is important to understand the theoretical underpinnings that may explain the process of imagery work. At a schema level, Arntz (2015a) notes there are five main functions to the imagery process, 1) the client has an opportunity to emotionally process emotions that typically may not be easily accessed, 2) care, nurturance and support is provided to the client in a way that was blocked as a child, 3) factors that have influenced how they feel about themselves can be externally reattributed (e.g. “It’s not that I was a bad child, my parents had serious limitations in their parenting,” 4) meaning is changed at a “child level” (one that is not “rational” and logical), and 5) the client is able to understand that their environment growing up was the exception and not the norm.
In terms of traumatic memories, from a cognitive-behavioural perspective, Arntz (2015b) describes how imagery offers a chance to change the meaning of difficult memories through a processing of “unconditioned stimuli revaluation.” Here, new information and perspectives are made available via the client having their needs met via fantasy, resulting in a change of the meaning of the memory to the client. The techniques here are not based on systematic desensitisation principals, and as a result therapists should note that they don’t need to “play through” the entirety of difficult, in some cases traumatic, events.
2) Increase Attunement in Float Backs to Assist with Better Links
Linking current triggering events to key childhood images can be accessed via a “float-back” or “affect bridge” process. Here, the therapist asks the client to access a current triggering image, identifies feelings and thoughts from this experience, and then links this back to a childhood event with similar sentiments.
Affect and meaning are the longitude and latitude for effective targeted float-backs. Clients can often initially note that they feel “bad”, “overwhelmed”, and “not good”. Here the therapist needs to increase attunement, and really “get” the experience, meaning, and themes for the client.
If the therapist takes as face value the described “bad” feeling (“so hold on to that bad feeling and get a bad feeling as a child”), clients can access a number of “bad” childhood experiences. Greater attunement allows for clearer links to past events. For example, “So is that bad feeling like you don’t matter, like you’re overlooked, and no one is interested?” “Hold on to that feeling and the sense that you don’t matter and get a childhood image where you felt the same”.
3) Accessing Specific Images & Memories
It’s difficult for anyone to specifically recall meaningful events from childhood, yet alone prize open the memory vault to access memories linked to schemas and modes within a float back context. One method is to use the “Google images” technique (De Jongh, Broeke & Meijer (2010), often used in an Eye Movement Desensitisation & Reprocessing EMDR context.
Here, the therapist suggests to the client that they are making a memory “search” into their mental “search engine” for a particular belief or schema, e.g. “I’m worthless, bad” (aka defectiveness).
Similar to internet search engines, clients are encouraged to suggest several memories that may be a part of their “search,” with the top “posting” most linked to the desired search. The therapist may encourage the client to complete such a task in his or her own time as a homework assignment, and use the exercise to “prime” the imagery work, or make links throughout the session. Such key memories can then be used for future imagery work.
3) Winning the Exchange in Imagery
In imagery, the use of fantasy can be especially useful if the therapist feels unable to provide the corrective emotional experience alone. In imagery, fantasy is limitless, so there is always something that can assist with a successful rescript. However, therapists need to be attuned to the client to determine if the intervention is meaningful and corrective. The client initially needs to have some sense of safety, allowing clients to construct an image that allows for safety (such as having a glass wall between the client and the antagonist, or having the client as a child stand behind the antagonist).
In order to create a sense of empowerment and strength, protective devices such as Tasers, Pepper Spray (Mace), or in some cases weapons could be used (particularly with violent antagonists). The therapist can also manipulate the size and form of the therapist (make me 9-foot tall), or the antagonist (make him smaller in size and put him in a glass box).
4) Recollecting, Not Experiencing
Clients can typically “recall” and retell events from the past when discussing childhood memories. However, it is important to help clients move from a “recollection” of an event to an “experience”. In some occasions it may be a way for a client to “distance” themselves from emotive aspects of a story (however some clients may be more accustomed to speaking in this way). In this case, the therapist can focus on sensory aspects, and aim to assist the client to speak in a visual and “present” way (preferably infirst person, present tense). For example, moving a sentiment from “she was a small girl scared of dad yelling” to “I’m looking at dad yelling and I’m scared.” Here the the client is able to take the childhood experience and view the experience from the child perspective, rather than a historical or adult one.
4) Key themes in Rescripting childhood trauma
Whilst not empirically validated, there are several key themes that are often observed in rescripting childhood trauma images and managing antagonists.
Empowerment & guidance: Standing up to antagonists and providing emotional strength.
Safety: Providing protection from antagonists.
Reattribution: Increase perspective and to place cause to external figures.
Compassion & Care: Providing nurturance, care via limited reparenting.
Validation & Grief: Validating experiences and supporting sadness and grief, as a result of not having childhood needs met.
It’s important for the therapist to keep in mind what is the corrective emotional experience required in the imagery scene. For example, a client that feels subjugated, dominated, and disempowered in an image may initially need a sense of empowerment and safety. If the therapist enters the image focusing on reattribution towards the antagonist (“What’s wrong with you?, you’re the problem”), this may not provide the key ingredients for a corrective experience. It may be pertinent for therapists to have in mind, “what does the client need?” and “what is the corrective emotion experience that I’m trying to provide for the client?”. Such awareness will act like a compass for rescripting work, resulting in attuned responses.
Often when tackling antagonists, it can be challenging for therapists to initiate effective responses to both antagonists and clients. Figure 1, notes possible responses based on rescripting themes.
5) The “Window of Tolerance” in Imagery
A number of theorists have previously discussed the use of the “Window of Tolerance” when working with affect (Segal, 1999, Ogden 2006). Here, similar concepts apply to imagery-based interventions. There is an optimal “window” of affective arousal that allows for effective imagery rescripting and processing. If there is not enough emotional arousal (Hypo-aroused), the client can present flat, detached, and disconnected from the visual material. Here the therapist may need to focus on working on coping modes that are obstructing imagery work. In addition, the therapist may need to increase sensory aspects to the rescript. One practical tip here is to close your own eyes in imagery work. If you are unable to create an image, then further sensory details may need to be sought.
In contrast, if the client is overwhelmed (or hyper-aroused), the therapist can help the client to use the image itself to “down regulate” affect. For example, the therapist can ask for the image to be “paused” or “to rewind,” or for the therapist to enter the scene (“I’m there with you, can you see me, I’m here to protect you”). Hence using the imagery itself as an affect regulation tool (rather than asking the client to open their eyes, etc.).
And so, back to our initial circumstance with the bikers and my client, what happened next…. I asked the frightened child client, “What do you need right now?”. She replied, “I need someone to protect me and get these bikers out of my house.”
I entered the image, made myself larger, brought along a Taser, a can of pepper spray, and an elite police team dressed in body amour and police dogs…
Despite my own imagined incapacity to “take on bikers” and protect the child, my client noted, “this was the first time I ever felt someone could stand up to them….” A good result…
Arntz, A. (2015a). Imagery Rescripting for Personality Disorders: Healing Early Maladaptive Schemas. In Working with Emotion in Cognitive-Behavioral Therapy Techniques for Clinical Practice Thomas, N. & McKay, D., Guildford, New York.
Arntz, A. (2015b). Imagery Rescripting for Posttraumatic Stress Disorder, In Working with Emotion in Cognitive-Behavioral Therapy Techniques for Clinical Practice Thomas, N. & McKay, D., Guildford, New York.
De Jongh, Ad, Erik ten Broeke, and Steven Meijer (2010). "Two method approach: A case conceptualization model in the context of EMDR." Journal of EMDR Practice and Research 4, 12-21.
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