The use of imagery in psychotherapy has a long tradition. Freud placed great emphasis on the 'dream content' and mental imagery of his analysands. For Freud, what seemed most important was to bring 'a state of evenly suspended attention' to the analysand's free-associations of words, images and feelings, avoiding 'as far as possible, reflection and the construction of conscious expectations,' trying not to 'fix' the things he heard but instead 'catching the drift of the patient's unconscious with his own' (Freud 1923:239).
In other words, and at least in the early stages of his career, Freud believed that the role of the therapist was to enter into a free-floating reflective state alongside the client and allow some kind of meaning to emerge.
Hypnotherapy has long made use of mental imagery to enable people to achieve a cognitive restructuring of their inner experience. The prevalence of the use of imagery in hypnotherapy might be because it seems to become easier for us to follow guided visualisation processes or become more aware of our spontaneous mental imagery when we close our eyes or begin to relax.
Sensory deprivation or distortion
The changes in the way that we experience ourselves proprioceptively in space that are commonly associated with hypnotic phenomena, seem to make it easier for us to shift our attention inward and practise visualisation techniques or become more aware of our own mental imagery.
In neuroscientific terms, studies seem to point to decreased activity in the parietal lobes and a deafferentation of the posterior superior parietal lobule (PSPL). The functional deafferentation suggests a decrease in the arrival of distracting stimuli to the striate cortex and PSPL, enhancing a sense of focus and producing an altered perception of self-experience. This PSPL deafferentation is supported by three neuroimaging studies of subjects engaged in meditation (Newberg and Iverson, 2003) but is not without controversy.
Guided imagery or visualisation
Guided imagery or visualisation might involve asking someone to imagine themselves in a number of situations or contexts, feeling calm, confident, relaxed and having already mastered a particular task that previously challenged them. It might involve them visualising themselves in a situation, whilst 'borrowing' resources from a role model (real or fictional) who does this task with total confidence, and then doing the task themselves.
Hypnotherapeutic techniques for physical healing make use of other applications of guided imagery: for example, imagining an affected area and then changing its colour or shape or sensation or using visual metaphors that represent the body healing itself. There are a number of studies looking at the use of guided imagery in physical healing such as: Roffe et al (2005), which suggests that guided imagery may be 'psycho-supportive' and may 'increase comfort' and recommends further research.
One area of research into hypnotherapy using guided imagery is in the treatment of IBS. A systematic review by Wilson et al (2006) found that out of the 20 studies (18 trials of which four were randomized, two controlled and 12 uncontrolled) and two case series evaluated, over half of the trials (10 of 18) indicated a significant benefit.
Imagery used in research studies includes 'gut-directed' scripts such as those developed by Whorwell at the Wythenshawe Hospital, including imagining the digestive system as a river and adjusting the river's flow.
It is interesting to note that guided imagery can be more or less guided, according to the style and approach of a particular therapist. For example, in the gut-directed work cited above, it might be more appropriate to suggest that a client connects with her own experience of her digestive system - its look and feel and colour or any images or metaphors that come into her mind - and work with these. Other clients may benefit from more specific suggestions: 'Imagine your digestive system as a river...' I would suggest that this is an area for further research.
Ability to visualise
One of the common issues encountered in hypnotherapy around the use of mental imagery is the client's ability to visualise. Some people will tell you that they find it very difficult to 'picture' things in their minds.
Visual mental imagery, or 'seeing with the mind's eye', has been the subject of considerable controversy in cognitive science. Scientists do not yet fully understand whether images are fundamentally different from verbal thoughts, whether they share underlying mechanisms with visual perception or how the information contained in images is represented.
What might be helpful in enabling clients to work with mental imagery is to help them to think of imagery in terms of imagination - the ability to form mental images, sensations, sounds and concepts. In this way, mental imagery becomes more than 'pictures in the mind' and encompasses the entire spectrum of our experiencing. (The literature on synesthesia may form useful clues in the future to understanding the rich and multi-modal ways that we process and structure our inner worlds.)
One of the assumptions made by NLP, despite a current lack of evidence, is that people structure their experience primarily according to visual, kinaesthetic, auditory (or digital) processes and that a therapist can deduce this sensory preference through subtle 'eye accessing cues.' Given the lack of evidence, it my be preferable to use language that enables someone to make use of the entire spectrum of sensory experience in their mental imaginings.
Further benefits
In addition to the kinds of cognitive restructurings that can be achieved through the specific content of guided visualisation (the specific tasks and contexts visualised), it seems that the process itself of repeated visualisation brings further underlying benefits.
As we continue to learn to connect with the inner world of our mental imagery or imagination, we tend to gain an increased sense of ourselves (what the traditional hypnotherapy literature might describe as 'ego-strengthening').
In the 1970s, the psychologist Jerome L. Singer, conducted an analysis of the use of mental imagery techniques in psychotherapy (1974) and concluded that clients who practice visualisation techniques develop an underlying sense of confidence and self-control which seems to correlate with their increasing sense of mastery over their own mental imagery (Singer, 1974: 132).
It's interesting to note Singer's use of 'affect,' suggesting that mental imagery is as much about working with and mastering our bodily affects and emotions as it is about 'picturing' things.
The process of consistent and repeated visualisation or mental imagining seems very similar, in this sense, to Jung's key therapeutic practice of 'active imagination.' Jung saw his technique as a way of granting the psyche freedom and time to express itself spontaneously, without the habitual interference of 'ego' (or of social and cultural constructs and expectations). Jung also called this process 'the art of letting things happen.'
According to Jung, the client makes himself more and more creatively independent through the method of active imagination. No longer dependent on his dreams or his therapist's knowledge, he gives shape to himself in a new sense, by actively imagining himself (Collected Works of C. Jung. XVI, para. 106).
References:
Newberg A.B., Iversen J.,(2003), The neural basis of the complex mental task of meditation: neurotransmitter and neurochemical considerations, Med Hypotheses, 61: 2, p 282-291.
Roffe et al. (2005) 'A systematic review of guided imagery as an adjuvant cancer therapy.' Psycho-Oncology Volume 14, Issue 8, pages 607-617, August 2005 which
Singer (1974) Imagery & Daydream Methods in Psychotherapy & Behaviour Modification. New York.
Wilson S, Maddison T., Roberts L, Greenfield S., Singh S. 2006. 'Systematic review: the effectiveness of hypnotherapy in the management of irritable bowel syndrome.'Alimentary Pharmacology & Therapeutics.Volume 24, Issue 5, pages 769-780, September.
Sophie Nicholls is a writer, consultant, speaker and clinical hypnotherapist. She has a DPhil from the University of Sussex where she researched the use of writing in therapy. Her poems have won several awards. She has worked with universities and organisations to develop innovative programmes in personal and professional development and she now runs a highly popular online programme in Creative Writing for Personal Developmemt at http://wordsauce.com
Find out more about Sophie's work and get a free ebook by subscribing to her ezine at: http://www.sophienicholls.com
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