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Guided
Imagery
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Mental imagery, sometimes called
visualization, guided imagery, and often used
interchangeably with the practice of meditation and
hypnosis, is the language used by the mind to
communicate and make sense about the inner and outer
worlds (Shafer & Greenfield, 2000). Imagery, refers
to the awareness of sensory (physical), and
perceptual (cognitive), experiences which have been
used in a variety of health and healing practices in
the Western world for over three decades (Heinschel,
2002). Meditation, mindfulness, hypnosis, and yoga
are also techniques commonly used in Behavioural
Health Programs today to assist in high-level
awareness health education sessions
(Kabot-Zinn,1990). While there is something unique
and peculiar about thinking in mental images, or
understanding the meaning of "pictures in the head"
as it applies to health and well being, this
uniqueness is to receiving attention in the
theoretical and research literature (Pslyshyn,
2002). Given the diverse role of the imagination
appears to have in healing, the difficulty in
studying the invisible world scientifically,
religious groups who oppose such practices, and the
differences in preconceptions held by practitioners,
it is no surprise that there are many distinct views
on the practice and value of mental imagery (Pinker
& Kosslyn, 1983, Snaith, 1998). Role of
Imagination in Healing
In the last decade, interest in the
practice of mental imagery, and the role of the
imagination in health and well being, has
dramatically increased as a popular approach for
treating a wide variety of psychiatric, medical
concerns, and enhancing sports performance (Shafer &
Greenfield, 2002; Bloom, 1998; Epstein, 1989). In
fact, ten million North Americans of all ages admit
openly to practicing some form of imagery or
meditation, to reduce stress, boost the immune
system, and cope with life threatening illnesses.
This number has doubled compared to admitted
devotees a decade ago (Stein, 2003; O’Donnell,
Maurice, & Beattie, 2002). While the principles of
mental imagery have been utilized in healing since
the beginning of medical history, recent pioneers
embracing the scientific merit of mental imagery are
transforming the healing practices in Western
medicine (Ader, 1981; LeShan, 1989; Selye, 1956;
Simonton & Henson, 1992; Borysenko, 1988; Benson,
1975; Brigham, 1994).Mental States and
Physical Health Are Intimately Connected
The era of health care reform has
placed a great emphasis on brief therapies,
behavioural health, and alternative practices
involving the cooperative relationship of the
therapist, and the active participation of the
client (Elliott, 2003). As a result, doctors, health
care providers, therapists, and patients acknowledge
that mental states and physical health are
intimately connected (Lemonick, 2003). Advances and
shifts in health care practice have stimulated
education, training, and the clinical application of
imagery for the treatment of mental health,
substance abuse, and medical problems. Mainstream
Americans no longer have to search for gurus in the
mountains or the Far East to inquire about the
practice of mental imagery. Information is now
offered and training provided in schools, hospitals,
law firms, government buildings, corporate offices,
and prisons (Gruzelier, 2002; Stein, 2003).
The central theme that emerges from
empirical research is the impact of the client's
sensory experience during the imaginal process (Heinschel,
2002). Clients do not have something "done" to them,
they live an actual experience during the imagery
exercise using the practitioner (clinician, health
care worker, as the guide). While the eyes are
either open (focused on a point in front of them) or
closed, the client is guided through the exercise in
the clinical setting (office, hospital, home, etc.),
to be practiced as "prescribed" (i.e. x times daily)
on their own between sessions (one time only, daily
for seven days, or for twenty one days) depending on
the presenting problem and the individual (Shafer &
Greenfield, 2002). Case Studies
The following case examples
illustrate how mental imagery can be utilized in a
variety of health concerns:
Case Example #1
Sandra, a 43-year-old attorney, has
been asthmatic since childhood. Despite using a
variety of approaches, she has always felt enslaved
to her disease. She has tried both ignoring her
condition and catering to it. Though everything
seems to help for a time, nothing gives her the
release she seeks. She is tired of searching for a
solution which constantly evades her. Feeling
drained and confused, she seeks out a clinician
trained in the use of mental imagery as a treatment
of last resort.
The therapist asks Sandra to close her eyes, turns
her senses inward, and does some reverse breathing
(exhaling first though her mouth, then inhaling
through her nose). With this simple preparation,
Sandra enters the world of her imagination where
anything is possible – for here there are no rules,
no diagnoses or prognoses, in fact, no limitations
of any kind. Using an imagery exercise called
“Liberation From Slavery,” Sandra sees and feels
herself chained to her illness which appears to her
as a large beast pressing her down, its foot planted
firmly on her chest. Uncomfortable as this image may
be, once she sees it she has the opportunity to
acknowledge it (in effect to experience it), and to
make a change. Using her imagination, she finds a
key that unlocks the chains, breaks free of the
beast, and releases herself from its power.
Suddenly, the beast begins shrinking, while Sandra
grows taller. As the chains fall away, the
restriction and heaviness in her chest diminish. She
feels lighter, her breathing becomes easier, and the
sense of fear and powerlessness she had been feeling
is replaced by hope and clarity.
When the imagery exercise is completed, the
clinician as the guide, instructs her to breathe out
and open her eyes. At this time, the therapist asks
Sandra how she feels, and asks Sandra to describe
her experience from the exercise in the present
tense. She is encouraged to try this exercise (the
prescribed dose), every day for at least seven days,
up to 21 days, and to record her experiences
(including night dreams) until her next appointment.
The benefits Sandra derives from doing this exercise
are far reaching and immediate. Her imagery acts as
a mirror that reveals her from the inside out.
Instantaneously, from the imagery exercise she has
learned truths about herself that until now she has
overlooked, even denied. Indeed, she is stronger,
“taller,” more powerful than she ever suspected. By
freeing herself from the chains (which she sensed
were her beliefs and fears about her illness), she
becomes bigger than this disease, something she had
always felt was all powerful, too much for her to
handle. In changing the image, which she does by
using the key to release herself, she has affected
her beliefs, thoughts, and feelings in a positive,
and liberating way. In doing this, she has gone
beyond ordinary thinking where such things are
“impossible,” and has become her own authority, the
one who is ultimately in control of her choices in
life (Shafer & Greenfield, 2002).
Dee is a 55 year old nurse who works
many hours and is the sole supporter of her family.
She presents at the office with her arms scarred and
scabbed severely from her digging and scatching.
After discussing the various issues in her life that
are “making her itch”, she is guided through a
mental imagery exercise (Epstein, 1989) for general
relaxation. Several days later, Dee emails the
clinician the following (personal communication,
with Shafer, 2003) exercise she developed on her
own, evolving from the general relaxation exercise
she was given in session. Her intention is to stop
the itching and heal the wounds on her arms:
I sit in a quiet place (if at all possible). I close
my eyes gently and take a few deep breaths. During
this time, my mind travels to the spleen and watches
as red blood cells (rbcs) come out to travel around
the body. They travel to the heart and to the lungs
and I watch as they pick up oxygen and return to the
heart to be sent to all parts of the body. At this
time, the rbc’s have also picked up glucose and
there are white blood cells and antibodies traveling
with them. I view them as they descend through the
network of arteries, arterioles, and capillaries and
then, they are at the sites that need healing. I
like to visualize the right and left sides
separately, but if I am tired and start fighting
sleep, then I pull my perspective back and watch
both sides at the same time. I see the rbc’s leaving
oxygen and glucose at the base of the lesions. I see
the antibodies surrounding the areas to prevent
infection and I see the wbc’s backing up the
antibodies.
I then pull my perspective back and gently stroke
each arm separately and visualize more blood going
to the areas to help them heal. The last thing I do
is to take several deep breaths and tell my body
that I do not want it to show me evidence of my
anger, frustration, or stress. I tell it that there
is no need for my body to hurt itself. Then I take
three long breaths out and with each exhale I say
(imaginably): “With this breath, I breathe out all
of my anger, with this breath, I breathe out all of
my stress, with this breath I breath out all my
frustration.”
Like Sandra, the impact for Dee was immediate. She
stopped itching within the week, created her own
imagery exercise making her the authority over her
healing, and the scabs were healed (without
scarring) within one month. The confidence and
esteem Dee gained from the creation of her own
exercise and the results she achieved from doing the
work herself drastically improved her sense of self.
Clients gain a sense of mastery and call recall such
achievements when future health challenges present
senses of doubt, and helplessness. Summary
As with the beginning of all habits,
start with simple relaxation exercises first,
perhaps with yourself and other colleagues to gain
comfort and familiarity with engaging the
imagination and each of the five senses. The mind
and the body can interact in many ways to bring
about health and illness as is introduced throughout
this chapter. At first these interactions may be
difficult to understand or see, however practice
observing and reading the images provided in the
exercises with a deeper appreciation. Experiment
with all the possible ways to gain access to the
sensory world of the client. For example start
listening in a more active way such as listening to
music. Or, if the client has trouble imaging,
involve the sense of smell or taste or touch,
integrate aromatherapy in the practice. Clients may
like to write impressions from the work in a
journal, record dreams, and utilize the therapist as
the teacher or guide in their journey.
What may be discovered as the work of mental imagery
continues, is that this not only attunes the
therapist’s ability to image, but how to expand in
this work with clients. While research is a
challenge and is highly debated in this work, the
evidence based research must continue to further the
credibility of this mind body practice.
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