The Use Of Guided Imagery Psychology Essay

In spite of guided imagery being considered and alternative or complementary technique, it has been widely used in psychotherapy for more than one hundred years. Its history is long. The first practitioners to mention it were Breuer and Freud in 1895 in the case of Anna O. in their studies in Hysteria. Later in 1913, Frank, a Viennese psychiatrist explored the spontaneous episodes of hypnagogic visualizations when clients were deeply relaxed, naming this technique the “Cathartic Method” which was Breuer’s old term (Frank, 1913). Ten years later, in 1922, a German psychiatrist called Kretschmer (3) suggested a new definition of the phenomenon. He called these inner visualizations Bildstreifendenken, which means “thinking in the form of a movie”. He demonstrated the direct relation to the dream-work studied by Freud. (Kretschmer, 1922)

Freud’s conviction in the primacy of verbal, rational or secondary processes had a profound effect in the field of psychotherapy. The use of imagery took place in counted instances as its development had normally been neglected in favour of verbal techniques. Nevertheless, the interest by psychotherapists in mental imagery has considerably increased in the last ten years. The use of imagery is becoming more important with time and a shift may be taking place where images are starting to become more powerful than words. (Ahsen, 1968, 1972; Assagioli, 1965); Desoille, 1965; Gendlin & Olsen, 1970; Horowitz, 1967, 1968; Panagiotou & Sheikh, in press; Shapiro, 1970).

Lazarus (1973) believes that imagery is one of the techniques to use to ensure durable results. Bugelski (1968) reveal that images produce “greater clarity of perception, stronger resistance to the experimenter’s suggestion, and an enormous wealth of detail” (Lazarus, 1972).

Practitioners with widely different theoretical backgrounds have applied imagery for therapeutic communication and change.

Guided imagery is certainly successful and effective in diverse areas.

Katherine Arbuthnott, Dennis Arbuthnott, and Lucille Rossiter (2001) present in their article an exceptional overview of the different uses of guided imagery. They also offer a summary of the effectiveness “of this therapeutic tool for numerous activities such as planning and rehearsing goals, coping with negative or intrusive thoughts, enhancing self-soothing skills, increasing clients’ confidence, helping clients articulate issues that are not fully understood, managing stress, gaining control over painful emotions, and overcoming strong reactions to feared experiences”. (Zerbe Enns, 2001)??

Furthermore, “guided imagery can be used to learn and rehearse skills, more effectively problem solve through visualizing possible outcomes of different alternatives, and increase creativity and imagination. It has also been shown to affect physiological processes.” (Utay & Miller, 2006) Apart from being applied in counselling, guided imagery has also been employed with very positive results in healthcare, rehabilitative medicine and sports training.

Hall, Hall, Stradling &Young (2006) offer us a comprehensive way to introduce guided imagery in the counselling and psychotherapy process. They mention that before implementing guided imagery in therapy it is important to consider clients’ expectations and assumptions about the nature of the process and even the outcomes; clients’ readiness for the activity having into account their age, intellectual ability and their emotional readiness; timing and time implications having into consideration when is best to offer the intervention and planning the session around the technique; the physical setting of the counselling room as providing a relaxing environment is vital; and additional equipment to facilitate further exploration after the visualization.

Hall et al. (2006) also offer in their book valuable guidance about the appropriate verbal interventions to guide imagery, bring the client back to the room and reflect on and explore the meaning of the experience after the visualization.

Summarising, they provide us with 6 suggestions in regards to guiding the client through the imagery process: Be sparing in the interventions and avoid to intervene too much respecting the pace of the client, asking few open questions or promts and leaving him/her to control the process; Avoiding why questions is also very important as they may interrupt the flow of the imagery journery as they require cognitive focus and rationalization of experience; combining what’s good about..? and what’s bad about..? questions is very beneficial as it promotes deeper reflection during the imagery journey; encouraging the “assertive I” suggesting the clients to try to express what they are saying introducing “I”; asking clients directly how do they feel about what they are saying or experiencing is recommended as they will normally tent to detach and avoid mentioning the feelings they experience; and lastly they suggested that tracking and reflecting the client’s vocavulary helps to stress important aspects of the client’s experience and ensures that the clients feels understood and minimises assumptions of meaning. (Hall et al., 2006)

Leuner (1969) explains guided imagery technique the following way:

“The technique for applying the method of Guided Affective Imagery is simple. The patient lies down on a couch. Outer stimuli are reduced as much as possible. The room should be quiet and the lights dimmed. He is then asked to relax. It may be advisable to offer some verbal suggestions that help to deepen the relaxation. One then starts with the first standard situation, the meadow. The patient is asked to imagine a meadow, any meadow that comes to mind. No further comment is given. Everything is left as open and as unstructured as possible so that the patient can develop his own image of a meadow with its associated feeling quality. The therapist gently persists in asking the patient to give detailed descriptions of his imagery and of the feelings associated with it. The therapist is, so to speak, always the companion of the patient in his world of imagery.” (p.2)

Discussion of research into the process of guided imagery: what are the aspects of guided imagery interventions that clients experience as helpful or unhelpful?

There is not a lot of written work that explores why guided imagery is helpful. Nightningale (1998), states that guided imagery facilitates clients connection with their internal cognitive, affective, and somatic resources.

Although a large amount of research has centred on the ways in which images are produced, the ways in which thought processes operate, and the value of imagery in memory and cognition, little attention has focused on the process by which people associate meaning to the images they produce or on the dynamic qualities or functions of imagery in the psychotherapeutic process. (Farr, 1990)

Farr (1990) in his study about the guided imagery process illustrates the experiences of five women using a spontaneous guided imagery process to investigate how much participants discovered meaning and increase their awareness regarding their personal issues. He carried out four guided imagery sessions, one per week. He found that “the guided imagery process facilitated participants’ discovery of personal meaning and increased understanding about their outer and inner lives. Subjects found the imagery enabled them to quickly discover and explore affective material related to important life experiences, issues, and relationships. It also allowed them to renew a connection with inner personal sources of creativity”. (Farr, 1990, p1)

In his study Farr explains that this technique is characterised by vivid, intense and very real like images that promote deep emotional exploration and reflection. Furthermore, every participant reported some kind of kinaesthetic body reactions. Participants also mentioned that it was beneficial not to have to analyse or even understand then and there what was happening on the visualization as this allowed them to directly access feelings. They stated this is different than in verbal therapy.

Participants also stated that they have learnt a lot about themselves and their life concerns, and also their perspective about the issues was broader as they could see them more clearly and from different points of views. Additionally, the spontaneous imagery technique facilitated the recovery of repressed issues or forgotten memories as well as every participant also experienced affective release or expression.

Interestingly enough every participant came across an image of a “positive guide” at some point of the visualization. It was observed that a shift in participants’ attitudes, a change in perception or more understanding about an issue took place as a consequence of the interaction with this character. Furthermore participants expressed that the experience emphasised their own needs to love herself and that as a consequence of the experience they felt empowered and interested in continuing exploring their inner life.

Lastly, participants pointed out that they felt the images were directly or indirectly related to their current life, their past or present relationships or issues. (Farr, 1990)

Discussion of research into the effectiveness of guided imagery interventions.

Guided imagery is a technique that has been widely applied by healthcare providers with remarkable results, especially with Cancer patients or pain control. For instance, Walker, Walker, Ogston, Heys, Ah-See, Miller, Hutcheon, Sarkar, and Eremin (1999) undertook an experiment with two groups of Cancer patients. Relaxation therapy was applied to one of the groups while the other one also received peaceful imagery. Participants in the second group presented with “enhanced lymphokine-activated killer cytotoxicity, higher numbers of activated T-cells and reduced blood levels of tumour necrosis factor” (p. 267). They, furthermore reported being “more relaxed and easy going, had fewer psychological symptoms and had a higher self-rated quality of life during chemotherapy” (p. 267). In summary, participants that also received peaceful imagery seemed to be healthier than the participants in the control group. 

Another similar study with two groups of stroke survivors showed that subjects who received both occupational therapy and guided imagery presented considerably more improvement in motor recovery than the group that did not use imagery (Levine, Sisto, & Johnston. 2001).

In a research with children who experienced recurrent abdominal pain it was shown that after the used of imagery pain was reduced a 67% (Ball, Shapiro, Monheim, and Weydert, 2003). 

The use of guided imagery is not exclusive of healthcare professions it is also effectively used in sports to reduce pain and accelerate healing, improve performance and motivation. There are many studies on this field that demonstrate that guided imagery is an effective tool that has many uses. For instance, in their study, Thelwell and Greenless investigated competitive endurance of athletes training for a triathlon through the use of a mental skill training composed by a combination of different strategies such as goal setting, relaxation, self-talk and imagery. They discovered that motivation did considerably increase, participants managed pain more effectively and their competitive performance was enhanced (2003). However, in this study is difficult to pin point how much imagery contributed to these benefits as the mental skill training was complex and other strategies were involved.

Additionally, there is also a substantial body of research that provides evidence that supports the idea that imagining performing a specific sports skill or activity improves the physical performance of that skill (Eddy and Mellalieu. 2003). In his mental imagery research with visually impaired athletes, they concluded: “mental imagery … [is] a useful psychological skill for athletes who are visually impaired” (p. 366) as it helps them to improve both their motivation and performance.

Research on guided Imagery in Counselling 

However, the research in guided imagery is extended to other fields, including counselling and psychotherapy where it is considered a therapeutic tool that has been investigated through decades. For instance, it has been used in grief therapy (Melges & DeMaso, 1980), decision-making and eating disorders (Hill, 2001), to name just a couple of many areas where guided imagery is used within counselling. On this literature review, just a few examples will be presented to stimulate the reader’s curiosity.


Over 100 people with unresolved or complicated grief were investigated by Melges and DeMaso (1980). They used three stages of treatment: “cognitive structuring for the decision to re-grieve and for clarification of procedures; guided imagery for reliving, revising, and revisiting scenes of the loss; and future-oriented identity reconstruction” (p. 55). They concluded that guided imagery was the essential part of the treatment because re-experiencing or re-imagining helped clients to change their views of reality regarding the grieving (Melges & DeMaso, 1980). 

Hill (2001) study is slightly different. He used fairy tales, “as a vision-to-action treatment alternative for psychological dysfunctions focusing on eating disorders” (p. 584). She combined guided imagery, cognitive refraining, and behavioural assignments to treat subjects with bulimia nervosa. She established that guided imagery “helps the client assimilate new chapters analogous to her life transitions and develop necessary accommodations” (p. 587). She also stated that, “fairy tales provide a paradigm that serves as a transitional structure in language, thoughts, and behaviors” (p. 587).

Skovholt and Thoen (1987) used guided imagery scripts in parent group counseling. They concluded that, “understanding the dilemmas of others and the resolutions possible can be very instructive for someone who feels stuck and alone” and that, “guided imagery and daydreams are method[s] for discovering rich social comparison data” (p. 316). 

These are some examples of the extended research that provides evidence for the effectiveness of guided imagery.

Guided imagery is a flexible technique that can be used by itself or in conjunction with other strategies, always having into account our clients’ needs, the counsellor’s experience, comfort with the approach and training necessary. Nightingale (1998) suggested that guided imagery can be applied in counselling for relaxation for stress reduction; motivation by imagining a positive future; and insight through exploration of possibilities and problem solving.

However, further research should focus on how specific aspects of the implementation of guided imagery influence or affect specific issues or populations. Furthermore, there is a imperative need to increase the research of the mechanisms by which guided imagery is effective.  Nevertheless, guided imagery is at the moment and without a doubt an effective, useful and flexible therapeutic tool as it has been demonstrated through extensive research during the last decades. It has earned the right to be considered a research-based approach to helping.

The evidence base for therapeutic use of past life regression techniques

The use of past life regression techniques in counselling and psychotherapy can be defined as any intervention that involves a process through which the client is invited to enter a relaxed state, then receives a suggestion to imagine a meadow or a relaxing place for them and a door. They are invited to go through that door after which they will be in a past life. The suggestion is open so the participant decides what to visualise, if anything. Through the regression the counsellor asks open questions about what the client may be seeing, questions such as who are you? What are you wearing? Is there anyone around? How is the environment? How you feel? What are you doing? Then the counsellor suggest the client to return to the door and go through it to return to the meadow or the place where they were relaxed and safe at the start of the regression to then return progressively to a normal waking state and reflect on the meaning of this experience for their current life.

In some contexts, hypnosis is used to assist the person to enter into a relaxed state in which they are open to suggestion. In other therapeutic contexts, the person is merely invited to adopt a relaxed posture, close their eyes, and breathe slowly and deeply. In essence, past life interventions are similar in structure to other guided imagery and guided fantasy techniques described by Hall; the only difference lies in the content and form of the guidance given to the participant. The guidance in past life imagery is a bit more open and less guided or direct, after going through the imaginary door the client decides what to see or even to not see it at all.

The therapeutic use of past life regression has been the focus of intensive interest for at least the past 30 years, through the work of transpersonal psychologists and psychotherapists such as Bragdon (1990), Grof (1988), Lucas (1993), Schlotterbeck (1987), Weiss (1988), and Woolger (1987). Some commentators have pointed to the similarity between past life ‘journeys’ and the kinds non-ordinary states of consciousness that are available and accessible to people in diverse cultures (Edwards, 1991, 1993; Knight, 1991, 1995; Moody & Perry, 1990; Ten Dam, 1990). Grof (1988, p.87) describes the essence of the experience of past life regression as comprising:

…. a convinced sense of remembering something that happened once before to the same entity, to the same unit of consciousness. The subjects participating in these dramatic sequences maintain a sense of individuality and personal identity, but experience themselves in another form, at another place and time, and in another context.

Some researchers who have studied the phenomenon of past life regression propose that these experiences seem to occur in a specific non-ordinary state of consciousness. Van Beekum and Lammers (1990,p. 51) call it the ‘past life state’, which they define as:

A specific, ego syntonic, altered state of consciousness in which the person experiences a coherent system of visual, auditory, kinaesthetic, and/or olfactory sensations within a clear historical context. This context is consistent in time and place, it seems to date from a single historical period before the present life of the individual, and its content usually refers to traumatic experiences.

Past life regression therapy is usually met by health care professionals with scepticism and suspiciousness due to various reasons. For instance, there is scepticism around the connection between this technique and the concept of reincarnation, a notion that is not an established belief in the western society. The association between past life regression and the occult creates difficulties for therapists trained in a scientific world view. .

Furthermore, some versions of past life regression therapy (PLRT) may be carried out through hypnosis. For many critics, the validity of hypnosis can be questioned on the basis of susceptibility to leading questions, false memory syndrome and the demand characteristics of the situation (Orne, Whitehouse, Dinges, Orne, 1988; Perry, Laurence, D’eon, & Tallant, 1988; Myersburg, Bogdan, Gallo, McNally, 2009; Schacter, 2001).

However, in response to this scepticism lies a body of research that reveals PLRT to be an effective therapeutic intervention for a wide variety of emotional, mental and physical problems including phobias, migraine headaches, personal growth, relationship troubles, insomnia, anxiety, weight issues and asthma, depression among others (Solovitch & Henricot, 1992).

Research into the effectiveness of past-life regression interventions

Dr. Raymond Moody, researcher and author in the field of Near Death Experience, also investigated past-life regressions. Through analysis of his studies and other psychiatrists” studies, he concluded that there are twelve traits common in past-life regressions such as: experiences are normally visual and in colour. Sometimes there are odours and sounds. From subjects’ perceptions images seem more “real” than dreams and don’t feel as distorted; additionally, experiences “seem to have a life of their own, the scenes seem to unfold on their own and subjects have the sense that they aren’t making it up such as in daydreams”. (Moody, 1990, p.43); the visualization seems familiar, in different degrees of intensity; “the subject strongly identifies with one character despite profound differences in physical appearance, occupation, sex, race or other life circumstances” (Moody, 1990, p.43); different emotions may be (re)experienced; events that take place on the visualization may be experienced from two different perspectives: first- and third person, “sometimes the subject feels as though they are in the body of the person with whom they identify, and at times they observe the scenes as they unfold from a detached viewpoint.” (Moody, 1990, p.44); the experience normally mirrors issues from the subjects’ present life. “The conflicts and dilemmas in the regression usually reflect the subject’s current life circumstances or struggles” (Moody, 1990, p.44); Changes and improvements in the subjects’ mental health normally take place after the regression as it seems repressed or stuck emotions seem to be relief by catharsis; Additionally, sessions may influencemedical physical conditions, “In rare instances, the subject may report dramatic improvement, or even spontaneous resolution, of physical symptoms following a past-life regression” (Moody, 1990, p.43); Furthermore, the visualizations seem to be organised around meaning, not linear timeline; other trait is that regressions tent to become easier with repetition; lastly, Moddy states that most past-lives are mundane, ordinary, normal (Moody, 1990).

Moody states that a person may not experience all these 12 traits although it is expected that several of them take place (Moody, 1990).

Although impossible to prove how PLT works, what have been demonstrated is the healing benefits of this technique as well as the enormous yet inscrutable potential of the subconscious mind.

Clark (1993-94) compiled a questionnaire in which she queried 136 therapists, each with at least 5 yrs experience with past life therapy. He discovered that therapist use past life regression for a wide range of issues, the most frequently treated and with more success were phobias, 62 types were reported to respond well to regression; relationship issues, finding purpose and meaning in life and physical illnesses. Furthermore, therapists stressed as significant the speed with which therapeutic change is achieved and the fact that many cases that have been bothering the subjects for years and been treated by all others short of interventions achieved permanent relief through past life regression.

In 2000 Eric J. Christopher sent a questionnaire to 222 practitioners that use past life therapy as combination to other therapeutic interventions. 73 therapists returned the questionnaire filled out. Results indicated that past life therapy helped to cure 30% of their client’s problems. Furthermore, A total of 77% of their clients’ problems were significantly helped, if not cured. Finally, the therapists stated that past life therapy helped to make some kind of improvement in 96% of their clients’ problems in the past 6 months in an avarege of 6 sessions of an average of 1 hour and 40 minutes length. Therefore, researcher concluded that past life therapy seems “to be reliable, extremely effective and fast in helping clients to deal with problems and improve their lives (…) The results of this study also indicate that PLT is a highly effective and fast therapeutic modality, and one certainly worthy of further investigation regarding its potential for human healing and personal growth” (Christopher, 2000, p.66)

This study may demonstrate the effectiveness of past life therapy but strictly from the therapists’ point of view and not the client. This is considered an important limitation

In addition to this, is important to have into account that in both of these studies the therapists are eclectic in their approach. They may use a combination of techniques and therapies with the same client therefore, how much of the outcomes are due to past life interventions is questionable.

In a similar study, Wambach & Snow (1986) surveyed 26 regression therapists. In total they worked with 17,350 past life reports. 40% improved their interpersonal relationships and 63% of the clients improved a Physical symptom. Furthermore, from that percentage, 60 % seem to have improved a physical symptom related to a death experience in a supposed past life after relieving or re-experiencing what happened then during regression.

In an attempt to evaluate his clients’ satisfaction Schlotter beck (1986) questioned 18 of his clients that presented with different issues whether they found past life regression and the tapes he made for them helpful tools for recovery or in opposition they might have “reprogrammed ” their symptoms. Results were positive. Clients also stated that his tapes were very helpful.

Moreover, the reports from these types of studies as the ones mentioned above are merely anecdotal in nature as no information about medical testing prior and after the therapy was provided.

Most of the evidence in regards to the efficacy of past life regression is in the form of anecdotal cases studies or surveys to practitioners such as the ones mentioned above. Tere are a vast number of books full of cases studies that show the efficacy and effectiveness of past life regression. This type of qualitative evidence is important, however it is not considered as scientifically valid as quantitative research. Therefore, it is important to include in this review the few studies that present more measurable data to support the claims of past life practitioners.

For instance, Cladder (1986) in his study with 30 Dutch clients with unresolved phobias by conventional therapies shows that 20 of them improved rapidly ang get ride of their phobias completely after an average of 11 “behavioural hypnotherapy with regression” sessions. Cladder refers this way to his therapeutic method. Past life regression was one of the various techniques he used in his treatment; therefore, this has to be taken into account when the results of this study are interpreted. He reported that 6 of the 20 participants that improved did not report any past lives at all.

Of the 20 clients that improved, 14 of them regressed to a past life when they were asked to go to the source or origin of their phobia or problem without directly instructing them to regress to a past life, while the other 6 regressed to an event in their present lifetime.

The remaining 10 clients that didn’t experience improvement in their symptoms seem to be quite severe cases. 5 of them had score high on the pre test and had serious compulsions. 3 of them were not cured after 22 sessions and the other 2 dropped out of the treatment.

Cladder concludes that past life regression seems more effective than conventional therapies because clients are less able to avoid traumatic issues. In his own words he states: “It is the patient himself who tunes into his own traumatic situation and not the therapist who invents it” (Cladder, 1986, p.84).

Additionally, he affirms that “the majority of phobic patients who have previously experienced unsuccessful therapies” would benefit using “the concept of past lives”. (Cladder, 1986, p.84).

Another interesting study with phobic patients safeguarding the limitations from the study mentioned above in regards to treatment definition and specification of outcome measurements is the one from Freedman (1997). In her study she measured the therapeutic outcome 27 clients with 52 phobias between them.

Each of these 52 phobias was treated separately. Once treated they were divided into three categories of treatment which were determined in function of where the subject placed the origin of the phobia during hypnotic trance, prior to this life, earlier in his current life or if the client could not reach trance depth. 28 phobias used past-life regression, 11 phobias used present-life regression also defined as age regression, and 13 phobias only used a talking method.

Freedman also measured the anxiety level for each of the 52 phobias using Sandler’s A test before and two months after the final session of treatment. The results showed that the average anxiety score for phobias using past life regression dropped significantly, from 6.79 to 1.71. Using present-life/age regression, the average anxiety score fell from 10.0 to 6.09, while the “talking-only” group anxiety scores’ drop from 5.77 to 4.54. Of the three methods of treatment, only PLT was considered clinically significant in reducing anxiety levels, according to the omega-squared test of significant findings.

Furthermore, within the past life regression group, Freedman further divided the phobias into three types, which capitulated varying degrees of clinical significance: simple phobias (p=<.001); agoraphobia (p=<.01); and social phobias (p=<.05). Freedman concluded that the results strongly suggested that past life regression reduces anxiety symptoms associated with all three types of phobias.

She also measured the length in sessions that each phobia took to improve or disappear. Using past life regression, the average number of sessions was 2.48 per phobia. Each session lasted two to three hours in length (Freedman, 1997).

She comments: “Considering the estimate of 28 million people in the U.S. who suffer from anxiety disorders and the amount of resources invested yearly in their treatment, any therapy that gives such rapid and apparently effective relief should be a therapy of choice, regardless of whether these reports are true reincarnation memories or fantasies” (Freedman, 1995, p.29).

It is worth differencieting here between two different types of research Practice based and evidence based. Practice based refers to research with large number of participants tested before and after undergoing therapy for a variety of issues. On the contrary, evidence based is a type of research that gathers data from clients with a specific type of problem often comparing results with a control group to demonstrate its effectiveness. Each of these methods has its advantages and disadvantages. Limited research resources may force some past life practitioners to utilise practice base analysis to evaluate their clients i practitioners have limited resources for research so tend to use practice based analysis to evaluate their clients’ improvements.

An example of practice based research is the one from Hazel Denning who analysed the results of eight regression therapists that worked with nearly a total of 1000 patients between the years 1985 and 1992. Denning measured clients outcomes straight away after the past life regression therapy , six months, one year, two years and five years later. 450 of clients were able to be tracked after 5 years. Of them, 24% reported the symptoms had completely gone, 23% reported considerable or dramatic improvement, 17% reported noticeable improvement and 36% reported no improvement. (TanDam, 1990).[xvii]

As an example of a significant evidence based research we present the studies by Ron Van der Maesen. In 1999, he investigated past life regression with 27 clients who were diagnosed with schizophrenia who suffered from auditory hallucinations. They filled

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