Picture this. Using Imagery in Psychotherapy
When I am with a patient, time and distractions fade out. I listen to the story the patient is telling me, and within that I am listening for the story he is telling himself. I focus on what is being said, how it is being said, while at the same time noting what is being left out. I take in the energy and the appearance of the patient.
At some point, I will tune into myself. How am I connecting with what he is saying? Do I feel I understand? Is it easy to be attentive? Or do I feel lost and confused about how he got from point A to point B? I search myself for emotional reactions to what this patient is saying. I know from experience that when I am bristling and feeling annoyed, I am sensing dependence, a patient who wants others, me, to take over his life. Some patients can bring out strong feelings of frustration, which I feel when I have been rejected, telling me that perhaps this patient is not wanting the help he says he does. These feelings help me understand both what it could be like to be the patient himself, and what it might be like to be someone in this patient's life, a friend or a family member for example. I use these observations to further build on my understanding of the person, a job that is never fully complete.
Sometimes I am struck with an image or scene that appears behind my eyes, the details getting filled in with what the patient is telling me. These images come naturally, immediately, but not all the time. Like a movie, they can be real or fantastical and elicit strong feelings. They can have movement, taste and smell. I have found they help me empathize and mentally experience what it might have been like for my patients. It is the closest I can get to having lived as the patients themselves.
An example:
I have a patient I have been following in therapy for several years. He has a history of a conflicted verbally abusive relationship with his mother and the early loss of his father when he was only 9. He remembers being tasked to look after his father's medical and emotional needs as his mother was willfully disinterested. I could not imagine what it must have been like for a young child to watch their only loving parent fight and lose painfully and loudly to illness before his eyes. I say it was loud because his father was highly anxious and would verbalize all his fears, aches and pains to his son as he deteriorated. I can not comprehend the helplessness of both father and child, and the pain my patient must have felt to have a father who could not protect his child from this tragedy.
In adulthood, my patient is severely anxious and physically sensitive. Convinced that he will follow the same fate, he is always worrying about not having enough time. For much of the therapy, I have been trying to correct this false belief; he is not his father. Can he see what control he has in his life and future? Can he see how he has yet to fulfill his potential? Often, he rejects the faith I have in him to get better, telling me it is because I do not understand how badly he is suffering. Just as often, he can present as a child, wanting me to hold him, coddle him, and make it all better. Most frequently, he is cruel and invalidating of himself and all that he has been through. It is as if when I attempt to throw him a lifeline, he turns away, telling me he does not deserve it.
We had a particular tense session last month. It started with him making one complaint after another about how his body was causing him suffering and how anxious he was. No amount of validation and careful listening seemed enough. I noticed how I was feeling bored and irritated. I had heard this all before, many times. I began to feel consumed by his anxiety and his need to be saved, a need I knew I could not meet. I felt trapped, doomed, like I was drowning. In response to this, I made the observation that he was in the most stable and least stressful time in his life (he had recently retired and work had been a major stressor) and I voiced curiosity at the timing of his worsening anxiety and physical symptoms. This observation inflamed him. He felt blamed for his suffering and grew angry and resentful towards me. "I came to you for compassion," he hissed. I think I replied with a comment about how years of compassion have not done very much and so we needed to take another look at things. Needless to say, I was not sure I was going to see him back in my office for our next scheduled appointment.
To his credit he came, and we had the opportunity to talk about what had happened. I became aware that indeed, feeling the weight of all that he was sharing, I had made a comment about his improved circumstances, unconsciously, to pull him under the weight with me so that I was not so overwhelmed. I then shared with him the following imagery that had filled my mind during our last meeting:
I am a wizard tasked with saving a wrongfully convicted prisoner. I come across the fortress where you are confined, and try every potion and spell to try to free you, but to no avail. You continue to scream in agony and desperation to be saved but my best is not enough. I retreat to the woods and look back only to see that you are also the judge who sentenced the prisoner AND the guard of the fortress as well.
I shared with him how I did not know who I was speaking to at any given moment, and each had his own agenda. In attempting to fill the needs of one, I anger the others and lose their alliance.
I knew we understood one another when I could see him relax and he said quietly, "That sounds impossible."
"Not if you keep showing up," I replied.