Commonalities observed in clinical practice

In general, the commonalities accepted across the different schools with regard to therapeutic practice with mental imagery are simple descriptive categories that rest on basic distinctions. These categories have arisen out of observations from clinical practice. Two examples of these simple distinctions would be between latent and manifest imagery and between autobiographical and metaphoric imagery. In the first pairing, the client’s mental images are either viewed as concealing meaning, i.e. latent, or as revealing meaning, i.e. manifest. Psychoanalytically informed therapy regards mental images as having hidden meanings and these images need to be deciphered to extract the real communication: other schools, particularly the humanistic ones, regard imagery as self-evident, in other words the surface image is regarded as the communication and the therapeutic method would involve further amplification of the image itself. The distinction in the second pairing rests on the difference between reality-based imagery such as memories or simulations (rehearsing behaviours in imagination) and nonliteral imagery such as symbols. More recently, the increased interest in mental imagery within contemporary cognitive behavioural therapy (CBT) has led to the naming of other distinctions. One example would be the difference regarded as important for therapeutic work with post-traumatic stress disorder (PTSD) between veridical and nonveridical imagery. The former relates to accurate truthful autobiographical memories of the trauma, whereas the latter refers to memories that are not factually correct.

However, there is another important simple distinction that rests on the production of the image rather than the nature of the mental image itself. This is the generally accepted difference between receptive/passive and directive/active imagery described as follows:

  • • Receptive or passive imagery (sometimes referred to as spontaneous imagery) comprises the mental images that arise into conscious awareness. These could either take the form of spontaneous images (such as memories or fantasies) or images that are deliberately elicited through guided imagery instructions. An example of the latter would be a client producing a metaphoric image of a prison cell when asked to produce a mental image representing a feeling of depression. Receptive or passive imagery is generated by the imaginal perspective.
  • • Directive or active imagery, on the other hand, comprises consciously manufactured or produced mental images (such as visualising oneself performing certain actions) or conscious deliberate modifications made to receptive mental images. An example of the latter would be suggesting to a depressed client who has produced an image of being inside a prison cell that they could visualise a key that could unlock the door. Directive or active imagery is created by the rational perspective.

Therapeutic procedures that are designed to employ both types of imagery are sometimes referred to as interactive or dialogic imagery techniques. These terms highlight the way that mental images operate as a means of communication between the rational and imaginal perspectives. A vestigial transtheoretical model can be detected in framing these techniques as a dialogical process. Yet, in this basic form, it is obviously too elementary to provide a useful framework for the wide range of practices and approaches that have been developed by different schools and clinical innovators.

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