The reparative function

Definition: Repairing/improving/restructuring maladaptive responses or dysfunctional states.

The reparative function is the deliberate use of imagery to promote a specific positive change or improvement in a presenting issue. As Shorr notes, ‘Another function of imagery that has special relevance to psychotherapy is the fact that images can be transformed, re-experienced and reshaped in line with a healthier self-concept’ (1983: 464). There has been an emphasis on this function in CBT; right from its inception, reality-based imagery has been commonly used in covert modelling procedures where clients are encouraged to imagine someone else performing the action that the clients experienced as problematic (discussed previously in Chapter 3). The premise is that through imagining a better outcome or a more skillful action this will lead to improvements in the actual behaviour of the person; examples of this can be seen in sports psychology applications. However, it is important to note that imagery rehearsal is not restricted to this school - other approaches recognise that, ‘ . . . maladaptive reactions can be changed, first in the imagination, then in reality’ (Desoille, 1966: 7).

More recently, cognitive therapies have recognised the importance of working directly on autobiographical memory in order to treat intrusive imagery. A good example of this kind of reparative work can be seen in rescripting techniques where mental imagery is employed to make changes to traumatic memories and thereby help clients manage them more effectively (see the example of Smucker et al.’s [2002] clinical work summarised in Chapter 3).

The reparative function is not restricted to reality-based or autobiographical imagery. Sophisticated integrations of metaphoric and reality-based imagery are possible as a memory-restructuring technique as the following example demonstrates. In a case study of interpersonal therapy (drawing on attachment theory), the therapist (Thomas, 2005) shows how intentional use of imagery can help clients with histories of childhood sexual abuse. The premise of his approach is that abuse survivors need to develop effective internal images of protection. His client had been in psychotherapy for two years but, despite discussing her sexual abuse in detail, she felt it still interfered with her ability to feel safe in intimate relationships. Thomas encouraged her to return to the memory of the abuse and visualise a figure that could protect her. The client imagined the figure of Wonder Woman and the therapist guided her through a process of picturing this figure standing between her and her abuser. In his report Thomas stated that the work his client did on restructuring her memories led to a new sense of confidence and strength as well as improvements in her relationship.

Finally, another example of the reparative function used with metaphoric imagery would be symptom relief. This is commonly used for psychosomatic issues such as tension headaches. An example of using imagery to restore a healthy sleeping pattern is given by Hall et al. (2006). A client was experiencing anxious racing thoughts that were interfering with her sleeping. When asked to produce an image for these racing thoughts she reported visualising a large basket full of balls of wool that had become tangled together. The counsellor encouraged her to untangle the wool and rewind it into separate balls. The client made the connection between the tangled state and her anxious muddled thinking. She reported later that by recreating this scene in her imagination before going to sleep had helped her gain some control over her internal processes.

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