The multi-functionality of mental images in therapeutic practice
When I analysed the data from the vignettes of clinical practice in my original research study (Thomas, 2011) I was struck by the way that the same mental image could show up in more than one function category. In some respects this multi-functionality is quite straightforward and it would be expected that one mental image can operate in different ways through the course of therapeutic work.
A simple example of this would be the monitoring function that often follows a diagnostic use (in the following discussion I will be referring back to the case material used to illustrate the different functions in the previous chapter). Mala- mud’s (1973) use of the ‘bird in the cage’ guided imagery is a case in point. The initial image of the bird in the cage is used diagnostically. One year later, when the client is directed to visualise the bird in the cage again, the image is being used to monitor the progress in the client’s therapy. An example of using the monitoring function following a different function can be seen in Bamber’s (2004) case study of schema therapy with an agoraphobic client. Because the client is instructed to visualise his four operating modes as figures and to help them interact in a more balanced way, this would represent the process management function. Towards the end of this therapeutic process, it is noted that there are changes in two of the images and this is taken as a commentary on the client’s progress in therapy (the black knight - the figure representing the client’s maladapted coping mechanism - appeared to have died). In other words the image is being used later on in its monitoring capacity.
Another different example of one image being used in more than one way over time can be seen in Chestnut’s (1971) case study of psychoanalytical work with a depressed patient. His work provides an example of the framing function when he initially asks his patient to visualise the barrier between them as a wall. Then, with the intention of helping the client begin to break down an old defence, Chestnut used the reparative function. He directed his patient to make a change to the image, by suggesting she should incorporate an image of himself sitting on top of the wall.
However, what is less obvious is that this multi-functionality is not just sequential: a mental image can display more than one function at the same time. Taking the same case study by Malamud as an illustration, right from the onset, the mental image of the bird in the cage is functioning in two different ways. There is a framing function operating, i.e. the bird in the cage is given as a template to shape the imagery production. This image is also, at the same time, functioning as a diagnostic tool, i.e. the nature of the image produced by the client is viewed as delivering significant information about her current difficulties. Another example of two functions operating at once can be seen in Shorr’s (1983) clinical work, which I used to illustrate the processing function in the previous chapter. His standard imagery procedure (of asking his client to imagine telling a secret to a stranger on a train that he will never see again) is another example of the framing function. When the client used mental imagery as directed he re-experienced a traumatic memory - the processing function in action.
In the examples given above, it can be seen that one mental image can display a range of functions both simultaneously and sequentially. The therapeutic functionality of mental imagery appears dynamic and complex. The helpful binary distinction between active and receptive functions is not a rigid either/or state. One image can be display directive and receptive functions at the same time such as Shorr’s example where the framing and processing functions are operating at the same time. Or this can be sequential - a client can produce a spontaneous image that initially is used diagnostically and then changes might be made to the image for reparative ends and so on.
This dynamic process appears to be shaped by two factors. First, dependent on the orientation of the therapist, certain functions may be favoured over others. Examples of this would be a tendency within CBT towards using directive functions and a bias towards the receptive functions that can be seen in psychodynamic practice. However, from an integrative perspective, it would seem that this process is more generally shaped by therapeutic requirements. Through the course of therapeutic work, particular functions come to the fore dependent on different therapeutic needs. At one stage the task might be to use imagery to help clients gain more insight into their presenting issues (diagnostic function); later on the image may be used to monitor the client’s progress. Initially, an image may arise that provides a rapid release of repressed material (processing function), later on it might become apparent that this image requires some reshaping for curative ends (reparative function). Somewhat tangentially, this brings to mind another inclusive model, i.e. Clarkson’s (2003) five relationship framework. Here, it is understood that there is the potential for different relationships operating between client and therapist that are informed by a particular intersubjective perspective. Different types of relationship come to the fore dependent on what is happening within the therapy. Clarkson’s framework allows a means for integrative psychotherapists to draw on a wide range of different theoretical perspectives on the nature of the therapeutic relationship.
The ‘interactive communicative' model of mental imagery
In the preceding section I have made a case that it is possible to differentiate out the basic distinction between directive and receptive imagery into a range of operations. Six functions have been identified so far that appear to comprise some of the main ways that mental images operate as bidirectional agents of communication between the rational and imaginal perspectives. Based on this case I am proposing an interactive communicative model of mental imagery that, I would argue, captures some of the complexity inherent in therapeutic practice with mental images. This model is represented schematically in Table 6.1.
