Understanding Imagery Rescripting Therapy for Childhood Trauma
Written by Stephanie Koutsoukos
Relentless psychological pain.
These are common experiences I witness in my ‘therapist chair’ each week. At times I notice my stomach churn, or a twitch in the back of my neck. These are signals my body sends me, prompting me to acknowledge what I am feeling. Our bodies do not always send us clear signals. Sometimes there is the blur of dissociation or the sneakiness of avoidance. Our brains are powerful and work in mysterious ways; sometimes by repressing difficult memories to protect us from our pain.
Perhaps you have some unprocessed pain, or trauma from childhood experiences, that is holding you back emotionally, psychologically or physically. The purpose of this article is to provide you with some context around a therapeutic treatment you may not have heard of before; IMR. Imagery Rescripting Therapy.
The DSM-5 defines trauma as the harm to a person’s function or ability to cope as a result of a distressing event/s (American Psychological Association, 2022). Trauma differs from distress, as the effects of trauma are observed long after an event has occurred. Examples of childhood trauma may include violence, interpersonal trauma, grief and loss, injury or illness and natural disasters.
Well-known abrasive symptoms include flashbacks, nightmares, intrusive thoughts and suicidality. More subtle symptoms can look like emotional dysregulation, relationship difficulties and a self-critic that feels overbearing and powerful. We know that certain groups or populations are more likely to develop trauma symptoms, often described as PTSD (post-traumatic stress disorder). Women and veterans are among those most likely to experience traumatic events within their lifetime (U.S. Department of Veteran Affairs, 2023).
Identifying and revisiting memories of trauma has been long supported amongst trauma therapies. Fresh literature has revealed patient and therapist perspectives on trauma treatment, with patients sharing experiences of empowerment and changes in insight (Boterhoven de Haan et al., 2021). You may be familiar with the term EMDR (Eye Movement Desensitisation and Reprocessing) Therapy, a psychotherapy intervention that activates the brain’s’ natural memory processing to reduce trauma symptoms associated with traumatic memories (EMDR Institute, 2020). Historically, EMDR has produced positive change outcomes for veterans with PTSD and there is a great amount of research to support this (Shapiro, 1996).
The use of imagery as a therapeutic intervention is not a new concept. Nightmares, intrusive thoughts about the past and anxieties about the future can be problematic and emotionally distressing for many. Images have the power to influence our emotional state and emotional responses. We know that nature-themed images, for example, have been linked to improvements in anxiety, stress and pain perception (Padget & Cottrell, 1996). IMR (Imagery Rescripting) therapy is informed by this knowledge, as a standalone treatment for various psychological presentations.
Studies show that Imagery Rescripting helps intervene with triggering images in nightmares (Long & Quevillon., 2009). A Western Australian study looking at the effects of EMDR and IMR on PTSD symptoms shows no significant difference between the two therapies’ effectiveness, with both treatments greatly reducing PTSD symptoms (Boterhoven de Haan et al., 2020). Another meta-analysis for Imagery Rescripting shows that conditions including
Depression, OCD, Social Anxiety Disorder and Body Dysmorphic Disorder are also treatable (Morina et al., 2017). Whilst IMR is still an emerging treatment, research on this continues to produce positive outcomes (Arntz, 2012).
So how does using imagery address traumatic memories? The relationship between imagery and emotions is strong (Holmes & Mathews, 2005). Emotions are linked to imagery and this allows us to form meaning about this imagery. IMR provides a rescripted version of the traumatic imagery, to change the meaning, which alleviates the trauma symptoms.
What should I expect when attending IMR therapy? Not all therapists are trained in IMR therapy, so ensure that you see a therapist who is trained and whether this treatment is suitable for you. There are other trauma therapies available, including EMDR and EFT (Emotion Focussed Therapy). Building a therapeutic alliance with your therapist is necessary in order to feel comfortable being vulnerable in accessing traumatic memories. I take the time to explore each client’s’ background and relationships to understand the impact and context of their presenting trauma. Mapping out traumatic memories and discussing any fears or doubts in processing are necessary tasks. Common concerns include clients fearing becoming overwhelmed or having disbelief that therapy could work for them. It is important to note that processing can stop at any time. I find clients are often surprised by how effective IMR can be in soothing them as well as addressing difficult memories.
When processing these memories, the client and I would have our eyes closed and navigate the memories together, until such a time arises where the rescripting process begins. The imagery is intervened with until the client is satisfied that the meaning and imagery has changed, whereby the processing would close.
“Until you make the unconscious conscious, it will direct your life and you will call it fate”- C.G.Jung
The idea of revisiting layers (years) of difficult memories can seem confronting. The above quote is a favourite of mine, from a wise psychotherapist and theorist. It encompasses the experience of healing; becoming aware of the
unconscious drives and pains that influence the way we live our lives. It also highlights the opportunity you have, to change your pathway, no matter how difficult your childhood may have been.