1st Las Vegas Conference on
Integrating Therapy for Women
Las Vegas Hilton � May 19-21, 2004
Guided Imagery: Redeeming the Wounded Feminine
Through the Magic of Imaginal Realm
Belleruth Naparstek, LISW, BCD (WMS24-016)
Note: Square brackets [ ] are used to indicate inaudible or indecipherable text or unknown spellings, where text placed inside brackets represents transcriber's best guess. Caret brackets < > indicate descriptions of intonations, background noise, technical problems, etc.
NAPARSTEK: I want to start by telling you the story of Franny, who was one of my clients from many years ago, and I think she represents as good as anybody does the wounded feminine and what is required to heal it. It also is a pretty freewheeling account of an incredible number of mistakes I made with good intention but nonetheless sorry results for a while.
Franny was one of my teachers from about nearly 20 years ago. I wound up at the end of my work with Franny being a lot smarter than when I started. So here's what happened to the best of my recollection and Franny's recollection because we recently got together to figure all of this out.
At the time Franny came to see me, she was in her late thirties and she was the successful CEO of a pretty big service organization. She came to see me because she had become suicidally depressed when her fiancé, who was someone who also happened to be her best friend and her mentor and her professional referral source and consultant, ended their five-year relationship. As sophisticated and capable and self-aware as Franny was in her work, she was every bit as naive and unschooled in matters of the heart. So she was, needless to say, devastated and heartsick and so depressed that for a while she was having trouble getting out of bed and eating or sleeping, although she was certainly putting away the beer, large chunks of beer. But inside, she felt empty and worthless and could not imagine getting beyond the loss of this man. Because she'd give up so much of her own interests to sort of fuse with him, losing him meant losing everything. It meant losing everything in her life. So she was baffled, she was grief-stricken, she was shocked and enraged, and she just could not let him go in her mind.
She had suspected that he had taken up with somebody else, a mutual friend, which turned out to be true; and she'd even done some mild forms of stalking the way people do � driving by his house, calling him up and hanging up the phone, and just looking for ways to stay in touch with him or to manipulate him into having one more conversation with her. Finally, her depression became so intense that her friends literally dragged her into my office to get some help.
In those early days, Franny sat across from me like a stone. She was barely able to speak. Her eyes had this kind of dead look at the center, which always make me worry about suicide when I see that look. In the weeks and months that followed that early beginning time, her face remained wooden, impassive, and her voice had no inflection, and her speech had these long, long pauses where she could say nothing. Luckily, she wrote copious notes on yellow legal paper, which she would hand to me at the beginning of each session. I was not allowed to read them until she left, but that was what gave me a clue as to how much feeling and thinking and intensity was going on inside. It did not show on the outside.
Eventually, after many, many weeks � probably months � she began to acknowledge that her life with this man was probably over. That helped her give up this tortured, doomed goal of winning him back. That, of course, also meant facing the full force of her grief and anger and sorrow and disappointment. You know, disappointment is a much-underestimated emotion, but she had a lot of that too. But she was doing that. She was getting that work done, as daunting as it was.
Slowly her concentration and her functioning at work was improving. Her energy was a little bit back, and she was starting to reconnect minimally with old friends and favorite activities. So so far, so good. I was still in territory that I understood. We were doing pretty well as a team, and things were looking pretty promising.
When her kind of most suicidal period was over and she was doing better, she decided she wanted to think better of herself and she wanted to understand how it was that she had given away so much of herself and squandered so much of her identity on this one relationship so that when the relationship ended she felt hollow, empty, and bereft. We decided that this would be a good time to start exploring some of her history and some of what made her tick in a deeper way.
Franny described her family of origin; it'll sound a lot like the families of people you deal with. She had, in this case, a harsh, kind of abusive father who was given to rages who drank too much. She had a kindly but distant, spacey, ineffective mother, who wasn't able to protect her but didn't do harm, and two very troubled younger brothers. She was the star of her family. She was the achiever, did well in school, had lots of talents, and was obviously the one who could make things happen.
Then she told me about Kyle, a fiancé she had in college many years earlier, a very good person who was kind and loving to her and her best friend but who had died prematurely of a brain tumor. Now it's about here that I started entering territory that I didn't understand. At about the same time that Franny began talking about Kyle, she began having panic attacks at seemingly random times during the day. She also began experiencing flashbacks in my office, although I wasn't sure what they were at the time. She'd start talking about Kyle, and she would then get engaged in this very strange sequence. She would whip her head around, and her eyes would roll with fear. Her eyebrows would be glued to the top of her head. She'd break a sweat, and she'd stop breathing. Then in this sort of strange, twisted position, she'd stay there for a few seconds, and then she'd come back around, front and center, daintily cross her ankles, and she would be back only she wouldn't know what she had just done.
For somebody like me who my idea of a great summer job was working at the neighboring state mental institution, Franny looked like a posturing schizophrenic only I knew she wasn't psychotic at all. I knew there was nothing crazy about this woman, but what was going on in my office looked really strange.
I would ask her what was going on, and she would become absolutely mute. She couldn't talk, but eventually over the weeks and months that followed, she was able to in disjointed, choppy, fragmented ways, tell me about a traumatic event that had happened to her while visiting Kyle in the hospital.
One night she had been visiting him. He was very sick, close to death. She left the hospital, came back to the parking lot to get into her car and was accosted by an attacker who grabbed her by what was at the time a very long ponytail � attacked her with a knife, raped her, and left her for dead in a pool of blood on the parking lot asphalt. She was discovered by a group of nurses who were coming into the hospital for their shift and was entered into the hospital as a patient � the same hospital she had just been a visitor at.
My asking her to tell this story to me about this attack, asking for it in words, is something that I would never do now knowing what I do now, but I didn't know any better. Asking her to describe in words, which she had a lot of trouble finding, taxed her needlessly and precipitated a cascade of flashbacks that grew in intensity. Not only did they not go away, but they got worse over time...more intense, more frequent.
I was asking her to do this in the absence of her having any tools to deal with the anxiety I was provoking by asking. I would have a different sequence now, which I'm going to tell you in a little bit, but let me tell you the whole story of the complete screw-up so you'll know exactly what we're talking about here.
Her ability to describe this accident in words was actually seriously compromised by the traumatic episode itself because trauma will do that. When you're being asked to talk about the trauma itself, language centers shut down and visual centers light up like a Christmas tree. So she was having flashbacks, and she was not finding words. In many psychotherapy practices today, this is still going on, although less and less so as we more and more understand how the brain works. So Franny never got very far into this story � telling the story � without precipitating a flashback where she was suddenly reliving this experience with all of its heart-stopping terror in the parking lot. Not only did the intensity fail to dissipate with the retelling, but as I said, I was noticing it was getting worse. She was having more of them, more frequently, and she was actually getting impaired with her daily functioning. She was starting to be more afraid of the flashbacks than she had been of anything else in her life. In fact, even though she was a great administrator/manager who prided herself on being totally available to her staff, she was so afraid of these flashbacks that she ended up being a manager who kept her office door shut because she didn't want anybody seeing her suddenly experiencing something like this.
So I'm coming from this old school, deep-dish, psychotherapy, practitioner model, which worked most of the time with most people. I'm thinking that here we've got this good strong, therapeutic bond between the two of us. We've got mutual trust. We've got respect between us. Franny had extraordinary courage and motivation, and we had a good track record together. She had already done some good work. So I'm thinking that...oh, and plus she had faith in her therapist, however unwarranted. So she had that placebo effect going on, too. In spite of that, I was not helping her; I was making her worse. After months of this I had to acknowledge that what I was doing wasn't working, that I was re-traumatizing her in my office and out of it, and that she was clearly not releasing anything by sharing the horror, which sort of is my paradigm: You share the horror of the attack, you tell the story, you get your feelings out about it, you cathartically release those feelings. You examine your subsequent behavior. You look at your altered view about yourself. You shatter rational guilt about the experience � any self-blame or shame that's hanging around that shouldn't be � and you integrate the experience into your life story and go on. Not happening.
So finally I had the good sense to go to my group of fellow practitioners who met on Tuesdays for lunch, and anybody who thinks you don't need supervision when you're doing this work, wrong! It doesn't matter how old you are, how good you are, how long you've been at this, you always need help sometimes. I needed help.
So I go to my fellow deep-dish, hardcore, psychodynamic psychotherapists, and I say to them, �What's happening?� and their suggestion was to stop talking about the trauma and instead start teaching Franny some relaxation, some breath work, some meditation, some guided imagery � self-regulation tools...right hemisphere...feminine principal. Self-regulation tools to help her master and calm the waves of panic and terror that were coming up for her that she was experiencing every day. In other words, my peers were giving me very uncharacteristic advice. They were saying address the symptoms and to hell with their deeper meaning. Just help this woman get back on track and feel less helpless and out of control.
So I felt like it was definitely worth a try to me. It was actually good to hear somebody give me permission to stop doing this to her. So at the time I did not know that these techniques would be exactly what would constitute what would best help her heal anyway. I just needed to help her manage her symptoms.
In our next session I asked Franny if she minded backing off our discussions of the rape and instead talk about managing her symptoms with some new tools. She rolled her eyes and said, �I thought you'd never ask.� That was her response. So we switched mid-course, and it was the best thing we could have done. It's where I would start and do start now. Franny learned all kinds of meditative techniques, which I didn't know about and didn't know enough to teach her, and relaxation skills that increased her ability to calm herself at will. And not surprisingly, like a good addict and a good trauma survivor, Franny was very adept at propelling herself into the altered state. She was a champ at guided imagery, and she loved meditation. And, in fact, she would, of course, be a great hand at the altered state � at the trance state � because she had been catapulted into a trance state when she had been traumatized and with every subsequent flashback, and it turned out before that from her crazy abusive father.
So she was great at doing this, and the parts of her brain that get sensory impressions and perceive images and sensations were hyperacute from the trauma. Those are the same parts of the brain that respond to guided imagery. So the bad news was she was getting flashbacks; the good news was she responded incredibly powerfully to guided imagery.
Okay, so she loved some of these very simple, no-brainer, anybody-can-do-it meditations. She did one where she just breathed in and out of her limbs � her hands, her feet, her different organs � and this allowed her to really get in touch with her body, which she really needed to do. The embodied spirit needed to get back in the body.
In another meditation that was one of her favorites, she would place her awareness inside of her body in sequence from head to toe � very important, starting with the head, going down to the toes. You don't want to go the other way because they'll be up and out in a second. So in and down. And this, being able to locate sensation on the inside of her body was like a revelation to her. She was so excited that something this simple was something that she could do because she hadn't been aware of her body for decades before the rape. Her father's abusive outbursts had sent her consciousness out into the ozone long before that.
And, of course, as most of us know, trauma survivors can use help with re-inhabiting their bodies and getting out of that dissociated state back in. The more she got connected to her body in just this physical, sensate way, the more she was able to start becoming aware of her feelings because that's a logical progression. Get in your body, feel sensation, ah, ha! Start divining emotions and feelings, and this was another exciting revelation to her. This was like becoming the great internal adventure for Franny. She was becoming aware of her feelings; and it wasn't like she could differentiate them so well. Everything sort of felt like this one rolling, chaotic mass of feeling, but she could feel that something was in there. It was big, it was powerful, and she was in touch with it.
What opened the door to her next stage, which was very critical to her healing, was a very simple metaphor, and just this one seminal image that came to her during one of her sessions � one of these body-awareness meditations. What happened next is the essence of the redemptive power of imagery in a very simple, gentle, but unbelievable potent way.
During one session after some very simple relaxation and breath work, I asked her if she could locate what she was feeling inside of her chest, which, by the way, was chronically wheezy and asthmatic, if she could assign a symbol or an image to it. Now she told me years later when we met for coffee that she would think to herself � she's talking about assigning an image to her chest � she said she was thinking to herself �what complete bullshit� but she went along with it anyway to be a good patient, to give me what I wanted, but also because she didn't have anything better to do. So initially she felt her part in this was make-believe, just going along, pseudo cooperative contrivance, but another part of her was into it. So this game became more and more real to her over time, and in my notes I have her telling me, �There is this heavy feeling in my chest. It's big and cold and heavy, like a big rock that's sitting in my chest. It's so heavy, it's like a cannonball that's made out of lead, and it's so old it's rusty, like a cannonball from the Revolutionary War that's landed right in the middle of my chest.�
Now those of us that work with images know that this is such a unique image, this is so incredibly specific, there is no way this image is bullshit. It came straight from somewhere inside of her. And again, she told me in this conversation later that she was very much of two minds. On the one hand, even though she could feel the weight of the stone cannonball fitting in her chest, she didn't believe anything was there; on the other hand, she could feel it. So both positions coexisted side by side in her mind for several weeks. Then at one point the touch of her own hand on the center of her chest just allowed her to contact this bottomless sorrow that was somehow connected with this stone, and this began a period of many weeks where she would just cry, heaving, wracking sobs, both in my office, and then she'd go home and sob some more at home. Then she'd miraculously get up, put in a full day of pretty efficient work, and then go home and cry some more.
Somehow the cathartic work began from this half-fake feeling image of a stone in her chest that she had touched physically with her hand. So you've got a kinesthetic body sensation and the symbolic metaphoric picture of this cannonball, both gifts from the right hemisphere of the brain and from The Goddess.
During this phase, she also became very attached to two guided meditations that are still in print that you can still find. They're both by Stephen Levine from his book called Healing Into Life and Death , and one was his meditation on grief and one was his meditation on the heart of the womb. She asked me to record those two meditations for her, which I did, and she would go home and listen to them over and over and over again.
She was still kind of frozen looking. She still couldn't say much directly to me, but she continued to write up a storm. She could be quite eloquent when talking about the symbol of the stone; and over time, aside from the papers that she would write to me which told me how feelingful and alive and sensate she was, aside from that she was able to talk about the stone in a way that she could not discuss her feelings or events in her life. She could examine the stone, she could describe the stone and how it was changing, she could connect to it, she could go into it and see what it was like on the inside, and she could even have a conversation with it. Sometimes the stone represented her pain, and all she could do was practice breathing into it and out of it. Sometimes it would be something hot and burning and ugly with shame and disgust, and other times it was softer, less threatening, more like sorrow and she could befriend it. And sometimes she felt sorry for the stone.
So it was obviously becoming clear to me that Franny could talk about the stone in ways that were safe and cushioned and that she could access. She could circumvent the booby trap of words that would promote a flashback by talking in this symbolic way, and I loved that and I started to feel excited and hopeful like maybe after all of this messing up we were going to get somewhere.
After many weeks of relating to the stone, Franny reported that she was starting to be able to distinguish one feeling from another, and this blew her mind. This was incredibly exciting, that there was an actual qualitative difference between sorrow and anger, disappointment and shame. She was starting to get the difference in a very direct way. So there was something again about the indirectness of the metaphor.
Eventually over the course of about two years, the stone melted. It disintegrated and came apart, piece by piece. It got softer, it got smaller, and it got more malleable; and one day when she went in to check on her stone to see what it was doing, it just wasn't there. She told me � and again, this is directly from my notes � �The stone had turned into my heart. Now it's just my heart. I can breathe in and out of it, I can connect to it, I can feel things through it. My heart is back, and I'm connected to myself now. I have mercy on myself now.�
Interestingly enough, that last line, �I have mercy on myself now,� that is a direct quote from the Stephen Levine meditation. I mean, people don't talk this way. They don't say �I have mercy on myself now.� That came right from Stephen Levine, and it became so much a part of her these were her words. Today, ten years later, Franny is free of these debilitating flashbacks. As I said, I met with her for coffee to discuss this after many years. She can talk about the parking lot; she can talk about the rape and not induce or precipitate a flashback. At the time we stopped working, I wasn't sure she was going to be able to do that or not. And with her new-found self-awareness and attunement to her own body, which is what saved her, she takes care to notice when she is beginning to get a little tired or stressed out, and she will immediately start working with her breathing and her imagery and her meditation skills to get herself back on track. She does not want to unwittingly court those hideous flashbacks. Her only remaining symptom really to this day now is a spring-loaded startle response, but everything else, all of the content, the emotional pain, is not there.
So Franny's final quote to me, and this was from an E-mail, �There came a point when I realized that the rape just wasn't inside of me anymore. It's part of my experience, but it's not in me. It's funny because before I'm not sure I could have said what my being was, what my sense of myself was, it was so incoherent. But now I know that I have this sense of myself. The rape was something that happened to me, but it's not me. I think about how I used to be afraid of the world and human beings, how just about every adult scared me. Fear governed my life. I never traveled. Now I scuba dive, I bird watch, I hike through rain forests, I snorkel with sharks and barracudas, I explore volcanoes, canoe in the tropics with snakes hanging down from the trees. I camp with strangers. I hang upside-down to photograph flocks of toucans. Pretty funny! Getting in touch with my body and discovering that stone on my chest, that was the turning point for my healing.�
Franny's now is a very committed relationship. She continues to love her work, and curiously enough, and this is almost too good to be true, it almost never happens this way, but it happened this way with her: She has no longer any asthma symptoms. They disappeared with her stone. This experience with Franny taught me a lot about the power of working through the right hemisphere, the feminine principle, to go where cognition and words and verbal stuff cannot go to help heal something like this � in this case, post-traumatic stress, but it could be many things other than that.
What I'd like to offer you is a sample of imagery that is very specifically designed just for post-traumatic stress because once I understood the power of working with the right hemisphere, I realized holy cow, this is where it's at; this is the mother lode, and you can really cut through a lot of stuff. So what I'd like to do is show you the experience; then I want to go back and analyze why.
This particular imagery � and by the way, it doesn't matter what the acute stress or traumatic stress or anxiety is specifically about...where it comes from � the imagery just dives under all of that into the person's internal process. It always bothers me now that in so many curricula we study the problems of this situation, that situation, when, in fact, the dynamics of internal stuff that's going on has nothing to do particularly with the situation. It's the dynamic, the process, the internal process that counts. So let me set this imagery up.
This is imagery designed to heal acute stress and traumatic stress and to dive under the wounded psyche to find wholeness. In this case...well, I'm not going to say too much about it. I've cut it down to about 20 minutes for the sake of time. So the part that I'm skipping over is basically a very simple induction that has the person � the listener � noticing how he feels/she feels in her head, neck, shoulders, breathing into these places and just moving down, becoming embodied. So that's the part that's missing that saved us about 5 minutes. We get to the place where the person's consciousness has sort of slipped down into the deep spaces of the body, and then a companion appears. Company is needed for the next part of this journey through the person's own traumatized heart.
<Begin audio clip.>
MODERATOR: You slowly become aware of a warm and gentle presence beside you. Very comforting. Maybe this someone or something is familiar, or maybe not, but clearly it is radiating love and protection and support, and you somehow know that this visitor knows you in a deep and true way, that this presence accepts you as you are and carries great comfort and care. And maybe with a soft touch on your shoulder, your guide invites you to come along so that together you can explore your own broken heart, the gentlest invitation to see if you are willing, and somehow together you magically enter the weary landscape of your own heart, perhaps slipping in through a torn or jagged place to have a look around for the sake of your own healing, and so you enter your heart.
It may seem harsh and dark and cold inside at first. As you look around your topmost layer, because you're making your way through crumpled piles of shattered dreams, ragged heaps of lost innocence, and your guide is at your side, comforting and encouraging you to continue, gently pointing out crusty outcroppings of old guilt and self-blame, acknowledging with the you the chilled wind of loneliness that howls through this place, helping you more through smoky slag heaps crackling and steaming with helpless anger, gently guiding you around sticky tar pits of shame, pointing out the heavy quicksand of self-pity and showing you startling geysers of terror suddenly bursting forth at unexpected times, announced by a loud crack as they break through the surface and then gone as inexplicably as they appear. And so you walk together, gently exploring the territory of your own pain, continuing to breathe, deeply and easily, always aware of the comforting presence at your side. And you notice that you can explore this harsh landscape with steady courage like the survivor that you are. Even though it's not pretty, somehow you know that even in this ravaged, lonely place, there is great power here. The treasures are buried deep in the debris, and your guide looks at you with wise and loving eyes and says, �You can't make this place go away, but your courage in exploring it will change it in time. There are gifts for you here where you'd least expect to find them,� and leaning down picks up a luminous object from under the rubble and gives it to you for safe keeping. It might feel warm in your hand, a perfect fit as you wrap your fingers around it and continue along the way, noticing the golden light glowing up from the ground some distance away and walking toward it.
You slowly approach what looks like a glowing cave or hollow with a hazy golden light filtering out from it, and you can see that this is a tunnel like no other because it glows, leading down into an older, deeper part of your heart. And so the two of you enter. Continuing to breathe deeply and easily, you're moving along the glowing pathway, deeper and deeper, sensing a sweet peace in the soft golden air that gently billows all around you. And so you travel together down into the deep center of your heart until you emerge into an exquisite landscape, a place pulsing with its own peaceful, stunning beauty, awash in light and color, with air that sings with feeling energy, dancing gently on your skin, and you're captivated by the breath-taking radiance and splendor of this place, void and held by the sweet magic all around you, aware that somehow this place is familiar to you. You know this place, and slowly you remember that this is your oldest home, the part of you that can never be destroyed, the exquisite core of who you really are, and you can inhale the beauty of this place with deep, full breaths, breathing it in and letting its healing energy permeate every part of you, sending soft waves of comfort and peace all through your body.
Your companion smiles; and with a gesture, calls forth a gentle parade of guardians and allies, sweet spirits and magical beings, animal helpers, guardian angels, teachers and guides, powerful ancestors, old and dear friends. Sweet singers and dancers, some familiar, some not, but all smiling and nodding, gently approaching one by one, and you can see that they are holding out to you with great tenderness and respect the shattered pieces of your heart, delicate sparkly chards and slivers lost or left along the way, separated from you at times of great fear and anguish. But now in this place, in the deepest, oldest, truest part of you, they are tenderly offered back, still pulsing with life and power, and you know that you can take back whatever you wish, whatever you're ready for, no more, no less. So you can stand full strength, your full self, in much more wisdom, more power, more compassion for yourself and others, more awareness of the invisible support all around you, and you might tentatively accept one or two pieces to see how it feels to have them back. Suddenly, you are certain. You know with your whole being that you are healing, that you will continue to heal, that a time is coming when you will accept your sorrow, dismiss your shame, release your anger, forgive yourself, reclaim your strength, and express your gifts.
And so whenever it's time to say goodbye, you thank your visitors and watch them depart, and you and your guide make your way back up through the tunnel lit with golden light. Step by step you walk together until closer to the surface you reach the darker, cooler landscape of your pain, although perhaps it looks a little different now, not quite as dismal or heavy or dark. As your departing steps crunch through the debris, you might notice other luminous treasures twinkling at you from the rubble, and you may pick one or two up, or you may decide to come back for them later because perhaps you have all you can carry now.
So together the two of you come back out of your heart, and your guide, with a look of great tenderness, gently touches the center of your chest, and you can feel the soft warmth of it fill your heart, spill over into your chest, fill your whole torso, your shoulders, neck, and head, moving to your arms and legs, your hands and feet, until your whole body is filled with warmth. And with a bow, your guide withdraws for now and you can be peaceful and easy knowing you can invoke more assistance whenever you wish to further the work you've already done.
And so, breathing deeply and easily, very aware of your hands and your feet, of the support beneath your body, your breath, and your belly, you can very softly open your eyes, perhaps becoming aware of how good it feels to stretch and move after being still for so long and knowing in a deep place that you are better for this. And so you are.
<End audio clip.>
NAPARSTEK: That's imagery designed to heal the deep self just using the basic essence of the feminine principle. I feel like I'd like to sort of go over the structure a little bit technically, but maybe for a transition from right brain, which this was, to this left-brain stuff. Yes? This meditation, it's called �Healing Trauma (PTSD),� and I think � I'm not sure what the deal is exactly, but I believe that the bookstore will order anything you want and we'll ship it to you immediately from our little warehouse in Akron. That's what that is. It was initially developed for combat veterans from Viet Nam at the VA Hospital, but it was later adapted so that it would suit survivors of abuse and incest and rape and hurricanes and 9/11. Yes?
You said, Do you have any problems with people having adverse reactions listening to this particular imagery in terms of not knowing what to do with the intensity of the affect? Great question. We have learned a lot since we first produced this. The answer to the question is yes. There are some people that will feel �I don't want to do this.� The good news about an audio intervention is you pause. That's one of the things you always want to tell somebody, too, is if this feels like not something you want to do, don't do it. The fact of the matter is that's how it goes anyway, and some people just won't do it. But we've learned a lot.
For instance, 9/11, which was a horrible event impacting so many people, because there were so many people all traumatized at exactly the same time, what we discovered was this is not something for newly traumatized people. Newly traumatized people want Andy Wyle's breathing tape or my simple �General Wellness� imagery. You want something simple. Nobody's ready to dive deep into this. The people who tend to do best with this are people who have seasoned wounds. Adult incest survivors from childhood incest really seem to work well almost to a man or woman with something like this. But the fact of the matter is, no matter who you're working with, some people will titrate the dosage of this imagery. They'll listen to five minutes a day and no more. There are other people, I've had a woman in the hospital actually dying from anorexia who played it all day long. It was the only thing she wanted to listen to. She could immerse herself and feel safe doing this. Other people, like you'll get a client, if you offer them some imagery � your own or this or anything � they might say, �I don't want you looking at me while I listen to this, but I'd like you nearby, so can I just listen to it in this empty office next to yours?� So different responses to it. Most people, interesting enough, do not have adverse reactions to it. Most people feel comforted by the fact that their symptoms have been named in this symbolic way, and they feel understood and like not crazy.
And somebody's yawning, what does that mean? That's great. The question is if you're doing imagery with somebody and they're yawning a lot, what does that mean? It means they're releasing energy. They're just moving energy, and it's coming out as a yawn. It'll also come out as some people feel like the tops of their heads are tingling or their arms, and some people will actually have twinges or jerks. It's all part of the same process of moving energy. Yeah? Tears flowing down? More of an emotional moving energy.
You say you were doing imagery with an eating-disordered client and she yawned through the whole thing? That's a good thing. That's just fine.
We have about 20 minutes left, and I'd like to talk about what it is about imagery that makes it so supremely healing in this right-brain way for depression, for anxiety, acute stress, or traumatic stress.
For starters, the first reason that's built into our development as human beings is very simply that all of us use images to get through the day. It's what we used as babies and toddlers to bear being separated from our caring parent, our caretaker. Don't forget, we went from absolutely having to have Mommy or whomever Mommy's substitute was, having to have Mommy to substituting a thumb or a teddy or a blankie, to substituting the word for Mommy to carrying her image on the inside as the way to be able to take the next steps away from her. So all of us have built into our psyches the fact that imagery is our primary transitional object. It is our tool for comfort, it is our emotional ballast that gets us through the day, whether consciously evoked or just unconsciously there. When events choose to configure, to diminish us, defeat us, disparage us, make us feel less than who we are, we either overtly conjure the voice, the image, the loving looks of somebody who stands for us in that spot. We either do it deliberately or it's just sitting there, the automatic default emotional ballast. So that's the main reason why imagery works for everybody. We've all used that device. It's been our favorite conceit to get through the day.
Another reason why it's so important for a stressed, anxious, panicky, depressed, or traumatized person is because of the way the brain works. There is an infant developmental expert named Bruce Perry who has studied the way that a stressed or anxious or traumatized brain is compelled to train its focus away from language and verbal content and to fix instead on non-verbal cues � danger cues, body movements, facial expressions, tone of voice, that kind of thing. Searching for threat-related information, that's what an anxious person does. That's what a traumatized person does. Cognition and behavior are both mediated by the more primitive parts of the brain, the brain stem and the mid-brain, at the expense of abstract thinking and language and absorbing ideas.
Only when the being is sufficiently calmed can attention be focused on ideas and the meaning of words, and this is why interventions that are based solely on cognitive problem-solving approaches cannot impact anxious or terror-driven behavior. The primitive brain in the mid-brain is not about to process a cognitive solution aimed at higher cortical functioning, not when there is this constant alertness for danger. But imagery or certain kinds of meditation with its calming voice tones, with its soothing music, and with its symbolic representations of safety, imagery can settle down a hypervigilant brain, and imagery can allow, calm it down enough, to allow the higher brain to get back to doing its job. That's what was going on with Franny in part.
The other part of what was going on with Franny and why she couldn't talk and could only work with images was because all of these fabulous brain scans, PET scans, started by Bessel Van der Kolk, the psychiatrist from BU, but now being done all over the place, where people are deliberately evoked to remember some traumatic material and pictures are taken of what parts of the brain become active. Sufferers of acute stress and panic and post-traumatic stress are people who have heightened reactivity in the parts of the brain that process emotion, sensation, and images � the amygdala and the surrounding neuronal network of the amygdala right smack in the middle of the brain. As a result, people who are anxious, who have acute stress, traumatic stress, trauma survivors are doubly responsive to sensation, to emotion, to perceptual cues, to images.
On the other hand, the [brochus area], the part of the brain that processes language, that translates personal experience into language, that part of the brain loses capacity when the person is thinking about what makes them anxious or their trauma, at least temporarily. That's why people under acute stress experience their emotions only as physical states rather than as verbally encoded happenings. They're not. They're not stashed in that part of the brain; they're not stashed in that part of the memory. They're physical states, and they're as strong, as intense, as current as if they were happening right in that moment. So when a person is asked to describe a traumatic event, they're often rendered literally speechless because that part of the brain is shut down. It was shut down during the traumatic event, and it's shut down trying to recall it.
So the usual methods of digestion of events aren't available to the person. Where do you go? You go to the feminine principle or the right side of the brain. You go to The Goddess. There's another reason...yes? How would you employ this in working with a group of newly recovering people? Okay, if they're newly recovering, again, newly recovering people I think of being fairly skinless, very supersensitive to stimuli, easily irritated. Things are very rough. I would, again, go very simply with simple self- soothing, self-calming things, the same way we did at Ground Zero. You don't start with the fancy stuff. Teach them to count the breaths, teach them to work with simple music, and eventually they will go to this and they will do well with this.
Another reason imagery is primary developmentally to all of us in our psychology, so it's right there as the ultimate transitional object we're going to turn to for comfort. Two, it works with the parts of the brain that are most available. In fact, you could say that it works with the parts of the brain that are so acute, so responsive, it's like they're on steroids, these parts of the brain, as opposed to the verbal cognitive higher-brain functioning, which is less available. So you're going in through the side door of what really works and is most available for the person.
Another reason why imagery is so critically important, especially to recovering addicts, is it has its own natural way of rebalancing biochemistry. It doesn't have quite the bang of massive doses of chemical substances, but it does help modulate biochemistry through releasing natural indigenous opioids � serotonins and wonderful releases of substances internally from the natural pharmacopoeia of the body. We know that people suffering from depression or acute stress or trauma are people who have extreme swings in their biochemistry. They go from having these jolts of cortisol and epinephrine and being in these sort of acute alarm states to the body's attempts to settle itself down with its own little supply of indigenous opioids, and it's very hard for the body to sort of settle itself down, although for most people sooner or later the body will settle itself down.
However, in cases where the body ends up in a sort of kindled cycle of constant activation and then under-producing cortisol and over-producing opioids, it's up to something, a technique guided imagery, to re-introduce to the body its memory of how to truly settle itself down. There are a host of studies that show that guided imagery will help regulate cortisol. Now to be perfectly fair, this happens most often in the short term, like for a matter of hours, but in many cases it can do this for a matter of weeks. And it's not just imagery that does this. There are studies that also show that mindfulness meditation will do it, basic relaxation using the breath will do it, certain forms of yoga and certain forms of [chi gang] and certain forms of massage therapy. All of these are techniques that use the feminine principle, work with the body, and work with image, fantasy, and the right side of the brain.
When you have hard results, and I have like four studies here that I could show you if anybody need ammunition, and there are more, but if you have hardcore clinical results that show that a soft, sweet, simple tool like imagery or meditation can deliver reliable lab results in cortisol change, that's awesome. Yes?
The question is are there any studies comparing different techniques with imagery and EMDR? There are some. Actually, I think Charles [Figley] did a study comparing EMDR � eye movement desensitization and reprogramming � which actually is a technique that at its core uses imagery, as does emotional freedom technique, as does thought field therapy, as does somatic experiencing. They all use imagery because they're all smart enough to know that's the way to go. But anyway, [Figley] has a study that compares I think EMDR with thought field therapy with visual...I've got it all down someplace if you want that, but there are a few studies. The biggest horse race is between EMDR and prolonged-exposure therapy. And again, these are both techniques that use imagery at their core; they're just surrounded by different sequential interventions.
Short-term therapy? Pretty effective. EMDR comes out slightly ahead of prolonged exposure, and more people drop out of prolonged exposure because it's a more upsetting technique, but they're both pretty good.
Another reason why imagery is a perfect tool for somebody who's suffering from some sort of emotional thing, very simply, it returns the person to mastery. They become of locus of control. They dispense their helplessness by having a technique that is available to them when, how, where, and if they want to use it. You don't need anything to use it. You can be anywhere and use it. All you need is your imagination. Yes?
Are there any studies using guided imagery and marital therapy? I know that people use it and swear by it; I have not seen any studies of it.
So, you want to help somebody restore a sense of efficacy, personal power, self-control, self-regulation, this is an intervention that has built-in value by definition.
Here is another reason why imagery is so important. A lot of people, a lot of recovering addicts, a lot of recovering trauma survivors, a lot of people in the population are dealing with dissociating and being in a sort of walking trance. One woman described it to me as �walking the fog walk,� but it's being dissociated. When you're using imagery, you're basically fighting trance with trance. It's sort of the power of positive dissociation, so to speak, but it can be deployed and it will go right where that traumatic process lives and it will meet it head on. It knows where to go. So you're basically using the person's tendency to dissociate for their own good by using a sort of strategic dissociative technique.
There was a study a long time ago, actually in the eighties, several of them, by Joan Fagen and Irma Shepherd from Georgia State University. I don't know if any of you are even old enough to remember this, but there was a big debate because they were basically using hypnosis with multiple-personality-disordered people, and a lot of people were saying, �You can't do that! You're using a dissociated state with people who already pathologically dissociate. You're going to make them worse.� Well, big surprise: It made them better, and they had the studies to prove it because, again, it was fighting trance with trance, and it was working with that dynamic that was strong in them. As I said earlier, it taught patients the difference between being gone and being home. Yes, question in the back?
Great question: Can you do guided imagery with somebody who's too frightened to close their eyes? Absolutely. In fact, there are some meditative techniques that highly recommend that you just keep your eyes at half-mast. But you don't have to close your eyes. You can keep your eyes half closed. You can just stare at a space on the wall. And when you're working with somebody who's having trouble closing their eyes, the other thing that's really nice to do is to be really sensitive to not watching them, sort of intruding upon them by just staring at them. A lot of therapists just intuitively kind of turn aside and just every now and then sort of check back to see how the person's doing. Some people would actually prefer to turn away from you.
Imagery provides a certain kind of blessed distance and detachment from your pain because with imagery, and people intuitively do this, they often don't even have to be guided to do it, they can do things like create images like putting their pain in a box or floating it away in a balloon or putting it on a TV screen and then lowering the volume and the color or shutting it off all together. We can surround ourselves with protection and support in an imagistic kind of way.
There are a lot of ways that people use imagery to create distance from pain that is functional and helpful and also obviates the need for dissociating because you can do it in this way.
Again, you can sidestep word traps that are so sensitive for some trauma survivors especially with symbol and metaphor. Imagery just lends itself to symbol; you automatically go there with it. You can use it to reenter, re-inhabit, re-ground the body, as we talked about this morning. It certainly can replace addictive substances to some extent.
It helps people sleep. Sleep is a big deal, and imagery can really lull somebody to sleep by cognitively recruiting just enough of the left brain so that the person stops doing whatever it is they're doing in their thinking mind to keep themselves up, going through their lists or their resentments or their replays. At the same time, it's offering these soothing tones that will help calm the body mind.
Another nice thing about image: People who are biased against therapy will use this. They can call it �learning a skill set,� and they don't have to be in therapy and they can do this. And it has a therapeutic effect. Again, at Ground Zero we found that especially with some of the more resistant early responders, fire fighters being the absolute worse but police were not so great either, they did not want therapy, they did not want a self-help book, but they could do guided imagery in their corner. You know, when they started to get a flashback, they could go to a calm scene, and that was a skill set that they learned. They were not in therapy.
Finally, one of the things I love about imagery best of all is it's like it's prayer for atheists. It's a way of giving people access to their spiritual selves even if they don't use that language or those concepts in their lives. It allows people, including very cynical and disappointed survivors of terrible things, it allows people access to that spiritual part of themselves. It opens those gateways. Some people say it has to do with affecting temporal lobes of the brain that help people feel a spiritual presence. I don't know why it does that, but it does. It pings on all of those openings, and people are newly blessed with a sense of the wider-perspective contact with the divine, and they don't even have to have said they prayed.
I want to just close by reading this one incredibly poignant, at least to me, E-mail message that I got from a trauma survivor who talked about this very point, how image afforded her a return to her own spirituality. She was someone who had been abused terribly as a child by church-related people, so anything that had any religious content to her sent her screaming inside right up the wall.
Here she talks about these tentative stirrings of spiritual reconnection that she got through imagery that she could no longer get anyplace else. She says: �I got the imagery for post-traumatic stress and tried to listen to it. I had to turn it off. I couldn't handle it for a while, then I got it back out and I started listening to the whole thing. I actually could feel a sense of connectedness for a few brief seconds. For just a little bit I entertained the thought that there really might be a loving God.� She says, �The imagery helps me imagine that there could be something basically good about me or like a home I came from that had purity and light. I want so much to be able to accept that things were not rosy for me as a child and realize that that's okay. I want to move forward, and I want to think of the universe as more friendly. I would love to believe that I have guardian angels or beings looking over me, just hanging around. I do know, however, that they cannot stop bad things from happening. But to go back in the past and think that maybe there was something there with me, somehow that shifts the memory for me. I hope it's true.�
Now that idea of being able to use the imagery to shift the memory of a past event, almost like pulling some of the ugliness out of it like pulling a thread through a weave, I love that idea. She was saying she could insert that idea back into her paths through the image. It's very exciting. So in its natural, non-threatening way, I think imagery could make God possible again for people who have lost God, and it's a great gift to give back. <Applause.>
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