This article describes the practical experience of an imagery rescript from schema therapy, and also discusses some of the evidence for this approach in treating trauma or schemas which originated in childhood.

A great deal of the problems people seek therapy for are the deep-seated type problems; the problems people feel they have always had. Problems with their current relationships, and problems with themselves. It is not, of course, always just parents, who are involved in parenting but also the numerous other figures who feature in the lives of children. So very often what was said, how people were treated, key misdemeanours, active abuse, or abuse by neglect by these people are at the heart of a client’s adult trauma. An experienced therapist once said that there are only two types of problems: ‘yourself and other people’. Naturally in the case of trauma, if it was not simply an accidental event, it is often other people who have left us with PTSD or else a significant schema. A schema is a way in which we view or interpret ourselves and the world around us; these may be healthy and positive or else maladaptive and unhelpful. These schemas are often impacted by our childhood experiences and the way we have been treated. Parents not offering reasonable validation, for example, could lead to people having a ‘defectiveness’ schema or else those for who nothing is ever good enough leading to their children developing ‘unrelenting standards’. Whatever the schema is, we can often be left in a position where we then struggle with our adult relationships.

When we reach an age to understand that injustice was visited upon us; we did not invite it, deserve it, or bear responsibility for it, but we have it anyway it is, of course, often too late to practically address the issue with the perpetrators and so we have to somehow find a way to move on. Some approaches to therapy, therefore, seek to go back and quite literally ‘re-parent’ what happened, essentially to process and affect memories from the past so they are more manageable and, in a sense, softer in the present day. A well-known treatment for such memories is Eye Movement Desensitisation and Reprocessing (EMDR) developed by Francine Shapiro (1989) and perhaps less well known is the equally powerful work originating from Jeffrey Young’s Schema Therapy (young and colleagues, 2006) on imagery rescripting.

The evidence around Imagery rescripting is compelling, with results showing similar outcomes for PTSD treatment as that obtained by Eye Movement Desensitisation and Reprocessing (EMDR) in a study by De Haan and colleagues (2020) both treatments showed significant effects after 8 weeks follow up in 150 adults who had all suffered childhood trauma (before the age of 16). Furthermore, in a systematic review conducted by Morina and colleagues (2017) encompassing the results of 19 separate studies there was a significant reduction in symptoms for PTSD, body-dysmorphia, social anxiety disorder, major depression, bulimia-nervosa, and obsessive-compulsive disorder. The fact that EMDR and IR seem to have comparative effects is telling as EMDR is established as a frontline intervention for PTSD. Of particular interest in the counselling field is the work around social anxiety and imagery rescripts, Llyod and Marczak (2022) focus on negative self-image (NSI) in their literature review of studies carried out on modifying NSI with Imagery rescripting. Interestingly reductions in images, beliefs and memories have been achieved in as little as a single session and the authors results state the following:

IR was associated with significant decreases in image distress, image vividness, memory vividness, memory distress, and encapsulated beliefs. Although reductions were found with image frequency, they were non-significant. Interpretation of results is limited by the small number of studies.

It is worth noting that the authors found ten separate studies using their selection criteria and that their conclusion is that more studies are needed for conclusive evidence for the effectiveness of IR in treating people for ‘sticky’, uncomfortable or otherwise traumatic memories.

Let’s briefly take a look at a practical experience of IR in a single counselling session. As the work done in schema therapy is thought of as re-parenting an imagery rescript fits well with this, as the approach relates to literally going back into a memory, often a childhood memory and usually a traumatic memory for the target of re-scripting. An example comes from a counselling client in the United States and gives us some context. Carl was 7 years old, when one morning he woke up to find that he was home all alone. At first, he noticed the silence and then tentatively he began to move from room to room and down the stairs becoming ever more frantic as he realised that his siblings and his mother and father had left for school/work without him. As Carl is talking, he becomes almost overwhelmed with the feelings that accompanied the experience, he describes a dull ache in his chest and is moved to tears as he recalls the memory. Carl scores his Standard Units of Disturbance (SUDS) at 8 out of 10 for how he feels now recalling the memory. In our imagery rescript the counsellor firstly and carefully explores what 7-year-old Carl liked doing (kicking a football) and we go back into the memory, with eyes closed the therapist asks Carl for the detail of that morning what he can see, hear, how he feels literally what is happening as he relives the memory. Then the therapist, as they are now i.e. an adult enters into the memory, meeting Carl in the kitchen and explaining ‘this is all wrong, you should never have been left like this, I know there will be an explanation but I am angry that you have been left here alone it’s not right and we are going to fix this and I will tell you parents just how scared and lonely it feels for you to be left like this’ Carl and the therapist then go out into the garden and kick the football to each other while they await the return of the embarrassed parents.  At the end of the imagery rescript the therapist checks in again and Carl’s SUDS are 2 out of 10. The therapist then asks Carl: ‘what worked best in that experience?’ and Carl replies: ‘having you there, a father figure to tell me it was not ok for me to be left and take care of me, effectively you were doing what should have been done in the first place’.

Imagery rescripting is often taught in workshops around schema therapy during which trainees carry out a number of imagery rescripts with each other as well as covering the theory and research underpinning schema therapy. Although the traumas of the group of counsellors and psychologists were specifically selected as small t traumas, they can be positively affected by the imagery rescript. Although careful consideration of the techniques and some supervision and training are clearly needed, it is arguably a fairly simple idea for people to include in their counselling practice. 
 
References

  1. De Haan, K. L. B., Lee, C. W., Fassbinder, E., Van Es, S. M., Menninga, S., Meewisse, M. L., … & Arntz, A. (2020). Imagery rescripting and eye movement desensitisation and reprocessing as treatment for adults with post-traumatic stress disorder from childhood trauma: randomised clinical trial. The British Journal of Psychiatry, 217(5), 609-615.
  2. Dominguez, S. K., Matthijssen, S. J., & Lee, C. W. (2021). Trauma-focused treatments for depression. A systematic review and meta-analysis. PLoS One, 16(7), e0254778.
  3. Lloyd, J., & Marczak, M. (2022). Imagery rescripting and negative self-imagery in social anxiety disorder: a systematic literature review. Behavioural and Cognitive Psychotherapy, 50(3), 280-297.
  4. Morina, N., Lancee, J., & Arntz, A. (2017). Imagery rescripting as a clinical intervention for aversive memories: A meta-analysis. Journal of behavior therapy and experimental psychiatry, 55, 6-15.
  5. Shapiro, F. (1989). Eye movement desensitization: A new treatment for post-traumatic stress disorder. Journal of behavior therapy and experimental psychiatry, 20(3), 211-217.
  6. Van der Wijngaart, R. (2021). Imagery Rescripting: Theory and Practice. Pavilion Publishing.
  7. Young, J. E., Klosko, J. S., & Weishaar, M. E. (2006). Schema therapy: A practitioner’s guide.Guilford press.