ImRS is one of my favourite treatments. I’m not sure if it’s because I’ve seen first hand how profound it can be: people contacting a deeper part of themselves, reaching emotions that have never been touched before. Or the fact that I’ve witnessed the healing power of doing this kind of work: letting go of parts of themselves they’ve been struggling with for a long time. Or maybe it’s the fact that I’ve experienced how powerful this technique is for myself in my own personal therapy?

So what is ImRS? I recently went to the physio for a sore hip that I’ve had for ages, which inspired this metaphor that helps to describe ImRS: 15 years ago, my hip got injured from the stress of high intensity sport, but I never did anything about it until it started becoming really painful when the discomfort spread down my whole leg. My physio, got to the root cause of the problem, did some treatment, which was uncomfortable, but already my hip is starting to feel freer, more flexible, and is less painful.

This is like ImRS, but instead of dealing with the physical, here we’re dealing with the emotional. Our body and mind learn to cope with emotionally stressful events, but sometimes whilst it gets us through it at the time, we end up suffering the consequences in the long-term, just like how the pain spread from my hip to my entire leg over time. ImRS is a treatment which allows us to “reset” the stressful event so that we don’t have to rely on the old way of coping with it. Instead, we learn a new more robust way of coping that has no negative consequences. Just like the physio treatment, ImRS can be uncomfortable during treatment but the outcomes are worth it.

What is Imagery Rescripting (ImRS)?

It’s a form of therapy created by American psychologist Jeffrey Young (the creator of Schema Therapy). ImRS is designed to gain access to, and do work with the patient’s subconscious rather than their intellectual side. It’s aim is to help the patient to get their emotional needs met on a subconscious level.

What are the benefits?

There are many positive byproducts of ImRS

• modifying negative core beliefs, or a particular inner voice/self-talk, or recurring memories (which can include flashbacks), or dreams (or nightmares)
• personal growth/self-validation and raising one’s ability to self-sooth
• processing emotional (or other types of) trauma or unresolved issues from one’s past

In a sense, the outcome of ImRS can be to help the patient reach their full potential as a human being, which includes increasing their capacity for acceptance and love of themselves and their loved ones.

How is it done?

Preparation session

About one session is taken to prepare: the patient and therapist explore and identify the memories that have lead to the traumatic memory. This could be something like being made fun of, or embarrassed or humiliated by a parent, or teacher, or peers, in front of others as a child. The memory doesn’t have to be a clear or single memory, it just needs to “feel authentic” to the client, as if it could have happened. For example, it could be an amalgamation of traumatic memories grouped together. In general, this takes the form of the patient getting their emotional needs met (as more often than not, their emotional needs were not met when the actual event took place).

To keep patient psychologically safe during ImRS, the therapist uses a number of safety procedures that client is taken through prior to ImRS:

1. The patient can stop at anytime by raising their hand;
2. The patient’s level of distress is monitored throughout the ImRS so that they do not get overwhelmed or flooded with distressing emotion;
3. The patient learns one or several self-soothing techniques (e.g., Progressive muscle relaxation, controlled breathing, or safe place visualisation) to help them rapidly reduce their distress if necessary during ImRS.

Furthermore, ImRS does not take place without proper informed consent from the patient, that is, the procedures is explained thoroughly to them, and any concerns are discussed with the therapist. When these safety procedures are adhered to, there is unlikely to be any chance of re-traumatisation from ImRS.

Rescripting session

Imagery rescripting is an exercise done in one therapy appointment, guided by the therapist who provides verbal instructions to the patient. An additional one appointment is needed to prepare the patient for the session. The therapist begins by enabling the patient to be in a calm state of mind by doing 5 minutes of guided mindfulness meditation. The patient then imagines the stressful/traumatic event or memory, and is guided by the therapist so as to help the patient create as vivid an image as possible. The patient describes their imagery out-loud to the therapist as it unfolds in their imagination. Once the patient has “re-experienced” the event in their imagination (which usually takes between 5-15 minutes), they then “re-script” the event. This involves the patient re-writing the story of their event/memory so that their core emotional needs are met, rather than neglected. For example, if the imagery was of the patient’s child-self being berated by their parent (e.g., “you good for nothing waste of space, you’ll never amount to anything!”), the re-scripting might entail the patient introducing an adult version of herself into the imagery, and the adult-self would stand-up to the parent for their child-self.

The pros and cons of ImRS

ImRS hits the heart

It can be a deeply moving and emotional experience for the patient. It appears to go beyond the conscious, intellectual mind, and penetrates and permeates into the subconscious, and the heart. Because it can be such an emotionally touching experience it can create shifts in a person’s core beliefs and the way they see themselves as a child and an adult now in the world.

Confronting ourselves rather than avoiding

Often before the ImRS exercise, patients say “it’s a very vague memory, it happened so long ago. I’m not sure if I’ll be able to do it properly”, but after completing the session they are often astounded by the level of detail they were able to recall during the exercise.

This level of detail in recall allows the client to process the previously unprocessed memory, which essentially allows them to “put it to bed” once and for all, rather than their subconscious attempting to avoid the memory or make sense of it in ineffective ways. I like to use the “beachball in the ocean” metaphor: imagine a giant beachball bobbing in the ocean, you’re trying to keep it submerged, but it takes a huge amount of effort, and eventually it just keeps on bobbing back up again. That’s what these unprocessed traumatic memories are like, we try to keep them out of the way, but they spring out and get us at the worst of times sometimes, and in doing so, can have a significant and negative impact on our lives. By enabling the patient to have a vivid re-experience of the past event, it helps them to process it so that the beachball (the target memory) no longer bobs out of the ocean (impacts the patient via intrusive memories, nightmares, inner voices, etc).

Feeling lighter

Often patients come away from the ImRS session saying they feel “lighter”, although slightly emotionally drained (from the intensive session). I find this point interesting because many patients initially have concerns that ImRS will “open the floodgates” of negative emotions, and they fear that by opening pandora’s box, they won’t be able to close it again. In my experience, the contrary is true: ImRS leads to a greater level of feeling at peace with one’s past, being able to “file it away” without having to desperately attempt to avoid it, and without wanting to forget it forever. Processing these kinds of memories is like creating new meaning and understanding of the event and the contextual factors associated with it, leading to greater integration and appreciation of one’s history and self (i.e., what makes me me).

Empowerment

When patients go through a stressful or traumatic event as a child/adolescent without emotional support from a healthy adult figure, it can leave the child feeling helpless, and  disempowered. Hence, naturally, they’d want to avoid thinking about the event, and obviously they’d want to avoid any sort of recurrence. This in turn creates fear and anxiety, even just at the thought of the event.

With ImRS, rather than avoiding thinking about the event, in a supported, safe way, the patient faces it head on, leaving them to feel a sense of empowerment. This feeling of empowerment can be powerfully healing to the patient, aiding them to better tackle the natural downers and difficulties that life tends to throw at us. In this way, ImRS helps a patient to sooth-themselves by having faith in their core being, rather than more superficial methods of self-soothing (e.g., drugs and alcohol, distraction, medication, mantras, even psychological tools and techniques).

Increasing one’s capacity for love

ImRS can not only show a patient what emotional needs are, but also what it feels like to have their emotional needs met. For some, ImRS offers the first opportunity for the patient to experience how this feels, and hence can be a powerful and moving experience. Having one’s emotional needs met (and meeting the emotional needs of a loved one) can enable someone to experience love, and increase one’s capacity for love.

The cons

For someone who is under resourced (has little emotional support from others and is unable to self-soothe), struggles to be vulnerable and/or is newly discovering themselves and their past, ImRS can be very confronting. In addition, ImRS is not recommended for people who are experiencing a high degree of stress or distress during the time of the appointment (e.g., work stress or stress arising from interpersonal conflict). ImRS is recommended for clients who are ready to take the “next step” in therapy and should be discussed and planned with the therapist to ensure the client has the resources necessary to undertake and process the experience.

Further reading

What are human emotional needs? http://eqi.org/needs.htm

What is Schema therapy? A 10 minute YouTube Video http://bit.ly/111pemQ