The Nightingale Center

What Is Interactive Guided Imagery ^SM?

Imagery has a long and varied history in the healing traditions of mankind. The long standing knowledge that imagery is a critical component of all healing experiences is distinguished when we consider the vital roles played by placebos, suggestion, and positive expectant faith.

Interactive Guided Imagery ^SM (IGI) utilizes imagery, the natural language of the unconscious mind. IGI is a powerful modality helping a patient/client connect with the deeper resources available to them at cognitive, affective and somatic levels. The guide's role is not to provide "better" images for the client, but to facilitate an enhanced awareness of the unconscious imagery the patient/client already has, and help clients learn to effectively work with this imagery on their own behalf. This process is capable of bringing about profound psychological and physiological change, as it simultaneously empowers and educates the patients.

For example, a client can be asked to close her eyes and allow her mind to prompt a picture that symbolizes her problem. Using IGI techniques, the client may then be guided in an imaginary dialogue with this image to explore and reveal its meaning and relevance to her problem or issue. These images can provide important information about the problem, as well as the client's beliefs, expectations, fears, resources and solutions. Since many clients have uncannily accurate intuitions about their problems and solutions, the imagery process makes these insights easily available to them and their clinician.

Physically, imagery has the ability to directly influence the autonomic nervous system, and the power of imagination can be recruited to promote specific physiological changes as an aid to healing. In addition, many studies indicate that certain imagery techniques may stimulate physiologic processes including immune and endocrine responses which can accelerate the healing process.

As clinicians working with patients suffering from a broad spectrum of medical and psychological problems, and with others eager to learn more about health promotion and weakness, Drs. Martin Rossman and David Bresler, Co-Directors of the Academy for Guided Imagery, have explored a wide variety of therapeutic and educational approaches over the past 25 years. They have found that the use of a highly interactive form of guided imagery has been most effective in helping to meet therapeutic goals in relatively brief periods of time.

The IGI approach is eclectic, holistic, humanistic and non-dogmatic, incorporating skills from many related disciplines including hypnosis, Jungian Psychology, psychosynthesis, self-actualization and ego-state psychology.

There are few physical, emotional or behavioral symptoms or illnesses that are not affected to some degree by the mind. IGI mobilizes the latent, innate healing abilities of the client to launch rehabilitation, recovery and health enrichment. IGI techniques are easy to learn with proper instruction, and carry few, if any, negative side effects when properly utilized; thus making them an ideal adjunct to any other type of therapy. It is our sincere hope that health professionals from all disciplines will begin to utilize these techniques to help their patients and clients more effectively help themselves.

The Work in Action

Example: A 43 year old nurse with breast cancer is bereft and terrified after hearing that her cancer has recurred. Using the technique of Evocative Imagery ^SM, she connects on both a cognitive and affective level with the strength and courage she will need to cope with another round of treatment.

Example: A 31 year old woman with a life-threatening autoimmune disease encounters a host of difficult abuse memories from childhood as she begins to use imagery. By connecting with an imaginary figure of wisdom and protection, she is able to resolve considerable emotional trauma and her illness goes into regression.

Example: A couple married 18 years is constantly bickering. Ideal Model Imagery helps them clarify and communicate their values and goals to each other, circumventing their ingrained verbal triggers. Core issues are clear after several sessions, and the communication skills they develop allow them to relate more lovingly.

History and Origins

A mental image is a thought with sensory qualities. It is something we mentally see, hear, taste, smell, touch, or feel. The term "guided imagery" refers to a wide variety of techniques, including simple visualization and direct suggestion using imagery, metaphor and story-telling, fantasy exploration and game playing, dream interpretation, drawing, and active imagination where elements of the unconscious are invited to appear as images that can communicate with the conscious mind.

Once considered an "alternative" "or complementary" approach, guided imagery is now finding widespread scientific and public acceptance, and it is being used to teach psychophysiological relaxation, alleviate anxiety and depression, relieve physical and psychological symptoms, overcome health-endangering habits, and help patients prepare for surgery and tolerate procedures more comfortably.

Mental images, formed long before we learn to understand and use words, lie at the core of who we think we are, what we believe the world is like, what we feel we deserve, what we think will happen to us, and how motivated we are to take care of ourselves. These images strongly influence our beliefs and attitude about how we fall ill, and what will help us get better.

All healing rituals involve manipulation of these images, either overtly or covertly, and thus guided imagery can be considered one of the oldest and most ubiquitous forms of medicine. The healing rituals of various cultures that have persisted over time all have a certain level of clinical efficacy, and while we may attribute these therapeutic benefits to 'placebo effects', they have real and measurable effects with important implications for our understanding of the healing process.

In the early 1970s, inspired by the pioneering work of Irving Oyle, Carl and Stephanie Simonton, Robert Assagioli and others, Dr. Martin Rossman and Dr. David Bresler began to develop and research contemporary imagery approaches for patients coping with chronic pain, immune dysfunction, cancer, heart disease, and other catastrophic and life-threatening illnesses.

By integrating techniques originating from Jungian psychology, Gestalt therapy, Psychosynthesis, Ericksonian hypnotherapy, object relations theory, humanistic psychology, and advanced communications theory, these approaches were constantly redefined, expanded, tested, and codified, giving birth to "Interactive Guided Imagery ^SM", an extremely powerful, yet remarkably safe and rapid therapeutic approach for mobilizing the untapped healing resources of the mind.

In 1989, the Academy for Guided Imagery was established to provide in depth training for clinicians, to raise public and professional awareness about the benefits of imagery, and to support research, professional communication, and the dissemination of imagery-related information. Since then, the Academy has obtained professional accreditation, recruited an interdisciplinary faculty, sponsored and conducted research, and set contemporary standards for Professional Certification in Interactive Guided Imagery ^SM.

Mechanisms of Action According to Basic Principles of Interactive Guided Imagery ^SM

Although no one really knows what "consciousness" is, it is critically related to the process of attention, for what we attend to and focus on is what we experience. There is an old saying that "whatever you give your attention to grows," whether it's your garden, your children, or your worries and fears.

Over the years, most of us learn to give our major attention to the conscious mind and the chatter of its little voice that narrates a linear, logical, rational, analytic monologue describing its perspective of the world and how we think about it. We quickly become lost in our thoughts, forgetting that any other parts of us exist.

However, we are much more than are conscious mind and what it thinks. We are also characterized by the richness of our unconscious mind and its intuitions, emotions, feelings, memories, drives, motives, goals, appetites, aspirations, ambitions, values, beliefs, attitudes, and perceptions, all of which are expressed more fully by our imagery experiences than by conscious verbal awareness. Yet, in our Western culture, we tend to pay much less attention to these images and the feelings they convey than we do to the "little voice" of our conscious mind.

Therapeutic guided imagery allows clients to enter a relaxed state of mind, and then to focus their attention on images associated with the issues they are confronting. For example, one can invite an image to form that represents a particular medical symptom, and then initiate an imaginary dialogue with the image to ask why it's there, what it wants, what it needs, where it's going, and what it has to offer. The information obtained from such a dialogue can often be more directly helpful than even the most sophisticated medical diagnostic tests.

Patients coping with chronic pain can be invited to visit and experience an "Inner Sanctuary" where there is no pain, and those facing difficult medical decisions can be introduced to a wise and caring "Inner Advisor" that can provide support and help to explore their feelings about the various options they are considering.

By using an interactive, non-judgmental, content-free guiding style, experienced imagery practitioners can encourage patients to tap their latent inner resources to find new and creative solutions for their own problems. The consistent emphasis on inner resources and solutions lead to minimal transference, greater opportunities for effective client self-care, an enhanced sense of self-efficacy, and the rapid development of patient autonomy.

Biologic Mechanism of Action

Imagery has profound physiological consequences, and the body tends to respond to imagery as it would to a genuine external experience. For example, if you vividly imagine slowly sucking on the sour, tart slice of a fresh, juicy lemon, you will soon begin to salivate. Another example is sexual fantasy and its attendant physiologic responses. What happens to your body when you bring to mind something that makes you ferociously angry?

Imagery has been shown to affect almost all major physiologic systems of the body, including respiration, heart rate, blood pressure, metabolic rates in cells, gastrointestinal mobility and secretion, sexual function, cortisol levels, blood lipids, and even immune responsiveness.

With respect to producing specific physiological changes that can promote healing, guided imagery represents an important alternative to pharmacotherapy with much greater safety and far fewer complications, precautions, and contra-indications.

Forms of Therapy

The term "guided imagery" is used to describe a range of techniques from simple visualization and direct imagery-based suggestion, to metaphor and story-telling. The service-marked term "Interactive Guided Imagery ^SM" (IGI) refers to the specific approach taught by the Academy in which imagery is used in a highly interactive format to evoke greater patient autonomy.

IGI is particularly suited to our current health care climate, where cost-effective mind/body medicine, improved medical self-care, and briefer, yet more empowering approaches to health care are valued by patients, providers, and insurers alike.

IGI is applicable as a self-care technique, in a group or class, or as part of an individual counseling relationship. Self-help imagery books and tapes are also an inexpensive option for many clients who are capable of learning and utilizing these techniques on their own.

Indications and Referrals For Treatment

Since imagery has powerful physiological consequences and also conveys important and otherwise inaccessible information from the unconscious mind, there are virtually an unlimited number of situations where it can be used in health care settings. For simplicity, however, it may be helpful to consider three major categories of use:

1. Relaxation and stress reduction, which is easy to teach, easy to learn, and almost universally helpful to patients;
2. Active visualization, or directed imagery, where the patient is encouraged to imagine desired therapeutic outcomes while in a relaxed, open state of mind. This affords patients a sense of participation and control in their own healing, which is of significant value by itself. In addition, visualization can be used to alleviate symptoms, stimulate healing responses in the body, modify health endangering behaviors, and provide effective motivation for making positive life changes;
3. Receptive, or insight oriented imagery, where images are invited to enter conscious awareness where they are interactively explored to gather more information about a symptom, illness, mood, treatment, situation, or possible solution.

Clinical Applications

Clinical applications of IGI in medicine are tremendously broad, and include, but are not limited to:

• Acute and chronic pain relief
• Addictions
• Anxiety disorder
• Cancer treatment and life-threatening illness
• Couples and relationships o Depression o Family and parenting o Fertility, birthing and delivery
• Fitness training
• Grief therapy
• Immune augmentation
• Issues of aging
• Managing chronic illness and preventing acute exacerbations
• Meaning and purpose
• Medication compliance and adherence issues
• Mind/body issues
• Post-traumatic stress disorder
• Preparation for surgery and medical procedures
• Relaxation training
• Sleep disorders
• Smoking cessation and weight control
• Spirituality
• Stress reduction and management
• Survivors of abuse
• Teaching self-care
• Terminal illness and end of life care

The Academy for Guided Imagery has developed IGI techniques applicable in the course of normal clinical interaction, in brief medical office visits, or in longer counseling or psychotherapy formats. Physicians may practice it themselves or employ an appropriate allied health professional to offer longer sessions.

Self Help Vs. Professional

While it is always advisable to seek care from a trained professional, many basic guided imagery techniques for simple relaxation, stress management, and related problems are commercially available on cassette tapes, and may be helpful for minor, self-limiting problems. For more serious situations requiring IGI, appropriate care can be provided by health professionals who have been trained and certified by the Academy for Guided Imagery.

Visiting a Professional

IGI is an easy-to-learn method of empowering your mind to enhance the process of healing. With the aid of a supportive, trained guide, you will learn specific techniques designed to help you relax, relieve stress, encourage physical healing, enhance mind/body communication, sharpen your intuition and creativity, and become more effective at reaching your goals.

Using simple relaxation techniques to help you focus attention on your own personal inner world, your IGI Guide teaches you skills that will help you be more effective in problem-solving, conflict-resolution, goal setting, stimulating healing responses in your body, and in using your latent inner strengths and resources to bring about emotional balance in your daily life.

Relations with Conventional Medicine

Most physicians recognize the importance of attitude, stress, and mind/body effects in medicine but are not well trained to help patients with these issues. Imagery and visualization are increasingly accepted practices with both patients and physicians, and both have deeply penetrated our culture. While physicians continue to be wary about the promulgation of unrealistic expectations, and are rightly concerned that patients with potentially treatable serious diseases do not substitute imagery for more definitive medical or surgical procedures, they are becoming increasingly more open to alternative and complementary approaches to healing.

Responsible mind/body approaches are generally quite acceptable to physicians. Several studies have recently shown that almost 60 percent of physicians refer to the top five complementary approaches, with stress reduction, imagery, meditation and hypnosis being the leading modalities. In addition, physicians utilize these services even more frequently for themselves and their families.

By and large, IGI is a potent form of adjunctive treatment for almost any medical or psychological situation. It is a simple, yet profoundly effective, inexpensive and safe form of care that allows the patient to participate in their own process of healing. This alone is a tremendous benefit, though other significant benefits frequently accrue. Imagery is rarely used as a sole form of treatment for serious illness, yet it is almost always helpful in combination with nearly any other type of treatment.

(Portions of the above What is Interactive Guided Imagery ^SM? section were excerpted from original manuscripts written by Martin Rossman, MD, and David Bresler, PhD, from "Interactive Guided Imagery ^SM", Clinician's Rapid Access Guide to Complementary and Alternative Medicine, Mosby, Co. (in press) and from "Common Modalities in Complementary and Alternative Medicine", A Textbook of Complementary and Alternative Medicine, New York: Williams and Wilkens (in press).)