FineTuningImageryRescripting
RemcovanderWijngaart
- Theoryofimageryre-scripting
- Refreshingthebasics
- Identifyingpitfalls
- ImageryAssessmentandimage
selection
- Workingwithantagonists(beginning
andendoftherapy)
- Managingproblems,challenges(coping
modes).
-Specialistareas,futureimagery,
nightmares
Whycouldimageryworkbeimportant?
Howwouldyoudescribetoaclienttherationalefor
imagery?
Howwouldyousuggesttodoimagerywork?
Groupsof2-discusshowyouexplaintherationaleto
aclient
Howdoesimageryforschema
changework?(Arntz2015a)
1)emotionallyprocessemotionsthattypicallymaynotbe
easilyaccessed,
2)care,nurturanceandsupportisprovided(blockedasa
child).
3)externalreattribution(e.g.“It’snotthatIwasabadchild,
myparentshadseriouslimitationsintheirparenting,”
4)meaningischangedata“childlevel”(onethatisnot
“rational”andlogical),
5)theclientisabletounderstandthattheirenvironment
growingupwastheexceptionandnotthenorm.
-  (FromAntz,2015b)
-  UnconditionedStimulus(US)–theoriginaltraumaexperience
-  Conditionedstimulus(CS)–thetraumareminder
-  US-CSassociationstoredinmemory,e.g..Asexualassault(US),smellof
typeofaftershave(CS)
-  Exposuretreatments-youexposeclienttoCS(e.g.sensingthesmellof
aftershave),withnounsafeexperiencesoccurringresultinginextinction.
-  Imageryrescripting-newinfoisfeedintothememorystoreoftheUS(i.e.
thetrauma),hencereducingthedistressasitschangingthemeaningof
theCS.
-  ImageryRescripting=“UnconditionedStimuliRe-
evaluation”-themeaningoftheUS(theTraumatic
experience)isaltered.
-  -Exposuretreatments-don'tchangethemeaningof
thetraumaitself,basedonextinctionprincipals,
exposuretothetraumaticmemory(Foa)
a)  Lookatmoreschemabasedconceptsthatmaybe
linkedtopresentingproblems(thesemaynotbe
“bigT”traumas)
b)  PTSDandTraumafocused-focusonrescripting
childhoodeventsthatarelinkedtoPSTresponse.
That’sthetheory,nowanexampleofthepowerofimaginaCon
ImageryRescripCngwithapaCent-
Fase1: TherapistRescripts
!  1)clientstartswithupsettingtriggeringevent,where
aretheyhowdotheyfeel,whatareyouthinking…?
!  2)floatback/affectbridgetopast“holdonthethe
feelingandgetanearlyexperiencewhenyouwerea
child
!  3)Childbasedimage,therapistentersandprovides
correctiveexperience
ExampleofimageryRescripCng-
PuniCveantagonist(withanadult)
- influencedbyintelligence,capacityofworkingmemory,
temperament,stressorsetc.
- Patientcanonlyprocessnewcorrectiveemotionalexperiences
withinthewindowoftolerance
- Dysfunctionalbehavioursareinadequateattemptstoregulate
thestressors,attemptingtogetintothewindowoftolerance.
-Patienthavetolearnmorehealthywaystoregulatethelevel
ofemotionalarousal
-Avoidretraumatising;don’tgointodetails
sinceitisaboutthemeaningoftheevents
-Usethesafeplace
-Offercomfortandsupportandmakeuseof
transitionalobjects
-Giveexplicitlycomplimentsandvalidate
emotions
-Practicemorehealthycopingstrategies
-Continuouscheckingtheemotionallevelof
clientandwhatmodesareactive
Regulateemotionsbymakinguseofplay,
laughter
SCrringupemoCons…
-  -Identificationofcommontherapistpitfallsin
imageryrescripting
1Tempo
Pacetoofast
!  Notenoughtimetoexperience,tofeel
!  Enhanceemotionalexperience=
!  takeyourtime,pauseatmomentsthatseemimportant,
emotional
!  Talkfasteratmomentstoescalateemotionalarousal,e.g.
Affectbridge
Pacetooslow
!  Notattuningtotheclient-startsto‘drift’,lowemotional
arousal
2)toneofvoice
!  Adulttoneofvoicewillconnecttoadultpartsofthe
pt,connectingtochildmodeswillbeeasierwhenth
soundswarm,inviting,caring
->Usetoneofvoiceasaninstrumenttoenhance
emotions
RecollecCngvsexperiencing
!  Describingtheimage,toogeneral:
‘Wheneverhewouldcomeoverhewouldbecritizing
me..’
!  Pasttense:‘ThenhegavemealookandIthought..’
!  Intellectualising
“apartofmethinksheishavinganexsitentialcrisis…”
OtherideastohelptoavoidIR
piPalls?
!  Closeyoureyesandtrytopicturetheimagetheptis
describing“whatdoyousee”
!  Askforsensoryexperiencesasifit’shappeningright
now:client-‘whenevermydadwouldcomehome
drunk..’Therapist-:’sowhereisyourdadstanding
now,lookathisface,howcanyoutellhe’sbeen
drinking?’
OtherideastohelptoavoidIR
piPalls?
!  Askyourselfifyoucanconnecttotheemotionsofthe
client.Ifnot,thenmaybeptisn’tconnectingfullyto
themeaningfulexperience
!  Don’tbeafraidtomaketheclientemotional,client
needstoconnecttoemotionstobeabletohavea
correctiveemotionalexperience.
Tuningintotheexperience
!  Lookforaffectandmeaningintheimage
!  Whenrescripting,keepinmindcoreemotionalneeds
thattheclientrequires
!  Keepinmindwhatisthecorrectiveemotional
experienceyouareseeingtoaccess?
-  Empowerment?
-  Reattribution?
-  Compassionandcare?
-  Grief
-  Safety
ATraumaticExperience
Emotion/
Somatic
Sensory
Meaning
A)  Emotion/Somatic=e.g.Fear,heartracing
B)  Sensory-e.g.imageofstepdadcomingintobedroom
C)  Meaning-e.g.“I’mpowerless,Ican’tdoanything”
- 
Floatbackandspecifictraumas
- “Googleimagesapproach”,askclienttothinkofmemories
thatgowithaparticularschema
“canyougiveme3memorieswereyoulearntthatyouhadto
complyoryouwouldbepunished””
- -homeworkassignments-top5bestmemories,5worst
memories-looktoidentifylinkstomodes/schemascurrent
lifeproblems
(Taylor(2015),personalcommunication)
Floatblack-ARunementtogeta
beRertarget…
!  Oftentoovague,e.g.‘feelsbad’,‘stressed’
!  Attunetothecurrentevent-
whatdoyousee-“myparentwatchingTV”
Whatdoyoufeel-“alone”
Whatdoyouthink…“idon’tmatter”
Clarifythethinkingtouncoverandclarifythemeaning…”is
itlikenoonelovesyou,amIgettingthatright”
Holdontothatsadness,andtheideaof“noonelovesme”
andgetanimageasachild
RescripCngimages
Howtomanagewhat“comesup”
!  Punitiveparents/antagonists
!  Guiltinducingparents/antagonists
!  Demandingparents/antagonists
!  Noparents/figures
!  Deprivingparents/figures
!  ->Demonstrationhowfightindifferentways
groupsof4-5
3participantsplayapunitive-,
demanding-andguiltinducingparent
Groupmemberstaketurnsinbeing
therapistfightingtheparentmodes
Goalforalltherapistsistoexperience
thedifferencesinfightingdifferent
parentmodes
- Youareincharge(nottheantagonist)inthe
imagery,needto“win”controltheimageif
needed
- Endoncorrectiveemotionalexperience,end
imagebeforenewproblemsarise
- Trytomakethings1stpersonpresenttense“I’m
hereinthekitchenandhe’syellingatme”
- Gowithwhattheclientneeds,letthemguidethe
imagery(ratherthantellingthemwhattheysee).
Workdifferentlywithpunitiveantagonistsvsguiltinducingand
demandingantagonists
-traumaisNOTrelived,stopbeforetheoccurrenceoftrauma
e.g.“freezetheimageofstepdadbeingthereintheroomand
youfeelingterrifiedandbringmeintotheimage”
Clientdoesn’tappeartobe“feeling”/recollects=focuson
experiential“whatdoyousee”
-Focusoncorrectiveemotionalexperience(e.g.powerlessvs
strength,alonevsbacked,itsaboutmevsitsaboutyou)
-
-Wishfulthinking“Ijustwantdadtobenice”*when
he’sjustnotgoingtobe-(validate-ofcourse….)
-  Loyaltytoparents(feelingguilty)-discusshealthy
loyaltyvsunhealthyloyalty
-  Toneofvoice-therapistneedstobedetermined,
wintheexchanged
-  Dissociation-grounding(therapeutic“window”)
Demandingfigures-Takehome
messages
!  Demandingcaregiversoftenhavegoodintentions;
buttoomuchpressure
!  validatetheneedforcare,spontaneityandplay.
-  Lessadversarial
-  thetherapistneedstochallengethedemanding
antagonistviatheuseofreasoningandargument
Guiltinducingantagonists
!  Initially,guiltinducinganddemandingantagonistmay
lookverysimilar
!  However,theexperienceofaguilt-inducingantagonist
canbesimilartothatofpunitivefigures;thechildfeels
defective,badabouttheirself.
!  Issuessuchasloyaltyandguilttocaregiversareoften
evident.Therefore,someauthorsarguethattheguiltinducingparentcouldbeavariantofthepunitiveparent.
!  Usingaloudforcefulapproachisnotrequired.The
therapistneedstobefirmandcalm,addressingthenonverbal,indirectmessagesoftheantagonisttowardsthe
child.
Depriving/neglecPulfigures
!  Highlighttothefigureaboutuniversalneeds
!  Instructtheparentthatitsnotgoodparentingto
ignoretheclient.
!  Remaininitiallymore“supportive”ratherthan
combative.Seehowthefiguresandrespondthe“win
theexchange”
Noparents/figures
-  Possiblybringintheantagonist,childrenmaylearn
earlytoavoid(orhaveothercopingmodes).
-  Ifclientneverwenttoaparentalfigurefor
nurturance,createanimagewheretheycanandplay
outhowthefigurerespondstotheneed.Re-scriptif
needed
-  Reparentthechildintheimageifantagonist
ThemesinrescripCng
!  Compassionandcare
!  GriefandValidation
!  Empowerment
!  Reattribution
!  Safety
WhatisthecorrecCveemoConal
experience
!  Needtothinkofwhattheclientneedsandwhatisthe
correctiveemotionalexperience….
!  E.g..atherapistmayfocusonempowerment“I’mnot
afraidofyou”butneedsafocusonreattribution“this
isnotaboutyourdaughter,thisisaboutyourbad
parenting”
PossibleResponsesinExperienCal
work-Empowerment
!  “Iam/wearerunningtheshownow..notyou”
!  “Youaregoingtohavetodealwithmenow”
!  “I’mnotgoingtoletyoudothat….”
!  “I’mnotafraidofyou…”“Icanhandleyoufine”
!  “I’mnotgoingtoletyoudictate/dominate”
!  “Youhavenopoweroverme”
!  “I’mnotgoingtobecoercedbyyou”
!  “Iamdonebeingsubmissivetoyou-it’stimeforyou
tolisten”(Clientresponds)
SafetyandTrustbasedthemes
Therapistsentimentsinrescriptingwithantagonists
!  “I’mheretoprotectlittleX”
!  “I’mnotgoingtoletyouharmher”(toantagonist)
!  “I’mnotheretoharmyoulittleX”(tochild)
!  “Sheneededyourprotection,youletherdown”(to
caregivers)
!  Shedoesn’tdeservethis…”
!  “stopbackoff-“I’mstrongerthanyou,I’mwellarmed”
!  “I’mnotlettingyoutouchhimagain”
Careandcompassionbased
themes
!  Therapistsentimentsinrescripting
!  “You’reveryimportant/visibletome”(tochild)
!  “she/heneedsyoutohearthem,takethem
seriously….”
!  “youneedtoshowthatyoucareaboutyourkids”
!  “She/heneedsyou….”,“Iknowitshardforyou,but
allkidsneedattention,careetc)
!  “Everychildneedstofeelliketheymatter.
Rea$ribu)on-BasedThemes
!  Therapistsentimentsinrescriptingwithantagonists
! 
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“whatiswrongwithyou…whatyouaredoing/sayingiswrong”
“Shedoesn’tdeservethis…”
“IknowIamright….”“you’retheproblem”
“whatcanaXyearolddothatdeservesthis….”
“I’mnotgoingtoletyoudothisanymore”
“you’retheoneinwrong,whodoyouthinkyouare”
“Whatkindofpersondoesthattoachild”
“I’mdonewithhearingXblameherself,youaretheproblemhere”
“I’mdoneblamingmyself-youaretheproblem”(Adultrescripts)
GriefandValidaCon
!  “itscompletelyunderstandablethatyoufeelthatway”
!  “Itsmakessensethatyouwantdadtobekinderto
you”
!  “it’ssadthatpeopledidn’ttreatyouthatyou
deserved,i’mhereandicareaboutyou”
nd
2 stage-Clientrescripts
!  1)a-currenteventwithafloatback
!  1)childhoodevent-description
!  2)clientcomesinasthehealthyadult-providescare,
protectionand“winstheexchange”
!  3)imageis“rewound”tothepointtheadultclient
enterstheimage,andtheclienttakesthe
perspectiveofthechild
DVD-Clientre-scriptsimage
Oftentherapistsownschemasandmodesimpedeeffectiverescripting.
Focusonothers(selfsacrifice,subjugation):
Thetherapistdoesn’ttakethelead
UnrelentingStandards
Addressesthepttoomuchasahealthyadult
remainstoocognitive
Failure,defectiveness
Feelshelpless,powerlessinchangingtheimage
Don’tforget:
ImageryislikeenteringaHarryPotterworld:anythingispossible
“whatifImakeitworse!”
-  “Ineedmoretimetolearnitget
itright”
-  “MyClientmightnottolerateit”
-  “Idon’tlikeupsettingmyclients”
- 
Whatschemasarerelatedto
thesereactions?
Whatwouldahealthyparentdo
ifthiswasaboutachild?
- 
- 
-  Copingmodescanfrequently“getintheway”of
effectiveimagerywork
-  -needtomanageandbypassthemodebefore
imageryrescriptingtakesplace
-  -Reverttoclientformulation“couldtherebeaX
partofyouthatdoesn’twanttodothisexercise?”
-”Ican’tremembermychildhood”
-“Icantdoimagery”
- “Ididn’twanttocometotoday’ssessionifit’sgoing
tobelikelastweek”
- ExperiencesIRinanunrealisticway
- -Dropoutsordisengagement
- “talking…..Talking…….talking”
- Cynicismandnegativity
-demeaning..“soyoudothiswithallyourpatientsdo
you”
-Angry“I’mnotdoingF…kingthisstuff”
-Overintellectualising“asI’mtherewithmumIthink
it’sarepresentationofsynchronousevent”
DVD-modeworkChallengingover-
compensatorclient
Letspractice!
-Preparingforbehaviouralpattern
breaking
-Strengtheningthehealthyadult
(developingfurther“innerstrength”
andresources)
->workshopSaturdayafternoon!
-Flashforwards(OCD,Social
AnxietyDisorder)
Recurrentnightmares
- Recurrentnightmares:
- Highdistressandsufferingfromnightmares
- Distressduringnightbutalsoduringdaytime
- Nightmaresassociatedwithpsychiatricdisorders
TreatmentopCons
!  Imaginalexposure:nightmarefrequencyislowerbut
notthedistress..
!  Imageryrehearsaltherapy;storylineismodifiedand
thismodifiedstorylineisrehearsed->lowersboth
frequencyanddistress
Currenttreatmentprotocol
!  Assessment
!  3individualsessionsinconsequtiveweeks
!  Session1:rationalefortherapy+determiningcore
nightmare
!  Session2:re-activationcorenightmare,changing
storyline,repeatingrescripting
!  ->rescriptingcanhavedifferentendings
!  Session3;repeatedprocedure
outcome
!  IRTeffectivebutnotsuperiortoIEonallmeasures
!  Explanation:rationaleIEiseasieraccepted
!  ->Payattentiontoexplainingthemechanismsof
imagery
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