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Guided Imagery and Psychotherapy in Medicine
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Published on 02/6/2011
 
By Leslie Davenport, MS, MFT.  Having offered psychotherapy with guided imagery to hundreds of patients with severe illness and injury, I have seen how multiple losses—physical, spiritual, and psychological—stemming from a health crisis deconstruct a core sense of self, leaving them feeling like a stranger in a strange land. Guided imagery has proven to be a valuable tool for helping patients find a safe harbor within themselves during these extremely stormy times. Guided imagery, which incorporates relaxation training, is a natural, meditative process that reliably offers direct access to inner strengths and clarity of mind.

By Leslie Davenport, MS, MFT

“I don’t recognize myself: My body doesn’t feel the same at all. And suddenly there is a division between myself and the people I love.

"I’m in the ‘heart attack’ club now, and my family has no idea what this is like.

"Friends are becoming strangers, and strangers in cardiac rehab are becoming friends. Everything has been hijacked: my vitality, my spiritual beliefs (this doesn’t happen to someone like me!), my financial security, my future. I have no idea who I am anymore. And I’m terrified.” — Daniel


Daniel’s story is familiar to me. Having offered psychotherapy with guided imagery to hundreds of patients with severe illness and injury, I have seen how multiple losses—physical, spiritual, and psychological—stemming from a health crisis deconstruct a core sense of self, leaving them feeling like a stranger in a strange land.

Guided imagery has proven to be a valuable tool for helping patients find a safe harbor within themselves during these extremely stormy times.

Guided imagery, which incorporates relaxation training, is a natural, meditative process that reliably offers direct access to inner strengths and clarity of mind.

But more than simply providing respite during distress, imagery can help patients reconstruct their sense of self with an even greater depth and meaning than before their health crisis.

Let’s follow Daniel’s recovery to get a glimpse into the role imagery can play in healing the body and healing the self.

Daniel was not familiar with guided imagery, but he came to my office on the recommendation of his cardiac rehabilitation team, who prescribed imagery as a useful stress management technique.

His physician had related to me the level of terror that accompanied the days immediately following Daniel’s heart attack.

In addition to addressing his known fears and concerns, imagery guided Daniel into areas of surprising levels of healing.

By the time Daniel contacted me, he had tucked away his early terror.

If he brought an expectation of healing to our initial appointment, it was from the hurry-up-and-get-on-with-it school of life—a stoic and earnest desire for a quick solution to the recent medical distractions that had gotten in the way of significant momentum in his career in finance.

Daniel had suffered a heart attack at the age of fifty-one.

When he first arrives in my office, ten minutes early, he takes advantage of that extra time in the waiting room to work on his laptop. His crisp, tailored appearance expresses his success and professionalism.

Although he seems friendly and upbeat, I think it is mostly the subtle slump in his upper back, a fatigue around his eyes, and a weight that rests in his voice that points to sadness not far below the surface.

In the first few sessions, we focus on some practical tools around his goals, such as reducing muscular tension by learning progressive relaxation and breath work. We also brainstorm tips for ending his work focus at the end of the day in a more complete way.

He is eager to do the homework from our sessions in order to meet his goals, and he does report sleeping better in the first couple of weeks.

Daniel now asks if there is a way we could address the pain in his chest. Although the surgical procedure, which had implanted a stent in an artery to increase the blood flow to his heart, had healed well, there is still lingering pain.

Trusting the success of our work together so far, he agrees to try guided imagery to visit his heart as a way to discover more about the pain.

“Close your eyes,” I begin, “and take those long, full breaths you’ve been practicing.”

I watch Daniel fill his abdomen with breath, then expand the breath through his rib cage, continuing until the breath rises up under his collarbones. The out-breath is just as complete, and his body softens a little more fully with each exhalation. We take time for several breath cycles to deepen his relaxation.

“Now that you are fully relaxed, bring your attention inside your chest and sense your heart. Invite an image, which may be literal or symbolic, to arise for your heart. Whatever appears, describe aloud what you become aware of.”

An image forms easily, and Daniel describes his heart as “tender and bruised with blue, purple, and pink patches.” He says this heart feels battered. This makes sense to him as he considers his recent surgery and heart attack.

He also describes his heart as having weight to it, as if there is something heavy caught at the bottom. I suspect this is related to the heaviness I have heard in his voice.

I encourage him to continue exploring and ask, “If your heart had a voice, or some way of expressing itself, what would it want you to know right now?”

There is a pause, and then emotions flash across his face—eyebrows rising in surprise and then downturned lips.

He speaks with the gentle voice of his heart: “I’ve been waiting a long time for you to come back.”

Although he can’t say why he feels tearful or even know quite what the message means, he is deeply moved and curious.

Over the next few weeks, he tells me the story of how his family had moved to this country from Eastern Europe when he was three years old. His father, who had died four years earlier, was very committed to the family and had been a hardworking man, a shopkeeper by trade.

Making ends meet had not come easily in those days. When his father finally found the means to move his family to America, fueled by the strong purpose of fulfilling the dream of a better life, it was a momentous event.

With some gentle sorting out over the next several sessions, it becomes clear to Daniel that he is living his father’s dream, his father’s heart’s desire, and not his own.

He had learned early that it broke a strong family rule to voice his own view if it deviated from the family values.

Although Daniel has proven to be quite capable in the business world, he had silenced his own call to landscape gardening as a young man because it did not fit the family legacy’s picture of success.

“How would you like to respond to your heart’s message?” I ask him during another imagery session a few weeks later.

His response arises immediately in a clear and strong voice: “I want to give my father’s dream back to him so that there is more room for my own.”

It’s not uncommon for such a bold declaration of change to summon other “selves,” other internal beliefs poised nearby. So we take time exploring his inner voices of ambivalence, guilt, and fear. He learns how to follow the banner of each of these feelings rather than ignoring them, which he had routinely done.

Over time, it becomes clear to Daniel that he wants to anchor his life in the strong, clear voice of his heart, which had championed his own dreams.

The intention for such deep change can be accelerated when it is made visible. This is evident in the rituals and ceremonies that arise within all cultures.

They mark transitions. For example, a wedding ceremony makes visible the intention and reality of a relationship that has evolved into a life partnership. The ritual of clapping at the end of a musical performance marks the transition out of the theatrical experience.

I encourage Daniel to consider whether there is a way to honor his significant transition to reclaim his heart’s desire through a symbol or ritual.

Not long after, Daniel arrives at our appointment and has barely taken his seat when he fishes a small round stone out of his pocket.

He had found it on one of his walks at the botanical gardens in his neighborhood. He rests it in the upturned palm of his left hand.

“I’m not really a religious man,” he says as he curls his fingers over the stone, “but I feel like I’ve been praying all week, sending thanks to my father for what he’s given me. I’ve been imagining that the parts of my father’s life I’ve been carrying have seeped into this stone in my pocket.”

He opens his hand, showing me the stone, now infused with his father’s dreams. He announces his plans to visit his father’s grave next month and respectfully place the stone there.

When we conclude our work together, Daniel is feeling much clearer and stronger in his body and in his life.

It is not clear whether Daniel is going to remain in the finance business or make a significant career shift. It is clear, however, that he is now making choices, on a daily basis, more responsive to his own heart.

The last time I see him, I can recognize it in the ease of his walk and hear it through the new clarity in his voice. He has placed his fingers on the pulse of his own life and discovered the life rhythms that have heart and meaning for him.

Daniel’s story is only one among hundreds that illustrate how imagery evokes a healing response that travels along the interconnected web of body, mind, emotions, and spirit.

Whether dealing with cancer, chronic pain, or any other medical crisis that shakes the very foundations of a patient’s sense of self, imagery offers a path into the person’s own wisdom and strength, and a path out of crisis.

~ ~ ~

Leslie Davenport, MS, MFT, is a psychotherapist in private practice in Kentfield, California, and also in the Health and Healing Clinic at California Pacific Medical Center in San Francisco.

She was the founding director of the Humanities Program at Marin General Hospital in 1989 and has more than twelve years of teaching experience at universities including Cal State University, Hayward; Mills College; Holy Names College; the University of San Francisco; and JFK University. She has established imagery programs in five Bay Area hospitals and consults internationally.

Leslie Davenport can be reached at her site www.lesliedavenport.com

Also hear her podcast interview at Shrink Rap Radio.

Daniel’s story is an excerpt from her book, Healing and Transformation Through Self-Guided Imagery.

Originally published in San Francisco Medicine, June 2008 www.sfms.org

Reprinted here with the kind permission of the author.

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"Self-censorship" image from post Are You Censoring Yourself? by Eric Maisel, PhD

Also see the Talent Development Resources site page Healing & Art

and post Visualization, protective dragons and higher achievement.