Imagery rescripting

1. Introduction

Version followed: Arntz (2025), "Imagery Rescripting: an update of the treatment protocol" (Behaviour Research and Therapy 195, 104913), the two-phase protocol for PTSD from childhood trauma used in the IREM, IREM-Freq and TOPA trials (therapist rescripts first, then the patient rescripts). Where other published versions differ, they are named: Arntz & Weertman (1999) three-phase version; Smucker's Imagery Rescripting and Reprocessing Therapy (IRRT; German manual Schmucker & Köster, Praxishandbuch IRRT, Klett-Cotta, 3rd ed. 2017); Wild & Clark (2011) single-session version for social phobia.

Imagery rescripting (ImRs) is an experiential technique, and also a stand-alone trauma treatment. The client brings an aversive memory (usually from childhood) vividly to mind in the present tense. At the worst moment (the "hotspot") the course of events in the image is changed: first the therapist, later the client's current adult self, enters the scene, stops the threat and meets the child's needs. The developers' model is that change comes from altering the emotional meaning of the memory (e.g. "I am worthless", "it was my fault", "nobody protects me"), not from extinction through prolonged exposure. Factual memory stays intact; the client knows the new version is deliberate fantasy. [source: Arntz 2025] The same core move (activate the memory, change it in imagery, end in safety) is used across schema therapy, cognitive therapy for PTSD and social anxiety, and nightmare treatment. [source: Arntz 2025 Box 1; Ehring et al. 2022 abstract]

2. Framework

Format (Arntz 2025 version). Individual, 12 sessions (or another fixed number) in a restricted period; sessions about 60 minutes (the original trials allowed up to 90). In the IREM trial: 12 sessions of 90 minutes, twice weekly, completed within 6 weeks (8 at most); in the qualitative study sessions were once or twice weekly. More than one memory may be rescripted in a session. [source: Arntz 2025; Boterhoven de Haan et al. 2017; Bosch & Arntz 2023]

Readiness and screening. The developers do not use a separate stabilisation phase; treatment starts after one preparation session. [source: Boterhoven de Haan et al. 2017; Arntz 2025] Before starting, check:

The client agrees to trauma processing and can commit to the schedule; postpone if surgery, exams, a holiday or another major event falls in the treatment window; plan session times so there is recovery time afterwards. [source: Arntz 2025]
No benzodiazepines (taper before starting); no alcohol or drugs in the 24 hours after a session, because they disturb sleep-dependent consolidation. Other psychotropic medication kept stable. [source: Arntz 2025; Boterhoven de Haan et al. 2017]
Trial exclusions (useful as a screening list, not as absolute contraindications): psychotic disorder, bipolar I disorder, alcohol or drug dependence, IQ below 80, acute suicide risk, PTSD from a trauma less than 6 months old. A dissociative disorder was not an exclusion. Non-acute psychosis: case series suggest ImRs is safe and helpful. [source: Boterhoven de Haan et al. 2017; Arntz 2025]
IRRT's manual has a chapter on exclusion criteria and contraindications in PTSD and on the relation between stabilisation, confrontation and retraumatisation (Köster argues IRRT dissolves that tension); the chapter text is not drawn on. [uncertain]
Added by this guide [synthesis]: the client is not currently being abused or in contact with a dangerous perpetrator (current safety first); a crisis and suicide-risk plan is in place; the client has at least one way of calming down after a session; severe current substance misuse or medical instability is treated first.

Phases.

Phase	Typical sessions	Goals	Moving on
Preparation	1 (more if needed)	Rationale and handout; list of trauma memories (age, perpetrator, how often, severity; no details yet); agree index trauma; optional pilot rescript on a minor memory	Client agrees and understands; list made [source: Arntz 2025]
Phase 1: therapist rescripts	about sessions 2–6	Client experiences being protected and having needs met; reattribution of guilt and shame; index trauma addressed early	Fixed by protocol (around session 7), not by a criterion [source: Arntz 2025; Boterhoven de Haan et al. 2017]
Phase 2: client rescripts	about sessions 7–12	Client's current self stops the threat and cares for the child; child perspective then re-experiences it	Ends at the agreed session number; index trauma revisited in this phase too [source: Arntz 2025]
Ending	last session	Review, remaining symptoms; habitual avoidance or coping that persists may need separate behavioural work	[source: Arntz 2025 for the last point; rest synthesis]

Memories: each memory may need rescripting only once, because successful rescripting often reduces related memories; the list is flexible and changes in symptoms (nightmares, anger, guilt) guide the next choice. [source: Arntz 2025] In the qualitative study, several clients found a memory other than the index trauma more helpful, so be willing to switch. [source: Bosch & Arntz 2023] [synthesis] A practical sign that a client can start Phase 2 earlier or later than session 7: they spontaneously want to act in the image, or conversely they still freeze completely when the therapist intervenes; the protocol itself keeps the switch fixed.

Other versions' framework.

Arntz & Weertman (1999): three phases within each rescript: (1) the client relives the memory as the child; (2) the client's adult self enters and changes the course of events; (3) the client re-experiences the rescripted version from the child's perspective. In the original version the client rescripts from the start and rescripting began before the hotspot; audio recordings were homework. [source: Bosch & Arntz 2023; Arntz 2025]
IRRT (Smucker; Schmucker & Köster): three phases: (1) exposure and re-experiencing of the whole scene to identify hotspots; (2) development of mastery (coping) images: the current self steps onto the "inner stage", confronts and disempowers the perpetrator; (3) self-calming and self-nurturing: the current self comforts the child. Phase orders vary (e.g. 1a, 1b, 2, 3 or 1, 2, 3, 2, 3). Sessions are audio-recorded and listened to daily. The therapist is non-directive about content ("Socratic imagery"). Session number is not fixed (case examples range from 1 to 50 sessions). [source: Schmucker & Köster extract; Smucker website; Bosch & Arntz 2023]
Wild & Clark (2011), social phobia: one session of about 1.5 hours (about 30–45 min cognitive restructuring, then about 45 min imagery), introduced only after at least four sessions of cognitive therapy for social anxiety. [source: Wild & Clark 2011]

3. Guiding principles

Change the meaning, not the facts. Practical meaning: you are aiming for a shift in what the event says about the client (fault, worth, safety), not for habituation; you do not need to make the client sit with horrific detail. [source: Arntz 2025]
Rescript at the hotspot. Activate only up to the worst moment, then intervene; do not intervene earlier unless dissociation is severe. [source: Arntz 2025]
Needs guide the script. Ask what the child needs at the hotspot and keep going until those needs are met; better need fulfilment predicts better outcome. [source: Arntz 2025]
Therapist first, client later. In Phase 1 the therapist's care is itself a corrective experience; the client watches a model of protection before doing it themself. [source: Arntz 2025]
Non-directive in content, directive in process. Follow the client's needs and wishes for what happens, but take the lead when the client cannot. [source: Bosch & Arntz 2023] IRRT puts more weight on Socratic, client-generated mastery images, with the therapist as "co-driver, not helmsman" (paraphrase of the German). [source: Schmucker & Köster extract; Smucker website]
Experience over talk. Keep the after-imagery discussion short; the experiential work is the main source of change. [source: Arntz 2025]
Present tense, first person, eyes closed. Gently restate past-tense descriptions in the present. [source: Arntz 2025; Wild & Clark 2011]
Trial and error is normal. If an intervention does not land, rewind and try another; the therapist's calm persistence is part of the treatment. [source: Arntz 2025]
Match force to the threat. Start moderately, escalate as needed; physical intervention is fitting for brutal abuse; persist if the perpetrator seems too strong. [source: Arntz 2025]
Put responsibility where it belongs. Tell the child explicitly it was not their fault and that the perpetrator should be ashamed; frame a parent's behaviour as caused by their own problems, not the child. [source: Arntz 2025]
End safe and pleasant. Every rescript ends with the child feeling fine and, ideally, doing something pleasant. [source: Arntz 2025; Wild & Clark 2011]
Do not let avoidance steer. The client chooses memories with guidance, but the therapist checks that the hardest ones are not postponed and that the index trauma comes early. [source: Arntz 2025; Bosch & Arntz 2023]
Fantasy is labelled as fantasy. Describe rescripting as deliberate imagination; never suggest details the client has not reported; do not confirm or deny whether something happened. [source: Arntz 2025]
Respect bodily boundaries. Offer comfort through touch only if tolerated; never force it. [source: Arntz 2025]
Imagined aggression is allowed; real risk is monitored. [source: Arntz 2025]
Get trained first. Smucker advises against clinical use before formal training; IREM therapists had a 2-day training, two supervised pilot cases and peer supervision. [source: Smucker website; Boterhoven de Haan et al. 2017]

4. Intervention inventory

Items 4.1–4.11 are the core Arntz (2025) protocol; 4.12–4.18 are variants for other memory types in the same paper; 4.19–4.22 are other published versions. All example language is illustrative unless quoted and cited. [source for 4.1–4.18: Arntz 2025 unless stated]

4.1 Rationale and psychoeducation

Purpose / when: Preparation session; makes the method credible and explains why fantasy can change felt meaning.
Steps: (1) Explain that childhood events left emotional conclusions about self and others that were drawn with a child's limited information and power. (2) Explain that in imagery you will go back to the moment it was worst and change what happens, so that the needs the child had then are finally met. (3) Say plainly that this is deliberate imagination: the memory of what happened stays; what changes is what it means and feels like. (4) Outline the two phases (therapist first, then client) and the fixed session plan. (5) Give the written handout. Arntz (2025) provides a standard rationale and handout as appendices; their text is not drawn on here. [uncertain about the appendix wording] Wild & Clark's rationale: the event shaped beliefs from limited information, and the adult now has new information that can update the memory. [source: Wild & Clark 2011]
Example language (illustrative): "We won't change what happened. We will use imagination to give the child in that memory what was missing then: protection, someone on their side, comfort. People usually find the memory then feels different, less like proof that something is wrong with them."
Watch for: Fear that this will "rewrite" memory (address with the fantasy framing, 4.11); intellectual over-discussion (Smucker notes abstract discussion is of limited use before the client has experienced a rescript; offer the pilot instead). [source: Smucker website]

4.2 Trauma memory list and choice of target

Purpose / when: Preparation, then revisited each session.
Steps: (1) List memories with approximate age, perpetrator(s), how often it happened and severity; no details. (2) Mark the index trauma (the one most linked to current symptoms) and the worst memory. (3) Agree the order: the client chooses with your guidance; the index trauma comes early in both phases. (4) At each session, check symptom changes (nightmares, anger, guilt) to pick the next memory; drop memories whose distress has already faded. [source: Arntz 2025; Boterhoven de Haan et al. 2017]
Example language (illustrative): "Just a headline for each one, no details. How old were you, who was there, did it happen once or many times?"
Watch for: A list that skips the obvious worst memory or keeps postponing it (avoidance); be willing to switch if another memory turns out to carry more meaning. [source: Arntz 2025; Bosch & Arntz 2023]

4.3 Pilot rescript

Purpose / when: Optional, end of the preparation session, with a minor unpleasant memory; lets the client experience the method before trauma work.
Steps: Run 4.4–4.7 briefly on a mildly upsetting memory; debrief.
Watch for: Difficulty closing the eyes, imagining, or accepting help; these preview later problems (see section 5).

4.4 Memory activation up to the hotspot (both phases)

Purpose / when: Start of every rescript; makes the memory emotionally live without exposure to every detail.
Steps: (1) Before imagery, ask briefly about the situation: age, setting, who is involved, and which moment is worst (the hotspot). (2) Client sits comfortably and closes the eyes. (3) Ask them to picture the beginning of the event, before the hotspot, as the child, in the first person and present tense. (4) Cycle the standard questions: what is happening; what do you see, hear, smell, feel; what are you feeling emotionally and where in the body; what are you thinking. (5) Restate any past-tense description in the present tense. (6) Move to the hotspot. Only there add the needs question: "What do you need (now)?" (Arntz 2025, verbatim). (7) If the client cannot name a need, reassure, suggest possibilities, and rescript anyway, then check the effect. Do not ask about needs before the hotspot.
Example language (illustrative): "You're eight, you're in the kitchen. What do you see? … What do you feel in your body right now? … What is going through your mind?"
Watch for: Narrating from outside ("I remember that…") rather than being in the scene; rising dissociation before the hotspot (start rescripting early, see 4.10); too much affect is not a reason to stop (see 5.3).

4.5 Phase 1, step 2a: therapist stops the threat

Purpose / when: Sessions about 2–6, at the hotspot.
Steps: (1) Announce that you are now in the image and where (e.g. between the child and the perpetrator); check that the client can see you. (2) Intervene firmly against the perpetrator, often combining action with psychoeducation that changes the meaning (it is forbidden to hurt children; the adult is responsible). (3) Ask how the perpetrator reacts, then return to the standard questions for the child. (4) Scale force to the situation: start moderately, escalate if needed, including physical intervention, police or removal for brutal abuse. (5) If the client rejects what you do, rewind and try something else: "No problem, then I will try out something else." (Arntz 2025, verbatim). (6) Continue until the threat is fully stopped.
Example language (illustrative): "I'm standing right in front of you now, between you and your father. Can you see me? … [to the father] Stop. You are not to touch her. She is a child and she has done nothing wrong. What you are doing is your responsibility." … "What does he do now? What do you feel, little one?"
Watch for: Child still frightened or the perpetrator "comes back" (escalate, add help, persist; see 5.6); the client tells you to stop because they fear revenge or don't trust you (5.5). Working: visible relief, fear dropping, the child describing feeling safer.

4.6 Phase 1, step 2b: therapist meets the child's further needs

Purpose / when: After the threat is stopped, same image.
Steps: (1) Reattribute: tell the child it was not their fault and that the perpetrator should be ashamed; attribute a parent's behaviour to that parent's emotional or mental-health problems, not to the child or to the parent's character. (2) Ask about and meet needs: comfort (imagined touch only if tolerated), protection (e.g. take the child to a safe place, give a pager or way to call you), being listened to, validation of anger or grief. (3) End with something pleasant; if the child proposes nothing, suggest an activity. (4) Close the image only when the child feels fine and has no further needs.
Example language (illustrative): "None of this is your fault. Grown-ups are responsible for keeping children safe. Your mum was drinking because she had big problems of her own; that is not because of you." … "What do you need now? … Shall we go somewhere nice together? What would you like to do?"
Watch for: The child not believing the reattribution (repeat, explain the child's powerlessness, see 5.10); flinching from touch (use a cuddly toy or pet instead). Working: the child accepts comfort, relaxes, can enjoy the pleasant activity. Bosch & Arntz (2023) describe a therapist lying down next to the child self; the child resisted at first and relaxed after one rescript. [source: Bosch & Arntz 2023]

4.7 Closing and debrief

Purpose / when: After every rescript.
Steps: (1) Ask the client to open their eyes and return to the room. (2) Short discussion of what they experienced and how the memory feels now; do not turn it into long cognitive work. (3) Make sure the client is calm before leaving. (4) Remind about no alcohol or drugs for 24 hours. [source: Arntz 2025; Boterhoven de Haan et al. 2017] (5) [synthesis] Note which needs were met and what did not work, to plan the next rescript.
Example language (illustrative): "What stands out to you from that? … How does the memory feel now compared with when we started?"
Watch for: Lingering high arousal or dissociation at the end (extend calming, see 5.3).

4.8 Phase 2, step 2: the client's current self rescripts

Purpose / when: Sessions about 7–12.
Steps: (1) Activate the memory as in 4.4 up to the hotspot. (2) Eyes still closed, ask the client to switch to their current adult self and step into the image. (3) Remind them they are in control and can do whatever is needed. (4) Instead of the needs question ask what they want to do or say; when they describe it, prompt "Okay, do that!" or "Okay, say that!" (Arntz 2025, verbatim) and have them speak out loud. (5) Use the standard questions after each action; repeat until the adult self is satisfied. (6) If the adult feels powerless, remind them they can call in help (therapist, police, friends). (7) Prompt the adult to tell the child it is not to blame, if they have not done so.
Example language (illustrative): "Now come in as the grown-up you are today. Where are you standing? … What do you want to do? … Okay, say it to him, out loud."
Watch for: The adult self freezing or siding with the perpetrator (bring in help; you may briefly model again); harsh treatment of the child by the adult self (redirect to what the child needs).

4.9 Phase 2, step 3: the child experiences the rescript

Purpose / when: Immediately after 4.8.
Steps: (1) Rewind to just before the hotspot; the client becomes the child again. (2) Replay the adult's interventions from the child's perspective with the standard questions, initially without the needs question. (3) At the end ask whether the child needs anything else. (4) If so, have the child ask the adult self: "Okay, ask big [name]!" (Arntz 2025, verbatim), out loud, and let the adult respond. (5) End with a pleasant activity, prompting the child to ask for one if needed.
Example language (illustrative): "You're little again. Big Sam is walking in now. What do you see her do? How does that feel? … Is there anything else you need from her?"
Watch for: Some clients and therapists found this step redundant; it is part of the protocol, but keep it brief if the child is already settled. [source: Bosch & Arntz 2023]

4.10 Grounding and early rescripting for dissociation

Purpose / when: Derealisation, depersonalisation or pseudo-hallucinations that block the task.
Steps: (1) The therapist takes control of the image. (2) If severe dissociation starts before the hotspot, start rescripting early; otherwise wait for the hotspot. (3) Grounding aids: a balance board, or a scarf that client and therapist both hold; tug gently and ask the client to stay with the image; the client can tug to signal readiness to rescript. Practise the aid before use. (4) For extreme reliving, do not stop; step into the image, stand between client and perpetrator and protect. (5) For pseudo-hallucinations, answer with strong imaginary actions (Arntz's example: giving the client a laser gun to shoot attacking images). (6) For severe dissociation, consider starting with less overwhelming memories to build control.
Example language (illustrative): "Feel the scarf in your hand. I'm holding the other end. Stay with the picture: you're in the hallway. I'm coming in now."
Watch for: Working: client re-engages with the image and emotion rather than going blank; responds to questions. [synthesis] If the client remains unreachable, open the eyes, orient to the room (name objects, feet on floor), and resume when oriented.

4.11 Safeguards against memory distortion

Purpose / when: Built into every session; essential where the client is unsure what happened.
Steps: (1) Call the rescript "active fantasy" so the client keeps track of what is memory and what is imagined. (2) Explain that the target is emotional meaning, not factual memory. (3) Never add details the client has not reported (who, what, where). (4) If asked whether something "really" happened, neither confirm nor deny; explain that for the treatment it does not matter. Arntz states there is no evidence the protocol creates false memories. [source: Arntz 2025] (5) [synthesis, in line with this guide's trauma rules] Do not use ImRs, hypnosis or suggestion to search for or "recover" memories the client does not have; work only with what the client already remembers or the feeling itself (4.12, 4.17). Smucker likewise states IR is not meant to alter original memories, recover fragments or reconstruct vague memories of suspected abuse. [source: Smucker website]
Example language (illustrative): "I can't know what happened and I won't guess. We work with the picture as it is in your mind and with the feeling it carries."
Watch for: Client treating the rescript as what "really" happened; pressure from the client or others to establish facts (refer to legal or forensic routes, not therapy).

4.12 Affect bridge (mainly non-PTSD presentations)

Purpose / when: When no obvious memory is linked to a current problem (e.g. personality disorder, depression, social anxiety).
Steps: (1) Activate a recent situation that triggered the problematic emotion, eyes closed, present tense. (2) Once the feeling is strong, let go of the image but keep the feeling. (3) Wait, without a controlled search, for a childhood image to appear. (4) If a positive memory appears, let it go and wait for a negative one. (5) Rescript the image that comes, as in 4.4–4.9. [source: Arntz 2025] (A related procedure, the floatback, is mentioned in the literature but is not described in the text used. [uncertain])
Example language (illustrative): "Stay with that feeling of being shut out… Now let the picture of the office go, keep only the feeling… and just notice whether a picture from when you were young comes up."
Watch for: Don't push or suggest content (4.11); treat whatever appears as an image to work with, not as proof of a past event.

4.13 Rescripting neglect

Purpose / when: Emotional neglect without one clear traumatic moment.
Steps: Start with a general or typical memory (e.g. the child alone and sad in their room); enter the image as soon as emotion is activated; there is no need to wait for a hotspot; meet the needs for attention, warmth and play. [source: Arntz 2025]
Example language (illustrative): "I'm coming into your room. I see you sitting on the bed by yourself. Can I sit with you? What would you like?"

4.14 Adult-onset trauma

Purpose / when: Trauma experienced as an adult.
Steps: Either use the childhood protocol with "former [name]" and "current [name]" in place of child and adult (better for older traumas), or keep the client in the original perspective while the therapist or helpers intervene (better for recent traumas). [source: Arntz 2025] (Cognitive therapy for PTSD uses its own imagery-transformation procedure for updating trauma memories; that is a separate protocol not covered here. [source: Ehring et al. 2022 abstract])
Example language (illustrative): "Current Maria is walking into that car park now. What does she do?"

4.15 Nightmare rescripting

Purpose / when: Recurring nightmares.
Steps: Either rescript the nightmare in session exactly like a memory (activate to the worst moment, intervene, meet needs, end safe), or use Imagery Rehearsal Therapy: write an alternative ending and rehearse it daily (IRT is a separate manualised treatment). [source: Arntz 2025]
Example language (illustrative): "Go back into the dream, just before the door opens… Now I'm there with you. What do you need?"

4.16 Future-oriented (prospective) imagery rescripting

Purpose / when: Feared future events (e.g. in social anxiety).
Steps: The client imagines the feared event, then imagines acting differently; use the standard questions and try various scripts until one feels right. [source: Arntz 2025] Evidence is from small trials only.
Example language (illustrative): "You're standing up to give the toast and your mind goes blank. Now try it differently: what would you like to do?"

4.17 Symbolic images

Purpose / when: A general dysfunctional feeling or idea without a specific memory (e.g. a feeling of being dirty, a sense of a dark weight).
Steps: Ask the client to let an image of the feeling form, then change the image (cleanse, remove, transform) using the standard questions to check the effect. [source: Arntz 2025]
Example language (illustrative): "If that feeling had a shape, what would it look like? … What would you like to happen to it?"

4.18 Pathological grief

Purpose / when: Prolonged or complicated grief.
Steps: The client imagines visiting the deceased in a peaceful place and asks permission to remember them through a ritual and go on with life; unfinished goodbyes can be completed. [source: Arntz 2025] Bosch & Arntz describe a client who had missed a grandfather's death being brought to the deathbed in imagery to say goodbye. [source: Bosch & Arntz 2023] IRRT's manual has a "fused self" variant for grief; its details are not drawn on. [uncertain]
Example language (illustrative): "Imagine you can visit him somewhere peaceful. What would you like to say to him? … What does he answer?"
Watch for: Grief that surfaces in any rescript is normalised and supported; avoiding it can keep symptoms going. [source: Arntz 2025]

4.19 Adaptations when eyes-closed imagery does not work

Purpose / when: Client refuses to close eyes or reports being unable to visualise.
Steps: (1) Explore why (fear of losing control, shame, distrust; or avoidance). (2) Alternatives: sitting back to back, looking at a blank wall or the floor. (3) For poor visualisers: use the auditory channel (what is said and heard) or drama rescripting with an empty chair representing the perpetrator or child. [source: Arntz 2025]
Example language (illustrative): "You can keep your eyes open and look at the floor; what matters is that you can sense the scene."

4.20 Between-session tasks

Purpose / when: Throughout.
Steps (Arntz 2025 version): Audio recordings are no longer prescribed (clinical observation suggests effectiveness stayed high without them; not tested in a trial). Clients may record sessions for personal use only. Optional preparation tasks: writing memories down, revising the trauma list, planning alternative scripts, visiting places linked to the trauma, bringing childhood photos. A brief self-help exercise for negative feelings is supplied as an appendix [uncertain]; a self-help version has been tested with smaller effects than therapist-delivered ImRs. In IREM, clients reviewed their trauma-memory list before the next session. [source: Arntz 2025; Boterhoven de Haan et al. 2017]
IRRT version: each imagery session is audio-recorded and the client listens daily, and keeps building self-nurturing imagery on their own; the manual includes a homework log. [source: Smucker website; Schmucker & Köster extract]

4.21 Wild & Clark (2011) single-session rescripting for social phobia

Purpose / when: Within cognitive therapy for social anxiety, after at least four sessions, when a recurrent negative self-image is linked to an early memory. [source: Wild & Clark 2011, for all of 4.21]
Steps: (1) Recurrent image: ask whether the client gets spontaneous images in anxious social situations; eyes closed, recreate and describe it; ask what is worst about it and what it means about them as a person. (2) Linked memory: ask when they first felt this way; describe the event in the present tense; ask the same meaning questions. (3) Encapsulated belief: summarise the shared meaning of image and memory; client phrases it in one or two sentences; rate belief. (4) Cognitive restructuring (about 30–45 min): list evidence for the belief as it seemed at that age; challenge with adult evidence, including results of behavioural experiments and video feedback, on a whiteboard; separate what was true then from what is true now. (5) Rescripting (about 45 min, eyes closed), three stages: Stage 1, relive the event at the original age, first person, present tense; Stage 2, retell it as the adult watching the younger self, in the third person (adult may intervene if they wish); Stage 3, relive it at the original age with the adult present, who brings the updated information and compassion and may intervene, guided by questions such as "What do you feel inclined to do?" and "Is there anything else she needs to do or say?" (verbatim). (6) Close: confirm the younger self is calm and comforted; return to the room; ask how the memory feels now; re-rate the belief.
Example language (illustrative): "What does that picture say about you as a person?" … "Now watch it as the adult you are today. What do you see happening to young Megan?"
Watch for: Spontaneous intervention in Stage 2 (just continue as Stage 3); slipping into past tense (gently restate); multiple memories (start with the most distressing and rescript others later if gains don't generalise). Violent rescripts were not needed in social phobia; if used, make clear they are imagined.

4.22 Arntz & Weertman (1999) three-phase rescript

Purpose / when: The original version; still used in schema therapy and some trials, and as the shape of Phase 2 in the current protocol.
Steps: (1) Relive the memory as the child. (2) The adult self enters and changes the course of events. (3) Re-experience the new version from the child's perspective. In this version the client rescripted from the start, rescripting began before the hotspot, and audio homework was used; the 2025 update changed all three. [source: Bosch & Arntz 2023; Arntz 2025] Bosch & Arntz note the earlier practice of using therapist rescripting (client stays as child) early in treatment and with more severe pathology, and the three-phase form later or with less severe presentations. [source: Bosch & Arntz 2023]

4.23 IRRT (Smucker; Schmucker & Köster)

Purpose / when: Stand-alone treatment for trauma-related disorders, anxiety, depression and grief, and in inpatient groups. [source: Schmucker & Köster extract; Smucker website]
Steps: (1) Exposure and re-experiencing: the trauma scene is relived fully in imagery to identify the hotspots (developed with Edna Foa in the 1990s). (2) Mastery imagery: the current adult self steps onto the inner stage, confronts and disempowers the perpetrator. (3) Self-calming and self-nurturing: the current self comforts and soothes the traumatised child self. Phases can be sequenced flexibly (e.g. 1, 2, 3, 2, 3). Mastery and coping images are generated by the client through Socratic questioning, not dictated. (4) Debrief and follow-up processing; audio recording listened to daily. [source: Schmucker & Köster extract; Smucker website] The manual's specific question lists, debrief procedure and contraindications are not drawn on. [uncertain]
Example language (illustrative): "What would your adult self like to do now? … And then? … How does the child react to that?"
Watch for: Smucker reports that realistic helpers (e.g. police) work better than abstract ones (e.g. angels) when confronting perpetrators, and that self-nurturing images often activate schemas of worthlessness, unlovability or abandonment, which then need work. [source: Smucker website] Note the difference in dosing: IRRT relives the whole scene before rescripting; Arntz (2025) activates only up to the hotspot.

4.24 Cognitive restructuring and imagery modification for feeling contaminated (CRIM)

Purpose / when: Two-session programme for adults with PTSD after childhood sexual abuse who feel physically contaminated. [source: Steil, Jung & Stangier 2011 abstract]
Steps: Combines cognitive restructuring of the contamination feeling with an imagery-modification exercise. The detailed steps are not described here. [uncertain] [synthesis] Until you can read the published protocol, 4.17 (symbolic image) is the closest procedure here.

5. Handling problems

Items marked [source] come from the texts (mainly the troubleshooting section of Arntz 2025); items marked [synthesis] are this guide's own suggestions.

5.1 Avoidance and stuck clients

Hardest memories keep being postponed: name the pattern; remind the client the index trauma comes early; agree a specific memory for the next session. [source: Arntz 2025] Breaking through avoidance by talking about the trauma, with encouragement, was experienced as important by clients. [source: Bosch & Arntz 2023]
Cannot access memories (common outside PTSD): affect bridge (4.12), motivational work, psychoeducation, empathic confrontation of avoidance. [source: Arntz 2025]
Depression with helplessness and low motivation: be more directive in process. [source: Arntz 2025]
Cannot name a need: suggest options and rescript anyway; check the response. [source: Arntz 2025]
Rescript "works" in session but old behaviour persists: habitual coping may need separate behavioural work (exposure, behavioural experiments). [source: Arntz 2025]
No progress after several sessions [synthesis]: check whether the real hotspot has been reached (ask which moment carries the meaning, e.g. a parent looking away rather than the blow itself); whether needs were met to the child's satisfaction or the session ended early; whether drugs, alcohol or benzodiazepines are being used; and whether a different memory carries the core meaning.

5.2 Resistance to the method

Refuses to close eyes: explore why; offer back-to-back sitting or looking at a blank wall or the floor. [source: Arntz 2025]
Cannot visualise: check for avoidance; use auditory channels or drama rescripting with an empty chair. [source: Arntz 2025]
Refuses the therapist's intervention in the image: explore fear of retaliation by the perpetrator, distrust, feeling vulnerable, or self-punishment; empathise but still aim to get through, because the therapist's care is the corrective experience. [source: Arntz 2025]
Rejects touch or comfort due to deep distrust: never force it; offer a cuddly toy, a pet, or physical distance with warmth. [source: Arntz 2025]

5.3 Overwhelm and dissociation

Extreme reliving: do not stop the exercise; enter the image at once, stand between the client and perpetrator and protect them. [source: Arntz 2025]
Dissociation blocking the task: take control of the image; start rescripting before the hotspot if dissociation is severe; use a scarf or balance board (4.10); begin with less overwhelming memories. [source: Arntz 2025]
Pseudo-hallucinations during imagery: respond with powerful imaginary action against the attacking images. [source: Arntz 2025]
Still dysregulated at session end [synthesis]: eyes open, orient to the room and the date, slow breathing, a warm drink, stay in the waiting room until settled; agree who the client will contact that evening; schedule the next session soon (twice weekly helps). If this happens repeatedly, shorten the activation phase and intervene earlier.
Suspected dissociative identity disorder or very frequent switching [synthesis]: dissociative disorders were not excluded in IREM, but the sources give no specific adaptation; get specialist consultation and build grounding before memory work.

5.4 Non-adherence and attendance

Postpone treatment if major events will interrupt it; agree the schedule and session times at the start. [source: Arntz 2025]
Missed sessions or long gaps [synthesis]: the protocol relies on a compressed course; re-contract on frequency, problem-solve barriers, and if the gap is long briefly re-establish the rationale before the next rescript.
Alcohol, drugs or benzodiazepines around sessions: revisit the rationale (consolidation); the trials required benzodiazepine tapering before starting. [source: Arntz 2025; Boterhoven de Haan et al. 2017]

5.5 Ruptures and the relationship

Client rejects a specific intervention: treat it as information, rewind, and try something else ("No problem, then I will try out something else."). [source: Arntz 2025]
Client feels the therapist failed to protect them in the image [synthesis]: acknowledge it outside the image, ask what would have been needed, then go back in and do it. This repair often becomes a strong corrective experience.
Client wants more talking time: some clients wanted an extra session for life issues and reactions to ImRs; consider a short check-in slot. [source: Bosch & Arntz 2023]
Therapist does not know what to do: accept trial and error, offer options, check the response; model calm persistence. [source: Arntz 2025]
Therapist distress or doubts [synthesis]: imagery of severe abuse is taxing; use peer supervision, as the trial therapists did. [source for supervision: Boterhoven de Haan et al. 2017]

5.6 Modality-specific difficulties

Perpetrator too powerful or attacks the therapist: use realistic means (police, a taser, more helpers) and magical ones (shrinking the perpetrator, putting them in a bubble); persist. Training is advised before treating such cases. [source: Arntz 2025] Smucker reports realistic helpers work better than abstract ones. [source: Smucker website]
A parent who failed to protect (co-responsible parent): the therapist takes the initiative to gently confront that parent, pointing out that the child needs protection. [source: Arntz 2025]
Parentification: name the reversed roles; let the child's needs, not the parent's, guide the script. [source: Arntz 2025]
Revenge and aggression: aggressive rescripting is generally allowed; the therapist need not personally endorse violence. If there is any concern about real-world risk, ask the client to avoid alcohol and drugs and to discuss any real-life plans with you first. [source: Arntz 2025] [synthesis] Do a standard violence-risk assessment if real plans emerge, and follow your duty-to-warn rules.
Extreme self-blame: explain the child's powerlessness, support the emotions this releases, and target the early memories that drive self-punishment. [source: Arntz 2025]
Grief appearing in a rescript: normalise and support it rather than moving on. [source: Arntz 2025]
Client asks whether a memory is real, or memories are vague: apply 4.11: neither confirm nor deny; do not add details; do not use ImRs to search for memories. [source: Arntz 2025; Smucker website]
Self-nurturing triggers worthlessness or abandonment schemas (IRRT): expect it and work with the schema rather than dropping the nurturing phase. [source: Smucker website] [synthesis: work with it through further rescripts of the memories behind the schema]
Psychosis (not acute): case series suggest ImRs is safe and effective; acute psychosis was an exclusion in trials. [source: Arntz 2025; Boterhoven de Haan et al. 2017]

5.7 Risk issues not addressed in the sources [synthesis]

Suicidality rising during treatment: pause memory work, do a standard risk assessment, update the safety plan (including lethal-means counselling about storage and removal), and resume when acute risk has passed. Acute suicide risk was an exclusion criterion in IREM. [source for exclusion: Boterhoven de Haan et al. 2017]
Ongoing abuse or current contact with the perpetrator: prioritise real-world safety (safety planning, safeguarding duties, child-protection reporting where children may be at risk) before or alongside rescripting; imagery protection does not replace real protection.
Legal proceedings: inform the client that therapy notes may be requested; document that rescripting was explicitly framed as imagination (4.11).
Cultural or religious frames: let the client choose helpers and safe places that fit their world (family elders, faith figures, community), keeping the realistic-helper advice in mind.

Sources

Sources:

Further reading (not drawn on; described only through the sources above):

Arntz, A., & Weertman, A. (1999). Treatment of childhood memories: theory and practice. Behaviour Research and Therapy, 37, 715–740.
Smucker, M. R., Dancu, C., Foa, E. B., & Niederee, J. L. (1995). Imagery rescripting: a new treatment for survivors of childhood sexual abuse suffering from posttraumatic stress. Journal of Cognitive Psychotherapy.
Schmucker, M., & Köster, R. (2014; 3rd ed. 2017). Praxishandbuch IRRT: Imagery Rescripting & Reprocessing Therapy bei Traumafolgestörungen, Angst, Depression und Trauer. Stuttgart: Klett-Cotta.
Boterhoven de Haan, K. L., et al. (2020). Imagery rescripting and EMDR as treatment for adults with PTSD from childhood trauma: randomised clinical trial. British Journal of Psychiatry.

Further reading (not drawn on): the DOI landing page for Wild & Clark; the ResearchGate copy of Smucker et al. 1995; DocCheck IRRT entry; ClinicalTrials.gov NCT00976859.

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