Guided imagery

1. Introduction

Version followed: clinician-guided imagery as described in the VA/University of Wisconsin Whole Health clinical overview (Singles & Mirgain, 2014, updated 2016 and 2023). The technique sequence follows Martin Rossman's Guided Imagery for Self-Healing (2nd ed.), the Academy for Guided Imagery's "self-healing" line, with procedures that Academy co-founder David Bresler describes in print (Bresler, Practical Pain Management, 2005). The trauma sequence in 4.23 follows Belleruth Naparstek's three-stage structure (Invisible Heroes, 2004, and its companion audio set). The "interactive (dialogic) vs scripted" distinction comes from Hall, Hall, Stradling & Young (2006). Status of sources: confirmed from publisher pages, Bresler's article, the UW Osher Center handout and a reference entry on Rossman: the names and order of Rossman's techniques; the inner-advisor, symptom-image dialogue, resistance-image dialogue and future-image techniques in outline; Rossman's position that imagery complements medical care and never replaces it; Naparstek's three stage names, goals, track themes and suggested listening frequency. No published text of Rossman's chapter procedures, of the Academy's IGI training manual or of the Invisible Heroes scripts is drawn on here [uncertain], so the step-by-step detail in 4.2, 4.8, 4.10–4.14 and 4.23 remains partly [synthesis], tagged block by block. This guide does not cover Leuner's Guided Affective Imagery / Katathym Imaginative Psychotherapie, which is a separate psychodynamic method with standard motifs, or imagery rescripting for trauma memories. [source: VA Whole Health Guided Imagery; New World Library and Red Wheel/Weiser book pages; Bresler 2005; UW Osher handout; Hay House and Penguin Random House pages; SAGE chapter page]

What it is. Guided imagery is a mind-body technique. The clinician helps the client relax into an inward-focused, altered state of awareness, then cues the client's imagination across all the senses ("the mind's eye") to reduce stress, ease symptoms, rehearse performance or gain insight. It is also called guided visualisation. It is a technique family, not a stand-alone psychotherapy, and is usually embedded in counselling, psychotherapy, nursing or integrative-medicine care. In the US it is unregulated. The Academy for Guided Imagery (co-founded 1989 by David Bresler and Martin Rossman) certifies licensed professionals in Interactive Guided Imagery (IGI): about 150 training hours plus 33 hours of independent study. [source: VA Whole Health; GoodTherapy (secondary)]

How change is thought to happen. Imagery is treated as a thought process that also produces physiological responses. Calming images are held to reduce stress arousal, much as stressful thoughts increase it. Deliberately changing an image is held to shift what the image stands for (an emotion, a symptom, a goal). The client stays in charge of the imagery, and that sense of control is itself seen as therapeutic: it builds mastery and self-directed change. In the interactive form, images that arise spontaneously are treated as messages to explore, not as facts. [source: VA Whole Health; Allina Penny George Institute slides; BSMHFT NHS leaflet] These are the proponents' explanations, not settled mechanism. [uncertain]

2. Framework

The sources give no fixed manualised course. What follows combines the session format and skill sequence they describe. Phase boundaries and session counts are [synthesis] unless tagged.

Typical session format (about 45–60 min). One secondary source describes five parts. [source: GoodTherapy (secondary)]

Preparation, 5–10 min: setting an intention and getting comfortable.
Relaxation, 5–10 min: breathing or progressive muscle relaxation.
Imagery journey, 15–25 min: multisensory imagery.
Integration, 5–10 min: returning to full alertness.
Discussion, 10–15 min: sharing insights and planning home practice.

Allina's training slides frame the same arc as assessment, then intervention (relaxed, inward focus and a special place), then deepening, then closure and review. [source: Allina]

Phase A – Assessment, consent and preparation (session 1).

Goal: decide whether imagery fits; set the intention; agree safety signals.
Content: prior experience with imagery, a preferred relaxation method, consent and safety, expectations (too little or too much), and beliefs that may conflict with imagery. [source: Allina; VA]
Move on when: there are no contraindications (see Screening in §4), the client understands they can stop at any time, and a goal is agreed. [synthesis]

Phase B – Skill building (sessions 1–3).

Goal: build imagery ability, relaxation and a reliable calming image.
Rossman's book orders the work as: exploring imagery abilities, then basic relaxation, then deepening. [source: New World Library TOC]
Most sources start with a positive "safe or beautiful place" before anything else. [source: VA; Allina; BSMHFT]
Move on when: the client can relax with the image, return from it calmly, and use it briefly between sessions. [synthesis]

Phase C – Targeted imagery (sessions 2–6+).

Goal: apply imagery to the presenting aim.
Methods: healing or symptom-relief imagery (as an adjunct to medical care); the inner advisor; symptom-as-symbol dialogue; symbolic transformation; outcome or performance rehearsal; work with images that arise spontaneously. Rossman's book sequence continues: healing imagery, inner advisor, symptoms as symbols, grounding insight, learning from resistance, image of wellness. [source: New World Library TOC; VA; GoodTherapy]
Move on when: insights have been turned into concrete action steps, and symptom or stress ratings show change. [synthesis]

Phase D – Consolidation and self-practice (final sessions and ongoing).

Goal: independence.
Clinicians may record sessions for home use or point clients to quality recordings. The VA source says practitioners can teach patients to continue the work on their own. [source: VA; Coursera UMN course outline]
End when: the client uses imagery independently and has a plan for setbacks. [synthesis]

Session count. No manual-style session count was found for clinician-led guided imagery. [uncertain] Published practice dosing: Naparstek's trauma audio set suggests listening once or twice a day for 2–3 weeks [source: Hay House product page]; surgical programmes give patients recordings to practise several times a day before surgery [source: UW Osher handout]; one medical-adjunct RCT used ten recorded sessions of about 25 minutes, twice a day for five days, under psychiatrist supervision (Parizad et al., 2021) [source: PMC]. Farr (1988, UVic thesis abstract) used four weekly sessions in a counselling study. As a rule of thumb, imagery used as a skill takes about 3–8 in-person sessions plus daily home practice, and imagery within longer therapy is used as and when needed. [synthesis]

Formats.

Individual face-to-face, interactive and dialogic: the client describes the imagery aloud as it unfolds.
Pre-scripted narrative read aloud to an individual or a group.
Recordings for home practice.

[source: SAGE Hall et al. 2006 chapter page; VA]

3. Guiding principles

The client controls the process. In practice: the client can change, leave or stop any image at any time. Say so before every session, and honour it at once. [source: VA]
Collaborative imagery. The image can come from the client, the clinician or both; collaboration is most common. In practice: offer open frames ("a place where you feel at ease") rather than a fixed scene, and adopt the client's images. [source: VA]
Start positive. In practice: build a safe or beautiful place before any problem-focused imagery. [source: VA; Allina]
Engage all the senses, and emotion. In practice: cue sight, sound, smell, touch, taste and bodily feeling, and note the emotions that arise. Imagery is not only visual. [source: VA; Allina; BSMHFT]
Images can be changed on purpose. In practice: when an image is unpleasant, invite the client to alter it (size, distance, colour, sound) and notice what shifts. [source: VA; GoodTherapy]
Take yourself out of the experience. In practice: do not insert your own reactions, praise or approval; reflect and invite instead. [source: Allina]
Use the client's words, pace slowly, use fewer words. In practice: mirror the client's terms for images and feelings, leave pauses, and keep cues short. [source: Allina] Phrase cues toward comfort rather than pain: Bresler advises asking "Is this comfortable?" rather than "Tell me when it hurts". [source: Bresler 2005]
Receive before analysing. In practice: during imagery, have the client notice and remember responses without interpreting them; meaning-making comes in the debrief. [source: Rogel/UM inner-advisor recording; Hall et al. book summary]
Always close and review. In practice: every session ends with an unhurried return, re-orientation and a review of what happened and what was learned. [source: Allina; GoodTherapy]
Practice builds skill. In practice: assign brief daily practice; vividness and ease increase with repetition. [source: Allina; BSMHFT]
Adjunct, not substitute. In practice: for any physical symptom or illness, imagery supports stress and symptom coping alongside medical assessment and treatment. It is never offered as a treatment for cancer or any other physical disease. [synthesis]
Images are experiences, not evidence. In practice: never use imagery to "recover" or verify memories, and never suggest past events. Treat any memory-like images that arise as the client's present experience. [synthesis; standard clinical caution]
Respect beliefs. In practice: ask about religious or personal beliefs; adapt the imagery content (for example, the advisor figure) or don't use imagery. [source: VA; Allina]

4. Intervention inventory

All example language is the author's own illustrative wording, not taken from any script. Where a source gives only a technique's name or a one-line outline (for example, Rossman's chapter titles or Bresler's short descriptions), the detailed steps are [synthesis] built on the principles in §3, and each block says which parts are sourced.

Screening and contraindications. Do not use guided imagery, or use it only with extreme care, for clients with:

Psychosis, hallucinations or delusions [source: VA; GoodTherapy]
Delirium or dementia, or severe cognitive impairment [source: VA; GoodTherapy]
Severe dissociation; specialised approaches may be needed [source: GoodTherapy]
A history of unprocessed trauma that may surface, since imagery can trigger without preparation [source: VA; GoodTherapy]
Religious or personal beliefs that conflict with imagery [source: VA; Allina]
Strong anxiety about imagery, or expectations that nothing, or too much, will happen [source: Allina]

Added cautions [synthesis]:

Acute suicidal crisis: assess and stabilise first, and use only brief grounding imagery.
Active substance intoxication.
Breath-focused induction in clients with panic disorder or respiratory illness: offer a non-breath focus instead.
Any physical symptom that has not been medically assessed: refer for assessment before symptom imagery.
Home recordings: never while driving or operating machinery.

4.1 Assessment, intention-setting and consent

Purpose: decide whether imagery fits, tailor it, and obtain informed consent. Use at intake and whenever imagery is first introduced. [source: Allina; VA]
Steps:
1. Ask about past experience of imagery, meditation or hypnosis, and what helped or hurt.
2. Ask which relaxation approach the client prefers (breath, body scan, muscle release) and which senses are most vivid for them.
3. Screen against the contraindication list above, including trauma history and dissociation (a brief dissociation screen is appropriate) [synthesis].
4. Ask about beliefs that could conflict with imagery or with particular images, such as spirit guides.
5. Set realistic expectations: images may be faint, non-visual or slow to come, and that is fine.
6. Agree the session's intention in the client's words.
7. Explain the client's control. Eyes can stay open or closed, and agree a stop signal (raising a finger or saying "stop").
8. Check the setting: noise, interruptions, music preference, and the risk of falling asleep. [source: Allina for setting factors; rest synthesis]
Example language (illustrative): "Before we try this, I want you to know you're in charge throughout. You can open your eyes, change anything you imagine, or stop, and we'll just talk."
Watch for: high anxiety about "losing control", unrealistic hopes (for example, imagery curing an illness), and disclosure of trauma or dissociation. Each of these changes the plan.

4.2 Exploring imagery abilities

Purpose: find out how this client imagines (visual, auditory, kinaesthetic, olfactory) and show that everyone can image in some way. Rossman's book opens with "Exploring Your Imagery Abilities", before relaxation and deepening; two publisher pages give the title and order, and the chapter's own procedure is not reproduced here. [source: New World Library and Red Wheel/Weiser pages] Steps below are [synthesis]. [uncertain: Rossman's own procedure]
Steps:
1. With eyes open or closed, invite the client to recall a familiar everyday object or scene: a piece of fruit, the front door, a favourite song.
2. Cue one sense at a time.
3. Ask the client to rate the vividness of each sense, then use the strongest senses as the entry route in later imagery.
Example language (illustrative): "Bring to mind something simple, maybe a lemon. Notice whatever comes: a picture, a smell, the weight of it in your hand. Any of those counts."
Watch for: self-criticism ("I'm bad at this"). Normalise it, and use whichever senses work.

4.3 Basic relaxation induction

Purpose: move from analytical thinking into a relaxed, inward focus. It is the standard opening of every imagery session. [source: VA; Allina; Rogel/UM recording; Rossman TOC]
Steps:
1. Have the client settle in a supported position.
2. Have them notice their breathing without changing it, then let each out-breath lengthen slightly.
3. Invite them to let go of tension progressively from the head down to the feet; tensing and releasing muscle groups is an alternative.
4. Thoughts that intrude are acknowledged and let pass, and attention returns to the breath.
5. Allow 3–10 minutes.
Example language (illustrative): "Just notice the breath as it is… and with each breath out, let a little tension drain from your forehead… your jaw… your shoulders… If a thought comes, let it go by, and come back to the breath."
Watch for: relaxation-induced anxiety (rising pulse, restlessness, intrusive images). Slow down, open the eyes, or switch to an eyes-open external focus [synthesis]. Signs it is working: slower breathing, softened face, slower speech.

4.4 Deepening

Purpose: deepen inward absorption before the main imagery. [source: Allina; Rossman TOC]
Steps:
1. Use a softened gaze or closed eyes.
2. Continue slower breathing.
3. Add further progressive relaxation, or a simple descending image (going down steps or a path) [synthesis for the descending image].
4. Check readiness with a minimal signal.
Example language (illustrative): "You might let your eyes rest, and with each breath allow yourself to settle a little further… a little more comfortable."
Watch for: sleepiness. Keep your voice engaged and invite a small response, such as a nod.

4.5 Safe / special / favourite place

Purpose: create a calming, reliable inner resource. It is the first imagery in nearly all sources, and it serves as a home base for later work and a refuge if distress arises. [source: VA; Allina; BSMHFT; GoodTherapy]
Steps:
1. After relaxation, invite a place, real or imagined, where the client feels calm and at ease. The client chooses it.
2. Cue each sense in turn: what they see (light, colours, near and far), hear, smell or taste, and feel (temperature, ground underfoot, air on the skin).
3. Ask whether they are in the scene or watching it, and whether anyone else is there. Others are present only if the client wants them.
4. Invite them to notice how the body feels here, and where calm is felt.
5. Have the client choose a cue to return quickly later: a word, a gesture, a detail of the place. [synthesis for the cue]
6. Return and debrief (4.16).
7. Optional: the client sketches or describes the place afterwards. [source: BSMHFT]
Example language (illustrative): "Let a place come to mind where you feel at ease. It can be somewhere you've been, or somewhere you make up… What do you notice around you? … What can you hear? … What's under your feet?"
Watch for: the place turning unsafe (a trauma intrusion, or an unwanted person appearing). Invite the client to change, leave or close the scene, or open their eyes. Never insist on a beach or nature scene, which can be aversive for some clients. Signs it is working: visible calming, a vivid description, and the client being able to re-enter it briefly at home.

4.6 Imagery in a minute

Purpose: a brief, eyes-open-possible version for busy clinical moments or between sessions. [source: Allina]
Steps:
1. Ask where the client would rather be right now.
2. Explore two or three sensory details and the feeling there.
3. Take one breath to anchor it.
4. Return.
Example language (illustrative): "If you could be anywhere for the next minute, where would it be? … What's the light like? … How does your body feel there?"
Watch for: use it as a coping micro-skill; agree a daily practice cue.

4.7 Dialling down pain (medical adjunct)

Purpose: symptom-coping imagery for pain, used within medical care after the pain has been assessed. [source: Allina]
Steps:
1. Have the client imagine a dial or 0–10 gauge and locate the current pain level on it.
2. Invite them to turn the dial down slowly, concentrating and noticing body responses.
3. Stop at a level that is tolerable and comfortable, and confirm it with the client.
4. Have the client "set" it with an image of their own choosing.
5. Record the rating before and after. [Steps 1–4 per Allina; recording synthesis]
Example language (illustrative): "Picture a dial that shows how strong the sensation is… Where is the needle now? … Slowly, at your own pace, see whether it can turn down a notch… and notice what your body does."
Watch for: new, worsening or unexplained pain needs medical review, not imagery. Do not imply that imagery replaces analgesia or treatment. Signs it is working: a lower rating and less guarding.

4.7a Glove anaesthesia imagery (medical adjunct)

Purpose: a pain-coping technique Bresler describes: the client first imagines numbness building in one hand, as if it were inside an anaesthetic glove, then transfers that numbness by placing the hand on the painful area. Use within medical care, after the pain has been assessed, as one coping tool alongside prescribed treatment. [source: Bresler 2005] It overlaps with clinical hypnosis; use it within your competence. [synthesis]
Steps:
1. Relaxation and deepening (4.3, 4.4).
2. Invite the client to focus on one hand and imagine a numbing, cool or tingling feeling spreading through it, as if a glove were slipping on. [source: Bresler 2005]
3. Ask for a signal when the hand feels noticeably different, and a rating of the change. [synthesis]
4. Have the client rest the hand on the painful area and imagine the numbness flowing across into it. [source: Bresler 2005]
5. Lift the hand away, let normal sensation return to the hand, re-alert (4.16), and record pain ratings before and after. [synthesis]
Example language (illustrative): "Let your attention settle in your right hand… notice any coolness or tingling… as if a soft, numbing glove were slipping on… When it feels different, give me a nod… Now rest that hand where the discomfort is, and let some of that numb feeling flow across."
Watch for: pain that is new, worsening or not yet medically assessed (refer, do not use imagery); normal sensation must return to the hand before the client leaves; never imply that the technique replaces analgesia or treatment. [synthesis]

4.8 Healing imagery (symptom-support imagery)

Purpose: in Rossman's self-healing approach, the client imagines their body's healing processes, or a soothing change in an affected area, to promote relaxation and a sense of agency during medical treatment. The publisher describes the book's aims as stimulating healing responses and building an inner dialogue about one's health; the procedure in the chapter itself ("Your Healing Imagery") is not reproduced here. Rossman's own conference teaching frames brief interactive imagery for people with cancer as a way to regain a sense of control and to support coping and decision-making during treatment [source: Erickson Foundation course listing, 2004]. Surgical programmes use a related form: imagining the operation going smoothly and recovery going well, practised from recordings before surgery. [source: Red Wheel/Weiser page; UW Osher handout] Steps below are [synthesis]. [uncertain: Rossman's own procedure]
Framing: offer it as a way to cope, relax and feel involved in one's own care, alongside medical treatment, never as a way to treat cancer or any other disease. Rossman's own published position is that these techniques should not take the place of responsible scientific medical care, should be used in tandem with it, and that the patient should first have a definitive diagnosis. [source: Encyclopedia.com entry on Rossman] Do not imply that the illness or its course depends on the quality of the client's imagery. [synthesis]
Steps:
1. Relaxation and the special place.
2. Invite an image of the area that needs care, in the client's own symbolism.
3. Invite an image of comfort or care reaching that area (warmth, light, coolness, soothing water, or the treatment doing its work), chosen by the client.
4. Notice body sensations and feelings.
5. Return and debrief.
Example language (illustrative): "Let an image come of the part of you that needs some care… and now an image of whatever would feel soothing there… There's nothing to force; just notice."
Watch for: blame or guilt ("my imagery wasn't strong enough"). Address this directly. Also watch for frightening body images; switch to the special place.

4.9 Meeting the inner advisor

Purpose: access the client's own intuitive knowledge, comfort and perspective through an imagined wise, caring figure. It is a core Rossman / Academy for Guided Imagery technique ("Meeting Your Inner Advisor"); Rossman holds that everyone can connect with an inner advisor. Bresler describes variants framed as an "Inner Advisor", "Inner Coach" or "Inner Doctor", used to support the client's recovery plans from within. It is also taught in the University of Minnesota imagery course. [source: New World Library TOC; Encyclopedia.com entry on Rossman; Bresler 2005; Coursera UMN outline; Rogel/UM recording] Treat the advisor's suggestions as the client's own ideas to weigh in the debrief, not as instructions. [synthesis]
Steps:
1. Relaxation and the special place.
2. Invite the client to bring to mind a question, or a need for comfort or guidance.
3. Invite a wise, kind figure to appear. It may be a person living or dead, an admired figure, an animal or a pet, and it is not to be analysed. [source: Rogel/UM recording]
4. Check that the figure feels safe and caring. If it does not, the client can dismiss it and invite another [synthesis].
5. The client greets the figure, asks their question or shares a concern, and receives whatever response comes (words, gesture, image or feeling) without interpreting it yet.
6. Optionally the client asks whether the advisor has anything else for them.
7. The client thanks the figure and lets it go. They are told the figure can be met again. They return.
8. Debrief: what came, what it might mean, what they want to do with it (move to 4.12).
Example language (illustrative): "In this place, let yourself become aware of a presence that is wise and kind toward you… It may be someone you know, an animal, a figure… Let it be whatever it is… If it feels right, ask it what you'd like to know, and simply notice the response."
Watch for: critical or frightening figures; offer the choice to dismiss them. A deceased loved one may bring grief, so allow time. Do not let the advisor's "advice" override clinical safety or medical decisions; discuss it in the debrief. Clients with conflicting beliefs may prefer an "inner wisdom" framing, or no figure at all.

4.10 Symptoms as symbols: dialogue with a symptom image

Purpose: explore what a symptom, feeling or problem "represents" by letting an image of it form and engaging with it. It is an interactive (IGI) technique (Rossman's chapter "Symptoms are Symbols"). The UW Osher handout gives the outline: focus on the pain, invite an image that may reveal something useful about it, then put a question to the image and let it answer. Its example is a Rossman patient whose pain appeared as a bird pecking at the area, which she then asked about the pain. [source: UW Osher handout; New World Library TOC; VA (interactive exploration for insight)] Steps 2 and 4 below follow that outline; the sensory exploration in step 3, the specific questions in step 4 and the exchange in step 5 are [synthesis]. [uncertain: exact IGI steps]
Steps:
1. Relaxation and the special place.
2. Invite the client to focus on the symptom or feeling and let an image form that represents it.
3. Explore it with all the senses: size, colour, texture, sound.
4. Invite the client to ask the image, through imagined dialogue, what it wants, what it is doing for them, and what it needs. They let the image answer, or answer as the image.
5. Ask what the client would like from it, and whether a change or exchange is possible.
6. Thank the image, return, and debrief toward action.
Example language (illustrative): "Let the tightness show itself as an image… What do you notice about it? … If it could speak, what might it say it's there for? … What does it need from you?"
Watch for: the image escalating into overwhelm (see §5). Medically unexplained or new symptoms still need medical assessment; insight work never replaces it.

4.11 Symbolic transformation

Purpose: change a distressing image deliberately (shrink it, move it away, recolour it, soften it) to shift the emotion or sensation it stands for. [source: VA (intentionally changing the image changes what it represents); GoodTherapy]
Steps:
1. The client forms an image of the distress (as in 4.10).
2. The client describes its qualities.
3. Invite one small change at a time, chosen by the client: making it smaller, further away, dimmer, quieter, cooler or softer.
4. After each change, ask what happens in the body. Keep changes that help and drop those that don't.
5. Optionally the client places the transformed image somewhere contained.
6. Return and debrief.
Example language (illustrative): "What would happen if it were just a little smaller? … Try that… What do you notice now?"
Watch for: forced positivity. If an image resists change, explore it (4.13) rather than override it. Signs it is working: lower subjective distress, and spontaneous body release such as a sigh or loosened shoulders.

4.12 Grounding the insight (from imagery to action)

Purpose: turn what emerged in imagery into concrete, realistic steps in daily life. Rossman's chapter is "Grounding Your Insight"; its own procedure is not reproduced here. The UW Osher handout describes the general move (after relaxing, approach the problem and look for solutions not considered before), and Bresler describes inner-advisor figures used to back the client's recovery plans. [source: New World Library TOC; UW Osher handout; Bresler 2005; GoodTherapy (discussion and planning)] Steps below are [synthesis].
Steps:
1. After the return, have the client state the main insight in one sentence.
2. Ask what one small action would honour it this week.
3. Check that the step is feasible, and look at obstacles and supports.
4. Optionally, briefly re-enter imagery and ask the advisor or symptom image whether the plan seems right.
5. Write the step down, and review it at the next session.
Example language (illustrative): "If you took that seriously, what's one small thing you'd do differently before we meet again?"
Watch for: insights that conflict with safety or medical advice (for example, stopping medication). Discuss them openly, and keep medical decisions with the treating team.

4.13 Learning from resistance

Purpose: treat difficulty imaging, blankness, scepticism or an inner "no" as information rather than failure. Rossman's chapter is "Learning From Your Resistance"; its own procedure is not reproduced here. Bresler describes the core move: invite an image to form for the part of the client that does not want to go along with the plan, then talk with that image to learn why it resists and what would help it ease. [source: Bresler 2005; New World Library TOC] Steps 2–3 below follow Bresler's outline; the rest is [synthesis]. [uncertain: Rossman's own procedure]
Steps:
1. Normalise the block.
2. Invite the client to let the resistance itself take an image form (a wall, a guard, a fog).
3. Approach it respectfully: ask what it protects them from and what it needs before it can ease.
4. Negotiate. The client may proceed more slowly, or not at all.
5. Debrief, and respect the answer.
Example language (illustrative): "It sounds like part of you isn't keen on this… That makes sense. Could we get to know that part a little: what is it concerned about?"
Watch for: resistance that signals trauma material or a mismatch with the client's beliefs. In that case switch method rather than push.

4.14 Image of wellness / end-state imagery

Purpose: build a vivid, motivating image of oneself well, coping or after a goal is reached, to strengthen hope and direction. Rossman's chapter is "Your Image of Wellness"; its own procedure is not reproduced here. Related published uses: Bresler encourages rehabilitation patients to imagine what they might be able to do "in time, over time", and surgical programmes have patients imagine an easy operation and recovery. [source: New World Library TOC; Bresler 2005; UW Osher handout] Steps below are [synthesis].
Steps:
1. Relaxation and the special place.
2. Invite an image of the client at a future point, doing well in the ways that matter to them.
3. Explore it with the senses: how they move, what they are doing, who is with them, how their body feels.
4. Ask what this future self knows that helped them get there.
5. Return, and link to the next step (4.12).
Example language (illustrative): "Imagine a time ahead when things are going well for you in the ways you care about… Where are you? … What are you doing? … How do you carry yourself?"
Watch for: with serious illness, keep the wellness image about quality of life, coping and values rather than cure, so as not to set up false hope or guilt. [synthesis]

4.15 Outcome and performance rehearsal imagery

Purpose: mentally rehearse a specific desired outcome or skill: a sports movement, a presentation, a medical procedure, an assertive conversation. [source: VA ("specific desired outcome", e.g. golf swing); Coursera UMN outline (imagery for performance)]
Steps:
1. Relaxation.
2. The client chooses the scene and the desired performance.
3. Rehearse it in the first person, in real time, with sensory and bodily detail: preparation, the action going well, and coping with a likely hitch.
4. Repeat two or three times.
5. Return, and plan real-life practice.
6. Steps 3–5 are [synthesis] (for example, including hitch-coping in the rehearsal).
Example language (illustrative): "See yourself walking into the room… feel your feet on the floor… hear your voice, steady… and if you stumble over a word, notice yourself pause, breathe and carry on."
Watch for: perfectionistic rehearsals that raise anxiety. Include realistic setbacks.

4.16 Re-alerting, closure and debrief

Purpose: return safely to ordinary alertness and consolidate what happened. It is required at the end of every imagery session. [source: Allina; Rogel/UM recording; GoodTherapy]
Steps:
1. Signal that the session is ending.
2. Invite the client to take a last look at the scene and note anything they want to bring back. If an advisor or symptom figure is present, they thank it and take leave of it.
3. Bring awareness back to the body and the breath, then to the room: sounds, the chair, the floor.
4. Invite movement (fingers, toes, a stretch). The client opens their eyes when ready.
5. Orient them: name the day and the place, look around [synthesis].
6. Debrief. What was it like? What stood out? What was learned? How do they feel now (a 0–10 rating)?
7. Check alertness before they leave, especially before driving [synthesis].
Example language (illustrative): "In a moment we'll come back… Bring with you whatever was useful… Feel the chair beneath you… wiggle your fingers… and open your eyes when you're ready."
Watch for: grogginess, lingering emotion or disorientation. Extend the grounding (see §5).

4.17 Interactive (dialogic) imagery with spontaneous images

Purpose: in a face-to-face session, follow the client's images as they arise, choosing themes in the moment and having the client describe the experience aloud. This contrasts with reading a fixed script. Hall et al. also describe using images that arise spontaneously in ordinary talk therapy. [source: SAGE Hall et al. 2006 chapter page; VA]
Steps:
1. Relaxation.
2. Give an open starting frame (a place, a path, an image of the feeling).
3. Ask the client to describe out loud what they notice, in the present tense.
4. Respond with brief, non-leading prompts: "What do you notice now?", "What happens next?", "How does that feel?". Use the client's own words.
5. Do not introduce content; offer choices only when the client is stuck.
6. Return and debrief.
7. If an image arises unprompted in ordinary talk (for example, "it's like a weight on my chest"), you can invite the client to stay with it briefly and explore it with the senses. [source for the spontaneous-image use: Hall et al. book summary; prompts synthesis]
Example language (illustrative): "You said it's like a weight… if you let yourself notice that weight now, what is it like?"
Watch for: your own leading suggestions. Keep prompts open, especially with memory-like material: never suggest events or people.

4.18 Scripted imagery (individual or group) and writing scripts

Purpose: a pre-written, multisensory imagery narrative read aloud to an individual or a group. It is useful for relaxation, groups and recordings. Hall et al. describe the scripted mode as more private and passive than the dialogic mode. [source: SAGE Hall et al. 2006 chapter page; Coursera UMN outline (writing your own script); VA (collections such as The Healing Waterfall)]
Steps:
1. Choose or write a script that matches the goal.
2. Use permissive, sense-rich, open language that lets each person fill in their own images.
3. Avoid specific settings that may be aversive (water, heights, crowds) unless the client chose them.
4. Build in pauses, and read slowly.
5. Include a clear return.
6. In groups, explain beforehand that anyone can open their eyes or stop, and leave time for sharing or drawing. [synthesis for steps 2–6 except group mode]
Example language (illustrative): "…and you may find yourself in a place that feels good to you, whatever it is…"
Watch for: in groups you cannot monitor everyone. Screen beforehand, and watch for anyone who is tearful, frozen or leaves.

4.19 Drawing to augment imagery

Purpose: externalise and process images after the experience. Hall et al. devote a chapter to drawing with imagery, and the NHS leaflet suggests a simple sketch of the calm place. In pain care, Bresler has patients draw their pain on admission and after treatment, discusses the drawings, and compares them over time: smaller, lighter, less jagged drawings indicated improvement. [source: Hall et al. book summary; BSMHFT; Bresler 2005]
Steps:
1. After the return, offer paper and pens.
2. The client draws the image or the experience, with no artistic standard.
3. Invite them to describe the drawing, and reflect it back in their own words.
4. Explore meaning and next steps. [steps synthesis]
Example language (illustrative): "Would you like to put something of that on paper? Shapes and colours are fine."
Watch for: the drawing can bring the experience back strongly; keep time to ground afterwards.

4.20 Music

Purpose: use background music to support relaxation and absorption. The University of Minnesota course covers music, entrainment and choosing music. [source: Coursera UMN outline] [uncertain: the course's specific selection criteria are not reproduced here]
Steps: ask the client's preference. Use slow, predictable instrumental music with no lyrics at low volume, or silence [synthesis].
Watch for: music that carries strong personal associations or grief.

4.21 Recording and home practice

Purpose: transfer the skill to daily life. [source: VA; Allina; BSMHFT; Coursera UMN outline]
Steps:
1. With the client's consent and under your service's recording policy, record the in-session imagery (the client's place and words), or recommend a vetted recording.
2. Agree a brief daily practice (5–20 min), plus the "imagery in a minute" cue for stressful moments.
3. The client keeps a simple log of practice and before/after ratings.
4. Review it next session. [frequency and log synthesis]
Watch for: recordings used in unsafe settings (driving), and over-reliance on the recording. Fade it towards self-guided practice.

4.22 Trauma-informed use: stabilisation imagery only

Purpose: guided imagery as described here is a stabilisation and coping tool, not a trauma-memory processing method. With trauma survivors, start with resource imagery only: the safe place, a container, comforting figures, grounding. Do this within a phased trauma treatment plan. This matches the first of Naparstek's three stages (safety and control: self-soothing skills for flashbacks, nightmares and intrusive thoughts); see 4.23 for her later stages. [source: Hay House page for the Naparstek set; VA and GoodTherapy caution that unprocessed trauma may surface; rest synthesis]
Readiness criteria before any eyes-closed imagery [synthesis]:
- The client can notice and name rising distress, and can use at least one eyes-open grounding skill.
- No current severe dissociation.
- A stop signal is agreed.
- There is time left in the session to ground.
Steps:
1. Start with eyes open, with short exposures (1–3 min) of resource imagery.
2. Check in frequently.
3. Lengthen gradually as tolerance builds.
4. Close with external orientation.
5. If memory processing is indicated, refer to, or use, a dedicated trauma-focused therapy with its own published protocol. Do not improvise memory work in imagery.
Example language (illustrative): "Let's keep our eyes open for this first try, and check in after a minute or so."
Watch for: intrusive memories, freezing or spacing out. See the overwhelm and dissociation responses in §5. Treat any memory-like images as present experience: never suggest, probe for or "recover" past events, and never treat imagery content as historical fact.

4.23 Naparstek's three-stage trauma imagery sequence (recorded imagery within phased care)

Purpose: Belleruth Naparstek (Invisible Heroes, 2004) organises imagery for post-traumatic stress into three stages of recovery, delivered mainly as recorded imagery for daily listening. The publisher describes the arc as moving from immediate relief of anxiety attacks, flashbacks, nightmares and insomnia, to relief from depression and isolation, to renewed engagement with life. Naparstek holds that imagery works on non-verbal processing and that talk-heavy trauma work can worsen symptoms in some survivors; these are her claims, not settled mechanism. [source: Penguin Random House page; Spirituality & Practice review] The publisher says the set can be used on its own or with other treatment; in clinical use, keep it inside a clinician-led phased trauma plan. [source: Hay House page; synthesis]
Stages as published (stage names and track themes from the companion audio set; script wording not reproduced) [source: Hay House page; Playaway page]:
1. Stage 1, establishing safety and control (protection and support): the goal is self-soothing skills to use during flashbacks, nightmares and intrusive thoughts. Content: relaxation imagery, a walking meditation, imagery for restful sleep. The publisher notes that for some listeners this stage alone substantially reduces symptoms.
2. Stage 2, deeper healing and integration: imagery addressing depression, grief and the trauma itself.
3. Stage 3, clean-up and renewal: imagery for confidence and self-worth, and for anger and forgiveness, plus brief affirmations.
Dosing: listening once or twice a day for 2–3 weeks is suggested for the set. [source: Hay House page] The sources cited give no criteria for moving between stages, and do not say how the trauma track is structured and dosed within a session. [uncertain]
Steps for the clinician [synthesis]:
1. Assess and stabilise first (4.1; readiness criteria in 4.22). Screen for dissociation, current crisis and substance use.
2. Assign Stage 1 material only. Review practice weekly: sleep, frequency of flashbacks and nightmares, distress during and after listening.
3. Move to Stage 2 only when the client reliably calms themselves with Stage 1 skills, distress after listening settles quickly, and dissociation or intrusions are not increasing. Agree that the client stops a track and uses a Stage 1 skill if distress rises.
4. Play the trauma track in session first, with grounding and debrief (4.16), before assigning it at home. If the client cannot tolerate it, stay with Stage 1 and consider a trauma-focused therapy with its own published protocol.
5. Use Stage 3 tracks to consolidate, linking confidence and anger-and-forgiveness work to real-life steps (4.12).
Example language (illustrative): "For the next couple of weeks the only job is the calming tracks, once or twice a day. We'll look together at how your sleep and the flashbacks go before we add anything else."
Watch for: rising intrusions, nightmares or dissociation after listening (step back to Stage 1; see §5); listening while driving; forgiveness imagery felt as an obligation (forgiveness is the client's choice). Treat any memory-like images as present experience; never use the tracks to "recover" or verify memories. [synthesis]

5. Handling problems

The sources name the challenges (difficulty imaging, temporary increase in anxiety, emotional release, falling asleep, unprocessed trauma surfacing) but give few responses. [source: GoodTherapy; Allina; VA] Unless tagged otherwise, the responses below are [synthesis].

"I can't see anything" or poor imagery ability. Normalise it: imagery need not be visual. Switch to the client's strongest sense (4.2), such as the feel of the sun, a sound or a remembered smell. Use eyes-open imagery, or a concrete memory of a real place. Shorten the exercise. Drop any demand for vividness. Clients often report images becoming clearer with practice. [source for the practice effect: Allina; BSMHFT]
Stuck or blank mid-imagery. Offer a choice of two or three open options ("You might be indoors or outside…"). Ask about the body instead of pictures. Or treat the blankness itself as an image and explore it (4.13).
Resistance or scepticism. Acknowledge it. Explain the rationale in plain physiological terms (imagery as a way to calm stress arousal). Offer a short trial with a rating before and after. Or approach the resistance through imagery (4.13). Do not persuade. If the client declines, use another method.
Belief conflicts (for example, discomfort with "spirit guides" or a sense that imagery is unacceptable to their faith). Ask what fits. Use secular "inner wisdom" framing or faith-congruent figures the client chooses, or do not use imagery. [source: VA; Allina flag the issue]
Relaxation-induced anxiety or panic. Open the eyes. Use an external focus (name five things you see). Use an eyes-open, shorter, movement-friendly version. Avoid a breath focus if breath cues trigger panic.
Overwhelm: a distressing image, emotion or bodily memory surfaces.
1. Slow your voice.
2. Remind the client of their control: they can change, distance or leave the image, or open their eyes.
3. Offer the safe place or a container image.
4. If distress continues, move to eyes-open grounding: feet on the floor, describe the room, hold a cold object, paced breathing.
5. Once the client is regulated, debrief, and validate the emotion as meaningful rather than as failure.
6. Check that they are safe to leave, and review the plan, including readiness for imagery and whether trauma-focused treatment is needed.
7. Record what happened. [source for unprocessed trauma surfacing: VA; GoodTherapy]
Dissociation (spacing out, flat voice, delayed responses, "far away"). Stop the imagery. Use the client's name. Ask orienting questions (date, place). Use sensory grounding with eyes open. Do not resume eyes-closed imagery that session. Re-screen for dissociation, and adapt or stop imagery. [source: GoodTherapy lists severe dissociation as a caution]
Memory-like content or "Did this really happen?" Treat it as present experience and meaning, not as evidence. Do not interpret it as proof of past events. Do not pursue it with imagery. If the client is preoccupied, discuss the reconstructive nature of memory, and refer for appropriate trauma-informed therapy if needed. [synthesis]
Falling asleep. Use a more upright posture and a shorter session. Keep your voice engaged and invite occasional responses. For clients with insomnia, sleeping during home practice can be acceptable if that is the aim. [source: Allina flags sleep risk]
Non-adherence to home practice. Shrink the task (1-minute imagery, 4.6). Attach it to an existing routine. Give a personalised recording in the client's own imagery. Explore barriers (time, privacy, scepticism). Review the log non-judgementally.
Ruptures (the client felt led, judged or exposed). Name and invite feedback ("Did anything I said not fit?"). Acknowledge any leading cues on your part. Return control: the client chooses the content and pace, and you use more of their words and fewer of yours. [source for minimal, mirroring language: Allina]
Unrealistic expectations or guilt in physical illness. Correct the idea that imagery can cure disease, or that outcomes reflect "imaging well". Reframe the goal as coping, comfort, agency and quality of life. Liaise with the medical team. Never support stopping or delaying medical treatment. [synthesis]
New or worsening physical symptoms during imagery work. Pause symptom imagery and refer for medical assessment.
Unwanted or frightening figures (in the advisor or symptom work). The client may dismiss them, ask them to step back, or return to the safe place. Explore them later, only if the client wishes.
Grief activated (a deceased loved one appears). Allow it, with time. Debrief gently. Consider grief-focused support.
Psychotic or reality-testing concerns emerge. Stop the imagery. Use grounding and reality-based conversation. Assess, and refer for psychiatric review. Psychosis is a listed contraindication. [source: VA; GoodTherapy]
Suicidal content appears in imagery (for example, images of not existing). Pause the imagery. Do a standard risk assessment and safety plan, including lethal-means counselling where indicated. Resume imagery only when the client is stable.
Group imagery: one participant becomes distressed. Use a pre-agreed signal and a co-facilitator who can step out with them. Close the imagery for the group with a full return. Follow up individually.

Sources

Web sources:

Further web sources:

Books cited (used through publisher pages and listings; [uncertain] where relied on):

Rossman, M. L. (2000). Guided Imagery for Self-Healing (2nd ed.). H J Kramer / New World Library.
Hall, E., Hall, C., Stradling, P., & Young, D. (2006). Guided Imagery: Creative Interventions in Counselling & Psychotherapy. SAGE.
Naparstek, B. (1994). Staying Well with Guided Imagery. Warner.
Naparstek, B. (2004/2005). Invisible Heroes: Survivors of Trauma and How They Heal. Bantam.

[uncertain] Rossman's chapter procedures (including his chapter on guided imagery and interactive guided imagery in Rakel (ed.), Integrative Medicine), the Academy for Guided Imagery's IGI training manual and the Invisible Heroes scripts are not reproduced here. Exact IGI procedures may differ from the steps given, which are anchored where possible in Bresler's and the Osher handout's outlines and otherwise tagged [synthesis]; criteria for moving between Naparstek's stages and in-session dosing of the trauma track are not given in the sources cited (4.23).

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