Catathymic imaginative psychotherapy (Guided Affective Imagery)

1. Introduction

Version followed: Leuner's classical three-level KIP (Grundstufe / Mittelstufe / Oberstufe, with his guiding techniques), read through the current psychodynamic textbooks of the German-language training tradition: Bahrke & Nohr (2013; English edition 2023) and Ullmann et al. (2017, Kohlhammer). Ullmann et al. use a two-step scheme (Grundstufe / Aufbaustufe) in their chapter structure; where the two schemes differ this guide names which one it follows. Most primary material drawn on was publisher reading samples and tables of contents, so step-level detail is partly built from secondary sources and marked.

Katathym Imaginative Psychotherapie (KIP), first called Katathymes Bilderleben (KB), also "Symboldrama", and in English Guided Affective Imagery (GAI), was developed by the Göttingen psychiatrist and psychoanalyst Hanscarl Leuner (1921–1996), who introduced it in 1955 [source: Springer 2023 book page; psychotherapeutensuche.de]. It is a psychodynamic, depth-psychological method: the patient, mildly relaxed with eyes closed, develops a daydream from a motif the therapist proposes (e.g. a meadow) and describes it aloud while the therapist accompanies in dialogue [source: psychotherapeutensuche.de; Spektrum Lexikon]. "Katathym" refers to the way affect shapes the images [source: Bahrke & Nohr 2013 sample, pp. 8–10; Spektrum Lexikon].

Core idea of change: the imagined scenes give symbolic, affect-laden form to unconscious wishes, conflicts, defences and the transference relationship, so they can be seen, lived through and worked on [source: Springer 2023 book page]. Bahrke & Nohr name four functions of the imagery: expression and clarification (making the unconscious symbolically visible), enlivening (affect experience, including imagined trial action), stabilisation (activating resources, binding anxiety, prompting self-care) and an aesthetic/creative function [source: Bahrke & Nohr 2013 sample, pp. 14–15]. A popular summary names four levels of effect: ego-strengthening (calming), regression (meeting earlier experience, the "inner child"), symbolic confrontation until things shift in a more bearable direction, and distancing (the overview from the mountain, the "katathymes Panorama") [source: therapie.de]. In Germany practice is reserved for psychologists and physicians with psychotherapy licensure [source: Ullmann et al. 2017 sample, p. 15].

2. Framework

KIP is not a fixed-session protocol; it is a technique embedded in psychodynamic short-term, depth-psychologically based, or analytic therapy. Bahrke & Nohr's three cases illustrate the range: a 21-session short-term therapy, a 50-session psychodynamic therapy and a 620-session analytic therapy [source: Bahrke & Nohr 2013 sample, pp. 3–4; Springer 2023 TOC].

Phase A: first contact, history, indication. Detailed history and current complaints first [source: psychotherapeutensuche.de]. The indication is set by asking which psychodynamic working model applies (conflict, developmental/structural deficit, or trauma), using structural diagnosis (OPD axis 4), and whether the goal is insight, managing external conflict, building structure, or stabilisation [source: Bahrke & Nohr 2013 sample, pp. 13–14]. Where benefit is foreseeable, one imagery sequence may already be done in the trial (probatory) sessions and fed into diagnosis and the insurance report [source: Bahrke & Nohr 2013 sample, pp. 12–13].

Phase B: initial imagination (initialer Tagtraum). A first imagination (classically a flower; Leuner also used flower and tree diagnostically) serves structural diagnosis and shows how the patient relates to the motif and to the therapist [source: Ullmann et al. 2017 sample, p. 13 and TOC §4.2; Ponomareva 2015]. For structurally impaired patients, a longer relationship-building period may precede the first imagination to prevent uncontrolled early regression [source: Dieter 2006, p. 18].

Phase C: Grundstufe (basic level). Standard motifs: meadow, brook, mountain, house, forest edge. Standard motifs ease access to the inner world mainly at this level [source: Ullmann et al. 2017 sample, p. 14; Ponomareva 2015; Kretschmar & Tzschaschel 2014 TOC]. Guiding is mostly accompanying; Leuner's first-level guiding principles are feeding and reconciliation [source: Ponomareva 2015].

Phase D: Mittelstufe (middle level). Motifs: significant figure (Bezugsperson), rose bush or car ride (sexuality), lion (aggression), ego-ideal (identity). Imagery becomes freer and more associative, often linked to childhood memories; focusing on acute conflicts is also used [source: Ponomareva 2015; Kretschmar & Tzschaschel 2014 TOC].

Phase E: Oberstufe (higher level). Motifs: cave, swamp hole, volcano, folio (old book). Reserved for highly qualified therapists who have completed higher-level training and personal therapy [source: Ponomareva 2015; Kretschmar & Tzschaschel 2014 TOC; Spektrum Lexikon]. In Ullmann et al.'s two-step scheme, everything beyond the basic motifs falls under the Aufbaustufe [source: Ullmann et al. 2017 sample, TOC §§5.2, 5.4].

Session format. Pre-talk, brief relaxation, imagery of about 20 minutes on average (varies with age and motif), closing questions and return to the here-and-now; interpretation is not done the same day but by the patient at the next session; patients draw an image between sessions [source: Ponomareva 2015]. Imagination sessions alternate with sessions for working through [source: Dieter 2006, p. 3]. Children's diagnostic imaginations were around 10 minutes [source: Hörn 1982, p. 57].

Dose and frequency. Short-term courses typically 8–25 sessions, one to two per week initially, then every 7–10 days [source: Ponomareva 2015, Russian symboldrama tradition]; with regressive patients, higher session frequency [source: Dieter 2006, p. 23]. Settings: individual, couples, group (G-KIP), inpatient, children and adolescents, with family imaginations [source: Ullmann et al. 2017 TOC; psychotherapeutensuche.de; Lehmanns TOC of child/adolescent KIP book].

Criteria for moving between levels. No explicit published criteria are given here [uncertain]. [synthesis] Move from Grundstufe to Mittelstufe motifs when the patient (a) can stay in an imagination and report it with affect, (b) tolerates frightening figures with the therapist's help and can return calmly, (c) can link images to life themes in the next-session talk; use Oberstufe motifs only with Oberstufe training and stable structure. Revert to resource and basic motifs whenever affect regulation slips.

3. Guiding principles

The image is a relationship message. The motif you offer should be emotionally attuned to the patient's needs and current state; the offer itself communicates something about the relationship [source: Dieter 2006, p. 11]. Practical meaning: choose motifs from what the hour is about, not from a checklist.
Unobtrusive empathic companion. The therapist accompanies the patient's self-exploration rather than directing it [source: Dieter 2006, p. 3]. Practical: brief acknowledgements and open questions, few suggestions.
Steer as little as possible. Less steering is associated with better outcome; special techniques only when specifically indicated [source: Brookhouse, summarising Leuner; secondary]. Practical: if in doubt, ask what the patient sees rather than suggest.
Open, non-leading questions. Ask about visual and bodily detail without embedding answers to minimise suggestion [source: Ponomareva 2015]. Practical: "What do you notice?" not "Is the water cold?"
Relaxation, but not too much. Leuner asked patients to relax "aber nicht zu sehr" (not too much) [source: Ullmann et al. 2017 sample, p. 13]; relaxation and image plasticity form a circular process that depends on structure level and transference and is easily disturbed [source: Bahrke & Nohr 2013 sample, p. 14]. Practical: short induction; watch the relationship if images will not come.
Imagery is relational work. Imaginations are worked within transference and resistance [source: Springer 2023 book page; Bahrke & Nohr 2013 sample]. Practical: look at what the patient shows you, how, and what it means between you.
Indication by working model. Conflict, structural deficit and trauma call for different uses (insight vs. structure-building vs. stabilisation) [source: Bahrke & Nohr 2013 sample, pp. 13–15]. Practical: diagnose structure before choosing confrontational motifs.
Explicit vs implicit technique. For neurotic patients with mature symbolising capacity, classical explicit technique (standard motifs, guiding rules, working-through hours). For borderline, post-traumatic and developmental pathology, an implicit technique where the therapist contains and mirrors archaic self-states and verbal interpretation serves relationship regulation more than insight [source: Dieter 2006, pp. 2–3, 13, 16–17, 27]. Practical: with fragile patients, hold and mirror; do not interpret the symbols.
Interpretation belongs to the patient. Clients often decode their symbolism themselves; interpretation is done jointly and not in the same session [source: psychotherapeutensuche.de; Ponomareva 2015]. Practical: ask the patient what the image means to them next time.
Nourish and reconcile before fighting. Leuner's principle of feeding and reconciling [source: Hörn 1982, p. 59; Ponomareva 2015]. Practical: befriend threatening figures before any confrontation.
Therapist roles. The therapist is described as protector, confidant and demanding figure [source: Kretschmar & Tzschaschel 2014 TOC]. Practical: offer safety, but also ask the patient to look and stay.
Competence by level. Oberstufe motifs and the most aggressive techniques only with corresponding training [source: Ponomareva 2015; Brookhouse summarising Leuner]. Practical: stay within the level you were trained in.

4. Intervention inventory

All example wording is my own paraphrase, marked (illustrative); no founder script is reproduced. Motif meanings are given as the sources describe them and are working hypotheses, not fixed dream-dictionary meanings.

4.1 Screening, indication and consent

Purpose: decide whether imagery fits this patient, at which level and with which technique (explicit or implicit).
Steps: (1) Take history and current complaints [source: psychotherapeutensuche.de]. (2) Formulate the working model (conflict, structural deficit, trauma) and assess structure, e.g. with OPD axis 4 [source: Bahrke & Nohr 2013 sample, pp. 13–14]. (3) Screen for contraindications (see 5.1). (4) Explain the method: eyes closed, mild relaxation, describe aloud whatever appears, the patient can open the eyes and stop at any time [synthesis]. (5) Obtain consent to try one imagination, possibly within the trial sessions [source: Bahrke & Nohr 2013 sample, pp. 12–13].
Example language (illustrative): "I'd like to suggest a picture and you just let something appear and tell me about it. Nothing has to be right. If it gets uncomfortable, open your eyes and we'll stop."
Watch for: fear of losing control, wish to please with "nice" images, history of psychosis or severe dissociation, current crisis.

4.2 Relaxation induction

Purpose: a light hypnoid state in which images become vivid while dialogue stays possible.
Steps: (1) Patient sits comfortably or lies on a couch [source: Spektrum Lexikon]. (2) Eyes closed. (3) A brief relaxation, sometimes only the request to settle and relax; in fuller form, suggestions of calm, heaviness and warmth through body parts, close to the first two stages of autogenic training [source: Ponomareva 2015]. (4) Keep it light: relaxed, "but not too much" [source: Ullmann et al. 2017 sample, p. 13]. (5) Give the motif.
Example language (illustrative): "Settle into the chair... let your breathing find its own pace... your arms can get a little heavy... you stay here with me and can talk to me the whole time."
Watch for: relaxation and image plasticity reinforce each other, but the loop is disturbed by low structure and transference tension [source: Bahrke & Nohr 2013 sample, p. 14]; if images stay blank, explore the relationship rather than deepening.

4.3 Initial imagination and diagnostic motifs (flower, tree)

Purpose: structural diagnosis; see how the patient imagines and relates to the therapist; test suitability.
Steps: (1) After induction, invite a flower to appear in the mind's eye, noting that something else may come [source: Ullmann et al. 2017 sample, p. 13]. (2) Ask for detail (colour, form, surroundings, how it feels to look at it). (3) Tree is another diagnostic motif Leuner used [source: Ponomareva 2015]; a 2018 society journal paper discusses "Baum und Traumbaum" [source: Imagination 3–4/2018 TOC]. (4) Note vividness, affect, ease of contact, and how the patient responds to your questions. (5) Return and talk briefly.
Example language (illustrative): "Let the image of a flower come... any flower, or whatever turns up instead. Describe it to me."
Watch for: flat, list-like reports (possible as-if mode), sudden intense archaic images (fragility) [source: Dieter 2006, pp. 15–21]; in children, how intensely they experienced it in the follow-up talk [source: Hörn 1982, pp. 56–57].

4.4 Motif selection (Motivvorgabe)

Purpose: choose a starting image that opens the relevant theme at a tolerable intensity.
Steps: (1) Start from what the hour is about and the patient's state; the motif is a relationship message [source: Dieter 2006, p. 11]. (2) Standard motifs at the basic level; more personal motifs later. (3) A motif may come from the therapist's countertransference (Dieter's example: a pram), used as a kind of proto-interpretation [source: Dieter 2006, pp. 21, 25]. (4) Continuation motifs pick up an unfinished scene from a previous imagination [source: Lehmanns TOC, Fortsetzungsmotive p. 154; steps uncertain].
Example language (illustrative): "Last time you stopped at the door of the house. If you like, let yourself arrive there again."
Watch for: motifs that are too confrontational for current structure; repeated identical motifs over many sessions can be useful (Dieter's patient had eight similar landscape imaginations before a shift) [source: Dieter 2006, p. 19].

4.5 Grundstufe motif: meadow (Wiese)

Purpose: usual first motif; shows current mood and basic emotional climate; all senses can be used [source: therapie.de].
Steps: (1) Induction. (2) Invite a meadow. (3) Explore season, weather, grass, flowers, smells, sounds, temperature, edges, whether the patient is alone. (4) Let the patient move and act in it (lie down, touch, walk). (5) Close via resource or the same place.
Example language (illustrative): "Let a meadow appear... what is underfoot?... what time of year might it be?"
Watch for: barren, fenced or threatening meadows as signs of mood or conflict; let the patient find what helps there rather than repairing it for them.

4.6 Grundstufe motif: brook (Bach) / river

Purpose: associated with flow of emotional life and the unconscious; murky water may signal a difficult emotional state [source: therapie.de]. Water also carries the magic-fluid technique (4.20).
Steps: (1) Invite a brook or stream, often from the meadow. (2) Explore water colour, clarity, temperature, banks. (3) Optionally invite the patient to follow it in a direction of their choosing and see where it leads [synthesis on direction]. (4) Invite contact (hands in the water, drinking) if the patient wishes.
Example language (illustrative): "Is there water somewhere nearby?... what is it like?... would you like to follow it for a bit?"
Watch for: dried-up, blocked or dangerous water; avoid forcing contact.

4.7 Grundstufe motif: mountain (Berg)

Purpose: associated with performance and achievement themes; a hard climb may point to a performance conflict [source: therapie.de]. The view from the top gives distance and overview, the "katathymes Panorama" [source: therapie.de].
Steps: (1) Invite a mountain seen from the meadow. (2) Explore height, shape, path. (3) Invite the patient to climb at their own pace. (4) At the top, ask them to look around in all directions and describe the landscape. (5) Descend or return.
Example language (illustrative): "If you look over to the horizon, is there a mountain?... would you like to climb it?... what do you see from up there?"
Watch for: giving up, being carried, refusing the climb; these are material for the talk, not failures.

4.8 Grundstufe motif: house (Haus)

Purpose: symbolises the self; a dark, unfriendly house is experienced as burdensome [source: therapie.de].
Steps: (1) Invite a house. (2) Explore outside first, then whether to go in. (3) Room by room at the patient's pace: kitchen, living rooms, upper floor, cellar, attic. (4) Notice who or what is there. (5) Leave by the way they came.
Example language (illustrative): "Let a house come into view... how does it look from outside?... would you like to go in?"
Watch for: locked rooms, cellars and attics often hold charged material; the patient decides whether to open them.

4.9 Grundstufe motif: forest edge (Waldrand)

Purpose: standard basic-level motif [source: Ponomareva 2015; Kretschmar & Tzschaschel 2014 TOC]. [uncertain] Its stated meaning is not given here. [synthesis] It is commonly used to let something emerge from the dark wood, giving the patient a figure to meet from a safe distance.
Steps: (1) From the meadow, the patient looks toward the edge of a forest. (2) Ask what they see in the dark of the trees and wait. (3) If a figure appears, explore it from a distance and decide with the patient how to respond (observe, approach, feed, reconcile).
Example language (illustrative): "Look over at the edge of the woods... take your time... is anything there?"
Watch for: threatening figures; stay with distance and the reconciling techniques; do not push toward confrontation early.

4.10 Mittelstufe motif: significant figure (Bezugsperson)

Purpose: explore relationships to parents or other important persons, directly or in symbolic animal form [source: Ponomareva 2015; Spektrum Lexikon (encounters with reference persons)].
Steps: (1) Invite the person or a symbolic animal representing them. (2) Explore appearance, distance, how they relate to the patient. (3) Let a dialogue develop if the patient wishes (see induced dialogue, 4.24).
Example language (illustrative): "Let your mother appear, perhaps as she is, perhaps as an animal... where is she in relation to you?"
Watch for: strong transference shifts toward the therapist after such imaginations.

4.11 Mittelstufe motif: rose bush / car ride

Purpose: sexual attitudes; historically the rose bush for men and the car ride for women [source: Kretschmar & Tzschaschel 2014 TOC; Ponomareva 2015]. [synthesis] The gendered assignment reflects its era; choose by clinical fit, not gender.
Steps: (1) Invite the motif (e.g. picking a rose; or driving or being driven in a car). (2) Explore approach, permission, pleasure, obstacles. (3) Debrief carefully.
Example language (illustrative): "There may be a rose bush somewhere... how would you like to approach it?"
Watch for: shame, intrusive memories; do not use with patients with sexual trauma without stabilisation and explicit consent [synthesis].

4.12 Mittelstufe motif: lion (Löwe)

Purpose: aggression, how the patient handles their own and others' aggression [source: Ponomareva 2015 (lion, wild cat); Kretschmar & Tzschaschel 2014 TOC].
Steps: (1) Invite a lion. (2) Explore its state and how it relates to the patient. (3) Ask how it would react to a person who troubles the patient [synthesis]. (4) Use feeding or reconciliation if it turns on the patient.
Example language (illustrative): "Let a lion appear... what is it doing?... how close is it to you?"
Watch for: a lion that attacks the patient, or a toothless one, as material for the talk.

4.13 Mittelstufe motif: ego-ideal (Ich-Ideal)

Purpose: identity [source: Ponomareva 2015; Kretschmar & Tzschaschel 2014 TOC].
Steps: (1) Invite the figure of the person the patient would like to be. (2) Explore appearance, distance, the patient's feelings toward them. (3) Explore what separates them [synthesis].
Example language (illustrative): "Let a person appear who is the way you would like to be... what are they like?"
Watch for: idealised, unreachable figures (narcissistic themes) or contempt.

4.14 Oberstufe motifs: cave, swamp hole, volcano, folio

Purpose: deep regressive material: cave (pre- and perinatal themes), folio/old book (personal meaning), volcano and swamp hole (aggression and fear) [source: Ponomareva 2015]; cave and swamp hole evoke symbolic or archaic images [source: Spektrum Lexikon].
Steps: Only after Oberstufe training and own therapy [source: Ponomareva 2015]. [synthesis] Prepare a resource image beforehand, agree a stop signal, keep the patient observing from a safe position, and plan a working-through session.
Example language (illustrative): "From where you stand, you can see an opening in the rock... you can stay right here and just look."
Watch for: uncontrolled regression; do not use with structurally impaired or acutely traumatised patients [synthesis].

4.15 Accompanying (Begleitung) during the imagination

Purpose: the default stance throughout; keeps the patient in contact and deepens experience without steering.
Steps: (1) Follow with brief acknowledgements. (2) Ask open questions about visual and kinaesthetic detail and about feelings. (3) Avoid questions that contain the answer. (4) Only if needed, gently steer in line with the treatment strategy [source: Ponomareva 2015]. (5) Use special techniques only when specifically indicated [source: Brookhouse summarising Leuner; secondary].
Example language (illustrative): "Mm-hm... what else do you notice?... and how is that for you, being there?"
Watch for: your own urge to fix the scene; with fragile patients, the accompanying itself is the intervention (containing, mirroring) [source: Dieter 2006, pp. 16–17].

4.16 Guide figure ("inner psychic pacemaker")

Purpose: let a benign figure lead the patient where the unconscious wants to go.
Steps: When a friendly animal (e.g. a horse or dog) appears, suggest it may lead the way; the patient follows and reports the journey [source: Brookhouse summarising Leuner 1969; secondary, uncertain on detail].
Example language (illustrative): "The dog seems to want to go somewhere. Would you like to follow and tell me where it takes you?"
Watch for: a guide leading into overwhelming scenes; stop and stabilise.

4.17 Symbol confrontation (Konfrontieren)

Purpose: face a threatening figure so its meaning can emerge and its power diminish; the imagery is worked through by mirroring, confronting and interpretive help [source: Spektrum Lexikon]; unpleasant themes are approached symbolically until they change in a more bearable direction [source: therapie.de].
Steps (per Brookhouse's summary of Leuner): the patient stands still facing the figure and, where appropriate, looks it in the eyes, to discover what it represents [secondary]. [synthesis] Before: check structure and current stability; agree a stop signal. During: keep the patient grounded in the body and in your voice; ask what the figure's eyes, size and movement are like; note changes. After: return to a resource image.
Example language (illustrative): "Stay where you are. You don't have to move toward it. Can you look at its face?... what happens as you look?"
Watch for: confrontation can provoke strong emotions [secondary]; with structurally impaired or traumatised patients, avoid and use feeding or reconciliation instead [synthesis].

4.18 Feeding (Nähren / Füttern)

Purpose: soften a threatening figure when confrontation is too much; also nourish deficient figures. Part of Leuner's principle of nourishing and reconciling, one of his first-level guiding principles [source: Hörn 1982, p. 59; Ponomareva 2015].
Steps: (1) The patient imagines food the figure would want, in ample amount. (2) Feeds it from a safe distance until it becomes drowsy and docile [source: Brookhouse summarising Leuner; secondary]. (3) Observe the change. Hörn's child patient fed imagined prisoners [source: Hörn 1982, p. 59].
Example language (illustrative): "What might the wolf like to eat?... you can have plenty of it with you... toss it over and see what it does."
Watch for: the patient's own neediness may show in what they choose to feed; material for the talk.

4.19 Reconciliation (Versöhnen)

Purpose: turn an enemy figure into an ally by friendly contact.
Steps: The patient speaks to the figure, offers friendship or tenderness, possibly touch, alone or combined with feeding or confrontation [source: Brookhouse summarising Leuner; secondary; principle in Hörn 1982, Ponomareva 2015].
Example language (illustrative): "Now that it's calmer, is there something you'd like to say to it?... how does it respond?"
Watch for: premature reconciliation with figures standing for real abusers; do not push it [synthesis].

4.20 Magic fluids (magische Flüssigkeiten)

Purpose: relief and renewal.
Steps: The patient imagines bathing in a stream or using another fluid to ease aches or refresh; other substances only if the patient agrees [source: Brookhouse summarising Leuner; secondary]. A 2018 society-journal paper addresses water symbols in affect processing [source: Imagination 3–4/2018 TOC; uncertain].
Example language (illustrative): "If you like, step into the water... where on your body would it feel good?"
Watch for: medical complaints: use only as an adjunct after medical assessment, never as treatment of physical disease [synthesis].

4.21 Exhausting and killing (historical; not recommended)

What it was: Leuner described exhausting a threatening figure until it died and dissolving its remains, and regarded it as the most dangerous technique, for very experienced therapists only, because the patient may experience it as an attack on themselves [source: Brookhouse summarising Leuner; secondary].
Use today: no current source cited recommends it [uncertain]. [synthesis] Do not use; reconciliation and feeding cover the indication more safely.

4.22 Associative approach and focusing on acute conflicts

Purpose: at the middle level and with adolescents, let images unfold freely rather than following a set motif; or start directly from a current conflict.
Steps: (1) Begin from a feeling, a bodily sensation or a current situation. (2) Let the patient follow what appears, image to image, often into childhood memories [source: Ponomareva 2015; associative approach named in Lehmanns TOC p. 152]. (3) Stay accompanying. (4) Treat memories as current experience, not as facts to be verified (see 5.4).
Example language (illustrative): "Stay with that tightness in your chest... let a picture form around it."
Watch for: loss of structure; return to a known motif if the flow becomes chaotic.

4.23 Imagined trial action (imaginiertes Probehandeln)

Purpose: enliven affect and rehearse new behaviour in the image [source: Bahrke & Nohr 2013 sample, pp. 14–15].
Steps: (1) Identify a feared or blocked action. (2) Let the patient do it in the scene. (3) Explore what happens. Hörn's therapist asked a child what he would do if he could do anything he wanted, which led to rearranging his room and meeting his parents' opposition [source: Hörn 1982, p. 58].
Example language (illustrative): "If you could do anything here, what would you do?... go ahead, and tell me what happens."
Watch for: magical, effortless solutions vs. struggles that show the real conflict.

4.24 Induced dialogue; role and perspective taking

Purpose: named techniques in the adolescent KIP literature [source: Lehmanns TOC pp. 158, 160]. Text is not drawn on here [uncertain]. [synthesis] Steps: ask the patient to speak to a figure and hear its answer; or, briefly, to see the scene from the figure's position, then return to themselves.
Example language (illustrative): "What would the old man say to you if he could talk?... and from where he stands, how do you look?"

4.25 Resource and stabilising imagery

Purpose: stabilisation function of imagery: activate resources, bind anxiety, foster self-care [source: Bahrke & Nohr 2013 sample, pp. 14–15]. Named resource motifs: safe place, inexhaustible source [source: Ponomareva 2015]; place of inner peace (Ort des inneren Friedens) [source: Kretschmar & Tzschaschel 2014 TOC].
Steps: (1) Invite a place where the patient feels safe and well. (2) Build it with all senses. (3) Install it as a place to return to at the end of difficult imaginations and between sessions [synthesis].
Example language (illustrative): "Let a place appear where you feel completely at ease... what do you hear there?... you can come back here whenever you need."
Watch for: the safe place turning unsafe (common in trauma); change it together or use a more distant image.

4.26 The feeling as a being; the inner child

Purpose: named supplementary elements [source: Kretschmar & Tzschaschel 2014 TOC]; meeting the inner child is the regression level of effect [source: therapie.de]. Text is not drawn on here [uncertain].
Steps (synthesis): feeling as being: ask the patient to let a troubling feeling take shape as a creature, then explore and befriend it with feeding/reconciliation. Inner child: invite the patient to meet themselves as a child, observe, and offer what the child needs.
Example language (illustrative): "If this sadness were a creature, what would it look like?"
Watch for: overwhelming grief in inner-child work; keep the adult self present.

4.27 Ending the imagination and re-alerting

Purpose: close safely and return to the here-and-now.
Steps: (1) Signal the end in advance. (2) Ask the standard closing questions: what was most intense, unpleasant, pleasant, surprising and important [source: Ponomareva 2015]. (3) Return to the here-and-now [source: Ponomareva 2015]: [synthesis] stretch, take deep breaths, open eyes, look around the room, short check of state.
Example language (illustrative): "We'll come to an end soon... look back over everything... what was the strongest moment?... now let the image fade, take a breath and open your eyes."
Watch for: drowsiness, residual affect; do not let the patient leave dissociated.

4.28 Post-imagery talk (Nachgespräch) and working through

Purpose: integrate the experience.
Steps: (1) Same day: no interpretation; just record and acknowledge [source: Ponomareva 2015]. Burdensome feelings are re-evaluated in the talk [source: therapie.de]. (2) Next session: the patient interprets their own imagery; therapist asks open questions [source: Ponomareva 2015]; images are interpreted jointly [source: psychotherapeutensuche.de]. (3) Link to life themes, transference and resistance [source: Springer 2023 page]. (4) Hours between imaginations are used for working through [source: Dieter 2006, p. 3].
Example language (illustrative): "Looking back at the house, what do you make of it now?... does any of it remind you of something in your life?"
Watch for: strong resistance can appear after only a few imaginations [source: Hörn 1982, p. 56].

4.29 Painting the image (Malen)

Purpose: deepens the effect [source: Hörn 1982, p. 59]; work with the painted image is a named technique [source: Lehmanns TOC p. 161]; interpreting patients' paintings is a supplementary element [source: Kretschmar & Tzschaschel 2014 TOC].
Steps: (1) Ask the patient to draw or paint one or more images from the session at home. (2) Discuss the pictures at the next session [source: Ponomareva 2015]. (3) [synthesis] Ask first what the patient sees and feels in the picture; compare with the spoken imagery.
Example language (illustrative): "If you like, paint one picture from today. No artistic skill needed. Bring it next time."
Watch for: refusals or perfectionism; treat as material.

4.30 Implicit technique for structurally impaired patients

Purpose: use KIP with borderline, post-traumatic and developmental pathology [source: Dieter 2006, pp. 1–3, 13].
Steps: (1) Long relationship-building before the first imagination [source: Dieter 2006, p. 18]. (2) Expect as-if (false-self) imagery and tolerate many similar imaginations [source: Dieter 2006, pp. 15, 18–19]. (3) When imagery shifts into psychic equivalence (image felt as real), contain and mirror the archaic self-state; avoid enacting concordant countertransference [source: Dieter 2006, pp. 16–17, 20–21]. (4) Use interpretation mainly to regulate the relationship [source: Dieter 2006, p. 27]. (5) Increase session frequency during regression [source: Dieter 2006, p. 23].
Example language (illustrative): "It feels completely real right now. I'm here with you, and we're in my office."
Watch for: acute regression; return to orientation and a resource image.

4.31 Settings: group, couples, family, children

Group KIP (G-KIP), inpatient and couples use are documented [source: Ullmann et al. 2017 TOC; psychotherapeutensuche.de]; family imaginations and parent involvement in child KIP [source: Lehmanns TOC pp. 91–104]; in child guidance, KB was combined with play, and children often came to prefer play [source: Hörn 1982, p. 59]. Procedure details are not drawn on here [uncertain]. Other named elements whose text is not drawn on: road and water network model [source: Kretschmar & Tzschaschel 2014 TOC; uncertain].

5. Handling problems

5.1 Screening and contraindications

From sources: Leuner himself counted borderline disorders among the contraindications; Dieter holds that the standard (explicit) procedure reaches its limits there and proposes the implicit technique instead [source: Dieter 2006, p. 2]. Oberstufe motifs need Oberstufe-trained therapists [source: Ponomareva 2015]. Exhausting/killing risks being felt as an attack on the self [source: Brookhouse summarising Leuner; secondary]. Imagery-based work of another school is described as less suitable for people with serious developmental deficits lacking a structured ego [source: Ullmann et al. 2017 sample, p. 18, in comparison with Jungian work, not a KIP list].
Fuller contraindication list is not given here [uncertain]. [synthesis] Do not start imagery with: acute psychosis or a history of psychotic decompensation under regression; acute suicidal crisis; severe dissociative disorders; intoxication; acute untreated PTSD for any confrontational or regressive motif (use stabilisation only); severe structural deficit without the implicit technique and experienced supervision. Use caution with epilepsy or medical conditions affected by relaxation, and with patients who expect magic or who fear loss of control.

5.2 No images, or images will not come

[synthesis, informed by Bahrke & Nohr 2013 sample, p. 14] Relaxation and image plasticity depend on structure and transference. Lighten the induction; keep eyes open if needed; start from a real place or a concrete object; ask about bodily sensation first. Explore the relationship: fear of exposure, of judgment, of the therapist's power. Do not deepen relaxation to force images.

5.3 Stuck, repetitive or as-if imagery

Flat, compliant landscapes can be the as-if mode of a false self; Dieter's patient produced eight similar landscape imaginations before a meadow imagination broke through into psychic equivalence [source: Dieter 2006, pp. 15, 18–21]. Response: tolerate repetition, stay curious, and address the relationship; consider a countertransference-derived motif [source: Dieter 2006, pp. 21, 25]. [synthesis] Alternatively shift from standard to associative or conflict-focused starts.

5.4 Resistance and premature ending

Strong resistance may set in after a few imaginations and lead to dropout [source: Hörn 1982, p. 56]. Response [synthesis]: interpret resistance within transference, slow the imagination frequency, alternate with talking sessions, and ask what the last image stirred that the patient may not want to see. Let the patient choose the motif.

5.5 Overwhelm and dissociation during imagery

[synthesis] Signs: breathing change, freezing, long silences, voice change, the image felt as real. Steps: (1) speak more, shorter sentences, use the patient's name; (2) increase distance in the image (step back, watch from a hill, behind glass); (3) apply feeding or reconciliation instead of confrontation; (4) if not settling: "open your eyes, look around the room", orient to time and place, feet on the floor, name five things in the room; (5) return to the safe place only if it helps; (6) do not end the session until the patient is oriented; (7) review in the next session and reduce intensity. In regression, contain and mirror rather than interpret [source: Dieter 2006, pp. 16–17].

5.6 Trauma and memories

KIP has been adapted for traumatised patients with differentiated strategies [source: Ullmann et al. 2017 sample, pp. 15–16]; a dedicated psychotraumatherapy variant exists (Steiner discusses stabilisation versus conflict work in it) [source: Imagination 3–4/2018 TOC]. Its procedures, readiness criteria and dosing are not drawn on here [uncertain].
[synthesis] Stabilisation first: resource imagery, helper figures, safe place and affect regulation before any trauma-related imagery. Readiness: patient can reliably reach and use a resource image, can stop on request and re-orient, life is stable enough, no acute suicidality. Dosing: short, distanced exposure segments (observe from a distance, screen-like framing) within a session, with time left for closure; close with a resource image and re-orientation. Never use imagery, relaxation or suggestion to recover or verify memories; treat images and memories that arise as the patient's experience, not historical fact, and avoid leading questions about past events.

5.7 Frightening figures

Use Leuner's sequence of softer options: feeding and reconciling before confrontation [source: Hörn 1982; Ponomareva 2015; Brookhouse secondary]. [synthesis] If neither works, increase distance, bring in a protective figure or the guide animal, or leave the scene and return to the meadow; process in the next session.

5.8 Non-adherence (painting, attendance)

[synthesis] Painting is an invitation, not a task; ask what kept the patient from it; offer a simple sketch or describing the image in writing. For missed sessions after intense imaginations, link absence to what was stirred.

5.9 Ruptures and transference

Imagination is relational work: the motif is a relationship message, and the therapist's guiding style can be experienced as intrusion or abandonment [source: Dieter 2006, p. 11; Springer 2023 page]. [synthesis] If the patient feels pushed, apologise for steering, return control of the scene, and explore the experience of being guided. If the patient idealises the method or therapist, explore the wish for magical rescue.

5.10 Suicidality and crisis

KIP is used in crisis intervention [source: psychotherapeutensuche.de; Ponomareva 2015]. [synthesis] Risk assessment comes first and follows standard practice; in acute risk do no regressive or confrontational imagery; resource imagery only alongside safety planning.

5.11 Medical and psychosomatic adjunct use

Psychosomatic, pain and psycho-oncological applications exist [source: Ullmann et al. 2017 TOC]. [synthesis] Use only as an adjunct within medical care after medical assessment; imagery is never a treatment for cancer or other physical disease and must not delay medical treatment.

Sources

Sources:

Books and papers cited:

Leuner, H. (1969). Guided affective imagery (GAI): a method of intensive psychotherapy. American Journal of Psychotherapy, 23, 4–22. (Full text not drawn on.)
Bahrke, U. & Nohr, K. (2013). Katathym Imaginative Psychotherapie. Lehrbuch der Arbeit mit Imaginationen in psychodynamischen Psychotherapien. Springer. English edition 2023.
Ullmann, H., Friedrichs-Dachale, A., Bauer-Neustädter, W. & Linke-Stillger, U. (2017). Katathym Imaginative Psychotherapie (KIP). Kohlhammer.
Kretschmar, T. & Tzschaschel, M. (2014). Die Kraft der inneren Bilder nutzen. Südwest.
Dieter, W. (2006). Explizite und implizite KIP-Behandlungstechnik. Imagination, 1/2006.
Hörn, G. (1982). Praxis der Kinderpsychologie und Kinderpsychiatrie, 31(2), 56–60.
Ponomareva, I. M. (2015). Uchenye zapiski SPbGIPSR, 23(1), 30–36.

Further reading (not drawn on; would close the gaps marked [uncertain]): Leuner's Lehrbuch des Katathymen Bilderlebens; the training societies' (AGKB, ÖGATAP, SAGKB/IGKB) own motif and curriculum pages; Steiner & Krippner on KIP psychotraumatherapy.

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