Imagery rescripting is the process whereby images based on childhood memories are rescripted by the therapist to meet the needs of the child. The therapist enters the image and protects the child from abusive figures, bringing about safety. The therapist soothes and cares for the child.
Many trainee schema therapists are worried about starting imagery rescripting with clients who have low emotion regulation skills and high levels of early trauma. This is a common concern as individuals seeking out schema therapy often have chronic and complex difficulties based on significant trauma in their early lives. Emotional regulation skills have not been learnt and the therapist is fearful of dysregulating the client in sessions. Here are some of the ideas I share in supervision for moving forwards safely with this client group.
Introduce your client to the idea of imagery rescripting several sessions prior to starting this process. You can download a handout for explaining imagery rescripting to your clients by signing up to my email list here.
Talk about what you would do in imagery rescripting when your client references a childhood memory. For example, “If I had been there, Jenny, I would have stopped your dad from shouting at you and told him that you deserve love and care and I would have said that I’m not going to let him treat you like that anymore.” This helps to acclimatise clients to the idea of imagery rescripting without the emotional intensity of being immersed in the image.
Spend time developing a safe place that you can go to with your client prior to rescripting a distressing memory. I have found it is powerful to develop the image of a house in calming surroundings where the little child can be with the therapist. Think about how to make the house safe and what they would like to do there. Do they want a pet with them? Is there a comfy place to sit and read a book together? Is there space outdoors for them to play with you, the therapist?
When you begin to rescript images, choose a memory that is less distressing to begin with. It might be that you choose a memory when the child is alone and provide nurturing and care by being alongside the child.
If the client is unable to access any memories due to their detached protector, ask the client to generate an image of a pretend situation, such as falling and hurting their knee, as this will still allow you to access the patterns of care or lack of care that they received from their caregivers.
Focus on safety first, which might mean that imagery rescripting is relatively brief, as you rescue the child from the scene to your safe place, provide care to the child and bring the imagery to a close. As the client can tolerate more rescripting you can extend the imagery to challenge the antagonist.
Reduce the emotional intensity of the image by giving the client permission to keep their eyes open during the rescripting. They may want to choose a spot to focus on or they may like to stay connected to you by looking at you as you rescript.
A scarf can be used to maintain the connection to the therapist if the client would like to keep their eyes closed. You can give the scarf a gentle tug if you think the client is getting dysregulated or starting to dissociate.
Another strategy to decrease the intensity of the image is to imagine watching the little child having their needs met during imagery rescripting rather than the client being the little child. Alternatively, the client can be taught that they can ‘go into an image’ and then come back ‘out of an image’ into the present and ground themselves. Imagery rescripting can then take place in short segments whilst the client can keep connected to you.
There is no need to replay the most distressing aspects of what happened to the client. Imagery rescripting can begin before the abuse starts in the image. There is value to rescripting the most intense aspects of memories, so this should be discussed and agreed with your client and potentially worked towards.
Trainee schema therapists can feel cautious about imagery rescripting with clients with complex early trauma and low emotional regulation skills. Using these strategies to reduce the emotional intensity of imagery rescripting can help you get started and build the confidence with your clients to move towards full imagery rescripting interventions with the most distressing memories.