Imaginal Reworking and Reprocessing Therapy

One of the most powerful tools that people who go to psychological therapy have to improve their mental health is imagination.. Through this resource, psychotherapists can access their schemes together with the patient. dysfunctional, to memories of negative experiences that have generated a damaging emotional impact on their person.

In this article we are going to talk about one of the Imaginal Reworking and Reprocessing Therapy, which includes some of the most complex and experiential techniques within psychological therapy, which, when used well (requires the ability to improvisation and therapeutic skills), can help many people to turn the page and adopt more adaptive points of view in relation to his past.

It should be noted that, unlike other experiential techniques that have not been scientifically proven, this therapy has shown its effectiveness for the Post Traumatic Stress Disorder. Specifically, it has shown to be effective for those patients with high levels of anger, hostility and guilt in relation to the trauma experienced.

What is Imaginal Reworking and Reprocessing Therapy?

Imaginal reworking and reprocessing therapy (IRRT) was originally devised to treat adults who have been sexually abused as children. It was proposed by Smucker and Dancu (1999, 2005), although today there are different variants (see Arntz and Weertman, 1999 and Wild and Clark, 2011) to deal with various problems.

TRIR gives prominence to the emotions, impulses and needs experienced by the patient by reliving the trauma in the imagination. The trauma is not denied: the patient corrects the situation in his imagination so that in his imagination he is now able to express his feelings and act according to his needs, which at the time was not possible (because of his vulnerability or defenselessness, or simply because he was in shock).

It is a combination of imaginal exposure, mastery imagery (in which the patient takes a more active-protagonist role), and trauma-focused cognitive restructuring. The main goals of imaginal reworking and reprocessing are:

• reduce anxiety, images and repetitive memories of the trauma/emotionally negative situation.
• Modify maladaptive schemas related to abuse (feeling of powerlessness, dirt, inherent evil).

Why is it recommended to use the TRIR?

The most effective therapies to treat traumatic memories they have in common an imaginal exposition component. Traumatic memories, especially childhood ones, are encoded primarily in the form of images of high emotional intensity, to which it is very difficult to access by purely linguistic. It is necessary to activate emotions to access them and to be able to elaborate and process them in a more adaptive way. Ultimately, imagination has a more powerful impact than verbal processing on negative and positive emotions..

In which cases can it be used?

In general, it has been used to a greater extent in those people who have suffered some trauma in their childhood (child sexual abuse, child maltreatment, bullying) and who, as a consequence, have developed Post Traumatic Stress Disorder.

However, It can be used in all those people who have lived negative experiences in childhood / adolescence -not necessarily traumatic- that have had a negative impact on the development of his person. For example, situations of negligence (not being cared for properly), not having seen their psychological needs in childhood (affection, security, feeling important and understood, validated as person…).

It is also used in cases of Social phobia, since these people habitually present recurring images linked to memories of traumatic social events (feeling of being humiliated, rejected, or made a fool of) that occurred at the onset of the disorder or during its deterioration.

It is also used in people with Personality Disorders, such as Borderline personality disorder or Avoidant Personality Disorder.

Variants and phases of this psychotherapeutic model

The two best-known variants of the TRIR are that of Smucker and Dancu (1999) and that of Arntz and Weertman (1999).

1. Smucker and Dancu variant (1999)

• Imagination Exposure Phase: consists of representing in the imagination, with eyes closed, the entire traumatic event, as it appears in flashbacks and nightmares. The client must verbalize aloud and in the present tense what he is experiencing: sensory details, feelings, thoughts, actions.
• Imaginal Reworking Phase: The client replays the beginning of the abuse scene, but now includes in the scene his "adult self" (from the present) who comes to help the child (which is his past self who suffered the abuse). The role of the “adult self” is to protect the child, expel the perpetrator, and guide the child to safety. The patient is the one who must decide the strategies to be used (that is why it is called domain imagination). The therapist guides you through the entire process, albeit in a non-directive way.
• Imagination phase of “Nurturing”. Through questions, the adult is induced to interact directly in the imagination with the child traumatized and support him (through hugs, reassurance, promises to stay with him and take care of it). When it is judged that the client may be ready to end the nurturing imagery, she is asked if she has anything else to say to the child before ending the imagery.
• Post-imagination reprocessing phase: it seeks to promote the linguistic processing of what is worked on in the imagination and reinforce the positive alternative representations (visual and verbal) created during the imagination of domain.

2. Arntz and Weertman variant (1999)

This variant consists of 3 phases (very similar to those of Smucker and Dancu) but differs from Smucker in 2 things:

• It is not necessary to imagine the entire traumatic memory, but can only be imagined until the patient understands that something terrible is going to happen (this is very important in the face of traumas related to child sexual abuse). The reworking can begin at this point and the patient does not have to remember the details of the trauma and related emotions.
• In the third phase, the new course of events is seen from the child's perspective instead of the adult's., which allows new emotions to emerge from the evolutionary level in which the trauma occurred. In this way, patients come to understand the perspective of the child, who really could do little or nothing to avoid the abusive situation. This third phase is very useful for working on feelings of guilt (“I could have stopped it”, “I I could have said that I didn't want to"), in short, feeling that something different from what was expected could have been done. did.