A powerful technique that heals the psyche. Tell you all about rescripting

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Let’s say you were attacked and bitten by a dog during your morning jog. Impressions were strong: fear when the animal ran at you, pain and unpleasant consequences in the form of treatment and shots for rabies and tetanus. Even if there are no serious marks on the body, psychological wounds are likely to be fixed in the memory for a long time.

In fact, even less extreme memories can be traumatic. But they can affect the quality of human life significantly. Because of them we will experience strong anxiety, fear, anger, irritation and other emotions, where there are no real prerequisites for this.

Rescripting is a psychotherapeutic technique aimed at alleviating negative emotions and psychological states by changing memories and images from the past.

It is widely used in various psychotherapeutic approaches: schema therapy, cognitive-behavioral psychotherapy, Gestalt approach and others. This technique has been shown to be effective in the treatment of psychological disorders such as depression, sociophobia, obsessive-compulsive disorder, post-traumatic stress disorder, complex post-traumatic stress disorder and others.

Empirical evidence has shown that rescripting reduces negative self-perceptions arising from traumatic memories from the past and thus helps to cope with challenging emotional states.

It can be useful not only for people with clinical diagnoses, but for anyone who feels that memories from the past are negatively affecting their current life.

History of the development of rescripting

Image rescripting has its origins in some of the oldest therapeutic techniques. It has been honed in various branches of psychotherapy. These include: hypnosis, psychoanalysis and Gestalt. Some psychotherapeutic techniques focus on the use of memory, while others focus on imagination. Image recapture is different in that it uses a combination of both.

Pierre Janet pioneered the use of visualization techniques back in 1889. He called it “Image Replacement.” Janet used hypnosis to help clients reframe traumatic events as positive, healing experiences. Despite reports of the success of such techniques, his work has been largely ignored. “Imagery replacement” fell out of use in practical science for a long time as Freudian psychoanalysis became the dominant approach.

In the psychoanalytic world, the power of the image was advocated by Carl Jung. He developed the Active Imagination method to help clients access unconscious material. Hanscarl Leuner also developed “Directed Affective Imagination” as part of his therapeutic model.

Both techniques are directed by the therapist. In the Jungian method, symbols come from dreams. “Directed Affective Imagination” uses certain images to bring the client into reveries. These help to evoke different emotions for clinical work.

Images have also been central targets for work in the Gestalt therapy method. Fritz Perls used them to help clients close out “unfinished business” for themselves. He would begin his sessions by discussing images from dreams or whatever was arising in the client’s mind at the moment.

Aaron Beck began adapting Perls’ technique within cognitive behavioral therapy in the 1980s. This was the beginning of the use of imagery in more traditional therapeutic circles. However, it wasn’t until the 1990s that researchers found ways to test and validate the positive effects of their use in psychotherapeutic work.

Such research helped lead to the emergence of the imaginal rescripting method. It has been refined through its use in cognitive behavioral psychotherapy, therapy for PTSD, cognitive behavioral therapy for nightmares, and schema therapy for personality disorders.

Originally, imaginal rescripting was focused specifically on working with patients who had extensive experience of physical, sexualized, or other types of abuse in childhood, and who were suffering from its effects in adulthood. Today, however, it is much more widely used in psychotherapeutic practice and has proven effective for working with a very wide range of psychological difficulties.

What does rescripting consist of?

Rescripting usually takes quite a long time in psychotherapeutic work. More often than not, it takes a session dedicated to processing a single traumatic memory. Each vivid traumatic event needs its own portion of attention. Therefore, it is normal that this method is used not once, not twice, but very many times during the therapy process.

Imaginal Reclaiming consists of several important stages.

Stage 1: Preparatory or introduction to rescripting

This part of the exercise usually takes 10-15 minutes.

Thepurpose of this stage is to gently prepare the client to dive into and work with the traumatic memory.

In order to do this, it is possible to use the technique of “safe place”, when the client together with the therapist presents any location (real or imaginary), where he/she does not feel threatened, but feels calm and relaxed.

The safe place is used in practice very often, but is not actually required. At the moment, there is no confirmed research that its use actually improves the effectiveness of rescripting. Nevertheless, a safe place is often an effective way to ground and slow down the client, as well as to create a special space where at any time a person can “escape” from too intense experiences that arise in the process of performing the technique.

What must be done at the stage of introduction to rescripting is to give the client, without too much detail, an explanation of what exactly will happen in the process of applying the technique.

The explanation might sound something like this: “For the next few minutes, I will ask you to close your eyes and keep them closed for about 10-15 minutes. In the process, I will encourage you to recall and visualize some situations from your past. This is a psychotherapeutic technique. Throughout the exercise I will be with you. It is necessary to follow my voice. Afterwards, we will discuss your feelings, and also – how all this will help us to deal with your current difficulties.”

The main objectives of this stage are:

• To make the exercise safe and predictable for the client;
• to help the client get used to the visualization (this is where the “safe place” technique helps).

Not all clients at this stage find it easy to trust the therapist’s voice, start visualizing, etc. In this case it is important not to rush the person, but to try to calmly, clearly, gently tell him about everything that will happen, validate his feelings, explain everything that is important for him to know.

Step 2: Finding the actual difficult situation

At this stage, the therapist can act in different ways.

1. To propose a specific situation from the present, voiced by the person in the process of work, which is difficult, painful for him.

For example, one of my clients has repeatedly complained that in a situation when her spouse stays at work for a long time, she can’t find a place for herself – she gets anxious, calls, and then gets very angry with her husband. A scandal occurs, and it spoils their relationship very badly.

Then the therapist can ask her to recall in detail the last time such a situation happened in her immediate past.

2. Invite the client to imagine a recent situation in which she felt uncomfortable.

In this case, the therapist does not set a specific context for the situation, but gives full freedom to the client and her imagination.

Then the instruction would sound something like this: “Try to imagine a situation in the recent past when you felt bad, hard, sad… Perhaps you were angry and very upset. Don’t try to analyze it too much. Try to give yourself over to your imagination, and then the images will come by themselves.”

Whether the situation is imagined by the client or given by the therapist, it is important that it be emotionally charged and evoke strong negative feelings in the present.

Step 3: Creating an affective bridge to the past

Thegoal of this stage is to make a connection between an experience from the past and current problematic events/remembrances.

Current experiences can be “gateways” to painful memories and traumatic events. In order to allow the client to access and mitigate these, it is first necessary to help them focus on the feelings and thoughts in the current unpleasant situation.

To make this work, ask the client about three components of their response.

1. What emotions are you experiencing right now? (anxiety/ anger/ frustration/sadness/fear, etc.).
2. What is happening in your body right now? What are your sensations and where exactly are they focused?
3. What meanings is the client putting into the sensations? What is he/she angry about? What is he/she sad about?

Instructions might be, “Try to focus on this feeling. How does it feel in your body? Feel it as much as you can and hold it a little longer.

Try to let go of the current image and situation… and focus on the feeling. Now try to remember – is this the first time it has arisen or have you been familiar with it before? What images and memories associated with them come back to you?”

If the client has difficulty visualizing an image, it is important for the therapist to hold them a little longer in the bodily sensations in the current distressing situation. Offer to feel them, to stay in them a little longer. Then the likelihood that memories that may point to traumatic experiences will still arise is greatly increased.

The third stage of rescripting is completed when the images from the present recede and dissolve in the imagination, and memories from the past take their place.

Stage 4: Exploring Past Experiences

Thetask of this stage is to activate the past experience, but at the same time to prevent the client from fully emotionally reliving the traumatic event again, which activates the present experience of strong negative emotions.

At this stage, the psychologist can help the person to immerse into the memories by describing the situation as the child saw it in the past: “Okay, you are 10 years old and you are in your room doing your homework. Suddenly the door opens abruptly, you flinch, turn around and see your grandmother. She has a very stern and angry face. You realize that she saw a D in your diary. How do you feel when you experience all this? What emotions do you feel when you see that grandmotherly look? Where do you feel fear in your body? What are you afraid of? What might Grandma do when she comes closer to you?”

Stage 5: Rescripting Meaningful Images

Thegoal of this stage is to meet the client’s relevant needs by creating relevant images in the imagination.

This may include preventing violence, creating a safe environment and doing whatever the adult feels is right in the situation given the child’s needs, setting boundaries, or expelling and living out any previously displaced emotions.

If it is necessary to create a sense of security, the therapist will have to intervene in the recreated image. Sometimes the therapist does this actively. He offers to use his image in the client’s memories.

However, this is not always necessary. If it is more about stimulating the client’s autonomy and self-expression, the therapist’s role at this stage will be more guiding – he will have to ask a lot of questions about what he thinks, feels and wants here and now.

The main questions asked of the client at this stage are as follows.

1. “What would you like most right now?”.
2. “What would you like to change now in this past situation?”.

At this stage it is important to support the client, to normalize their desires and actions in their imagination. Sometimes it can be difficult for a person to allow themselves to act aggressively toward the abuser even in their own head. Then the therapist can share with the client their own feelings about what is happening.

For example, “When I see this little 10-year-old girl who is so scared of her grandmother’s reaction, I get so angry that I want to stomp my foot and threaten to stop this woman. To say, “No, I will not let you hurt my granddaughter for bad grades! You will not do it again.”

In this way we normalize the client’s aggression and create a space where he or she expresses it without regard to public opinion. This may be the first situation in the client’s life where he or she is allowed to feel anger and even hatred toward the offender without judgment.

Step 6: Return to a safe place

Thegoal of this stage is healing and a calm and slow return of the client to the present moment.

This stage can be operationalized in two ways.

1. Returning the client to a safe place

At this stage, the psychologist should ask the client to return back to the safe place from which you started. And then from there to the current reality.

You can help the client return to the safe place by reminding him or her of the description of that place that he or she gave you at the beginning.

Say to the client, “Now I am asking you to let go of the image. Let it dissolve or float away to make room for the safe place. Try to focus on the details, the memories of it. Where are you? Tell me in detail what you see around you?”

If the client initially names any details that surround them in the safe space, the therapist can use this description to help trigger the imagination a bit.

2. Returning to the safe place with the traumatized part

In order for further healing to be possible and effective, it is important to invite the traumatized part to move to a safe place as well.

Ask, “Does she want to stay here or would she prefer to go to a special place in her imagination where she will have everything she needs?”

If the part refuses to move to a safe place or doubts her decision, it is worth asking her: “Is there anything else you want to do here together? Where else is it important to support you? What help do you need to give? What else do you want to do before you want to go to a safe place with me? If you don’t want to leave and would rather stay here, how else can I support you now? What else can I do? Perhaps you want me to visit you here sometimes? Or would you like to come and see me yourself sometimes?”

Step 7: Ending the rescripting and debriefing

This is the final stage of the technique.

Thegoal of this stage is to reduce emotional tension, to show the logical connection between the experiences from the past, which have been activated now, and the actual situation in the present.

In the process of rescripting in the imagination, a person is forced to live unpleasant, quite intense emotions. When the exercise is over, it is very important to show the client the interconnections so that the work is structured, clear and complete in his or her mind.

For example, explain that the client reacts so negatively and at the same time anxiously to the fact that her husband is late at work, because of a traumatic experience in her memories, when her mother left her at the age of six with her grandmother, and she herself left for six months to earn money.

Then the little girl was very sad, cried and worried. She felt fear, helplessness and panic that she couldn’t do anything. And that’s normal for a little child.

But now the situation is different – her husband has not left her, and she is no longer a baby. However, old memories are still activated every time she feels that her husband stays at work longer than usual.

To make the explanation even more telling, we can use a metaphor: “Suppose you scratch your hand. Germs get into the wound and it starts to abscess. Then, on the outside, it healed and is almost gone. However, on the inside, the healing process is still not complete. And then you accidentally bumped the corner with that very spot. A bump is painful in and of itself. But if at that moment you hit the traumatized place, the sensations will be much stronger. This is why, when a situation in the present ‘hurts’ our past experience, we experience much stronger emotions than usual.”

An additional step in the work may be homework, consisting of recommending that for one or two weeks the client periodically return to a safe place, or where they left the traumatized part, and communicate with it.

What is rescripting used for?

Rescripting is widely used in working with a diverse range of psychological problems. The list of situations in which this method has shown its effectiveness is very wide. However, to date, the effect of using rescripting in psychotherapy has been most extensively studied in the following cases.

1. Rescripting early traumatic situations triggering sociophobia

On the basis of research, it has been proven that situations in the present and actual images in the imagination act as a trigger for triggering severe anxiety in sociophobia. In social settings, such people usually see negative representations of how they would be afraid to be among people.

However, research has revealed that these negative self-perceptions are fueled by old childhood traumatic memories (Hackmann et al., 2000). They increase anxiety and significantly reduce the comfort and quality of life of people with sociophobia.

In order to understand exactly how rescripting affects people suffering from high levels of social anxiety, special studies were conducted in 2007 and 2008. What were their specifics?

In analyzing what effect a single application of rescripting has on the emotional state of a person with sociophobia. The study involved 14 patients. They were asked to attend a session in which rescripting of negative memories in imagination was applied. What was the result?

The researchers found that the application of rescripting reduced the clients’ stress levels and social fear. Negative imaginings of the future and past were then analyzed without using this method.

The results were recorded before the session and then patients were debriefed a week later. It was found that rescripting contributed to a significant reduction in social anxiety. In the control group, where the technique was not used, no such results were observed in the patients.

2. Rescripting traumatic situations in bulimia and other eating disorders

Similar studies have been conducted for clients with bulimia. Their condition before and after a session using the rescripting technique was studied. This analysis confirmed that a single session reduced these clients’ negative self-evaluation and even had an effect on current mood and behavior (including cravings for overeating).

Thus, the use of rescripting in RPP has also been shown to be effective.

3. Rescripting in the treatment of depression

Traumatic memories are common in depression. The use of rescripting for its treatment was the focus of a pilot study conducted in 2009. Its purpose was to find out how effective it is to use it as a primary intervention in treating depression in patients with intrusive memories.

The study involved 10 patients who had suffered from depression for a long time. In some, it was linked to unfavorable circumstances in childhood. While others faced depression due to traumatic events in adulthood. There were also those who experienced traumatic situations at different stages. Both in childhood and in adulthood. This led to intrusive memories throughout their lives.

The average age of the study participants was 41.3 years and the average duration of the episode of depression at the time of testing was 2.3 years. All had previous episodes of depression. Six also had anxiety disorders. Before starting therapy, half of the patients had a maximum score on the Beck Depression Questionnaire, while others showed an average score.

The results of the study revealed that rescripting was effective in dealing with both intrusive memories from childhood and traumas from adulthood. The mean Beck Depression Scale score decreased by 16.60 (SD 13.47) after about 8.3 sessions of rescripting. Surprisingly, these results were also confirmed at one year follow-up.

This study provides new perspectives on the treatment of depression using rescripting. The approach was most effective when intrusive memories occurred regularly, providing hope for more effective and lasting relief for patients.

Imaginal rescripting is a psychotherapeutic technique that has proven to be one of the very effective methods in dealing with various psychological difficulties. As we can see, it is not a technique of any one psychotherapeutic method. It perfectly combines and fits into the work of psychologists of various directions.

Moreover, today it is possible to meet techniques of self-rescripting in imagination. That is, as a variant of self-help for various psychological difficulties, reducing the intensity of living unpleasant memories.

However, it remains the most effective and efficient as part of long-term psychotherapeutic work. Of course, imaginative rescripting complements it well and makes it more effective, but it does not replace other processes in psychotherapy, which are impossible without the presence of a specialist.

Research on imaginal rescripting is still relevant today. And as part of further study of this technique, it will be important to explore the many features of its operation and how it affects the manifestation of symptoms of certain psychological disorders. The cognitive mechanisms underlying this broad efficacy are now the subject of debate. This, too, is the subject of further research and study.