Image formation and psychotherapy (revised edition)

Abstract: Contents: Part 1. Phenomenology of Image Formation Images and image formation - Types of images - The circumstances that increase image formation Part 2. Psychodynamics of Image Formation Early concepts of the role of images in thought - Modes of represenattion of thought - Psychodynamics of image formation - regulation of image formation - Unbidden images Part 3. Neurobiologic Influences on Image Formation The contribution of the eye - Influence of the brain - Psychedelic images and flashbacks - Hallucinations reconsidered Part 4. The Uses of Images in Psychotherapy Art therapy - Visualizing techniques

Note: By Ellen Thomasen and Lars Ole Bonde: AH began his studies in imagery in 1959. He raises the questions: 1) When are images useful, 2) how do we differentiate internal images from perceptions, 3) how do we control image formation? In answering the qustions he distinguishes between a) psychodynamic influences (early concepts of the image in thought processes, examplified with a model and case examples), b) neurobiological influences (physical factors) and 3) therapeutic uses (applications) An image is defined as a Mental representation. It has a neurobiological dimension (anatomic/physiologic) and a psychologic dimension (cognitive use and psychodynamic meaning, motivational aspects) Image formation is discussed from three perspectives: A. To "SEE" and image = the client's report of I; B. To "FORM" an image = I produced within the psychic system; C. To "PERCEIVE" = I directly perceived from external visual experience. AH's CATEGORIZATION of IMAGES: 4 main categories and 23 subcategories (table p. 6): 1. Images categorized by vividnes (Hallucination, Pseudohallucination, Thought image, Unconscious image) 2. Images categorized by context (Hypnagogic/Hypnopomoic, Dream image/Nightmare, Psychedelic Image, Flashback, Flickering image) 3. Image categorized by Interaction with percpetions (Illusion, Perceptual distortion, Synesthesia, Déjà vu, Negative hallucination, After-image) 4. Images categorized by Content (Memory image/eidetic image, Imaginary image, Entoptic image, Body image/body schema experience, Phantom limb, Paranormal hallucination, Imaginary companion, Number and diagram forms). - All types are identified. In chapter 3 - The Circumstances that increase image formation AH discusses when and how people can form images; in Normal wakefulnes Brower found that 97% could form a visual image, 59% an auditory and 39% an olfactory. Imagery in Childhood is discussed: "Overall, these findings suggest that a preoccupation with imagery and a relatively lower level of of control may characterize the era of mid-childhood. (p. 31)The formation of images in reveries and hypnagogic staes, in dreams and nightmares, in REM sleep, in sensory deprivation, in neuroses and psychoses are discussed based on research results. - Much of the research is concerned with the experimental induction of image formation - of unusual but natural occurences, but according to AH musch of the reserach reveals the lack of clear difinitons of I types, and the two types of control loss over image formation should be differentiated clearly: loss of control over contents, and loss of contol over vivedness (and other formal properties) (p. 43). This is important i.e. for the understanding of hallucinations and I in psychosis. After discussion the influence of drugs and hypnosis on I the author concludes (p. 49) "Any situation that induces an altered stae of consc. will change image experiences." ...."While there is great variance between persons, certain generalisations can be made as to changes in the quality of image expereince. As a person becomes less wakeful, reality-oriented, and commited to reason and probelm-solving, images begin to occur more frequently, to attin greater vivedness, and to escape directions of the will and limitations of censorship. The contents of images tend to be derived more and more from inner sources, less and less from external stimuli. In their organisation they follow progressively more primitive and simple styles....(and)... there is a tendency toward fantasy elaboration of elementary sensations.." Part II introduces the "Psychodynamics of Image Formation". After a historic account of eraly concepts in psychology, gestalt etc. AH introduces Bruner's model of "Three forms of representation": 1. Enactive representation, 2. Iconic representation and symbolic representation. 3 levels of I concreteness, from concrete to abstract. - Discussion Bruner's and Guilfords model (content, operation and product categories - in content Guilford distinguishes between: figural, symbolic, semantic and behavioral) the author suggests his own model (p.77). Focusing on the subjective quality of thought representation he labels three interacting systems: 1. The ENACTIVE (subsystems: skeletal muscle; visceral mucle) 2. IMAGE (tactile, gustatory, visual, olfactory and auditory; either conscious, preconsious or unconscious) 3. LEXICAL (formal and informal properties of languages and numbers) "Representation" is defined as "an organisation of information in a form that can be part of conscious expereince". (p.78) All three modes of representation have their Subsystems, Sample organizational tendencies, sample statement types, and Sample of complex units (table p. 86). This model/theory is opposed to former theories of thought represention. The three modes of rep. dissolves the dichotomy words/images and their organization place them "relatively close to emotion". "In ordinary thought, the modes interrelate flexibly"...thus..."The goal of psychotherapy...is to reestablish continuity between ideas and attitudes in various modes of representation." (p. 94) In chapter 6 it is shown, how images "may serve as partial graticifacion of wishes, and they may also be the first expression in awareness of emergent and previously hidden ideas or feelings." (p. 113) In chapter 7 AH presents "A Conceptual Model of Image Formation", showing how different inputs (perceptual stimuli and momory input) influences the miage systems. Over- or undercontrol may be symptoms of psychopathology, reflected in the imagery. Often the person cannot distinguish images from perceptions and may wish to avoid the "unbidden images". AH offers a threfold theoretical explanation of these shifts in image vividness and quality: 1. traumatic repetition, 2. breakthrough of repressed ideas or feelings; 3. defensive transformation. (p. 135) Chapters 7 and 8 give detailed case examples of "unbidden images" and their explanation. Part III on the neurobiology of imagery will not be summarized here. Part IV is a brief discussion of the potentials of art therapy and visualization in psychotherapy. "Painting and drawing furthers expresion of emotional ideas by allowing participation of the motor and perceptual systems" (p.259) The non-verbal information communicated through visual art (individually or in group sessions) is useful for clinical interpretation. "The method seems especially useful in mute, withdrawn, or very blocked persons." (p. 275) In chapter 14 AH discusses the aims and purposes of interventions that increase the use of image formation as compared with lexical or enactive thought and communication" (p.277) Aims of The use of imagery in psychotherapy: 1. Obtaining useful information for case formulation 2. establish empathic understanding 3. evoke expression and working through 4. Transformation of feelings or attitudes Several techniques are introduced and discussed. they may be more or less directive/suggestive; and more or less interpretative. a. Freud's early technique of letting the pt. form an image - and his later technique of free association b. Jung's "active imagination" c. Kubie's "induced hypnagogic reverie" d. reyher's "emergent uncovering technique" e. sacerdote's "induced dream" f. Psychedelic and psycholytic techmiques, based on drugs like LSD. g. Evocation of images - like in Lazarus' "deserted island fantasy technique" h. Image instruction - like in fernczi's "On Forced Fantasies", Beck's different image formation techniques, gestalt techniques. h. Directed Imagery techniques - like Jung's, Leuner's and Assagioli's techniques. Ahsen, hammer, and Psychodrama are other examples. i. In Behavior therapy the major technique is Systematic desensitization (ex. Wolpe). Kolvin's "Aversive training" uses imagery to change conditioned responsivity. j. Implosive or Flooding Therapy are also behavioral techniques based on learning theory - using imagery to undermine the patient's defenses. AH discusses Lazarus' behavioral, multimodal approach in details. The major pdifference is their views of the effect of the proposed interventions, escpecially in terms of their influence upon the relationship between therapist and patient." (p. 303) The psychotehrapist using visualization techniques faces the problem of defensive inhibitions and the development of related interventions Interpretive or directive). (Systematized in table p. 291) The author concludes, that any exclusive focus on image formation in psychotherapy is unbalanced. "Image techniques should be related to a larger, well-formulated plan for how a patient may change." (p. 305) The transference aspect cannot be ignored.

Keyword(s): Imagery (Psychology). Cognition. Art therapy

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