Guided Imagery Child Play Therapy

GUIDED IMAGERY

DEFINITION

Guided imagery therapy is a cognitive-behavioral technique in which a child is guided in imagining a relaxing scene or series of experiences.

RATIONALE

Guided Imagery is similar to hypnosis and various relaxation strategies. Guided Imagery lies somewhere in the middle of a continuum consisting of standard relaxation techniques on one end of the spectrum and hypnosis on the other. As used by the author, guided imagery involves the child engaged in some sort of focused relaxation exercise followed by the use of visual imagery for the purpose of either direct or indirect problem-solving with the child. Guided Imagery brings two primary benefits to the play-therapy process. First, it can be used to help children gain a sense of mastery over both their bodies and their feelings, and secondarily, it can be used to augment generalization of other gains made in the play therapy by allowing children to use their imaginations to create hypothetical life situations in the play room so as to practice their newly acquired skills with the support of the therapist. Guided Imagery is thus really an elaborate form of role playing. While conventional role playing can be very effective, it is the use of Guided Imagery to augment mastery that is the focus of this discussion.

DESCRIPTION

Guided Imagery can be introduced at any point in the play therapy process. The child must be able to follow simple sequential directions and must be willing to relax in session. The ultimate goal is to provide the child with an increased sense of mastery, but the initial process requires that the child relinquish some control to the therapist, as the therapist will need to teach the child the techniques. There are a number of ways the therapist may introduce the process to the child -- younger children often respond to the idea of taking an imaginary trip, while older children often like the idea of personal mastery, including the concept of self-hypnosis.

However Guided Imagery is introduced, the therapist begins by teaching the child a basic relaxation strategy. If the child is willing, it is useful to have him or her lie down or sit in a recliner for the early training; alternatively, sitting in a beanbag chair works well. Progressive deep muscle relaxation is probably the most effective way of preparing the child for guided imagery. Is this approach to relaxation the child is asked to focus on one muscle group at a time while working to achieve maximum relaxation of that area of the body. Groups of muscles are added in sequence with the goal of achieving total body relaxation. Younger children may have difficulty with progressive deep muscle relaxation because it is such a passive process. For them a sequence of contract-relax instructions that take them through all of the major muscle groups is usually more effective. For example the child might be told to curl his toes then relax them, push his knees together then relax, tighten his stomach muscles and relax, and so on. Each muscle group is contracted and relaxed several times in a slow sequential progression. While deep relaxation facilitates the guided imagery process it is not necessary; simply getting the child to focus and follow directions is sufficient. Note that the child should be encouraged to achieve relaxation with his/her eyes open. This will make easier for the child to access the effects of the imagery later, in situations where full relaxation is not possible.

Once even minimal relaxation has been achieved, Guided Imagery can be introduced. The imagery used needs to be tailored to the child's needs, experiences, and developmental levels. This is best illustrated through a case example.

Imagery techniques have been combined with a wide range of behavioral and cognitive procedures and treatment methods of some psychotherapeutic approaches, including behavior modification, cognitive processing therapy, rational emotive therapy, multimodal therapy, and hypnotherapy. Combinations of treatment methods among these approaches lead to the following general uses of imagery:

 antifuture shock imagery (preparing for a feared future event)

 positive imagery (using pleasant scenes for relaxation training)

 aversive imagery (using an unpleasant image to help eliminate or reduce undesirable behavior)

 associated imagery (using imagery to track unpleasant feelings)

 coping imagery (using images to rehearse to reach a behavioral goal or manage a situation

 "step-up" technique (exaggerating a feared situation and using imagery to cope with it)

An assessment of the child and their problems is an essential part of treatment, both at the beginning of therapy and throughout the entire process. This is to ensure that the therapist has sufficient understanding of the child's situation and diagnosis of the problem(s). The assessment generally covers a variety of areas, such as developmental history (including family, education, and social relationships), past traumatic experiences, medical and psychiatric treatments, and goals.

HEALTHY IMAGERY

The University of Michigan Comprehensive Cancer Center reports that clinicians often use guided imagery to help people (including children) deal with cancer. Guided Imagery can help children with cancer or other illnesses cope with the pain and the stress they may experience. To help a child through this Guided Imagery exercise, tell him or her to sit comfortably or lie down and close his or her eyes. Then ask the child to tell you their idea of the color of sickness and the color of healthiness. He or she might choose black for sickness and yellow for healthiness. Ask the child to visualize the black color in the area of the sickness, and then ask them to visualize the yellow color calmly filling the body, destroying all areas of black. Encourage the child to feel the warmth of the yellow color and the happiness that it brings. This can be done by the