'Venturing Towards the Dark Side': The Use of Imagery Interventions by Recently Qualified Cognitive-Behavioural Therapists

• Published in: Clinical psychology and psychotherapy 2015-11, Vol.22 (6), p.591-603
• Main Authors: Bell, Tobyn, Mackie, Lynn, Bennett-Levy, James
• Format: Article
• Language: English
• Subjects: Adult; Attitude of Health Personnel; CBT Training; Cognitive Behavioural Therapy; Cognitive Therapy - methods; Female; Humans; Imagery; Imagery (Psychotherapy) - methods; Interpretative Phenomenological Analysis (IPA); Interviews as Topic; Male; Mental Disorders - therapy; Middle Aged; Therapist Skills; Treatment Outcome
• ISSN: 1063-3995; 1099-0879
• DOI: 10.1002/cpp.1920

Despite the growing recognition of the value of mental imagery within the field of cognitive–behavioural therapy (CBT), there is minimal research relating to clinicians' experiences of using imagery. This paper explores recently qualified CBT therapists' clinical experiences of using imagery and their perception of the role of imagery within their practice. Twelve therapists, qualified within the past 4 years, were interviewed using a semi‐structured format, and the resulting transcriptions were analysed using Interpretative Phenomenological Analysis (IPA). The analysis identified six super‐ordinate themes: (1) broad and fluid conception of imagery; (2) the importance given to imagery and the varied rationale for its inclusion; (3) varied application; (4) clinician avoidance and apprehension; (5) personal experience of imagery and impact on use; and (6) limited core training and the potential for future use. The themes, as a whole, described a complex and often dichotomous reaction to imagery amongst the therapists. Although a section of participants reported a natural affinity with imagery, other therapists felt that using, and experiencing, imagery was anxiety provoking and problematic. There was, however, unity in the value placed on imagery, the strong rationale for usage and the importance given to imagery‐specific training. Avoidance and apprehension regarding imagery were evident in the majority of participants, and the reasons for such responses included personal, clinical and cultural factors. The overall findings highlight the importance of clinician factors in the way in which imagery is utilized and understood, which has positive implications for training, personal development and future research. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message There is a universal recognition of the value of imagery for experiential learning and emotional connection. Therapists apply a variety of rationales for using imagery. Avoidance of using imagery in CBT practice is widely reported and occurs for a variety of personal and clinical reasons. Clinicians' own experience of imagery has a significant influence on the way in which imagery is understood, utilized and experienced in therapy. Future training and research in imagery should more explicitly address the clinician factors that can inhibit or facilitate the use of evidence‐based imagery interventions.