Imaginal Reprocessing and Imaginal Reprocessing Therapy (IRRT)

We explain what this type of therapy consists of and in which cases it can be of great help.

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

In this article we are going to talk about one of the most effective Imaginal Reprocessing and Imaginal Reprocessing TherapyThis is one of the most complex and experiential techniques in psychological therapy, which, when used well (it requires improvisation and therapeutic skills), can help many people to turn the page and adopt more adaptive points of view in relation to their past.

It should be noted that, unlike other experiential techniques that have not been scientifically contrasted, this therapy has shown its efficacy for 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 suffered childhood sexual abuse. It was proposed by Smucker and Dancu (1999, 2005), although different variants exist today (see Arntz and Weertman, 1999 and Wild and Clark, 2011) to treat a variety of problems.

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

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

• Reduce anxiety, imagery and repetitive memories of the trauma/emotionally negative situation.
• Modify the maladaptive schemas related to the abuse related to the abuse (sense of helplessness, of uncleanness, of inherent evil).

Why is IRRT recommended?

The most effective therapies for treating traumatic memories have in common an imaginal exposure component. Traumatic memories, especially childhood memories, are encoded primarily in the form of images of high emotional intensity, which are very difficult to access by purely linguistic means. It is necessary to activate emotions in order to access them and to be able to elaborate and process them in a more adaptive way. In short, 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 abuse, 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 their personal development. For example, situations of neglect (not being cared for properly), not having had their psychological needs met in childhood (affection, security, feeling important and understood, validated as a person...).

It is also used in cases of Social Phobia, since these people usually present recurrent images linked to memories of traumatic social events (feeling of being humiliated, rejected or having made a fool of oneself), which occurred at the onset of the disorder or during its worsening.

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 IRRT are those of Smucker and Dancu (1999) and Arntz and Weertman (1999).

1. Smucker and Dancu's variant (1999)

• Phase of Exposure in imaginationconsists in representing in the imagination, with closed eyes, the whole traumatic event, as it appears in flashbacks and nightmares. The client must verbalize aloud and in the present tense what he/she is experiencing: sensory details, feelings, thoughts, actions.
• Imaginal Reprocessing PhaseThe client re-envisions 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, to expel the perpetrator and to lead the child to a safe place. It is up to the patient to decide on the strategies to be employed (that is why it is called mastery imagination). The therapist guides him/her throughout the process, although in a non-directive way.
• Nurturing phase of imagination. Through questions, the adult is prompted to interact directly in the imagery with the traumatized child and to sustain the child (through hugs, reassurance, promises to stay with and care for the child). When it is felt that the client may be ready to conclude the nurturing imagery, the client is asked if he or she has anything else to say to the child before ending the imagery.
• Post-imagination reprocessing phaseThe aim is to encourage the linguistic processing of what was worked on in the imagination and to reinforce the positive alternative representations (visual and verbal) created during the mastery imagination.

2. Arntz and Weertman's variant (1999)

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

• It is not necessary to imagine the whole traumatic memory.but can be imagined only 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). Reprocessing 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 rather than from the adult's, which allows for new emotions to emerge.This allows new emotions to emerge from the developmental level at 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 to work on feelings of guilt ("I could have stopped it", "I could have said I didn't want to"), in short, to feel that something could have been done differently than what was done.