Visualization in Therapy: 16 Simple Techniques & Tools

Our imagination provides a powerful vehicle for exploring aspects of the self and promoting behavioral change (Thomas, 2016).

In sports, visualization is helpful for rehearsal and optimizing performance; in therapy, mental imagery is an instrument for understanding problems and shaping personality (Kremer, Moran, & Kearney, 2019; Thomas, 2016).

Visualization, whether picturing a journey or image, can open the therapeutic dialogue and help the client express complex emotions.

This article explores how to use visualization in therapy and introduces techniques and worksheets that assist mental health practitioners in promoting change and increasing the client’s self-understanding.

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How to Perform Visualization: A Guide

Despite its long history, visualization is relatively under-represented in academic research. And yet, psychological treatments, such as Cognitive-Behavioral Therapy (CBT), increasingly use mental imagery as a practical counseling approach for modifying and restructuring dysfunctional schemas (Thomas, 2016).

While visualization has many uses, it is typically used in therapy to facilitate treatment processes and represent aspects of the self (Thomas, 2016).

Framing images provide conceptual metaphors, offering “deep level schemas or ‘experiential gestalts’ that cognitively restructure the individual’s perception of self and self in relation to the environment” (Thomas, 2016, p. 82).

Each image provides a focus and vehicle for the therapeutic dialogue and a bridge between rational and imaginational thinking.

Performing visualization in therapy

For example, psychotherapist and academic Valerie Thomas (2016) uses the framing image of a path as a simple metaphor for life’s journey and living a purposeful life.

The image is familiar in our day-to-day conversation, such as “she is back on track” or “he lost his way.”

The following steps show how we can introduce the metaphor in therapy to explore where clients are in their lives and the obstacles they face (Thomas, 2016):

1. Before you begin, introduce the image of a path as a metaphor for where clients see themselves on their journey through life.
2. Ask the client to position themselves comfortably and close their eyes, taking a few slow, deep breaths to help them relax.
3. Encourage the client to picture themselves on a path that represents where they are in their life. Make that picture as real as possible.
4. Ask them to consider the following question (modify as required):
   How would you describe where you are in your journey through life?
5. Seek more clarification if their answer is too limited.
6. Next, help the client engage more fully with their metaphorical landscape.

Ask them to:

Be present in the landscape rather than seeing it only as a picture.
How does the landscape look from within? Describe it for me.

7. To gain further insight, ask them:

How long have you been in this place?
How do you feel about being here?

8. Once you and your client have formed a strong picture of what their path (and life journey) looks like, start bringing the activity to a close.
9. Ask the client to leave the image and bring their attention back to their physical body.
10. Once over, it can be helpful to summarize and repeat back to the client a description of their landscape and the feelings it brings up. Such reflection is useful for the ongoing discussion.

Unlike some other framing images used, the path metaphor often changes considerably due to the dynamic nature of the subject (Thomas, 2016).

Best Practices for Visualization in Therapy

The following list contains best practices for visualization. It’s purpose is to offer helpful guidance for the visualization process (Hall, Hall, Stradling, and Young, 2006):

• Build trust
  A client wants a therapist who is knowledgeable, experienced, and provides a sense of security and confidence. Create a therapeutic alliance based on mutual trust and respect.
• Choose the right image
  The image choice affects the visualization and yields different psychological insights. For example, mental pictures of a waterfall or climbing a steep mountain path may prompt entirely different responses.
• Don’t interfere
  Once the image is chosen, let the client form their own interpretation.
• Limit interventions
  Hold back from encouraging the client to move on to the next part of the image. Bear in mind that this may be playing into the client’s (conscious or unconscious) strategies to avoid some aspects of the visualization. Instead, use questions such as, “Can you say more about that?”
• Take care with parallel imagery
  Inevitably, the visualization process will bring images to mind for the therapist that differ greatly from the client’s. Try not to bias the client’s mental imagery.
• Remain in your role as a guide
  While it would be easy to become drawn into the client’s narrative, remain in your role as the guide.
• Don’t judge
  The client may pick up on verbal or nonverbal communication cues if you are being judgmental.
• Don’t encourage avoidance
  Encouraging the client to avoid negative images and feelings can be unhelpful (unless causing a high degree of upset) to the therapeutic process.
• Avoid ‘shoulds’
  Avoid telling clients what they should experience and how they should feel.
• Don’t over-explain
  Over-sharing theories, causes, and reasons can be unhelpful.

Ultimately, the above points are only guides. The visualization process must be appropriate to the client and tailored to their present needs. Flexibility and a high degree of professionalism are always essential.

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Visualization Methods Explained

With different approaches to visualization, we explain some of the most common visualization methods below.

Essential visualization factors

Several factors contribute to visualization as a successful therapeutic treatment (modified from Thomas, 2016):

• Conscious relaxation state
  A state of relative relaxation is necessary for patients attempting to engage in and use the imagery experience.
• Therapist’s attitude
  The attitude that the therapist adopts to visualization will influence its success. How the health professional “identifies with particular characteristics and values […] will impact on the approach to the client’s images” (Thomas, 2016, p. 78).
• Client’s attitude
  Personal and cultural experiences shape the client’s approach to mental imagery. Any negative bias may surface as resistance to either the process or the images that arise during visualization.

Examples of validated framing images

While the therapist can adopt a wide variety of framing images, Thomas (2016) uses the following three, based on her many years in practice:

• People are buildings
  Houses have been used in many cultures to represent the self.
• People are plants
  The use of flowers and plants to signify development and growth is almost universal.
• Life is a journey
  Throughout history and across cultures, a trip or voyage often represents traveling toward a purposeful life.

Guided imagery visualization

Hall et al. (2006) offer some easy-to-use guidelines for therapists practicing guided imagery visualizations:

1. Once a framing image or theme is chosen, allow time for the client to immerse themselves in their visualization before proceeding.
2. Ask them to focus inward on the chosen image. Suggest they close their eyes and take a few deep breaths.
3. Use interventions sparingly through the guided imagery experience. Restrict questions and suggestions and let the client explore the journey at their own pace.
4. Use nonverbal behavior to assess when to intervene. For example, after a long pause, ask:

What’s going on for you now?
Can you explain what the image is?

5. ‘Why’ questions can interrupt the client’s flow by asking them to explain their motivation. Replace them with questions that require factual answers, such as how, what, when, and where?

Take care regarding tone, as asking, “What did you do that for?” can be heard as an accusative “why” question.

6. The questions What is good about X? and What is bad about X? work well together.

Used in tandem, they encourage the client to dig a little deeper into their visualization and recognize that rarely is everything entirely good or bad.

7. Use the personal pronoun I rather than we, you, or it to make the interaction more personal. You might say, I also get anxious when I don’t understand my choices.
8. Encourage conversation regarding feelings. How do you feel about X? helps the client verbalize their feelings regarding what they are experiencing.
9. Take care to use the wording of the client. Hearing their words repeated back can prompt insights in the client.
10. When ready to bring the guided imagery to a close, gently suggest this might be a good time to end. Perhaps use phrases such as:

When you’re ready, slowly start to come back to the room.
Move your fingers and toes and feel the sensations in your body.

11. After concluding, work with the client to understand the meaning of their experience.

Note that verbal interventions become a more natural aspect of the visualization flow with practice and experience.

3 Simple Visualization Techniques & Tools

The following simple techniques and tools are helpful for therapists using visualization during therapy.

Interpreting imagery

The therapist has a vital role to play in interpreting images produced during visualization. Thomas (2016) proposes considering three levels of interpretation in the meaning-making process for a more complete, less-biased view:

• Personal level
  The image is unique and personal and draws on the client’s memories, experiences, and beliefs.
• Cultural level
  The cultures we grow up in influence the meaning we assign to symbols, shapes, and even colors. Be aware that our mental images and their interpretation may be molded by our cultural and historical context.
• Universal level
  Some images have a meaning common to everyone (i.e., neither personal nor cultural), such as a fire burning, a building collapsing, or plant flowering.

Detached involvement

Detached involvement is central to the “guiding process and involves a state of relaxed concentration which is similar to that experienced during meditation” (Hall et al., 2006, p. 52). This approach requires performing the following four processes simultaneously during visualization:

• Careful listening to the narrative shared by the client
• Maintaining awareness and consideration of possible interventions
• Simultaneous consideration your own journey and emotions as the therapist
• Attention to the client’s nonverbal communication

Detached involvement is central to managing all four modes simultaneously.

Spontaneous imagery

The “spontaneously occurring fragments of imagery, which emerge in the form of symbols, metaphors and similes” can be valuable during therapy. Maintaining awareness and tuning in to the client’s use of images can help “restore meaning and feelings of integration or wholeness” (Hall et al., 2006, p. 86).

However, identification is not always easy. Statements such as, “I feel under pressure” or “I am trapped” are in common usage and do not always stand out. Yet, they arise from the client’s inner world and can offer deeper understandings.

The therapist will benefit from practice, experience, and a strong focused attention.

4 Relaxation & Anxiety Visualization Exercises

Visualization is a powerful tool for relaxation and managing anxiety (Thomas, 2016).

The following worksheets assist the process of visualization and using mental imagery to revisit anxiety-causing situations.

Anxiety Visualization

Clients can safely explore their anxiety by visualizing and working through situations that cause emotional discomfort.

Use the Anxiety Visualization worksheet to capture and visualize anxiety-causing events, reflecting on what might happen if different thoughts were adopted.

Anxiety Visualization Creation

Visualizations can benefit from planning and preparation.

Use the Anxiety Visualization Creation worksheet to plan the visualization and maximize its effectiveness for a situation causing anxiety.

Drawing and Visualizing a Tree

Clients may find it difficult to enter directly into mental imagery or visualization. Art provides a practical stimulus for internal reflection (Hall et al., 2006).

Use the Drawing and Visualizing a Tree worksheet to create an image of a tree – a popular metaphor for growth and development – to begin a guided imagery dialogue.

Building Visualization

Buildings can be valuable metaphors for representing the self and uncovering the psychological condition of the individual (Thomas, 2016).

Use the Building Visualization worksheet to create a mental image of a building that represents aspects of early life experiences and trauma later on in life.

Can Visualization Exercises Help With Sleep?

Research has found that individuals practicing visualization are rewarded with a better night’s sleep.

Patricolo et al. (2017) found that patients in a progressive care unit provided with a 30-minute guided imagery recording reported improved sleep.

In a further study, older adults practicing mindfulness, including visualization, had lower stress levels, found it easier to get to sleep, and experienced fewer sleep disturbances (Black, O’Reilly, Olmstead, Breen, & Irwin, 2015).

Strategies for Kids: 2 Visualization Games

Visualization can be equally helpful with children, yet may require careful explanation and a clear understanding that there is no right or wrong.

Visualization and the Senses for Kids

Children and adults are likely to get better at visualizing with practice. The Visualization and the Senses for Kids worksheet helps reflect on the visualization by revisiting the child’s senses.

What’s Good and What’s Bad in Your Visualization?

Children can benefit from digging a little deeper into their visualization.

Use the What’s Good and What’s Bad in Your Visualization? worksheet to prompt them to write down words or draw pictures to capture positives and negatives in a situation and reflect more deeply.

Visualization Resources From PositivePsychology.com

We have powerful visualization tools, audio, and scripts available from our Positive Psychology Toolkit©, an online subscription platform with over 400 tools and exercises.

If you’d like to try a sample of this platform’s resources for yourself, be sure to download our free 3 Positive CBT Exercises Pack and check out the Solution-Focused Guided Imagery exercise.

In this exercise, the therapist follows a detailed sequence of steps to help clients imagine a recurring problem in terms of its behavioral manifestations and consequences. The therapist then invites the client to imagine what reality would look like to themselves and others if this problem were miraculously solved.

As part of the exercise, clients will explore small actions taken in the past that have helped them work toward resolving their recurrent problem. By doing this, clients can connect deeply to their strengths and resources, energizing them to engage in coping strategies even when they are in crisis or feel stuck.

Get the exercise, together with the Strengths Spotting by Exception Finding and Reframing Critical Self-Talk exercises, by downloading the free exercise pack.

Likewise, if you’re looking for more science-based ways to help others through CBT, check out this collection of 17 validated positive CBT tools for practitioners. Use them to help others overcome unhelpful thoughts and feelings and develop more positive behaviors.

A Take-Home Message

Visualization provides a safe and secure place for clients to explore a scene, image, or journey during therapy. Due to its potential to dig deeper into aspects of the self and facilitate treatment processes, it is increasingly used in CBT and beyond.

Selecting an appropriate framing image can encourage therapeutic dialogue and uncover what is consciously or unconsciously ignored or avoided. Answers to simple questions such as ‘How long have you been in this place?’ or ‘How do you feel about being here?’ facilitate ongoing dialogue while building confidence and trust in the therapeutic relationship.

Interpretation remains crucial, as does the experience of knowing when to let the client stay where they are in their mental imagery or gently push on. Through careful listening and an awareness of nonverbal communication, the therapist can gain a more detailed understanding of the problems the client is facing and the meanings attached to each aspect of their experience.

Try out some of the techniques and use them to help your clients reflect on their past and present, and prompt discussion regarding how to move forward to a wished-for future.

We hope you enjoyed reading this article. For more information, don’t forget to download our three Positive CBT Exercises for free.