Using mental imagery in psychotherapy : epistemological perspectives Philippe Grosbois senior lecturer, Universit Catholique de lOuest - Angers - France

e previous convenor and member of the EFPA Standing Committee on Psychotherapy

Key-words Anthropology , creativity , epistemology , mental imagery , psychotherapy . Abstract Background: There is a long european tradition of what was first called depth techniques in using mental imagery in psychotherapy, having in common to consider the image as the symbol of a deeper psychological reality. Method: We question the status and the function of mental images in the framework of psychotherapic pratices requiring daydream. Discussion: We propose some epistemological considerations on the different ways of looking at imaginary, linked with daydream and their impact in the framework of oneirotherapies (psychotherapies using oneiric mental imagery) and psychoanalytical and phenomenological hermeneutics which specify the different approaches of the symbolic features of mental images. We draw an analisis based on possible views of the psychotherapic setting and process in a comparative perspective from an anthropological view. Conclusion: We emphasize the link between imaginary function and creativity.

Introduction Mind theories are a technical element among other ones in taking in cure suffering people. In front of to the necessity to consider the same suffering from different interpretative frameworks, we compulsorily have to always measure the incidental but essential of our categories. So, we consider that psychotherapy has to rely on two points of view, an epistemological one about knowledge theories and an anthropological one about clinical practice [1]. Such an ethical position, strongly recommending tolerance and recognizing the

matre de confrences en psychologie clinique et psychopathologie, anthropologue de la sant, Institut de Psychologie et Sociologie Appliques, Universit Catholique de lOuest, Angers (France), Equipe dAccueil 4050 (Rennes-Poitiers-Brest-Angers), Laboratoire de Recherches en Psychopathologie Nouveaux symptmes et lien social , phil.grosbois@free.fr

2 relativity of the different representation systems of mental illness and their treatment, leads to establish a fruitful dialogue between the different psychotherapic trends. This means psychotherapy training has not only to take into consideration the personal emotional implication of the therapist with his patients, but also to become conscious and to be able to use on a controlled way our social and cultural belonging, our self values and beliefs, whatever they are scientific or popular [2].

Background Historical context We work since thirty years in such a perspective on the therapeutic setting, on the therapeutic process and on altered states of consciousness in the framework of use of dreamlike mental imagery in psychotherapy. We practice mental imagery in psychotherapy lying upon a long european tradition of what was first called depth techniques [3-4], such upper cycle of Johannes Heinrich Schultz autogen training, phantasy method of Carl Happich, guided affective imagery of Hanscarl Leuner in Germany, imaginative method of analisis and depth restructuring of Leopoldo Rigo in Italy, directed daydream of Robert Desoille or integration oneirotherapy of Andr Virel in France. Interest of mental imagery in psychotherapy Advantages of mental imagery are linked with the emotional value of images and with the fact that the affects they express are not often opened to verbal expression. Besides that, mental imagery is a favourable way to access to memory of early periods of life, it means periods before speech or, at least, its predominance. Imagery is also a more direct way of expression of non conscious aspects of mind. We want to speak of course of dream activity but also of daydream in hypnosis and all psychotherapic settings which induce a relative disconnection, an artificial induced dissociation with outer reality, a state which is defined by a lowering of watchfullness we can objectivize by electroencephalographic measurements. Two main psychotherapic trends in Europe 1 - In a psychoanalytical framework, imagery is considered as a kind of privileged language of unconscious : mental images are so the direct and eruptive expression, in the field of consciousness, of repressed ideas and feelings. These images, as symbolic representations of unconscious conflicts of the patient, are able to be the subject of an analisis between patient and therapist and to guide the diagnosis. 2 - Other methods, not compulsorily attached to a psychoanalytical way, have in common to consider the image as the symbol of a deeper psychological reality ; they are

3 lying not only upon spontaneous imagery but also upon imaginative constructions of the patient expressly requested by the therapist. In this perspective, the images function is not only diagnostic since they represent the material itself of the therapeutic work. Method So, we worked on the comparative study of theoreticians and practicioners of oneiric mental imagery in psychotherapy to underline the presupposed points on which they base their point of view. Our aim was less to give clinical illustrations of this kind of practices than to question on an historical and epistemological point of view the way these practices are joined with a theoretical framework, in a kind of distant look, as an anthropological approach [5]. Discussion Mental imagery and psychoanalisis We noted that the european studies, but the directed daydream and its heirs, ignore the approaches based on the idea that the image can be the symbol of a deeper psychologic reality because of the predominance of psychoanalitically oriented studies on psychotherapy. Psychoanalysts always attached importance to spontaneous mental images in a session but they were always interpreted in fact as an expression of the patient resistance to the psychoanalytical work ; its the case when they happen in a verbal block : images are so considered as a way for the patient to avoid the rational aspect of verbal communication, because they express a temporary regression to a more primitive cognition way. The american psychiatrist Shorr underlined its from the time when the free ideas association method was established by Sigmund Freud that imaginative productions of the patients were neglected by the psychoanalists ; only psychoanalists in the years 1920 considered phantasies and dreams of their patients as relevant to research on imagery. Free use of imagination was not promoted since it was considered as a resistance and the patient was invited to come back to verbalization [6]. So we have to go back to the pre-psychoanalytical period of Freud work, particularly to the period of his studies with Breuer on hysteria and on dream [7] to find marks of his interest for mental images in his clinical practice. For his daughter Anna, its because she was confronted with technical difficulties in child psychoanalisis that she sometimes used spontaneous mental images [8]. Lack of comparative studies The european studies on mental imagery psychotherapy are mostly focused on a specific psychotherapic method which leads not to compare or to do connections with other similar methods. And yet the setting of these methods allows to compare the way

4 of psycho-physiological getting into shape, the way of starting up mental images, the way of development of imagery and of the interventions of the therapist. Common factor On a meta-point of view, we noticed that the main common factor of these approaches is influenced by a phenomenological point of view about the relationship between man and reality : in fact, if we consider the body in its dialectic connection with the world, we have four categories : - the body, to which we give a presumed identity ; - the world, to which we give a presumed exteriority ; - the body image and the world image, images we consider as virtual images. So, mental image study is possible only in its connection with images external to the patient, in an interactive conception of the inside and the outside, of the ego and the world, of the body and space-time. Where there is a bodily ego, there is also a psychic ego. As said Paul Schilder, the psychiatrist who spoke the first one on body image : A body is always the expression of an ego and of a personality and the body is always in the world [9] Mental image, perception and affect Mental imagery parttakes of the thematic of mental diseases and is a reflect of emotional life of the patients. It is directly linked with the analogic processes contributing to the development of mental pathology. Besides, mental imagery arises from psychosensorial primary elements to express an affective living ; it therefore represents a personal meaning for each patient. Psychotherapic use of oneiric mental imagery leads to become aware of images become subconscious, being able to express traumatic emotions and to free himself by an emotional catharsis. The mental image : just a visual one ? Most of the psychotherapies using oneiric mental imagery dont work exclusively on a visual plan because images production have their roots in a cenesthesic bodily living : these ones concern so all the sensorial departments, as when we used hallucinogenic drugs in a psychotherapic way ; a mental image can be an olfactive, gustative, tactile or hearing one. You have so a complementarity between bodily living and phantasmatic activity, in the meaning that the different sensorial departments are going to talk in an anarchic way and that the screening usually dividing each sensation are going to be removed. The interpretations of oneiric mental image Its symbolic dimension is considered according to the fact we are in a psychoanalytical understanding or a phenomenological one of imaginary productions, the first one focused on the relationship between unconscious and sexuality, the second one giving a

5 major place to the creative and poetic aspect. In this perspective, the therapist has to have a good mastery of the symbols in different cultural contexts, of the myths and of the analogies, including the history of religions. In fact, mental images are connected with symbolic representations crossing individual and collective registers : mythology is, as underlined Sigmund Freud, a psychology projected to the outer. So, the historian of religions Mircea Eliade establishes a link between the function of mastery of chronologic time in the myths and the reupdating of affective experiences of first childhood. He borrows to psychoanalisis the idea that a come back can reactualize some decisive events of chilhood and thus do an individual return to the origin time, what realized many initiatic rites in archac societies : to find again images of primitive experiences amounts to throw the light on the personal mythology at work in everybody. We dont repair an used mind but we do it again : the patient has to be born again and to recover potentialities by the memory, as did men in traditional societies when they recited the episodes of a cosmogonic myth. There is an anthropological continuity between magico-religious practices of traditional societies and contemporary psychotherapies : the dimension of fear and anxiety is present in every psychotherapy owing to the diving of intimacy of the patient who has the feeling it is a source of change. Besides, the french anthropologist Claude Lvi-Strauss underlined, in his study on symbolic effectiveness, the links between chamanism and daydream psychotherapy for what he shows that we can access to psychopathological troubles by the way of symbolic language of mental images [10]. Perception, sign and symbol On one hand you have psychotherapic approaches focused on the subjective living by the patient of the image full of affects ; on the other hand, you have approaches closer to a semiologic objective one, focused on the place of mental image in the mental illness. About subjective approaches, both psychoanalytical and phenomenological ones propose to consider the mental image in an intersubjective way between patient and therapist ; on the opposite, the objective approaches describe the images to more scientifically tackle psychopathology. The intrication of the two sides of the image, the subjective one and the objective one, represents the main difficulty of the study of mental imagery in psychotherapy.

Dissociation in psychotherapy : normal or pathological process ? The dissociation of body image is a common factor of all these psychotherapies based upon oneiric mental imagery. The concept of dissociation was first saved for neurology but particularly hypnosis practice showed that dissociation is a normal function of the mind. In the XIXth century, the french psychologist Pierre Janet considered that dissociation is as much a pathological phenomenon as a therapeutic agent, conception which was got back in the years 1970 in the framework of hypnosis by Ernest Hilgard

6 who talks about the hidden observer, phenomenon which maintains a kind of awareness not conscious and would represent an internal agent founding the feeling of the ego unity and continuity [11]. We also find this process of a normal dissociation in the transe states of traditional magico-religious rites and in psychotherapic practice of hallucinogens like LSD or Ketamine. In all these altered states of consciousness we have this awareness phenomenon at several levels, as if a part of the ego, lucid and critical, was observing the other part of the ego fallen into the transe. In these situations, the body and space-time schemes are changed and imagination has so nothing to do with a strange daydream but it becomes a new way of perception, a new kind of living experience. Occidental therapists, when they were confronted to so-called demonic possession and since contemporary hysteria troubles, try to put an end to dissociation in working to the reunification of patients, when traditional healers in societies with ritualized possession choose, on the opposite, to control dissociation by institutionnalizing it. Besides, we dont stress on the ritual aspect of current psychotherapies by the establishment of a setting defined in space and time, its technical and financial modalities and its reference to an underlying theory which represents itself one of the therapeutic factors. Imaginary and creativity Many practicioners using oneiric mental imagery in Europe [12-13-14-15] and in the USA (like Akhter Ahsen [16], Anees Sheikh [17-18], Joseph Shorr or Jerome Singer) do a narrow link between imaginary and creativity. So, Singer writes that the ability to fantasize is perhaps the predominant feature of humankind evolution [19]. To talk about creativity about mental imagery in psychotherapy concerns in fact both the patient and the therapist : the creative act of the therapist consists in his (or her) ability to create a sphere of play, a transitional space in the meaning of Donald Woods Winnicott in the framework of space-time of the session ; the creativity of the therapist lies upon his ability to promote an emergence of meaning from the clinical material, what questions, of course, the status of images interpretation. So, the difficulty rests in the compatibility between the respect of imaginary productions of the patient as a creative act - and the necessary reference to a psychopathological interpretative framework which ideally would lead to an understanding more than an explanation of the existential course of him (or her). Conclusions Beyond sometimes a symptomatic action to relief psychic suffering, beyond helping to resolve psychopathological conflicts, our main aim in oneirotherapies is to put the patient into conditions to create, requiring resources of his (her) imaginary, that means a kind of setting the subject free to imagine and able to give himself, as said the french philosopher and epistemologist Gaston Bachelard the right to dream [20]. Oneiric mental imagery psychotherapies are oriented less towards the adaptation of the patient to his social sphere than towards a restoration of adaptability which implies the

7 ability to always question himself and to search solutions in front of the tribulations of life

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