Guided imagery is a flexible intervention whose efficacy has been
indicated through a large body of research over many decades in
counseling and allied fields. It has earned the right to be considered a
research-based approach to helping. This article provides a brief
introduction to the history of guided imagery and examples of selected
research indicating its efficacy.
Prepare to learn in an interesting way ... Some learning will be
obvious and some may occur at a different level ... You are about to
begin a journey back in time to meet researchers in the helping
profession who will help you better understand the scientific validation
for the use of guided imagery ... As you read this, you may or may not
notice your rate of reading ... or rate of breathing ... As you continue
feeling as relaxed and safe as you feel comfortable ... you might be
curious about the topic, maybe excited, maybe you have healthy doubts
too ... Whatever you are feeling about guided imagery is okay ... You
are free at any time to pause to contemplate ... or move on to another
article for any reason. Now better prepared, you can begin this brief
primer on some history and selected research on therapeutic uses of
guided imagery ...
Guided imagery was defined by Bresler and Rossman, co-founders of
the Academy for Guided Imagery, as a, "range of techniques from
simple visualization and direct imagery-based suggestion through
metaphor and storytelling" (2003). It is not a new approach to
helping but well established in Native American and other indigenous
traditions; Hinduism, Judeo-Christian, and other religious traditions;
and traditional Chinese medicine, to name a few historically-based uses.
Though guided imagery is currently understood to be mainly an
"alternative" or "complementary" therapeutic
technique, it has been used in psychotherapy for over a century. So,
though guided imagery has long been used in many religious and healing
traditions, the focus of this review is limited to the past 100 years.
When writing on the history of guided imagery, Schoettle (1980)
described many early 20th century examples of its use, starting with
therapeutically working with daydreams. For example, Schoettle pointed
out that Freud's psychoanalysis is based on the, "unraveling
of the patient's fantasies, daydreams, and dreams" and,
"continues to be a cornerstone in current analytical
techniques" (p. 220). In the 1920s, Kretschmer and Desoille began
using the daydream in therapy. Kretschmer referred to these inner
visions as bildstreifendenken, or thinking in the form of a movie.
Desoille referred to his therapeutic technique as the guided daydream
Jacob Morena developed the therapeutic technique of psychodrama in
the 1940s, in which trained participants, referred to as "auxiliary
egos," playing key individuals in a person's life, re-enacted
the patient's personal problems on stage. This can be now
understood as a way of guiding the externalization of the client's
internal imagery. In 1954, Hans Carl Leuner developed a technique he
called experimentelles katathymes bilderleben, or experimentally
introduced cathathymic imagery, and further developed psychodrama, which
he called Symboldrama psychotherapy or guided affective imagery. William
Swartley introduced Leuner's technique in the United States in 1965
as a diagnostic tool, calling it initiated symbol projection (Schoettle,
In the late 1960s, Joseph Wolpe introduced several imagery-related
techniques in behavior-modification therapy: systematic desensitization,
aversive-imagery methods, symbolic-modeling techniques and implosive
therapy. Since that time there have been many advocates of guided
imagery including the Simontons, Achterberg, Klapish, Lawlis, Oyle,
Bresler, and Rossman (Schoettle, 1980).
Not a lot is written on why guided imagery is often helpful.
According to Nightningale (1998), guided imagery helps clients connect
with their internal cognitive, affective, and somatic resources. The
goal is not to provide new-and-improved images for the client, but to
facilitate awareness of the imagery that already exists and guide
clients to work with this imagery for their own needs (Nightingale,
1998). Regardless of explanation, it certainly has many champions in
diverse areas. Guided imagery can be used to learn and rehearse skills,
more effectively problem solve through visualizing possible outcomes of
different alternatives, and increase creativity and imagination. It has
also been shown to affect physiological processes. As described in the
remainder of this section, in addition to its use in counseling, guided
imagery has also been used with very positive results in sports
training, rehabilitative medicine, and healthcare.
Guided imagery has been used increasingly by healthcare providers
in the medical field with impressive results. This is particularly true
with Cancer patients but also with patients who have other medical
concerns such as stroke or recurrent abdominal pain. For example,
Walker, Walker, Ogston, Heys, Ah-See, Miller, Hutcheon, Sarkar, and
Eremin (1999) compared two groups of Cancer patients. One group received
relaxation therapy and the other received relaxation therapy with
peaceful imagery. Women in the peaceful imagery group were, "more
relaxed and easy going, had fewer psychological symptoms and had a
higher self-rated quality of life during chemotherapy" (p. 267).
These women also had, "enhanced lymphokine-activated killer
cytotoxicity, higher numbers of activated T-cells and reduced blood
levels of tumour necrosis factor" (p. 267). In other words, they
seemed to be healthier than the group without peaceful imagery.
In a 2001 article published in Clinical Rehabilitation, Page,
Levine, Sisto, and Johnston discussed results of a study by the Kessler
Medical Rehabilitation Research and Education Corporation which studied
the efficacy of combining imagery and occupational therapy for stroke
survivors. Participants in this study who received both therapy and
guided imagery showed significantly more improvement in motor recovery
than those who did not use imagery (2001). Also, in a pilot study by
Ball, Shapiro, Monheim, and Weydert, children's recurrent abdominal
pain was reduced 67 percent following the use of guided imagery (2003).
Guided imagery has also been used in sports, especially to improve
motivation and performance as well as reducing pain during healing. For
example, Thelwell and Greenless studied competitive endurance using
mental skills training, including goal setting, relaxation, imagery and
self-talk, for athletes preparing for a triathlon. This training
enhanced competitive performance, increased motivation, and contributed
to athletes' management of pain (2003).
Substantial research has suggested that imagining performing a
specific sports skill improves the physical performance of that skill
(for example, Eddy and Mellalieu. 2003). In a study by Eddy and
Mellalieu (2003), of mental imagery in visually impaired athletes, the
authors concluded that, "mental imagery ... [is] a useful
psychological skill for athletes who are visually impaired" (p.
366) by improving both their motivation and performance. Imagery is not
limited to sight, however. Hearing, smell, taste, and touch can also be
incorporated into imagery or guided imagery.
The use of imagery in limiting strength loss in injured immobilized
athletes was the focus of a study by Newsom, Knight and Balnave (2003).
Participants in this study who used imagery experienced no significant
change in wrist-flexion and extension during immobilization.
Participants who did not use imagery showed a significant decrease in
wrist-flexion and extension (2003).
Guided Imagery in Counseling
Guided imagery has been studied extensively as a therapeutic tool
in counseling. For example, it has been applied to grief therapy (Melges
& DeMaso, 1980) and decision-making and identity issues in
individuals with eating disorders (Hill, 2001), to name just two of
thousands. A recent Google search using the search terms, "guided
imagery, counseling, and research" resulted in 108,000 hits. The
following are brief examples to whet the appetite and encourage the
reader to narrow readings to their specific area of interests, for
certain populations, in particular settings.
Melges and DeMaso (1980) studied over 100 people with unresolved
grief reactions. They employed three phases of treatment: "(1)
cognitive structuring for the decision to re-grieve and for
clarification of procedures, (2) guided imagery for reliving, revising,
and revisiting scenes of the loss, and (3) future-oriented identity
reconstruction" (p. 55). They found that reliving or re-imagining
changed the client's view of reality concerning the grieving and
therefore, the guided imagery part of the treatment was essential
(Melges & DeMaso, 1980).
Hill (2001) used fairy tales, "as a vision-to-action treatment
alternative for psychological dysfunctions focusing on eating
disorders" (p. 584). She integrated guided imagery, cognitive
refraining, and behavioral assignments in her treatment of individuals
with bulimia nervosa. Hill concluded that, "fairy tales provide a
paradigm that serves as a transitional structure in language, thoughts,
and behaviors" (p. 587). She found that it, "helps the client
assimilate new chapters analogous to her life transitions and develop
necessary accommodations" (p. 587). Guided imagery was seen as a
powerful tool in helping her clients overcome eating disorders.
Skovholt and Thoen (1987) used guided imagery scripts in parent
group counseling. They concluded that, "understanding the dilemmas
of others and the resolutions possible can be very instructive for
someone who feels stuck and alone" and that, "guided imagery
and daydreams are method[s] for discovering rich social comparison
data" (p. 316).
Those are just a few of the many studies indicating the
effectiveness of guided imagery for mental health and other helping
professionals trained in its ethical use. Nightingale (1998) suggested
three ways guided imagery can be used in counseling: 1) relaxation for
stress reduction, 2) motivation by imagining a positive future, and 3)
insight through exploration of possibilities and problem solving. A
great advantage is that guided imagery is quite flexibly used by itself
or in conjunction with other techniques, depending on the needs of the
client and setting as well as the counselor's training, experience,
and comfort with the approach.
Further research should reveal more information regarding the
extent specific aspects of implementing guided imagery affects specific
populations or issues. The nature of the mechanisms by which it is
effective should also become increasingly clear through the growing body
of research. In the meantime however, guided imagery is clearly already
a versatile intervention whose efficacy has been indicated through much
research over many decades in counseling and allied fields.
It has earned the right to be considered a research-based approach
to helping. "Your journey is over, for now ... Some of what you
read may have been new and interesting... Some may have been a useful
review ... Perhaps you feel this is just the tip of the iceberg of
research in guided imagery ... And you are correct ... You can feel
thankful for this journal facilitating this learning experience ... And,
you can congratulate yourself for your open mindedness to the potential
usefulness of guided imagery ... You might be able right now to imagine
learning more about guided imagery ... Or maybe using it with one of
your clients ... Or yourself ... You can return to this article, this
safe place of learning, any time you wish ... You can move on to another
article now knowing there will be many opportunities for further
learning about guided imagery in upcoming hours, days, weeks, months and
years ..." (Utay & Kojsza, 2003).
Ball, T. M., Shapiro, D. E., Monheim, C. J., & Weydert, J. A.
(2003, July/August). A pilot study of the use of guided imagery for the
treatment of recurrent abdominal pain in children. Clinical Pediatrics,
Bresler, D. E. & Rossman, M. L. (2003). History of guided
imagery. Retrieved January 1, 2005, from http://www.healthyroads.com/
Eddy, K. A. T., & Mellalieu, S. D. (2003). Mental imagery in
athletes with visual impairments. Adapted Physical Activity Quarterly,
Hill, L. (1992, May/June). Fairy tales: Visions for problem
resolution in eating disorders. Journal of Counseling & Development,
Melges, F. T., & DeMaso, D. R. (1980, January).
Grief-resolution therapy: Reliving, revising, and revisiting. American
Journal of Psychotherapy, XXXIV, 1, 51-61.
Newsom, J., Knight, P., & Balnave, R. (2003). Use of mental
imagery to limit strength loss alter immobilization. Sport
Rehabilitation, 12, 249-258.
Nightingale, L. (1998). What is interactive guided imagery[SM]?
Retrieved November 4, 2003, from
Nightingale, L. (1998). What is interactive guided imagery[SM]?
Retrieved January 1, 2005, from http://www.nightingalecenter.com/guided.
Page, S. J., Levine, R, Sisto, S., & Johnston, M. V. (2001). A
randomized efficacy and feasibility study of imagery in acute stroke.
Clinical Rehabilitation, 15, 233-240.
Schoettle, U. C. (1980). Guided imagery--A tool in child
psychotherapy. American Journal of Psychotherapy, XXXIV, 2, 220-227.
Skovholt, T. M. & Thoen, G. A. (1987, February). Mental imagery
and parenthood decision making. Journal of Counseling & Development,
Thelwell, R. C., & Greenless, I. A. (2003). Developing
competitive endurance performance using mental skills training. The
Sport Psychologist, 17, 318-337.
Utay, J., & Kojsza, M. Advanced guided imagery: A 20 step
process explained and experienced. Adapted from an exercise presented at
the 2003 Western Regional Pennsylvania School Counselors Association
Conference at Slippery Rock University Friday, November 7, 2003.
Walker L.G., Walker, M.B., Ogston, K., Heys, S.D., Ah-See, A.K.,
& Miller, I.D. (1999). Pschological, clinical and pathological
effects of relaxation training and guided imagery during primary
chemotherapy. British Journal of Cancer, 80, 262-268.
Joe Utay, EdD, LPC, LMFT, AAMFT. NCC, Assistant Professor,
Counselor Education, Indiana University of Pennsylvania, Director of
Counseling and Evaluation Services, Total Learning Centers. Megan
Miller, M.A. (in progress), Indiana University of Pennsylvania.
Correspondence concerning this article should be addressed to