In Consultation

Picture This!

Enhancing Emotional Healing with Visual Images

Magazine Issue
May/June 2018
A tarot card

Q: I often ask clients to focus on mental images, such as a wise inner guide, but find this work falls flat for some people. How can I use imagery more effectively?

A: Many years ago, I attended a two-hour workshop on ego-state therapy and came home never to practice the same way again. When clients said, “I’ll never find love,” instead of saying, “It sounds like you feel hopeless,” or challenging their self-defeating automatic thought, I asked, “What part of you is making dire predictions?” One client, Aimee, said she pictured a little gnome telling her she’s a failure. She added that she felt it had been with her since high school, but a different part of her had always been able to counter it with compassionate words. When I asked her what the compassionate part looked like, she said she immediately pictured a purple dolphin, able to cut through negativity with grace and the hint of a playful smile. As we explored the kinds of things the dolphin might say to the gnome, they took on new depth and meaning. Throughout our work together, she often reported calling upon the dolphin between sessions whenever the gnome got particularly loud.

I soon found, however, that unlike Aimee, other clients had trouble imagining their various subpersonalities in useful ways. When I asked them to visualize the angry part of themselves—or even a safe place or a wise inner guide—they struggled to bring these mental images to life, which of course resulted in a frustrating session. When I pushed with verbal prompts, several of these clients simply shut down.

“I can’t do that. Nothing comes to mind,” one man told me in no uncertain terms after I’d suggested he go inside himself for a moment and envision the part of him that believes the world is a dangerous place. We sat in silence for a moment. Then he saw a postcard of Edvard Munch’s famous painting of The Scream tacked on my bulletin board. “That’s the part of me that fears life,” he suddenly declared. To my astonishment, this laconic man stood up and, taking the postcard in his hand, began to talk openly about the terror-driven part of him in ways I hadn’t heard from him before.

Realizing I also needed to help him vividly connect with inner strengths, and inspired by his un-expected engagement with The Scream, I gestured toward the back wall of my office, where years ago I’d hung some reprints of landscapes I liked. “Do any of these images speak to you?” I asked.

“I’ve always felt good in the mountains,” he said. “I grew up in New Hampshire, and they give me a sense of peace.” I could see tension melting from his face as he gazed wistfully at the mountains. Noticing this shift, I encouraged him to silently tell his terrified part that it had endured a frightening childhood, which had made it hard to realize he could protect himself now. With a look of surprise, he said the screaming face now seemed soothed.

Just the simple external stimulus of those visual images was enough to open new doors for him. Rather than asking him to conjure up his own mental images, giving him something to respond to sparked his imagination and enlivened our work. Over the years, I’ve honed my approach to using visual (as opposed to mental) images, which combines somatic, brain-based, and inner-dialogue therapies. In fact, I’ve found that when clients juxtapose disturbing images that personify parts of themselves with uplifting ones framed as internal resources, and then bring that experience into their bodies with sensory awareness or movement, a lasting therapeutic change often occurs.

Personify Parts

Wayne had been unemployed for a year since moving from Michigan to the East Coast. Even with an accomplished résumé in his legal field, he was having difficulty finding meaningful work. It wasn’t surprising that he was feeling a sense of doom after interviewing for several positions and receiving rejection letters. This go-getter was on the verge of giving up, but he didn’t want to set a bad example for his son, whose faltering schoolwork had brought the family into therapy in the first place.

To start, I had him look through eight alarming images I have on cards. He chose a William Blake painting from 1826 of a man running while holding his head. It suggests an atmosphere of despair, with dark stormy clouds. Yellow strips of wind seem to be propelling the running figure, as a blood-red sun appears to pursue him. As Wayne looked at the image, which I purposely placed at a bit of a distance from him, I asked, “How does this picture show your fear?”

He said, “It’s the part of me that thinks I’ll never find work again.” Asking how a picture represents someone’s experience often deepens clients’ exploration of their issues, revealing the core beliefs at the heart of their problems. I could see the wheels turning in Wayne’s head and waited. After a few moments, he elaborated, “I’m cursed. My family is cursed. I’m running from the curse. I’m the only person in my family to go to college, much less earn a graduate degree.” He said the red ball in the picture is the curse of unemployment his family has been battling.

To make sure that clients are doing more than just talking about feelings, I next ask what sensations they notice as they look at a chosen picture. Wayne said he felt a knot in his gut. Noticing physical sensations makes a brain–body connection that Fritz Perls called losing your mind and coming to your senses, which adds a crucial dimension to the therapy experience.

Identify Inner Resources

Before further focusing on disturbing sensations, I want to connect people to their inner strengths. So I then asked Wayne to choose an image from 24 uplifting picture cards that he liked for any reason. His favorite was of a northern sun peeking through snowcapped mountains, with pine branches covered in snow in the foreground and strikingly bright white rays stretching up and outward from the sun against a black background.

I find that having clients choose pictures they enjoy and asking what they like about them is a projective device that helps them identify qualities they value. These can easily be reframed as inner resources or strengths. After years of using various images, I’ve learned which ones usually resonate with people: a carefree fool, dolphins, soaring eagles, warming suns, starlit night skies, inviting water, and religious figures of all kinds. Although not Jungian by training, even I could recognize these archetypes. Viewing them with clients creates a shared experience of their awe or joy or calm, whereas mental imagery is a more solitary experience, which keeps me from fully joining clients in the amphitheater of their minds.

But Wayne couldn’t answer what he liked about the picture he chose, shrugging, “I don’t know; maybe it’s the art-deco design.” So I proposed an experiment: “You’re no longer Wayne. You’re this scene. Tell me about your life.” Without hesitating, he said, “I’m the light at the end of the tunnel. I give people hope.”

Because I wanted this quality of light and hope to sink in and stay with him, I slowly restated, “You have a resource for feeling hope in dark times.” Wayne nodded with almost hypnotic agreement as he made the transition from being convinced that he’s cursed to becoming open to a more hopeful vision of his future.

Keep a Dual Focus

To heighten their feelings after choosing an image they like, I ask clients to look at the unsettling image they initially chose. Neuroscience shows that disturbing images activate the amygdala, releasing adrenalin. This makes emotions less stable and more available to change. As Wayne recalled his last rejection letter and looked at the running man, the knot in his stomach returned. “Just be with that knot,” I told him gently. “Let it know you understand its terror. It may get worse for a little bit and then change in some other way.”

After seeing that Wayne was reexperiencing his distress, I suggested that he look at the sun image while simultaneously focusing on the knot in his stomach. Uplifting images activate the left prefrontal cortex, which then stimulates the nucleus accumbens (the reward center of the brain) to release dopamine. Asking Wayne to keep this dual focus allows calming neurochemicals to offset the fight-or-flight hormones brought on by the disturbing image. In Bruce Ecker’s coherence therapy, juxtaposing symptom-producing memories (the “curse” of not finding work) with incompatible ideas (“I give people hope”) facilitates healing. This may also happen when pictures “mismatch” the different neurochemicals that stressful and uplifting images evoke.

After a few minutes, Wayne reported feeling calmer, so I asked him to look at the running man being chased by the blood-red sun and notice if any sensations returned. He looked at me, then at the image, and said, “It just seems like a picture now. I don’t really feel much when I look at it.” If Wayne had reported some disturbance, rather than an absence of stressful sensations, I’d have asked him to return to observing the knot in his stomach and the uplifting image (dual focus) until the distressing picture no longer had an effect.

Incorporate Movements

Peter Levine’s somatic experiencing brings mindfulness not only to sensations, but to motor patterns and postures. With this in mind, I asked Wayne to assume the fleeing man’s pose. He held his head with his hands and placed his left foot forward. Then I said, “Notice what your body wants to do.” He said he wanted to turn around and face the ball. Now his right foot was forward and his arms outstretched. When I asked what he was sensing, he responded that he wanted to crush the ball and was experiencing a tingling in his hands. I placed the backs of my hands inside his palms to give him resistance against which he could push (to simulate crushing the ball). After a few moments, Wayne said he no longer felt tingling. He put his arms down, stood erect, and reported feeing present. Then he said that the thought I’m going places had bubbled up from somewhere inside him. I mirrored his erect posture and relaxed shoulders, and joined him in a sense of new possibilities unfolding from our work.

By attending to what his body wanted to do, Wayne moved from helplessness and hyperarousal to mobilization and mastery. He came to his final session as a courtesy to me and said he was no longer worried about finding a job. He continued to apply for work in his field, but was handling rejections well. In the meantime, he was doing what he’d always wanted to do: write a book of short stories.

Of course, not every client comes to a sense of new possibility as quickly as Wayne. Sometimes, when stubborn thoughts become tyrannical personality parts, agonizing sensations can seem stuck. At these times, using inner dialogue can be especially effective. Recently, I said to a client, “Silently tell the Queen of Hearts [her inner critic] that you know she’s trying to help you make others happy, but the weight you feel from propping everyone up is exhausting.” After a moment, the client reported, “Her face just softened. She’s quiet.”

Now that almost all my clients have cell phones, I add a final step: having them take pictures of the images they choose, with their strength cards in prominent positions, where they can manage vexing inner parts. When feeling distress, rather than delving inside to find a mental image, they can easily see the part causing angst, and quickly focus on and expand their uplifting image. This is no-fail homework.

Although I’ve used particular collections of pictures—like Tarot, Osho, and Inner Active cards—many available decks contain evocative images. And simply having striking art hanging on your walls can be useful. Paintings from Picasso’s blue period and anything from Leonardo da Vinci are handy focal points. Wayne’s snowy scene is a striking addition to my office decor, and I imagine the sun bringing warmth and energy to a frozen world, just as I hope pictures become a treatment tool that enlivens psychotherapy.


Photo © Sara Milana/

Kate Cohen-Posey

Kate Cohen-Posey, MS, LMHC, LMFT, is the director of Psychiatric & Psychological Services in Lakeland, FL and has 40 years of clinical experience. Her best-selling client handout books offer concise information on common disorders and relationship problems;  Making Hostile Words Harmless teaches how to disarm attack-defend-withdraw neural pathways and is endorsed by Stephen R. Lankton, protégé of Milton Erickson; Empowering Dialogues Within gives more than 50 examples of brain change strategies by wiring negative brain centers with their counter parts in the positive frontal lobe through dialogue. She is the inventor of the Handy Brain Model – a teaching tool that makes complex neurological information understandable. Kate has a knack for integrating wisdom from CBT, Ericksonian hypnosis, Gestalt, Ego State, EMDR, Somatic, and Brain-spotting therapies with knowledge emerging from neuroscience and brain imaging studies. She has also studied with the Hokori-Ji Zen Center and has been practicing yoga for many years.