Healing Factors in Guided Affective Imagery

380 Pages·2010·1.99 MB·English

Healing Factors in Guided Affective Imagery:
A Qualitative Meta-Analysis

Submitted in Partial Fulfillment
Of the Requirements for the

Degree of
Doctor of Philosophy
with a concentration in
Psychology and a specialization in
Counseling and Psychotherapy

at the Union Institute & University
Cincinnati, Ohio

Elaine Sue Kramer
April 3, 2010
Core Faculty: Lawrence J. Ryan, PhD
i
Abstract

This qualitative meta-analysis compares and contrasts European and American
approaches to Guided Affective Imagery (GAI). From a comparative review of
literature of the European and American approaches, it is observed that there are
noteworthy differences in how GAI is understood in theory and applied in practice.
In the United States, GAI is not perceived as a method of deep psychotherapeutic
intervention for neurotic disorders by most practitioners. In Europe, GAI is one of
the more prevalent intervention techniques that has been reported to be effective in
many disorders. Secondly, this meta-analysis seeks to identify the essential healing
elements of GAI as they are implemented in psychotherapy. Twelve factors are
identified from the literature. Of fundamental clinical importance is the activation of
a patient’s “resources,” the positive characteristics of an individual that can be
accessed to reinforce the patient’s ability to deal with a past traumatic experience.
GAI provides the imagery context by which the patient may re-experience the trauma.
The therapist assists by encouraging the patient to repeatedly utilize internal resources
to confront the fearful event. Lasting relief may be conceptualized as repeated
resource activation leading to a biochemically-induced remapping at synaptic sites
away from the limbic-centered, emotion-based neural path associated with the
traumatic event toward the prefrontal cortex-centered, cognitive-based path of
appropriate behavior.
ii

Dedication
To Ronald
iii
Acknowledgements

I am fortunate, indeed, to have so many people to acknowledge in gratitude for their
support and guidance on this journey. Dr. Lawrence J. Ryan, my Core Faculty Professor,
for his unwavering dedication, encouragement, and enthusiasm of my work. Dr.
Christopher W. Lovell, my Second Core Faculty Professor, for his insight and
encouragement of my creativity. Dr. William A. Richards, my adjunct faculty member,
for introducing me to Guided-Affective Imagery and his wisdom and support throughout
this process. Dr. Gail Kalin, my other adjunct faculty member, for her humor and
compassion that lifted my spirits. Dr. Kathleen Altork, a peer member on my committee,
for her friendship and keen insight. Dr. Lynne E. Muller, also a peer member, for her
contributions to my work. Dr. Robert C. Anderson, who served as a consultant, for his
vision and humorously spiritual approach to life’s adventures. Chaplain John M. Burke,
my dear friend, for his weekly phone calls, loving ways, and constant encouragement.
And, most of all, my husband, Ronald P. Kramer, for his excitement surrounding my
work, his ever-present faith in me, and for being my best friend.
iv

Symbolic Portrayal of the Enemy Within One’s Self

Paul Klee's imagery of a catbird and the cat. The bird, his prey, is on the forehead of the
cat. A genetically anchored picture of the enemy within itself. (From G. Tuschy’s “Die
heilsame Kraft innerer Bilder und ihre Verwendung in der Psychotherapie-Die
Einbeziehung von Wachtraumtechniken in die analytische und tiefenpsychologisch
fundierte Psychotherapie” [The healing powers of inner vision and its use in
psychotherapy - The use of imaginative techniques in psychoanalytic and analytically
orientated psychotherapy], Göttingen, 2007).
v

Table of Contents
Abstract................................................................................................................................i
Acknowledgements............................................................................................................iii
Table of Figures...............................................................................................................viii
List of Tables.....................................................................................................................ix
Chapter One: Introduction...................................................................................................1
Topic Overview and Historical Context......................................................................1
Personal Connection with GAI....................................................................................3
Importance of Research Regarding GAI.....................................................................3
Research Objective......................................................................................................4
Glossary of Terms Pertinent to the Current Study......................................................4
Chapter Two: Literature Review......................................................................................12
Introduction...............................................................................................................12
Sigmund Freud..........................................................................................................13
Carl G. Jung...............................................................................................................14
Roberto Assagioli......................................................................................................15
J. H. Schultz...............................................................................................................15
Robert Desoille..........................................................................................................16
Akhter Ahsen.............................................................................................................18
Frétigny and Virel......................................................................................................21
Hanscarl Leuner -- Guided-Affective Imagery.........................................................22
General methods for evoking, guiding, and interpreting imagery.............................23
Standard imagery situations......................................................................................30
vi
Major Female Contributors of GAI...........................................................................36
Current Work in Guided-Affective Imagery.............................................................36
American articles..............................................................................................36
European articles...............................................................................................43
Literature Review Integration....................................................................................49
Research Question.....................................................................................................51
Chapter Three: Method.....................................................................................................52
Research Question.....................................................................................................52
Definition and Philosophical Background of the Methodology................................53
Human Subject’s Research Considerations...............................................................57
Significance of the Study...........................................................................................58
Chapter Four: Results.......................................................................................................60
Approach...................................................................................................................60
Research Question One Results.................................................................................64
Research Question Two Results................................................................................73
Essential GAI Factors................................................................................................78
Chapter Five: Discussion..................................................................................................83
Implications Regarding Theory.................................................................................83
Implications Regarding Practice................................................................................94
What makes an effective psychotherapeutic practice?............................................101
An actual therapeutic application of GAI in service to the needs of the dying.......104
Limitations of the current study..............................................................................106
Recomendations for future research........................................................................107
References........................................................................................................................108
Appendix A. European Literature Meta-analysis Coding...............................................126
vii
Appendix B. American Literature Meta-analysis Coding..............................................153
Appendix C. GAI Effectiveness Studies.........................................................................157
Effectiveness Study 1. Is GAI Effective?...............................................................159
Effectiveness Study 2. The Effectiveness of GAI in an Outpatient
Longitudinal Study,........................................................................................171
Effectiveness Study 3. Efficiency of a 20-hour GAI a in Short Psychotherapy.....184
Effectiveness Study 4. The GAI Psychosomatic Sexual Disorders in Both
Sexes...............................................................................................................196
Effectiveness Study 5. Emotions and Primary Process in GAI..............................204
Effectiveness Study 6. Primary Process and Positive Emotions in Cancer
Patients............................................................................................................228
Effectiveness Study 7. Blood Pressure, Heart Rate and EEG During GAI............246
Effectiveness Study 8. GAI as Short Psychotherapy in Psychosomatic
Gynecology.....................................................................................................250
Effectiveness Study 9. Emotional Experience, and Overcoming Fear Using
GAI.................................................................................................................263
Effectiveness Study 10. Results of a GAI for Test Anxiety...................................274
Effectiveness Study 11. Short-term GAI Therapy (A Controlled Study)...............278
Appendix D. GAI Literature...........................................................................................289
European Sources that Qualified for Inclusion in the Meta-Analysis.....................289
American Sources that Qualified for Inclusion in the Meta-Analysis....................367
viii
Table of Figures

Figure 1. Research Question One Approach.....................................................................63
Figure 2. Research Question Two Approach....................................................................66
Figure 3. European and American Literature Produced...................................................67
Figure 4. Primary Research Question Focus Areas and Authors......................................68
Figure 5. Frequency of Intervention Factors Mentioned in GAI Literature.....................77
Figure 6. Roadmap of the Therapist – Patient – Trauma Relationship in Guided
Affective Imagery Therapy........................................................................................95
Figure C-3-1. Variations in the FPI Profile with 26 Psychotherapy Patients after a 20
hour KB Treatment.................................................................................................190
Figure C-5-1. Regressive Imagery Dictionary (RID) (patient): Primary process from
Session 1 to Session 19...........................................................................................213
Figure C-5-2. Affective Dictionary Ulm (ADU) (patient): Positive Emotions from
Session 1 to Session 19...........................................................................................218
Figure C-5-3. Affective Dictionary Ulm (ADU) (patient): Negative Emotions from
Session 1 to Session 19...........................................................................................219
Figure C-9-1. Anxiety of Scenes and Changes of Anxiety Levels for GAI, Systematic
Desensitization and Autogenic Training Methods..................................................270
Figure C-9-2. Emotional Scaleand Respiratory Rate for KB and SD Treatment...........271
Figure C-10-1. Effect of GAI on Patient “A” Before, Immediately After, and One Year
After Thearpy Compared to Student Norm............................................................276
Figure C-11-1. Results of Clinical External Evaluation (rating)...................................285
ix
List of Tables

Table 1. GAI Characterization Summary.........................................................................70
Table A-1. Quick Look Coding Sheet of European GAI Literature...............................126
Table B-1. Quick Look Coding Sheet of American GAI Literature................................153
Table C-1-1. Group a. CCRT Positive and Negative Scores for Imagination and
Discussion Phases......................................................................................................161
Table C-1-2. Group b. CCRT Positive and Negative Scores for Imagination and
Discussion Phases......................................................................................................162
Table C-1-3. RID Primary Process Vocabulary Words Used..........................................163
Table C-1-4. Group b. ADU Positivity Index for Emotions during Verbalization,
Imagination and Post Performance Discussion..........................................................164
Table C-1-6. Group e. Proportions of Positive and Negative Words during Preliminary
Interview, Imagination, and Post Performance Discussion.......................................164
Table C-1-7. Group a. RO and RS CCRT Positivity for Human and Non-Human
Objects.......................................................................................................................166
Table C-1-8. CCRT Positivity Index for Verbal, Night Dreams and
Imagination Phases....................................................................................................167