In my previous blog post I went into some detail about the difference between content and process. In this post I explore this important distinction further by examining a method called, “Imagery with Rescripting,” described in an article, “Treatment of childhood memories: theory and practice,”  (pdf) by Arntz and Weertman. The article is unusually clear in describing exactly what the authors actually do with a client, including examples of verbatim dialogue, making it possible to clearly distinguish process interventions from those involving content.

This article presupposes that a problem in the present is a result of a memory of a traumatic event, and that the best way to change the present problem is to change the memory. In my commentary below, I will also accept those presuppositions, but it is useful to keep in mind that some other change method, such as core transformation, timeline adjustment, strategies, submodalities, etc., might be more appropriate and effective. All quotes below are taken directly from the article.

Outline of the Method

The article describes a package of several different interventions to change a troublesome memory, derived from what is called “Schema-based therapy.” A schema is defined as “an organized knowledge structure, which develops during childhood and manifests in certain behaviors, feelings and thoughts,” also described as a “belief.” The authors present a three-phase process for changing a schema experience, summarized below:

  1. Client thinks of a troublesome memory from childhood. Client reviews this memory as a child, and describes what happens in detail out loud in present tense to the therapist as s/he relives it. “Now he is turning and coming toward me. . . .”
  2. Client reviews the same memory as an adult bystander, and intervenes to alter the memory by taking some kind of action.
  3. Client experiences the altered memory as a child again, and if needed, asks for further intervention from the client as adult.

The authors present graphs showing improvements on several outcome measures using this method with a client, indicating scores at 5 different times, pretest, at 12 and 24 sessions “focusing on the past,” and at 12 and 24 sessions “focusing on the present,” for a total of 48 sessions. This is definitely not brief therapy, indicating a laborious process, and one that offers only limited improvement. No figures are presented for rates of dropping out of treatment.

Commentary

Phase 1. Describing the troubling memory out loud to the therapist is a process intervention, because the verbal description will always be a huge simplification of the experience itself. Describing the experience verbally will also slow down the tempo of the memory. The therapist may ask about categories of experience to elicit what the client sees, hears, feels, thinks, does, etc., but the client supplies the content.

This kind of re-experiencing is a kind of “exposure” therapy; depending on how long it goes on, perhaps even “prolonged exposure.” Exposure is widely accepted as a valid treatment, but it risks re-traumatizing the client. At best it is usually very uncomfortable for the client, slow, only partially effective, and typically has a high dropout rate.

Phase 2. “Becoming an adult bystander” is another process intervention, because being an adult implies a more extensive background of knowledge and experience gained in the years between childhood and adulthood, and it also provides a different point of view, but the client provides the content for both.

The bystander point of view involves “self-distancing” and this often elicits different feelings, for instance compassion instead of terror. This is somewhat similar to the phobia cure, but with a very significant difference; instead of seeing a movie of the entire memory from a distant outside point of view as if viewing it in a movie theater, the bystander is in the memory as they review it. This limits the separation between the viewer and the events viewed, like being in a play, in comparison to viewing the play from the back of a theater. When viewing a movie, the implication is that the events occurred in a different time frame, which creates additional separation, but if the bystander is in the play, there is no separation in time.

The adult client is invited to first describe what s/he sees, hears, feels, thinks, does, etc., which again is a process intervention, since the process of describing is different from the sensory-based experience. Then the adult client is asked, “What are you inclined to do?” and then instructed to do it. These actions can range from lecturing an abusive parent in the scene, or telling the child that “it is safe now, and the abuse was not your fault,” to physical interventions such as “pull him off the little girl, curse him, and throw him out of the room,” or even getting a gun to threaten or shoot an abuser. All these actions are content interventions, which can be revised, repeatedly if necessary, until the child is fully satisfied.

Phase 3. The client becomes a child again, and the process of changing the content of what happens continues by having the child as adult ask the child, “Is there anything you need,” and changing events in order to provide it. For instance, if the child says, “I’m afraid that papa will punish me,” the adult says, “I won’t allow that to happen.” If the child says, “I want to be comforted, held in your lap,” then the adult does that.

Any action, comforting, etc., that the adult does is a content intervention, because it changes what happens in the memory, not just the process used to represent it. There are several aspects of these content interventions that need to be examined and clarified in order to understand their consequences.

Problems with making content changes

Altering reality. Any content change in what happens in the memory will create an alternate reality for the client, which can lead to confusion about what actually happened in the past. In careful NLP work we don’t attempt to change the external events; instead, we change the way those events are perceived, evaluated, and responded to internally, as I described in considerable detail in an earlier blog post:

If a change in internal response suggests an action to be taken, that is only useful if it is both under the client’s control, and consistent with external events. For instance, if the client is reviewing a memory of being in a car wreck in which they were injured, the client could decide to relax just before the impact, so that their body is softer and less likely to be damaged. That is under their control, and it is something that doesn’t change the external facts of the accident—the speed of the car, the force of the impact, etc.

If you attempt to change the external events in a memory, such as “pull him off the little girl, curse him, and throw him out of the room,” that can lead to confusion between imagination and memory. It can result in denial of the events that actually happened, and/or living in a fantasy world in which we expect unpleasant events to be magically “fixed” for us. Many clients already have confusions of this kind, sometimes called “delusions.” We certainly don’t want to add to them.

Under client’s control? Even as an adult, the client may not have the strength or ability to, “pull him off the little girl, curse him, and throw him out of the room.” To imagine that this is possible provides another kind of discrepancy between the reality of what is possible for the client and imagination. If the client accepts this kind of intervention, it will be at the cost of their sense of what is real or possible for them and what isn’t. If the client holds onto reality and says, “I wouldn’t be able to do that,” the intervention will have no effect.

Indeed, the article states that in some cases, “the patient is too anxious or feels too powerless in the adult role to undertake any corrective action,” and that sometimes “the patient dismisses the intervention and starts an argument with the therapist (using rationalizations like that the intervention would have been impossible, that the method is useless because the past cannot be redone, etc.)” These “rationalizations” sound quite rational and reasonable to me; these objections can easily be avoided if no there are no attempts to change the external events of the memory.

Empowerment. “The major aim (of imagery with rescripting) is to increase the sense of empowerment. . . . When the patient does not feel powerful enough to intervene (e.g. stop the abuse) in phase 2, or is too afraid of the perpetrator(s) the patient can imagine others, and/or tools as helpers.” These “others” can include friends, family members, neighbors, the police, “or fantasy figures like Batman,” and “tools” can include guns or other weapons.

If these content interventions are not fully successful, “the therapist might actively instruct the patient in what needs to be done, proposes actions, etc. . . . When the patient is completely unable to play an active role in phase 2, or is unable to view the situation as an adult, the therapist plays the role of the correcting adult. In that case, the patient imagines the interventions by the therapist from the perspective of the child.”

Even when this kind of intervention makes the client feel better during a session, it doesn’t empower them, because the power is in the “other,” not themselves. It might be very nice to be rescued by Batman or a gun or the therapist, but that implies that the client is powerless to act on their own, so it actually decreases the sense of empowerment, rather than increasing it.

When the client as child is comforted, assured, held, etc., by the client as adult, that is also disempowering, because the power is in the “other,” not the self. However, if the child as adult does any of this with the child, it is empowering, because the adult has the power. This may seem like a trivial distinction, but empowerment will only occur when the client identifies with having the power, rather than being only the recipient of power provided by an “other,” whether real or imaginary.

These are inevitable results of using content interventions to change what happens in a memory. There is a simple test of any such content change to decide whether it is useful or not. Ask, “If a similar situation were to happen in the future, would the proposed change help the client deal with it?” Clearly expecting to be rescued by Batman would not be helpful, but relaxing just before a car crash could be. The therapist is unlikely to be available to help, but the client’s knowledge that they survived a similar event in the past could be useful in reducing the fear of imminent death.

This illustrates that a useful intervention will be one that changes the client’s perception, understanding, attitude, ability, etc., as described in my earlier blog post. In contrast, any intervention that attempts to change the objective external event will not protect from a recurrence, and will only confuse and delude the client.

Role-playing. The article goes on to describe how phases 2 & 3 can also involve role-playing, which involves further content changes. “The patient playing him/herself as a child, the therapist playing the other person (often a parent),” and that other people (colleagues, friends) can also play roles as needed. Role-playing only further complicates the problems I have described above.

If the therapist plays the role of an abusive parent, that aversive role may become part of how the client perceives the therapist’s identity—and this can happen even with careful de-roleing after a role-play (the article doesn’t even mention de-roleing). Reversing roles is also a possible intervention. “The patient takes the role of the other person, the therapist takes the role of the child.” If the client identifies with the other, that can be very useful in gaining understanding the other’s point of view, intention, confusion, limitation, etc., because the client provides the content.

But if the therapist plays the role of the child, that will add content, because even an accomplished actor will play a role somewhat differently than how the client remembers someone in their past. A therapist’s role-play will always be only a rough approximation to the client’s experience, introducing additional changes in content, both verbally and nonverbally, increasing possibilities for confusion. All these possible content confusions resulting from role-plays can be completely avoided if the client plays all the roles him/herself. When the client imagines being someone else, the resulting understandings emerge from the client’s experience, uncontaminated by content introduced by others.

Useful alternatives

It would be far better to begin phase 1 by using the phobia cure on the entire event—or on the worst example of a series of events. The phobia cure teaches a dependable and clear form of dissociation, in contrast to the exposure method presented in phase 1 of this method. The phobia cure neutralizes the intense feelings from the unpleasant memory, making any additional changes much easier, faster, and more comfortable. Often the reduction of the strong feeling also results in more details of the event becoming available to the client, and this additional information can result in some useful spontaneous reframing. After using the phobia process, there are much more elegant ways to reprocess a troublesome event.

Robert Dilts’ Reimprinting

In this method, the client finds an appropriate resource experience that happened at a different time and place, elicits it, and combines it with the problem event. This alters the client’s internal response to the event, without changing what actually happened.

Richard Bandler’s Decision Destroyer

In this process the client is asked, “What experience could you have had earlier than that event, which would have prepared you for it in some way? That if you had had it earlier, it would have prepared you for that problem experience?” Then the client is instructed to create this experience in a way that is vivid and powerful in preparing them for the traumatic event. Both the choice of the experience, and the details of it, is content that emerges entirely from the client, so no content is introduced from a therapist, role-player, or other outside source. It results in an internal experience that the client carries with them, and it is one that is carefully designed so that it doesn’t change external events. The entire process is essentially a way to reorganize the client’s internal experience, in contrast to meddling with what happened in the traumatic memory.

The inspiration for the Decision Destroyer was Milton Erickson’s case titled “The February Man” in which Erickson age-regressed a woman and appeared at various times in her lonely childhood in order to give her experiences of being cared for and acknowledged. Erickson was extremely careful to appear in her life at times that would not conflict with actual events in her life.

The client advises and comforts the younger self.

The client imagines being with the younger self in the troubling memory, and advises and comforts the younger self in whatever way is appropriate, using nonverbal feedback to verify when the younger you has, in fact, been comforted and reassured. This process was published in Frogs into Princes (1979) by Richard Bandler and John Grinder, s a follow-up to the phobia cure, but this step was later replaced by the “rewind” process.

“And now I want you to do something very powerful and important for yourself. Younger Tammy did something very powerful for you; she went through those feelings again for you, and she let you watch and listen with comfort and strength to stimuli which in the past have triggered overwhelming responses. This time you were able to see and hear those without panicking. I want you to walk over to young Tammy in your mind’s eye. I want you to reach out and use all of the adult female resources you have, to comfort her and reassure her that she will never have to go through that again. Thank her for living through the old feelings for the last time for you. Explain to her that you can guarantee that she lived through it, because you are from her future. And when you see on her face and in her posture and in her breathing that she is reassured that you will be there to take care of her from now on, I want you to really reach out, take her by the shoulders and pull her close and actually feel her enter your body. Pull her inside. She is a part of you, and she’s a very energetic part. That energy is freed now from that phobic response. I would like your unconscious mind to select some particular pleasurable activity that some of that energy can now be used for, for yourself here in the present and in the future. Because energy is energy and you deserve it. Just sit there and relax and enjoy those feelings. Let them spread through your whole body. Take your time.” (p. 115)

This process is completely content-free, so it avoids all the problems I discussed earlier. It’s immensely faster—typically effective in one session, instead of 48! It’s a really lovely integration process that can be used for any troubling memory. I have used it to reprocess past memories of many different difficult times of uncertainty, turmoil, despair, losses, etc. The statement that, “I can guarantee that you lived through it, because I am from your future” is hard to argue with, and you can expand on this by mentioning positive events that happened later that the younger you couldn’t know about—achievements, relationships, children, etc. This provides a broader positive perspective in time for the unpleasant memory. I urge you to try this process yourself, and let me know how you experienced it.