The Use Of Guided Imagery Psychology Essay

Published Date: 23 Mar 2015

In spite of guided imagery being considered and alternative or complementary technique, it has been widely used in psychotherapy for more than one hundred years. Its history is long. The first practitioners to mention it were Breuer and Freud in 1895 in the case of Anna O. in their studies in Hysteria. Later in 1913, Frank, a Viennese psychiatrist explored the spontaneous episodes of hypnagogic visualizations when clients were deeply relaxed, naming this technique the "Cathartic Method" which was Breuer's old term (Frank, 1913). Ten years later, in 1922, a German psychiatrist called Kretschmer (3) suggested a new definition of the phenomenon. He called these inner visualizations Bildstreifendenken, which means "thinking in the form of a movie". He demonstrated the direct relation to the dream-work studied by Freud. (Kretschmer, 1922)

Freud's conviction in the primacy of verbal, rational or secondary processes had a profound effect in the field of psychotherapy. The use of imagery took place in counted instances as its development had normally been neglected in favour of verbal techniques. Nevertheless, the interest by psychotherapists in mental imagery has considerably increased in the last ten years. The use of imagery is becoming more important with time and a shift may be taking place where images are starting to become more powerful than words. (Ahsen, 1968, 1972; Assagioli, 1965); Desoille, 1965; Gendlin & Olsen, 1970; Horowitz, 1967, 1968; Panagiotou & Sheikh, in press; Shapiro, 1970).

Lazarus (1973) believes that imagery is one of the techniques to use to ensure durable results. Bugelski (1968) reveal that images produce "greater clarity of perception, stronger resistance to the experimenter's suggestion, and an enormous wealth of detail" (Lazarus, 1972).

Practitioners with widely different theoretical backgrounds have applied imagery for therapeutic communication and change.

Guided imagery is certainly successful and effective in diverse areas.

Katherine Arbuthnott, Dennis Arbuthnott, and Lucille Rossiter (2001) present in their article an exceptional overview of the different uses of guided imagery. They also offer a summary of the effectiveness "of this therapeutic tool for numerous activities such as planning and rehearsing goals, coping with negative or intrusive thoughts, enhancing self-soothing skills, increasing clients' confidence, helping clients articulate issues that are not fully understood, managing stress, gaining control over painful emotions, and overcoming strong reactions to feared experiences". (Zerbe Enns, 2001)??

Furthermore, "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." (Utay & Miller, 2006) Apart from being applied in counselling, guided imagery has also been employed with very positive results in healthcare, rehabilitative medicine and sports training.

Hall, Hall, Stradling &Young (2006) offer us a comprehensive way to introduce guided imagery in the counselling and psychotherapy process. They mention that before implementing guided imagery in therapy it is important to consider clients' expectations and assumptions about the nature of the process and even the outcomes; clients' readiness for the activity having into account their age, intellectual ability and their emotional readiness; timing and time implications having into consideration when is best to offer the intervention and planning the session around the technique; the physical setting of the counselling room as providing a relaxing environment is vital; and additional equipment to facilitate further exploration after the visualization.

Hall et al. (2006) also offer in their book valuable guidance about the appropriate verbal interventions to guide imagery, bring the client back to the room and reflect on and explore the meaning of the experience after the visualization.

Summarising, they provide us with 6 suggestions in regards to guiding the client through the imagery process: Be sparing in the interventions and avoid to intervene too much respecting the pace of the client, asking few open questions or promts and leaving him/her to control the process; Avoiding why questions is also very important as they may interrupt the flow of the imagery journery as they require cognitive focus and rationalization of experience; combining what's good about..? and what's bad about..? questions is very beneficial as it promotes deeper reflection during the imagery journey; encouraging the "assertive I" suggesting the clients to try to express what they are saying introducing "I"; asking clients directly how do they feel about what they are saying or experiencing is recommended as they will normally tent to detach and avoid mentioning the feelings they experience; and lastly they suggested that tracking and reflecting the client's vocavulary helps to stress important aspects of the client's experience and ensures that the clients feels understood and minimises assumptions of meaning. (Hall et al., 2006)

Leuner (1969) explains guided imagery technique the following way:

"The technique for applying the method of Guided Affective Imagery is simple. The patient lies down on a couch. Outer stimuli are reduced as much as possible. The room should be quiet and the lights dimmed. He is then asked to relax. It may be advisable to offer some verbal suggestions that help to deepen the relaxation. One then starts with the first standard situation, the meadow. The patient is asked to imagine a meadow, any meadow that comes to mind. No further comment is given. Everything is left as open and as unstructured as possible so that the patient can develop his own image of a meadow with its associated feeling quality. The therapist gently persists in asking the patient to give detailed descriptions of his imagery and of the feelings associated with it. The therapist is, so to speak, always the companion of the patient in his world of imagery." (p.2)

Discussion of research into the process of guided imagery: what are the aspects of guided imagery interventions that clients experience as helpful or unhelpful?

There is not a lot of written work that explores why guided imagery is helpful. Nightningale (1998), states that guided imagery facilitates clients connection with their internal cognitive, affective, and somatic resources.

Although a large amount of research has centred on the ways in which images are produced, the ways in which thought processes operate, and the value of imagery in memory and cognition, little attention has focused on the process by which people associate meaning to the images they produce or on the dynamic qualities or functions of imagery in the psychotherapeutic process. (Farr, 1990)

Farr (1990) in his study about the guided imagery process illustrates the experiences of five women using a spontaneous guided imagery process to investigate how much participants discovered meaning and increase their awareness regarding their personal issues. He carried out four guided imagery sessions, one per week. He found that "the guided imagery process facilitated participants' discovery of personal meaning and increased understanding about their outer and inner lives. Subjects found the imagery enabled them to quickly discover and explore affective material related to important life experiences, issues, and relationships. It also allowed them to renew a connection with inner personal sources of creativity". (Farr, 1990, p1)

In his study Farr explains that this technique is characterised by vivid, intense and very real like images that promote deep emotional exploration and reflection. Furthermore, every participant reported some kind of kinaesthetic body reactions. Participants also mentioned that it was beneficial not to have to analyse or even understand then and there what was happening on the visualization as this allowed them to directly access feelings. They stated this is different than in verbal therapy.

Participants also stated that they have learnt a lot about themselves and their life concerns, and also their perspective about the issues was broader as they could see them more clearly and from different points of views. Additionally, the spontaneous imagery technique facilitated the recovery of repressed issues or forgotten memories as well as every participant also experienced affective release or expression.

Interestingly enough every participant came across an image of a "positive guide" at some point of the visualization. It was observed that a shift in participants' attitudes, a change in perception or more understanding about an issue took place as a consequence of the interaction with this character. Furthermore participants expressed that the experience emphasised their own needs to love herself and that as a consequence of the experience they felt empowered and interested in continuing exploring their inner life.

Lastly, participants pointed out that they felt the images were directly or indirectly related to their current life, their past or present relationships or issues. (Farr, 1990)

Discussion of research into the effectiveness of guided imagery interventions.

Guided imagery is a technique that has been widely applied by healthcare providers with remarkable results, especially with Cancer patients or pain control. For instance, Walker, Walker, Ogston, Heys, Ah-See, Miller, Hutcheon, Sarkar, and Eremin (1999) undertook an experiment with two groups of Cancer patients. Relaxation therapy was applied to one of the groups while the other one also received peaceful imagery. Participants in the second group presented with "enhanced lymphokine-activated killer cytotoxicity, higher numbers of activated T-cells and reduced blood levels of tumour necrosis factor" (p. 267). They, furthermore reported being "more relaxed and easy going, had fewer psychological symptoms and had a higher self-rated quality of life during chemotherapy" (p. 267). In summary, participants that also received peaceful imagery seemed to be healthier than the participants in the control group. 

Another similar study with two groups of stroke survivors showed that subjects who received both occupational therapy and guided imagery presented considerably more improvement in motor recovery than the group that did not use imagery (Levine, Sisto, & Johnston. 2001).

In a research with children who experienced recurrent abdominal pain it was shown that after the used of imagery pain was reduced a 67% (Ball, Shapiro, Monheim, and Weydert, 2003). 

The use of guided imagery is not exclusive of healthcare professions it is also effectively used in sports to reduce pain and accelerate healing, improve performance and motivation. There are many studies on this field that demonstrate that guided imagery is an effective tool that has many uses. For instance, in their study, Thelwell and Greenless investigated competitive endurance of athletes training for a triathlon through the use of a mental skill training composed by a combination of different strategies such as goal setting, relaxation, self-talk and imagery. They discovered that motivation did considerably increase, participants managed pain more effectively and their competitive performance was enhanced (2003). However, in this study is difficult to pin point how much imagery contributed to these benefits as the mental skill training was complex and other strategies were involved.

Additionally, there is also a substantial body of research that provides evidence that supports the idea that imagining performing a specific sports skill or activity improves the physical performance of that skill (Eddy and Mellalieu. 2003). In his mental imagery research with visually impaired athletes, they concluded: "mental imagery ... [is] a useful psychological skill for athletes who are visually impaired" (p. 366) as it helps them to improve both their motivation and performance.

Research on guided Imagery in Counselling 

However, the research in guided imagery is extended to other fields, including counselling and psychotherapy where it is considered a therapeutic tool that has been investigated through decades. For instance, it has been used in grief therapy (Melges & DeMaso, 1980), decision-making and eating disorders (Hill, 2001), to name just a couple of many areas where guided imagery is used within counselling. On this literature review, just a few examples will be presented to stimulate the reader's curiosity.

 

Over 100 people with unresolved or complicated grief were investigated by Melges and DeMaso (1980). They used three stages of treatment: "cognitive structuring for the decision to re-grieve and for clarification of procedures; guided imagery for reliving, revising, and revisiting scenes of the loss; and future-oriented identity reconstruction" (p. 55). They concluded that guided imagery was the essential part of the treatment because re-experiencing or re-imagining helped clients to change their views of reality regarding the grieving (Melges & DeMaso, 1980). 

Hill (2001) study is slightly different. He used fairy tales, "as a vision-to-action treatment alternative for psychological dysfunctions focusing on eating disorders" (p. 584). She combined guided imagery, cognitive refraining, and behavioural assignments to treat subjects with bulimia nervosa. She established that guided imagery "helps the client assimilate new chapters analogous to her life transitions and develop necessary accommodations" (p. 587). She also stated that, "fairy tales provide a paradigm that serves as a transitional structure in language, thoughts, and behaviors" (p. 587).

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). 

These are some examples of the extended research that provides evidence for the effectiveness of guided imagery.

Guided imagery is a flexible technique that can be used by itself or in conjunction with other strategies, always having into account our clients' needs, the counsellor's experience, comfort with the approach and training necessary. Nightingale (1998) suggested that guided imagery can be applied in counselling for relaxation for stress reduction; motivation by imagining a positive future; and insight through exploration of possibilities and problem solving.

However, further research should focus on how specific aspects of the implementation of guided imagery influence or affect specific issues or populations. Furthermore, there is a imperative need to increase the research of the mechanisms by which guided imagery is effective.  Nevertheless, guided imagery is at the moment and without a doubt an effective, useful and flexible therapeutic tool as it has been demonstrated through extensive research during the last decades. It has earned the right to be considered a research-based approach to helping.

The evidence base for therapeutic use of past life regression techniques

The use of past life regression techniques in counselling and psychotherapy can be defined as any intervention that involves a process through which the client is invited to enter a relaxed state, then receives a suggestion to imagine a meadow or a relaxing place for them and a door. They are invited to go through that door after which they will be in a past life. The suggestion is open so the participant decides what to visualise, if anything. Through the regression the counsellor asks open questions about what the client may be seeing, questions such as who are you? What are you wearing? Is there anyone around? How is the environment? How you feel? What are you doing? Then the counsellor suggest the client to return to the door and go through it to return to the meadow or the place where they were relaxed and safe at the start of the regression to then return progressively to a normal waking state and reflect on the meaning of this experience for their current life.

In some contexts, hypnosis is used to assist the person to enter into a relaxed state in which they are open to suggestion. In other therapeutic contexts, the person is merely invited to adopt a relaxed posture, close their eyes, and breathe slowly and deeply. In essence, past life interventions are similar in structure to other guided imagery and guided fantasy techniques described by Hall; the only difference lies in the content and form of the guidance given to the participant. The guidance in past life imagery is a bit more open and less guided or direct, after going through the imaginary door the client decides what to see or even to not see it at all.

The therapeutic use of past life regression has been the focus of intensive interest for at least the past 30 years, through the work of transpersonal psychologists and psychotherapists such as Bragdon (1990), Grof (1988), Lucas (1993), Schlotterbeck (1987), Weiss (1988), and Woolger (1987). Some commentators have pointed to the similarity between past life 'journeys' and the kinds non-ordinary states of consciousness that are available and accessible to people in diverse cultures (Edwards, 1991, 1993; Knight, 1991, 1995; Moody & Perry, 1990; Ten Dam, 1990). Grof (1988, p.87) describes the essence of the experience of past life regression as comprising:

…. a convinced sense of remembering something that happened once before to the same entity, to the same unit of consciousness. The subjects participating in these dramatic sequences maintain a sense of individuality and personal identity, but experience themselves in another form, at another place and time, and in another context.

Some researchers who have studied the phenomenon of past life regression propose that these experiences seem to occur in a specific non-ordinary state of consciousness. Van Beekum and Lammers (1990,p. 51) call it the 'past life state', which they define as:

A specific, ego syntonic, altered state of consciousness in which the person experiences a coherent system of visual, auditory, kinaesthetic, and/or olfactory sensations within a clear historical context. This context is consistent in time and place, it seems to date from a single historical period before the present life of the individual, and its content usually refers to traumatic experiences.

Past life regression therapy is usually met by health care professionals with scepticism and suspiciousness due to various reasons. For instance, there is scepticism around the connection between this technique and the concept of reincarnation, a notion that is not an established belief in the western society. The association between past life regression and the occult creates difficulties for therapists trained in a scientific world view. .

Furthermore, some versions of past life regression therapy (PLRT) may be carried out through hypnosis. For many critics, the validity of hypnosis can be questioned on the basis of susceptibility to leading questions, false memory syndrome and the demand characteristics of the situation (Orne, Whitehouse, Dinges, Orne, 1988; Perry, Laurence, D'eon, & Tallant, 1988; Myersburg, Bogdan, Gallo, McNally, 2009; Schacter, 2001).

However, in response to this scepticism lies a body of research that reveals PLRT to be an effective therapeutic intervention for a wide variety of emotional, mental and physical problems including phobias, migraine headaches, personal growth, relationship troubles, insomnia, anxiety, weight issues and asthma, depression among others (Solovitch & Henricot, 1992).

Research into the effectiveness of past-life regression interventions

Dr. Raymond Moody, researcher and author in the field of Near Death Experience, also investigated past-life regressions. Through analysis of his studies and other psychiatrists'' studies, he concluded that there are twelve traits common in past-life regressions such as: experiences are normally visual and in colour. Sometimes there are odours and sounds. From subjects' perceptions images seem more "real" than dreams and don't feel as distorted; additionally, experiences "seem to have a life of their own, the scenes seem to unfold on their own and subjects have the sense that they aren't making it up such as in daydreams". (Moody, 1990, p.43); the visualization seems familiar, in different degrees of intensity; "the subject strongly identifies with one character despite profound differences in physical appearance, occupation, sex, race or other life circumstances" (Moody, 1990, p.43); different emotions may be (re)experienced; events that take place on the visualization may be experienced from two different perspectives: first- and third person, "sometimes the subject feels as though they are in the body of the person with whom they identify, and at times they observe the scenes as they unfold from a detached viewpoint." (Moody, 1990, p.44); the experience normally mirrors issues from the subjects' present life. "The conflicts and dilemmas in the regression usually reflect the subject's current life circumstances or struggles" (Moody, 1990, p.44); Changes and improvements in the subjects' mental health normally take place after the regression as it seems repressed or stuck emotions seem to be relief by catharsis; Additionally, sessions may influencemedical physical conditions, "In rare instances, the subject may report dramatic improvement, or even spontaneous resolution, of physical symptoms following a past-life regression" (Moody, 1990, p.43); Furthermore, the visualizations seem to be organised around meaning, not linear timeline; other trait is that regressions tent to become easier with repetition; lastly, Moddy states that most past-lives are mundane, ordinary, normal (Moody, 1990).

Moody states that a person may not experience all these 12 traits although it is expected that several of them take place (Moody, 1990).

Although impossible to prove how PLT works, what have been demonstrated is the healing benefits of this technique as well as the enormous yet inscrutable potential of the subconscious mind.

Clark (1993-94) compiled a questionnaire in which she queried 136 therapists, each with at least 5 yrs experience with past life therapy. He discovered that therapist use past life regression for a wide range of issues, the most frequently treated and with more success were phobias, 62 types were reported to respond well to regression; relationship issues, finding purpose and meaning in life and physical illnesses. Furthermore, therapists stressed as significant the speed with which therapeutic change is achieved and the fact that many cases that have been bothering the subjects for years and been treated by all others short of interventions achieved permanent relief through past life regression.

In 2000 Eric J. Christopher sent a questionnaire to 222 practitioners that use past life therapy as combination to other therapeutic interventions. 73 therapists returned the questionnaire filled out. Results indicated that past life therapy helped to cure 30% of their client's problems. Furthermore, A total of 77% of their clients' problems were significantly helped, if not cured. Finally, the therapists stated that past life therapy helped to make some kind of improvement in 96% of their clients' problems in the past 6 months in an avarege of 6 sessions of an average of 1 hour and 40 minutes length. Therefore, researcher concluded that past life therapy seems "to be reliable, extremely effective and fast in helping clients to deal with problems and improve their lives (...) The results of this study also indicate that PLT is a highly effective and fast therapeutic modality, and one certainly worthy of further investigation regarding its potential for human healing and personal growth" (Christopher, 2000, p.66)

This study may demonstrate the effectiveness of past life therapy but strictly from the therapists' point of view and not the client. This is considered an important limitation

In addition to this, is important to have into account that in both of these studies the therapists are eclectic in their approach. They may use a combination of techniques and therapies with the same client therefore, how much of the outcomes are due to past life interventions is questionable.

In a similar study, Wambach & Snow (1986) surveyed 26 regression therapists. In total they worked with 17,350 past life reports. 40% improved their interpersonal relationships and 63% of the clients improved a Physical symptom. Furthermore, from that percentage, 60 % seem to have improved a physical symptom related to a death experience in a supposed past life after relieving or re-experiencing what happened then during regression.

In an attempt to evaluate his clients' satisfaction Schlotter beck (1986) questioned 18 of his clients that presented with different issues whether they found past life regression and the tapes he made for them helpful tools for recovery or in opposition they might have "reprogrammed " their symptoms. Results were positive. Clients also stated that his tapes were very helpful.

Moreover, the reports from these types of studies as the ones mentioned above are merely anecdotal in nature as no information about medical testing prior and after the therapy was provided.

Most of the evidence in regards to the efficacy of past life regression is in the form of anecdotal cases studies or surveys to practitioners such as the ones mentioned above. Tere are a vast number of books full of cases studies that show the efficacy and effectiveness of past life regression. This type of qualitative evidence is important, however it is not considered as scientifically valid as quantitative research. Therefore, it is important to include in this review the few studies that present more measurable data to support the claims of past life practitioners.

For instance, Cladder (1986) in his study with 30 Dutch clients with unresolved phobias by conventional therapies shows that 20 of them improved rapidly ang get ride of their phobias completely after an average of 11 "behavioural hypnotherapy with regression" sessions. Cladder refers this way to his therapeutic method. Past life regression was one of the various techniques he used in his treatment; therefore, this has to be taken into account when the results of this study are interpreted. He reported that 6 of the 20 participants that improved did not report any past lives at all.

Of the 20 clients that improved, 14 of them regressed to a past life when they were asked to go to the source or origin of their phobia or problem without directly instructing them to regress to a past life, while the other 6 regressed to an event in their present lifetime.

The remaining 10 clients that didn't experience improvement in their symptoms seem to be quite severe cases. 5 of them had score high on the pre test and had serious compulsions. 3 of them were not cured after 22 sessions and the other 2 dropped out of the treatment.

Cladder concludes that past life regression seems more effective than conventional therapies because clients are less able to avoid traumatic issues. In his own words he states: "It is the patient himself who tunes into his own traumatic situation and not the therapist who invents it" (Cladder, 1986, p.84).

Additionally, he affirms that "the majority of phobic patients who have previously experienced unsuccessful therapies" would benefit using "the concept of past lives". (Cladder, 1986, p.84).

Another interesting study with phobic patients safeguarding the limitations from the study mentioned above in regards to treatment definition and specification of outcome measurements is the one from Freedman (1997). In her study she measured the therapeutic outcome 27 clients with 52 phobias between them.

Each of these 52 phobias was treated separately. Once treated they were divided into three categories of treatment which were determined in function of where the subject placed the origin of the phobia during hypnotic trance, prior to this life, earlier in his current life or if the client could not reach trance depth. 28 phobias used past-life regression, 11 phobias used present-life regression also defined as age regression, and 13 phobias only used a talking method.

Freedman also measured the anxiety level for each of the 52 phobias using Sandler's A test before and two months after the final session of treatment. The results showed that the average anxiety score for phobias using past life regression dropped significantly, from 6.79 to 1.71. Using present-life/age regression, the average anxiety score fell from 10.0 to 6.09, while the "talking-only" group anxiety scores' drop from 5.77 to 4.54. Of the three methods of treatment, only PLT was considered clinically significant in reducing anxiety levels, according to the omega-squared test of significant findings.

Furthermore, within the past life regression group, Freedman further divided the phobias into three types, which capitulated varying degrees of clinical significance: simple phobias (p=<.001); agoraphobia (p=<.01); and social phobias (p=<.05). Freedman concluded that the results strongly suggested that past life regression reduces anxiety symptoms associated with all three types of phobias.

She also measured the length in sessions that each phobia took to improve or disappear. Using past life regression, the average number of sessions was 2.48 per phobia. Each session lasted two to three hours in length (Freedman, 1997).

She comments: "Considering the estimate of 28 million people in the U.S. who suffer from anxiety disorders and the amount of resources invested yearly in their treatment, any therapy that gives such rapid and apparently effective relief should be a therapy of choice, regardless of whether these reports are true reincarnation memories or fantasies" (Freedman, 1995, p.29).

It is worth differencieting here between two different types of research Practice based and evidence based. Practice based refers to research with large number of participants tested before and after undergoing therapy for a variety of issues. On the contrary, evidence based is a type of research that gathers data from clients with a specific type of problem often comparing results with a control group to demonstrate its effectiveness. Each of these methods has its advantages and disadvantages. Limited research resources may force some past life practitioners to utilise practice base analysis to evaluate their clients i practitioners have limited resources for research so tend to use practice based analysis to evaluate their clients' improvements.

An example of practice based research is the one from Hazel Denning who analysed the results of eight regression therapists that worked with nearly a total of 1000 patients between the years 1985 and 1992. Denning measured clients outcomes straight away after the past life regression therapy , six months, one year, two years and five years later. 450 of clients were able to be tracked after 5 years. Of them, 24% reported the symptoms had completely gone, 23% reported considerable or dramatic improvement, 17% reported noticeable improvement and 36% reported no improvement. (TanDam, 1990).[xvii]

As an example of a significant evidence based research we present the studies by Ron Van der Maesen. In 1999, he investigated past life regression with 27 clients who were diagnosed with schizophrenia who suffered from auditory hallucinations. They filled in the Symptom Checklist (SCL-90) before and six months after they had completed the 12 sessions treatment of past life regression. 14 of them scored significant improvement on the SCL-90 six months after the treatment. Additionally, the scores of 11 clients moved from the range associated with "psychiatric patient" to that of the normal population. Furthermore, clients completed a questionnaire where 25% stated that past life therapy had alleviated their voices, while four stopped hearing voices entirely. A total of 78% indicated that the therapy had "other, positive meanings." Having into account the difficulty of treating schizophrenic patients Van Der Maesen's results should be considered quite significant (van der Maesen, 1999, pp.38-41).

Another study by Ronald van der Maesen in 1998 aimed to measure the effects that past life therapy had on people suffering from Tourette's Syndrome, a life-long illness characterised with involuntary repetitive behaviours considered to have little or no cure. 10 clients who suffered from this condition with symptoms ranged from "moderate" to "very serious" underwent past life therapy treatment from six to 22 sessions (an average of 11.9) of an average of 2 hours in length. Results were followed up for one year. The researcher discovered that 5 of the subjects reported the disappearance or significant reduction in frequency of their motor tics while being entirely free of medication. Two clients didn't improve their motor or vocal skills, another two clients improved somewhat, and one client increased his medication than before the study. The researcher also points out that there is direct correlation between the success of the treatment and the deeper levels of trance depth each client could achieve. In this study, is also worth mentioning that given the very poor prospects in treating people with Tourette's Syndrome, this study is significant not only for PLT, but also for sufferers of this disease (Van der Maesen, 1998).

The change process in therapeutic past-life regression

It is possible to understand the effectiveness of past life regression experiences from a number of different perspectives. Some adherents of past life regression therapy believe that the images and experiences reported by clients are real, and refer to actual events in previous lives. On the contrary, others believe past life regression is a product of our imagination. Research seems not to be conclusive in either of the two arguments. However, this is not the focus of this research which aims to strictly focus only on the psychological change processes associated with counselling and psychotherapy practice. Therefore theories of therapeutic change representing both frameworks will be included without entering into the debate concerning the experiences authenticity.

Terazi (1990) has presented an exhaustive summary of all the mechanisms that may explain the phenomena of past-lives experiences in PLRT.

One widely adopted perspective has been to attribute the effects of past life regression to Psychodynamic factors, "Past-life experiences [are] fantasies motivated by the unconscious needs of the subject" (p. 330). In a variant of this theory, material in the personal subconscious that is originally disturbing and anxiety-provoking to the ego, is neutralized by being projected onto and integrated into a fabricated personality that lived a "previous life" and not the present one (Zolik, 1958). On one of his experiments, Zolik regresses a subject through hypnosis to a past life and gives him a post hypnotic suggestion of amnesia after the regression, to then hypnotisize him four days later to investigate, without the induction of age regression, the source of the past life experience fantasy. After some questioning about the character the subject saw in his past life regression he discloses that he knows that person because his grandfather used to tell stories about him. Grandfather used to say this character was soldier who he hated that died in a horse accident when he was around 40. Furthermore he then discloses that when he was little his grandfather never liked him, especially since he took out his favourite horse to wonder around and this did hurt him. Through psychoanalytical interpretation of this case, Zolik, concludes that the past life regression fantasy is based on a central conflict which was not adequately resolved and that this past life fantasy is dynamically related to the subject's personality, its motivational systems and interpersonal relationships (Zolik, 1958) However, it is worth considering that this study was just carried out with only one subject and that his psychoanalytical analysis is open to different interpretations from different perspectives, including transpersonal ones.

A second perspective regards the outcomes of past life regression as arising from a role playing or placebo effect. Through the power of belief and imagination and a desire to please the therapist or hypnotist and give him (her) what the subject feels is desired, the subject creates a dramatic personification of a fantasized character induced by the hypnotic suggestions and shaped by the expectations of the therapist or experimenter and the demand characteristics of the experimental or clinical setting, drawing upon subconscious memory for many of the details, inventing others to fill the gap.

Other opposite perspectives are the ones considered by transpersonal counselling such as for example "the extended self" which supports the idea that therapeutic change takes place in past life regression in the same way it does in psychodynamic theory,  but having into account that our self is a continuo that lives more than one life, therefore traumas from other lives can be unresolved and stuck and, thus, influence our current life and through past life regression some of this unresolved trauma gets relieved and processed. 

Another theory from this perspective "the multiple subpersonalities in the transpersonal inner self" which is Woolger's (1987) unique approach. He sees the characters of past lives as 'other selves' or subpersonalities. These 'other selves' appear to re-enact their own story in this lifetime, a story which has remained unfinished. Past life experiences are viewed as the "unfinished dramas of the soul" which emerge from the deeper levels of the unconscious. (Woolger, 1987, p. 15).

On this literature review, firstly, the research in past lives as a construction of our imagination will be outlined. How therapeutic change may take place will be discussed. In order to do this, the research on placebo and other factors such as roll playing and expectations from the therapist will be covered as well as Psychodynamic theories, the human need for self actualization and growth and the process of realising emotion through the use of imagination.

Secondly, to have into account both arguments, theories about how therapeutic change may take place from a transpersonal point of view that understand past life regression as recollections from reincarnation will be also covered.

Role playing and placebo effect

Expectancy and placebo effects and factors such as the therapist expectations projected into the client are worth to take into account regarding how therapeutic change may occur if we understand past life experiences as product of our imagination.

There is extensive research undertaken on the psychotherapy outcome that points out that these factors have an important impact on psychotherapeutic change counting for 15% of the variance in client change (Lambert, 1992). Frank (1973) also adds that the expectation that the client will be helped is a common factor in every psychotherapeutic approach. However, it is also true that the use of placebo controls in psychotherapy research is controversial (Lambert and Bergin, 1994)

Michael Heap wrote an article about the characteristics that a Placebo therapy may have to be effective. He mentioned that a relaxing and suitable environment is important if possible with the practitioners' qualifications hanging out on the wall. Additionally, the practitioner must have an appearance and demeanour that inspires confidence to your patient. A good first appointment where the overall of the problem is presented and the clinical history of the patient is covered is also important as well as a good description and introduction of the treatment provided the theory and the rationale behind them. He believes these components are enough to promote therapeutic change. Past life regression therapy as any other type of psychotherapy fulfils these requirements.

More specifically, a couple of investigations that contribute to the evidence of placebo effects and expectations for change are the ones carried out by Dr. Nicholas Spanos (director of the Laboratory for Experimental Hypnosis and a professor at Carleton University in Ottawa). He demonstrated that there are three important elements to a successful Past Life Regression.

First, the subject must be hypnotizable. Second, it helps if they are open to the belief in reincarnation. And third, the most important element in the whole process was that the hypnotist had to convey the expectation that their client really would remember a past-life.(reference 1d)

Additionally, the psychologist Robert Baker demonstrated that the hypnotist's expectations can influence this therapeutic process. He conducted a study where he randomly divided 60 students into three groups. The first group were given a real pep talk and told that they were about to experience the most amazing therapy that would involve them actually recalling memories from a past life. The second group were told (in a neutral way) that they were going to experience a therapy that may or may-not be able to help them recall memories from a past-life. While the third group was told that they were about to experience a crazy therapy that some believed was supposed to help them recall memories of a past life, even though it didn't really work on anyone who was normal. Then all three groups listened to the same hypnotic script. Eighty-five percent of those in the first group recalled a memory from a past life, compared to only 60% in the second group, and 10% in the third.(reference 2f)

Normal memory in the waking state is recognized to be reconstructive, not reproductive (Bartlett, 1932). Hypnosis seems to facilitate this common reconstructive process of integrating confabulations, fantasies, and external influences such as the expectations of the therapist or leading questions into actual memories in highly hypnotizable individuals, especially when memories occur with intense visual imagery (Council on Scientific Affairs, American Medical Association, 1985).

Furthermore, factors such as how vividly the clients experience the images, how much they believe them and the confidence of their factual accuracy no guarantee that the memory -- whether it be of this present life or a past one -- is necessarily "objectively" accurate (Bowers & Hilgard, 1988). Perry, Laurence, D'eon, & Tallant (1988) indicate that a hypnotic past-life report, just like ordinary age-regression present-life reports, should not be taken literally because of five important "recall problems" that occur in any verbal reports obtained under hypnosis: "(1) confabulation; (2) the creation of pseudomemories; (3) inadvertent cueing by the hypnotist, and the hypnotist's beliefs about hypnosis; (4) the beliefs and preconceptions of the hypnotized subject; and (5) in some cases, source amnesia (Evans & Thorne, 1966)" (p. 135).

Psychodynamic theory

These creations may be the way the client represents their current issues as a metaphor for self exploration and meaning making.

Moody stated that in the majority of the cases the most past life experiences that patients brought up in the sessions mirrored an issue in their current life (Moody, 1990).

Zolik (1962) states that:

The crucial elements of the "previous existence" phenomenon [are] based on unconscious memories which, when systematically investigated, would reveal a dynamic relationship between the subject's personality and his "previous existence" fantasy. It [is] further postulated that the fantasy serve[s] as a screen onto which would be projected the important motivational systems of the personality and major interpersonal relationships. (p. 67)

She also adds that that these fantasies or in other words, the way the unconscious express itself, should never be taken literally. "Rather, the interpretation of the unconscious involves a conversion to the terms of consciousness" (p. 74).

The therapeutic process of change in this occasion will be exactly the same as in traditional psychodynamic theory. The only difference is that past lives experiences will be an extra material that will form a vital part of the therapist interpretation of the problems brought by the client to therapy.

Pychodynamic theory is complex and it is far beyond this piece of work. However, some basic concepts regarding the therapeutic process will be interested to mention here.

Leiper, & Maltby, (2004) explain the process in a very simple way. They state that there are three main aspects that explain the main ways in which personal change has traditionally been thought to take place are expression, understanding and relationships. They understand the act of expression as releasing of emotional content through verbalisation, catharsis and confession. This release can be done directly and more indirectly and symbolically in Language. For this, psychodynamic psychotherapy have always use different means that can facilitate the expression of emotions such as expressive therapies based on art, drama and bodywork. Past-lives therapy is just another way to facilitate expression.

"Whether or not past-lives are viewed as actual memories or a metaphor does not matter. What is important is getting in touch with the feelings the other lifetime evokes" (Lucas, 2001). He also adds that some clients are able to connect how their past life memories relate to their current situation (Lucas, 2001). This along with releasing the feelings connected to the past life memories provide emotional healing ( reference 1)

Verbalisation is expression experiences verbally and in order to do this symbolisation is required (Leiper, & Maltby, 2004). Images are normally full of symbolism, thus we can say that past lives may help clients to verbalise their unconscious issues.

Catharsis is another concept related to the expression of emotions. Freud used the term as a method for reviving and discharging emotional reactions arising from traumatic experiences that have been repressed from memory (Leiper, & Maltby, 2004). However, if past lives experiences are understood as imaginative creations of our mind the only way this term will make sense here is if we think as these experiences as a metaphor or expression of other traumatic experience that still unlock on our client's unconscious.

The other two very important aspects of the therapeutic process in psychodynamic theory is understanding and relationships. Understanding is understood as "becoming more aware of our own hidden motives and impulses, and more generally perhaps, of the dynamic processes that underpin all aspects of our behaviour. "Developing insight already represents, in itself, a process of change"(Leiper, & Maltby, 2004, p.62). Past lives experiences may help us to gain insight and search for meaning to facilitate making the unconscious conscious. Regarding relationships, the concept is similar, clients may gain insight about the way they relate to others in current life through the analysis of the metaphorical symbolism of past lives experiences.

Multiple Sub-personalities in the inner transpersonal self

Woolger (1987) approaches the experiences of past lives in therapy in a unique way, seeing the characters of past lives as 'other selves' or subpersonalities. These 'other selves' appear to re-enact their own story in this lifetime, a story which has remained unfinished. Past life experiences are viewed as the 'unfinished dramas of the soul' which emerge from the deeper levels of the unconscious (p. 15).

Woolger has documented three distinct stages or levels that a client may need to go through to achieve therapeutic change through past life regression.

The first level he calls the realistic-cathartic stage. At this level he treats the stories that have been dramatized by the psyche as if absolutely real. We may legitimately take the stories or past lives literally, as if there were a linear sequence that operates within the lives. The stories are treated as a product of a living trauma that is in need of healing and often catharsis. The trauma/story is brought into consciousness and allowed to be expressed, and all the blocked pain and emotion associated with it is released.

'Absolute respect for the psychic reality of the experience is necessary so that this other life or story can be reconstituted and re-lived. The stance of the therapeutic "as if" provides an attitude of unconditional concern and is the basis for the successful release and expression of the story in all its confusion, pain, or fragmentation. And whatever embroidering, distortion or unconscious reworking may have occurred, each client's story needs nevertheless to be heard totally without judgement or without interpretation' (p. 320).

Woolger (1987) refers to the second stage as the symbolic-archetypal stage, where a certain overall detachment begins to occur with specific insights into the metaphorical and often spiritual meanings of the lives. At this level, there is a movement from identification to disidentification, so that certain thoughts and patterns which are psychologically unhealthy or damaging are recognized, and are able to be changed or abandoned.

According to Woolger, we now ask for meaning rather than catharsis, for metaphor rather than realism. Psychologically speaking, the client is encouraged to use a detached perspective, to adopt a 'witness point' so that the story may become integrated and accepted into consciousness. In this way, "a split is healed, a lost part of the soul, like a prodigal son, is redeemed through love and acceptance" (p. 326).

Woolger (1987) refers to the third stage as the integral-mystical stage, where a "kind of transcendent realisation of the meanings of the entire process may begin to occur" (p. 318). Woolger believes that this stage can only be hinted at and we are obliged to turn to images and metaphors to understand it. The assumption here is that the psyche has an innate drive towards wholeness and expanded consciousness, and psychological healing is grounded in the spiritual and mystical dimension of the psyche.

Transpersonal psychiatrist Roberto Assagioli (1965/1993; 1988/1991) also agrees with Wolger and proposes that areas of the subconscious in normal human personality are indeed populated by many and various subpersonalities, and important concept in "psychosynthesis." One important goal and outcome of the process of psychosynthesis is to first identify and then integrate the various subpersonalities into the whole self and to make clients aware of the differences and even contradictions of their own behaviour at different times in different places. Once we learn to identify our various "faces", we are able to free ourselves from their control and increase our integration by allowing our subpersonalities to work together rather than against each other, as we move ever closer to discovering our underlying basic identity -- the inner Transpersonal Self.

The therapeutic process of psychosynthesis involves four consecutive stages. At first, the client learns about various elements of his or her personality that were previously hidden and accepts them on a conscious level. The next step is freeing oneself from their psychological influence and developing the ability to control them; this is what Assagioli calls 'disidentification.' After the client has gradually discovered his or her unifying psychological center, it is possible to achieve psychosynthesis, characterized by a culmination of the self-realization process and integration of various selves around a new center. (Grof & Grof, 1989, p. 29)

The extended self in transpersonal counselling: the new psychodynamic theory.

The extended self in transpersonal therapy which supports the idea that therapeutic change takes place in past life regression in the same way it does in psychodynamic theory, but having into account that our self is a continuum that lives more than one life, therefore traumas from other lives can be unresolved and stuck and, thus, influence our current life and through past life regression some of this unresolved trauma gets relieved and processed. 

Here, the mechanism of change in past life therapy is the same as that in psycho-analysis - making the unconscious conscious in an effort to re-establish the individual's personal choice.(reference A1)

The unconscious operates as a tape recorder; it records and stores every experience, both positive and negative. Unlike the conscious mind, the unconscious never turns off; it can remember anything from anytime (Weiss; Netherton & Shiffrin). It is not bound by limits of time, logic, or space. (reference A1)

Freud hypothesized that the most severe trauma is buried within the unconscious. The conscious mind often is not able to remember the events that caused the trauma or the direct results. The after-effects are often only visible in the form of maladaptive behaviours (Netherton & Shiffrin, 1978). It was Freud that first discovered the link between trauma and the subsequent symptoms that appear while accessing repressed memories through first hypnosis and later free association. He called this connection psychic determinism, and it is considered the foundation of regression work (Lucas, 2001). When first introduced by Freud this concept was considered quite radical and not well received. (aa1)

Edith Fiore's book, You Have Been Here Before (1978), focuses on case studies that demonstrate the effectiveness of past life therapy. Similar to Freud, Fiore believes that a person's present problems chiefly originate from unresolved issues in the unconscious mind. Her goal is to help bring these issues into consciousness.

Here the process of therapeutic change is like in psychodynamic therapy. However, if we considered that the experience of past lives are a recall of real memories from those lives then realising trauma, expressing and reliving unlock emotions become the most fundamental part of the process.

Morris Netherton and Nancy Shiffrin (1 978) stated that in order to decrease the effects of the past lives and reduce the symptoms, the client must re-experience the trauma and release the backed up energy connected with it.

To assist with the retrieval and processing of past life memories a three step process has been developed: identification, searching for patterns, and integration (Lucas, 2001)

The process of recalling past life memories and experiencing the emotions of the person one was then, feeling their physical body, and their thoughts is the process of identification (Lucas, 2001). It is important re-experiences the emotions that this past live evoke. This way the repressed emotional memory is released and there is a reduction of the clients' symptoms. Furthermore, making connections between the past-lives and our current-life will also contribute to the emotional healing (Lucas, 2001).

The second stage is the identification of patterns to increase awareness and help us realise that our lives are not totally determined by the past. This is also called Karma in transpersonal counselling. Here, the client experiences the lives from a third person perspective (Lucas, 2001). Lucas states without patterns there would be no regression therapy. It is the existence of patterns that allows us to see nothing is chance.

According to Dethlefsen ( in Lucas, 2001):

"Knowledge of former lifetimes affects an enormous increase in a person's conscious knowledge. The individual suddenly learns how to interpret and understand details in his present life in a new manner. He recognizes associations and receives insights that greatly expedite his learning process". (p.41)

The examination of these patters between themselves and others also influence the clients' current-life relationships (Lucas, 2001). The client sees himself exchanging roles in different lives and sometimes our reactions, attitudes or behaviours towards someone become explained and clear through the exploration of these lives.

The last step for the therapist is to help the client to create meaning and take a wider perspective (Lucas, 2001). "The therapist assists the client to identify the parallels between events, emotions, and attitudes of the past life characters and those of the current incarnation. It is important for the therapist to offer support so the client may release built up judgement, hate, denial, and guilt" (reference 1b)

Summarizing, the key to healing is helping the patient to 'reframe' their current problem, either by recognizing it as part of a longer-term destructive pattern that they now want to break free from, or by gaining appropriate insights from the inter-life - (reference 16)