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Introduction

“Neuroscience is rapidly increasing the understanding of mental imagery, image

formation, and the regions of the brain involved in image creation” (Malchiodi, 2003, p. 18).

Guided imagery incorporates positive imagery instructions which can help to recreate preexisting

pathological patterns and responses related to trauma (Moral, 2017). This experiential workbook

connects the Neurosequential Model of Therapeutics (NMT) related to trauma (Perry, 2006) with

a guided imagery process of Perry’s 6 R’s for working with individuals who have experienced

trauma. Guided imagery, “an experiential process in which an individual is directed through

relaxation followed by suggestions to imagine specific images, has been used to reduce

symptoms, change mood, and harness the body’s healing capacities” (Malchiodi, 2003, p. 18).

Symptoms connected to trauma can impact daily functioning due to hyperarousal responses and

guided imagery can help to reduce this state of arousal and improve focus and attention (Moral,

2017).

“Trauma victims cannot recover until they become familiar with and befriend the

sensations in their bodies” (Van der Kolk, 2014, p. 100). Guided imagery as a mindfulness-

based practice can help individuals who have experienced trauma become more aware and

comfortable in their bodies within a safe and therapeutic environment. “If adverse experiences

alter the developing brain and result in negative functional effects, can therapeutic experiences

change the brain in ways that allow for healing, recovery, and restoration of healthy function?

The short answer is yes.” (Perry, 2006, p. 29).

This workbook is not intended for the use of trauma processing, as it focuses on creating

a foundation for building a sense of safety with grounding techniques prior to the start of trauma

work. This workbook can be utilized in both individual and group therapy settings and when

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facilitated within a group setting, can promote social interest and community feeling

(Ferguson, 2010) which has been demonstrated to promote positive mental health

benefits.

The use of this workbook is designed to be utilized by trained art therapists as there are

many safety considerations when using art materials in a therapeutic context with individuals

including those who have a history of trauma. Engaging in art processes can access stored

memories connected to trauma and may lead to feelings of dysregulation within an individual. It

is important to assess for any negative feelings which may arise with the use of guided imagery

and art making, and for the art therapist to assist with containment and regulation if this occurs.

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1. Repetitive (patterned)

Repetition is the second principle of the NMT. “All functional capacities in the brain are

dependent to some degree upon the presence of appropriately timed, appropriately patterned

signals that will specifically stimulate the neural systems mediating that function” (Perry, 2006,

p. 36). With the integration and use of repetition, neural pathways and systems can change.

“Healthy organization of neural networks depends upon the pattern, frequency, and timing of key

experiences during development. Patterned, repetitive activity changes the brain” (Perry, 2006, p.

36). Eye movement desensitization and reprocessing (EMDR) is a treatment approach which

utilizes patterned and rhythmic techniques. “Because the brain is organized in a hierarchical

fashion, with symptoms of fear first arising in the brainstem and then moving all the way to the

cortex, the first step in therapeutic success is brainstem regulation” (Perry & Hambrick, 2008, p.

42). An additional process of using art as therapy can continue the process of regulating

emotions by providing repetitive techniques and processes as a means of working through

trauma. A reflective art process can assist in creating movement with trauma healing as “clients

can develop a higher level of tolerance for previously overwhelming emotions through the

repeated use of art to express troublesome feelings” (Hinz, 2009, p. 115).

This workbook of guided imagery integrates repetition, one of the 6 R’s (Perry, 2006)

across multiple areas, as a means of creating structure and emphasizing and Adlerian concept of

the crucial c’s which consist of feeling connected, capable, having a sense of courage, and

feeling as if one counts (Dreikurs & Soltz, 1964). The process of engaging in an art reflection

process is one component utilized to display repetition in this process. Additionally, a mantra

integrating the concepts of the crucial c’s provides repetition and structure. After each guided

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imagery process, the following mantra will be included to provide closure to the guided

mediation and emphasize the importance of repetition. “I am capable of healing, I matter,

therefore I deserve to heal, I have the courage it will take to heal, and through this experience of

connection, I begin my healing process.”

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2. Relevant (developmentally-matched to the individual)

The first principle within the NMT states that “the brain is organized in a hierarchical

fashion, such that all incoming sensory input first enters the lower parts of the brain” (Perry,

2006, p. 30). Understanding brain development as a bottom up process assists with providing

relevant treatment approaches for the individual. It is essential to match the correct therapeutic

interventions to the individuals developmental stage to best support their physiological needs

related to their trauma (Perry, 2006). Engaging the client in therapeutic processes which are not

relevant to their trauma or state of functioning may be unsafe and create feelings of

dysregulation. “Without an appreciation of how the brain is organized and how it changes,

therapeutic interventions are likely to be inefficient or, sadly, ineffective” (Perry, 2006, p. 30).

This guided imagery will support allowing the person to be exactly where they are in the

process of healing within the meditation. It will support the therapist to understand the client’s

psychological capacity to address the trauma based on the reflection questions and process. A

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fundamental principle which will be the focus of the meditation process will provide relevancy in

accepting the client at their emotional, cognitive and developmental level of functioning. The

therapist will have full acceptance that every participant may be functioning at various levels and

through this meditation, allowing full acceptance and support.

Guided Imagery: Relevant

Imagine yourself hiking through a beautiful wooded area. You are surrounded by the

sound of birds chirping, the feeling of the wind touching your body as you move

forward, and the smell of new growth in the air. As you proceed on your uphill hike,

you approach a point on the trail where you can continue straight or take the trail to

the right. Continuing straight will lead you to the highest point of the trail, where you

will be rewarded by a beautiful view of the valley. Turning right will take you on a

beautiful loop through the woods, back towards the base of the trail. Now pausing in

this moment, think about which direction you would like to pursue. Both options will

be filled with the beautiful scenery and there is no right or wrong direction. Now that

you have decided, continue to imagine yourself walking on the path. Where does your

path lead to? What do you see? What smells are you noticing, what sounds do you

hear, pay attention to all of your five senses; sight, sound, smell, hear taste. Notice if

there is a stronger sense for you, which sense stands out, which sense is limited? Is

there a particular place on your path you would like to explore more of? Is there a

particular spot that stands out to you. Pay attention to your surroundings and

appreciate what you are noticing.

Now, slowly bring your attention back to your body. Take one big deep breath in,

hold for 5 seconds, and slowly release. Now repeat this mantra with me, either in your

head or out loud, “I am capable of healing, I matter, therefore I deserve to heal, I have

the courage it will take to heal, and through this experience of connection, I begin my

healing process.”

Art Processing Piece: “The view”

Reflect back on the trail you chose to take in the guided mediation. Using any art

materials, create the image you saw when you reached the most scenic and rewarding

point of your hike.

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Reflection Process Questions

1. What aspects of your piece stand out the most to you and why do you think

that is?

2. Can you find any connections to where you are currently in your journey of

trauma healing?

3. Do you see any aspects or symbols in your art piece that represent courage?

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3. Respectful (of the child, family, and culture)

In order to build a positive therapeutic relationship with a client, it is important to be

respectful of their thoughts, feelings, beliefs, and environment and cultural experiences. An

individual who does not feel respected by their therapist will likely display resistance to therapy.

Feeling respected is helpful in creating a sense of safety which is necessary in the foundation of

trauma work. Through this guided mediation, the individual is able to explore and express

aspects of their life which they find important and valuable. This in turn provides an opportunity

for the therapist to witness and respond in a respectful and positive manner, showing the client

that they are supported, and building a sense of respect and safety for a healthy foundation to

move into therapeutic work.

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Guided Imagery: Respectful

Think about yourself as a whole. Consider the morals and values you hold, what is important to

you in life, and any important familial or cultural aspects related to you who are today. Let go of

any judgments you may have felt in your lifetime. Release any negative comments you might have

been told. For right here, in this moment, you are accepted. You are currently in a space of respect,

where you have the opportunity to open up if you wish. I invite you to state the following mantra

with me, either out loud, or in your head: “I am capable of healing, I matter, therefore I deserve to

heal, I have the courage it will take to heal, and through this experience of connection, I begin my

healing process.”

Art Processing Piece: “Feeling Respected”

Think back to what if feels like to let go of judgments, either self-judgments, or those which you

have taken on by others. Using magazines and collage materials, look for images and/or words

which represent this feeling of being supported and respected by others. Consider what respect

means to you. What actions can others do for you that would make you feel respected?

Reflection Process Questions

1. During this process, did you find yourself remembering times when you felt disrespected

by others?

a. If so, were you able to let go of those memories and feelings?

2. Did you experience any feelings of empowerment, courage, or connection during this

process?

3. Explain and explore the images and/or words you chose to incorporate in your piece, and

discuss what it is about these that are important to you in terms of respect.

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4. Relational (safe)

Guided imagery can assist in the process of healing from trauma through allowing the

individual to explore experiences in a safe and intentional manner. “For our physiology to calm

down, heal, and grow we need a visceral feeling of safety” (Van der Kolk, 2014, p. 79). The

following guided imagery process emphasizes the importance of feeling a sense of safety, prior

to beginning trauma processing. Through the processes of defining and creating imagery

surrounding a secure and safe place, this step is to assist with identifying a coping skill and

mental space to access once engaged in the processing of the trauma.

Guided Imagery: Relational (safe)

Take a deep breath in. You are invited slowly close your eyes if you are comfortable. Place your

body in a comfortable position where you feel relaxed, yet supported. Now imagine a place that

feels comforting and safe to you. This may be a place you have been to before, it may be a place

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that you have dreamt of going to, or it may be an entirely new or made up space. Now tune into

the feeling this safe place provides you with. Notice how you are feeling.

Do you feel safe…calm…content…peaceful…rested? Feel your feet touching the ground.

Imagine the Earth below you, supporting you as you experience your safe space. Notice what

you see, what you hear, notice what textures and smells are around you. Take a moment to notice

and pay attention to how you feel in your safe space. What colors and textures in your

environment stand out to you.

(Pause) Remind yourself that you are safe. You are in a place where you can be yourself and take

care of yourself. Now slowly come back to your body. Feel your feet placed steady on the

ground. Focus on your breathing, take a deep breath in, hold for five seconds, and slowly release.

When you are ready, open your eyes and awaken your body. Now together, let us repeat this

phrase. “I am capable of healing, I matter, therefore I deserve to heal, I have the courage it will

take to heal, and through this experience of connection, I begin my healing process.”

Art Processing Piece: “Safety box”

Think back to a point in your safe place guided imagery that stands out to you. At what point did

you feel the most safe and secure. What was it about that point in the guided imagery that made

it feel so comforting and safe? Think about colors, sights, textures… etc.

Using a shoe box, recreate your safe space. Incorporate important aspects from your guided

imagery, and feel free to incorporate more materials and concepts which provide you with a

feeling of safety and comfort.

Reflection Process Questions

Open up a discussion about the important pieces incorporated into the safety box.

1. What elements of your piece bring you comfort and why?

2. Did this process of creating a safe box or the final piece provide you with a sense of

courage?

a. If not, what could you add to your box that would give you a feeling of courage?

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5. Rhythmic (resonant with neural patterns)

“Trauma-related symptoms are related to dysfunction of neural systems in the lower, less

plastic parts of the brain” (Perry, 2006, p. 43). Through repetition of intentional processes,

neural patterns may begin to undergo changes related to neuroplasticity. Art therapy can provide

a rhythmic experience for an individual related to sensory and kinesthetic levels. This guided

mediation incorporates rhythm through the experience of the guided mediation, as well as in the

art reflection process, further providing a repetitive and rhythmic experience for the individual.

Guided imagery: Rhythmic

Imagine yourself being cradled and held with loving arms. Your entire body is held tightly,

securely, and rocking slowly from left to right. Continue to imagine yourself slowly being

swayed, back and forth…back and forth…back and forth. Pausing here in this moment. Continue

to feel this motion.

When you are ready, begin to bring your attention back to the present moment. Now either to

yourself or out loud, state: “I am capable of healing, I matter, therefore I deserve to heal, I have

the courage it will take to heal, and through this experience of connection, I begin my healing

process.”

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Art Processing Piece: “Feeling Movement with Line Drawing”

Reflect on the feeling of movement you experienced during the guided mediation. Using a

drawing material of your choice, on an 11x18 piece of paper, slowly draw the motion you felt

your body moving in during your mediation process. Continue to draw this pattern over and over

again until you feel a sense of completion.

Reflection Process Questions

1. During the process of the guided mediation and/or art processing piece, did you feel a

sense of connection and how?

a. In not, what do you think would provide you with a feeling of connection?

2. What type of feelings did the repetition and rhythm provide you with during this process?

3. Was there a specific person you thought of when you imagined yourself being cradled?

a. If so, what about this person provides you with feelings of comfort and support?

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6. Rewarding (pleasurable)

MRI studies have shown positive results in the use of guided mediation improving brain

areas associated with control of emotions, decision making, and distress tolerance while helping

improve response patterns to negative stimuli and experiences (Moral, 2017). Negative

symptoms related to trauma may impact an individual’s daily functioning and affect experiences

which may feel rewarding to others.

The process of art making in and of itself is rewarding and for this process should be seen

as pleasurable. The focus for this guided meditation will be on finding pleasure and pleasurable

experiences to support this fundamental principle. The art process will also invite participants to

have a free choice of materials to reflect this aspect on a deeper level.

Guided imagery: Rewarding

Picture yourself engaging in an activity you find enjoyable. Explore the joy you experience when

partaking in this activity. Pausing for a moment, focus on how your mood changes when you are

in this place of pleasure. Examine the way your body feels. Are you relaxed? Do you feel calm?

Are you energized? Now holding on to that rewarding experience and feeling you get from this

activity, bring your attention back to the present moment and repeat the following phrase: “I am

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capable of healing, I matter, therefore I deserve to heal, I have the courage it will take to heal,

and through this experience of connection, I begin my healing process.”

Art Processing Piece: “Holding on to Joy”

Using any art materials you choose, create a representation of this experience. However you

would like to represent your experience of joy is up to you. You may choose to focus on

representing the feelings you experienced when engaging in your activity, or you may want to

create a symbol that represents the activity as a reminder of what makes you happy.

Reflection Process Questions

1. Is there a reason you chose to work with the art materials that you did?

a. Did you find the materials you used enjoyable and rewarding?

2. What is it about this activity that brings you the most joy?

a. Were you able to represent that aspect in your piece?

3. Is the activity you imagined yourself engaging in something you are able to experience

regularly?

a. If not, how can you incorporate this more into your life and/or what other

activities could provide you with a similar experience?

4. Did this experience of focusing on joy allow for any feelings of being capable and

courageous as you begin your journey of healing?

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References

Dreikurs, R. & Soltz, V. (1964). Children the Challenge. New York: Hawthorn Books.

Ferguson, E. D. (2010). Adler’s innovative contributions regarding the deed to belong. Journal

of Individual Psychology, 66(1), 1–7. Retrieved from

http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=52350743&site=ehost

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Hinz, L. D. (2009). Expressive therapies continuum: A framework for using art in therapy: New

York: Routledge.

Perry, B. D., & Hambrick, E. P. (2008). The neurosequential model of therapeutics. Reclaiming

Children & Youth, 17(3), 38–43. Retrieved from

http://search.ebscohost.com/login.aspx?direct=true&db=keh&AN=35442936&site=ehost

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Perry, B. D. (2006). Applying principles of neurodevelopment to clinical work with maltreated

and traumatized children: The neurosequential model of therapeutics. In N. B. Webb

(Ed.), Social Work Practice with Children and Families. Working with traumatized youth

in child welfare (pp. 27-52). New York, NY, US: Guilford Press.

Malchiodi, C. A. (2003). Handbook of art therapy. New York, NY: Guilford Press.

Moral, A. (2017). Guided meditation: A regimen for mental health. Indian Journal of Health &

Wellbeing, 8(2), 180–182. Retrieved from http://search.ebscohost.com/login.aspx?direct=

true&db=aph&AN=122565568&site=ehost-live

Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of

trauma. New York, NY: Viking.