Healing Factors in Guided Affective Imagery: A Qualitative Meta-Analysis Submitted in Partial Fulfillment Of the Requirements for the Degree of Doctor of Philosophy with a concentration in Psychology and a specialization in Counseling and Psychotherapy at the Union Institute & University Cincinnati, Ohio Elaine Sue Kramer Core Faculty: Lawrence J. Ryan, PhD i Abstract This qualitative meta-analysis compares and contrasts European and American approaches to Guided Affective Imagery (GAI). From a comparative review of literature of the European and American approaches, it is observed that there are noteworthy differences in how GAI is understood in theory and applied in practice. In the United States, GAI is not perceived as a method of deep psychotherapeutic intervention for neurotic disorders by most practitioners. In Europe, GAI is one of the more prevalent intervention techniques that has been reported to be effective in many disorders. Secondly, this meta-analysis seeks to identify the essential healing elements of GAI as they are implemented in psychotherapy. Twelve factors are identified from the literature. Of fundamental clinical importance is the activation of a patient’s “resources,” the positive characteristics of an individual that can be accessed to reinforce the patient’s ability to deal with a past traumatic experience. GAI provides the imagery context by which the patient may re-experience the trauma. The therapist assists by encouraging the patient to repeatedly utilize internal resources to confront the fearful event. Lasting relief may be conceptualized as repeated resource activation leading to a biochemically-induced remapping at synaptic sites away from the limbic-centered, emotion-based neural path associated with the traumatic event toward the prefrontal cortex-centered, cognitive-based path of appropriate behavior. ii Dedication To Ronald iii Acknowledgements I am fortunate, indeed, to have so many people to acknowledge in gratitude for their support and guidance on this journey. Dr. Lawrence J. Ryan, my Core Faculty Professor, for his unwavering dedication, encouragement, and enthusiasm of my work. Dr. Christopher W. Lovell, my Second Core Faculty Professor, for his insight and encouragement of my creativity. Dr. William A. Richards, my adjunct faculty member, for introducing me to Guided-Affective Imagery and his wisdom and support throughout this process. Dr. Gail Kalin, my other adjunct faculty member, for her humor and compassion that lifted my spirits. Dr. Kathleen Altork, a peer member on my committee, for her friendship and keen insight. Dr. Lynne E. Muller, also a peer member, for her contributions to my work. Dr. Robert C. Anderson, who served as a consultant, for his vision and humorously spiritual approach to life’s adventures. Chaplain John M. Burke, my dear friend, for his weekly phone calls, loving ways, and constant encouragement. And, most of all, my husband, Ronald P. Kramer, for his excitement surrounding my work, his ever-present faith in me, and for being my best friend. iv Symbolic Portrayal of the Enemy Within One’s Self Paul Klee's imagery of a catbird and the cat. The bird, his prey, is on the forehead of the cat. A genetically anchored picture of the enemy within itself. (From G. Tuschy’s “Die heilsame Kraft innerer Bilder und ihre Verwendung in der Psychotherapie-Die Einbeziehung von Wachtraumtechniken in die analytische und tiefenpsychologisch fundierte Psychotherapie” [The healing powers of inner vision and its use in psychotherapy - The use of imaginative techniques in psychoanalytic and analytically orientated psychotherapy], Göttingen, 2007). v Table of Contents Abstract ................................................................................................................................ i Acknowledgements ............................................................................................................ iii Table of Figures ............................................................................................................... viii List of Tables ....................................................................................................................... x Chapter One: Introduction .......................................................................................... 1 Topic Overview and Historical Context ..................................................................... 1 Personal Connection with GAI ................................................................................... 3 Importance of Research Regarding GAI .................................................................... 3 Research Objective ..................................................................................................... 4 Glossary of Terms Pertinent to the Current Study ...................................................... 4 Chapter Two: Literature Review ...................................................................................... 12 Introduction ............................................................................................................... 12 Sigmund Freud .......................................................................................................... 13 Carl G. Jung .............................................................................................................. 14 Roberto Assagioli ..................................................................................................... 15 J. H. Schultz .............................................................................................................. 15 Robert Desoille ......................................................................................................... 16 Akhter Ahsen ............................................................................................................ 18 Frétigny and Virel ..................................................................................................... 21 Hanscarl Leuner -- Guided-Affective Imagery ......................................................... 22 General methods for evoking, guiding, and interpreting imagery ............................ 23 Standard imagery situations ...................................................................................... 30 vi Major Female Contributors of GAI .......................................................................... 36 Current Work in Guided-Affective Imagery ............................................................ 36 American articles. ............................................................................................. 36 European articles. ............................................................................................. 43 Literature Review Integration ................................................................................... 49 Research Question .................................................................................................... 51 Chapter Three: Method .................................................................................................... 52 Research Question .................................................................................................... 52 Definition and Philosophical Background of the Methodology ............................... 53 Human Subject’s Research Considerations .............................................................. 57 Significance of the Study .......................................................................................... 58 Chapter Four: Results ....................................................................................................... 60 Approach ................................................................................................................... 60 Research Question One Results ................................................................................ 64 Research Question Two Results ............................................................................... 73 Essential GAI Factors ............................................................................................... 78 Chapter Five: Discussion ................................................................................................. 83 Implications Regarding Theory ................................................................................ 83 Implications Regarding Practice ............................................................................... 94 What makes an effective psychotherapeutic practice? ........................................... 101 An actual therapeutic application of GAI in service to the needs of the dying ...... 104 Limitations of the current study .............................................................................. 106 Recomendations for future research ....................................................................... 107 References ....................................................................................................................... 108 Appendix A. European Literature Meta-analysis Coding .............................................. 126 vii Appendix B. American Literature Meta-analysis Coding .............................................. 153 Appendix C. GAI Effectiveness Studies ........................................................................ 157 Effectiveness Study 1. Is GAI Effective? ....................................................... 159 Effectiveness Study 2. The Effectiveness of GAI in an