Using imagery as a resource in clinical supervision

by Claire Colreavy Donnelly

I believe the use of imagination, creativity and image is a foundational ingredient of psychotherapeutic work. This is true, whether we are specifically trained in a creative psychotherapeutic medium, or work as verbal psychotherapists. As psychotherapists, the process of mentalisation, which is essential, is based on our ability to imagine and conceptualise what is happening internally for others, as well as ourselves. A questioning mind is an essential characteristic of a curious, interested, and attuned psychotherapist.

Lou Cozolino (2023), posed an intriguing and provocative question in a recent online training: “What are you protecting yourself from when you do therapy?” When I do therapy (and clinical supervision), I protect myself from a life without meaning! His question catapulted my imagination into a rich exploration of all the years of memories of sessions together with clients and therapists where we sought meaning for the challenges, pain, and adversity that life brings. Without my imagination and a creative approach that helps spark my clients’ and supervisees’ imagination, it would be impossible to develop alternative strategies or ways of looking to reframe life’s opportunities for learning, meaning and growth.

As I wrote about elsewhere, I make a distinction between the use of embodied imagery and diagrammatic imagery in therapeutic work (Colreavy Donnelly, 2017). In Jonah Hill’s documentary film ‘Stutz’ (2022) about his relationship with his psychiatrist, Stutz creates diagrammatic images for his clients which illustrate psychological tools that they can use as therapeutic reminders for growth. These images, although very powerful, have a different quality to them because they come from the imagination of someone else and are passed on to the client or therapist as generic messages for life. However, something unique and special happens when the therapist encourages the client, or the supervisor encourages the supervisee to enter their own imagination and be open to what emerges specifically for them.

I also write about it elsewhere, (Colreavy Donnelly, 2017), the notion that within our unconscious are deeply personal and profound messages that can emerge as images for our understanding and healing in the form of what I call our own Image Medication. This concept, when shared with patients, appeared very helpful when I worked in a psychiatric hospital where they were used to being fed generic prescriptions for their mental health difficulties. As we worked together, I consistently encouraged them to learn to trust what emerged through their imaginations as communications from their unconscious in the same way as suggesting that their symptoms might also be a way that their mind and body communicates with them.

In order to help clients become more flexible in their approach to life’s challenges, we need to develop our own imaginative capacities in order to invite them into a creative space of “what ifs” and “as ifs”. When we want supervisees to become more flexible in their approach or understanding of their clients’ experience, we also need to encourage them to use a more experimental thought process and play with ideas about possible meanings, underlying behaviour and relational dynamics. Some people find this easier than others. Can we imagine what we have not yet experienced? Yes. This is the space of daydream and reverie which we found easier to access in childhood. Unfortunately, as we mature and become conditioned for living up to, or down to, society’s expectations of us, we can lose our capacity to imagine and dream of alternatives. Creativity and play are hard to access if we are feeling dysregulated or evaluated in any way, so it is imperative for therapists, and in turn supervisors, to create a safe space where clients or supervisees can become freer to lean into creative possibilities, without feeling judged. If we take on the role of supervision with a heavy hand of criticism, policing the profession with rights and wrongs without empowering therapists to work through the subtleties of context and encouraging them to take responsibility for clinical judgements that value process as much as outcome, we create a closed system where imagination cannot flourish.

The use of imagery, whether imagined or projected into an artwork, is a vital aspect of my clinical supervision with therapists working within a variety of private practice, social care, education, or health care settings. In creating space in supervision for accessing the world of their own and our shared imagination I invite supervisees to engage with images for a range of reasons. I will describe this approach and explore the reasons why inviting therapists into an imaginative space of reverie can deepen their understanding of therapeutic work. The use of imagery can highlight their countertransference and enrich their understanding of their clients. It can also, in the form of visualisations, help resource them in a sustainable way for managing vicarious trauma. I will illustrate how important our relationship to image is in working as therapists, supervisees and supervisors.

Whether working with play therapists, creative arts therapists, creative psychotherapists, or therapists new to working creatively, my suggestion is to work imagistically, to open up new insights, access untapped areas of information, engage in live intrapersonal and interpersonal discourse, and keep the work fresh. There is no emphasis on creative skill with this approach, just an openness to be playful and a curiosity to tap into creative dialogue together and subsequently to develop the supervisor’s internal creative supervisor.

Creative supervision consists of developing a safe, honest space where we can both play collaboratively with imaginative possibilities around the potential meaning underlying client symptoms, we can decipher the impact of our countertransference, we can explore latent parallel processes and we can encourage the therapist’s awareness of somatic information which they carry over from their client and which they have yet to become conscious of.

The reasons why working with image in supervision as idea or artwork is effective are:

• The therapist’s imagery which explores their countertransference may help us attune to their clients’ experience and choose the direction they may need to follow with their future treatment plan.
• Being open to whatever spontaneously emerges in our imagination when thinking on the therapeutic dance we engage in with our clients can help us access underlying relational content; mapping intersubjectivity and help us become aware of shared unconscious processes - ‘we swim in the same psychic sea.’ (Jung, 1960).
• Creatively projecting out the ‘side effects’ or impact of vicarious trauma that therapists carry from the work can help them unburden physically, energetically, and psychodynamically.
• Engaging in the visualisation of powerful imagery can act as a spiritually rich resource to prevent therapist burnout and create professional sustainability.

Imagery around countertransference
I encourage supervisees to work creatively by asking them what image they have of their client. This might be a symbolic image – “She seems like a drooping flower with no soil” or a memory of a significant action or behaviour the client made during a session that has stayed with them - “He kept biting his hand when talking about his father as if trying not to say something…” Both these kinds of images can offer helpful information in understanding the client’s process. With the first image, I may ask “What might the picture need?” To which the therapist could reply “Some roots, a healthy environment.” The task is then to help the therapist explore with the client whether developing “some roots” or “healthy environment” in life might be personally significant and a direction to go in. With the last example, the crystalised memory of the client biting their hand may have some significance around the father son relationship and is worth initiating a dialogue compassionately and with curiosity. Both therapeutic interventions would be done in a speculative and collaborative way, in tandem with case conceptualisation and developing a space to creatively explore possible meanings.

Sometimes one of my tasks in supervision is to help the supervisee trust that they are a sensitive instrument which can, when finely tuned, or attuned, pick up vast amounts of information about the client’s process. Again, Cozolino talked about shuttling, when the therapist acts as a kind of antenna through his mind and body, opening a channel that is porous, receiving information, “shuttling to attention and then to our internal process.” (Cozolino, 2023). This kind of information gathering can be processed after the session through creative supervision. I also model that the client will engage in what they find relevant from therapist’s reflection of them and if the therapist’s sensitivity or pacing is off, this then becomes more content to explore creatively in supervision.

Sometimes in supervision I mirror facially, or through body work, the image the supervisee has embodied when they describe a client in a difficult session. They seem unaware that they may have absorbed an aspect of their client until they see it reflected back to them and when this lands, they appear to gain some insight into the client and their process. If a supervisee, in a charged session, is unsure whether they have read a client’s behaviour appropriately, I ask them to embody the client and when I reflect back, they seem to access a space to observe without the stress of responding in session. Something lands with them in terms of being able to press pause and they feel more confident with what may be going on psychodynamically. “Ah, I hadn’t thought of this, or in this way”, can be a typical response.

Figure 1 is an image I created when I worked with a young man with a brain tumour. The sadness I felt in my heart and body whilst working with him called for me to create an image in response to my sense of helplessness. Whilst working with him I would hold this in mind to sustain me in staying attuned to his experience and present to him. The image seemed to hold a clue as to how I should continue to stay hopeful in his therapy. It felt like a direction I needed to hold onto. This was my visual amulet that influenced the treatment approach which I used with him – “stay hopeful and move towards the light”. I encourage supervisees to manifest that which feels latent to them, something they can’t quite articulate but are aware is there. I invite them to make an actual image or speak about what emerges in their imagination when channeling the client or reflecting on sessions. This appears to be a way of accessing how our unconscious meets theirs and is very helpful in naming and exploring countertransference issues in a gentle and insightful way.

Creative projection
I consistently encourage supervisees to develop a practice of projecting out whatever they may be left with following a difficult session. This can be a creative projection in terms of an abstract painting, drawing or sculpture of colour, shape, texture or have a movement associated with it. This can help the therapist shed or metabolise some affect that the client may have projected onto them. It can also help them process and digest what may have been transferred or displaced onto them by helping them objectify and release energetically and in a concrete way the content of the session. I have found that this practice not only encourages dialogue with their internal supervisor but can also help prevent therapist burnout. Having some way of processing and projecting out what we absorb from clients is an essential tool and underestimated in my opinion. I have witnessed experienced therapists concerned by how much they carry from their clients and believing that they are doing something wrong. “Surely, with all my experience, I shouldn’t be so sensitive to the intensity of my client’s trauma?” I respond by saying that I would be more concerned with them if they were not moved, touched or affected by their client’s pain. I cite the seminal work of Isobel Menzies (1960) which explored organisational and professional defences when working with trauma and anxiety. The key is in having a way to process what we absorb from our clients, not in defending ourselves against being touched by them.

When thinking about a young, deeply traumatised and depressed client at the start of my own therapeutic career, I remember how weighed down I felt with the heaviness of his trauma and depression. I found it hard to breathe in sessions and when he’d leave, I felt there was nowhere to go but just to withstand his projections and my feelings of helplessness in witnessing his own. I created the image in figure 2 after one of his sessions and felt a little relief in externalising my sense of impending dread. Objectifying the effect he had on me and my own affect seemed to help me sustain the work. I held onto part of an image he had created, torn off and discarded. It was a light source. Keeping this and connecting it in my imagination with my own dark image, seemed to help me hold onto a sense of hope for him by investing in a symbolic narrative that manifested a kind of aesthetic alchemy.

Mapping the therapeutic dance
Exploring with the supervisee the image they have of the kind of dance they are engaged in with the client can be very revealing. This might be a drawn, painted, small world (a technique which uses figurines or natural objects to describe a mental image), embodied or conceptual image but all can be a powerful reflection on the client's or therapist's attachment schema. Trish Banks (2022), in her online course Creative Practice for Self-supervision, explores interesting psychodynamic parallels between her own countertransference and what may be going on with the client’s process by reflecting on her own artwork after a session.

It can also be interesting to wonder whether the dynamic between therapist and client is recreated in the supervisory relationship by collaboratively engaging in the live here and now dance that is created in supervision. When supervising supervisors, this imaginative venture can reap interesting results.

Visualisation of powerful imagery

Figure 3.
When faced with a supervisee heavily carrying the responsibility of a client’s pain, trauma, or search for meaning, I invite them (whatever their religious or spiritual bent) into a world of imagery which can resource them personally and professionally. I offer a personal image which has sustained me through my own therapeutic practice. It begins with grounding and deepening my breath, then tapping into my imagination to call upon a greater source of energy and wisdom. An image emerges for me, a little like figure 3, of a bright source, a web of golden filigree with myself, my supervisee and their client being safely held, supported by a loving matrix. I see myself both connected to and channeling this life force in my work. This image, which emerged spontaneously very early in my career has always provided much comfort and support to sustain me through my therapeutic and supervisory practice. When together we have ethically managed known risk factors, exhausted all avenues of support, and I know they have been a good enough therapist, I encourage my supervisee to spiritually offer the client and their pain over to something greater and wiser. I invite my supervisees to source their own image which will sustain them through dark times when working with vulnerable suicidal or bereaved clients. Their own image will have much more power than one prescribed by me, but I offer this as my example.

No doubt, this process reflects my deep connection with Spirit, Soul, God, Chi or Life force. Whatever our spiritual beliefs, as humanistic therapists we are sustained by the notion that our human pain creates opportunities for personal growth once we find facilitating environments to support our journey. As organisms if we can just move towards the light we can flourish through adversity. Making real our beliefs in terms of meditation practices which focus on symbolic imagery provides a map for why we do what we do and how we can sustain ourselves and our clients in this very taxing but meaningful work.

In conclusion, my belief in using imagery in therapy and supervision sustains my energy and passion for the work. It helps me connect to and trust the language and wisdom of my own unconscious as a doorway into a collective unconscious, a bigger power. It helps me imagine maps for my practice and navigate potential approaches. Throughout my career when I’ve encouraged clients and therapists to open up to connecting with the language of their own unconscious I have witnessed them growing in awareness, trusting themselves more and becoming more flexible in their personal and professional lives.

Claire Colreavy Donnelly, MIACAT, MIAHIP, SIAHIP, MICP, has worked as a community artist, youth counsellor, art psychotherapist, clinical supervisor, and arts therapy trainer. Her clinical experience includes working within adult psychiatry, UK CAMHS, an adolescent in-patient unit, Áthas, a community mental health disability project, within primary and secondary schools and in private practice in her studios in Kildare since 2003. She also provides creative clinical supervision. She has published articles, book chapters and conference presentations related to her psychotherapy work.

References

Banks, T. (2022). Creative practice for self supervision [online course]. Therapy Academy. https:// therapyacademy.ie/details/online/1134

Colreavy Donnelly, C. (2010). The importance of image in the creative arts therapies.Inside Out,Summer 2010.

Colreavy Donnelly, C. (2017). Art in psychotherapy: The healing power of images. In Howard, J. and Prendiville, E. (Eds.), Creative Psychotherapy: Applying the principles of neurobiology to play and expressive arts-based practice (Chapter 8). Routledge.

Cozolino, L. (2023). The making of a therapist, online course [online course]. PCPSI. https://pcpsi.ie/ product/the-making-of-a-therapist-with-dr-lou-cozolino-recording/

Jung, C.G. (1933). Modern man in search of a soul. Kegan Paul.

Menzies, I.E.P. (1960). A case-study in the functioning of social systems as a defence against anxiety: A report on a study of the nursing service of a general hospital. Human Relations, 13(2), 95-121.

Hill, J. (Director). (2022). Stutz documentary [Film]. Netflix.

IAHIP 2023 - INSIDE OUT 100 - Summer 2023