Advances in medical research, the consumer empowerment, and rising cost of health care have demonstrated the need to treatment models that are holistic and client driven. Complementary and alternative medicine (CAM) offers consumers choices. It includes traditional healing practices, medical systems that are thousands of years old and new or innovative treatments that may be consider unconventional. Well known examples of CAM include herbal remedies, mindfulness, meditation, manipulative/movement therapies, and Chinese Medicine. Knowledge of CAM offers social workers in all settings the opportunity to provide education and advocacy in seeking client centered and culturally competent treatment options.

Tuesday, May 3, 2011

Guided Imagery

One popular CAM intervention that is being used by therapist and social workers is Guided Imagery (GI).  Did you know that GI is an evidence-based practice? GI is a mind-body therapy.  It has been defined as a “the thought process that invokes and uses senses: vision, audition, smell, taste, movement, position, and touch” (Trakhtenberg, 2008, p. 3).  GI incorporates a variety of techniques which can include visualization, suggestion using imagery, and story-telling or narratives.  Other forms of guided imagery involve evoking elements of the unconscious to consciousness via the imagination.  GI is used to promote relaxation and positive health outcomes.  Van Kuiken (2004) described four types of guided imagery:  pleasant imagery (imagining a calm place), physiologically focused imagery (focusing on a bodily function or part of the body and needs healing), mental rehearsal or reframing (imagining a specific task or event before it happens), and receptive imagery (scanning the body to direct healing).  Although GI has been used in alternative medical systems since ancient times, it was re-introduced into Western Medicine in the 1960’s.  It has also been used in conjunction with hypnosis, relaxation techniques, and mindfulness meditation.  GI is used in many settings.  During GI sessions patients are taught to use either positive or negative images to combat illness.  Positive thinking or images can be used to evoke relaxation and decrease pain.  Aggressive or violent images can be used to fight disease or pain.  Practice is encouraged in between sessions and can be supported with the use of audio tapes.   The ultimate goal is for the patient to be able to conjure up an image which evokes the desired result as quickly as possible.  GI is believed to work in different ways.  It can evoke neurohormonal changes in the body that mimic the changes that occur when an actual event occur.  By helping induce relaxation, it can promote a positive immunological response.  Trakhtenberg completed a critical review of the immunological impact of GI.  Donaldson (2000) hypothesized that GI may stimulate certain thoughts, which in turn could produce physiological outcomes that have an effect on the immune system.  His findings indicated an increased in white blood cell counts after GI intervention.   Hall et al. (1996) findings indicated that GI and relaxation was associated with decreases in neutrophil adherence.  Rider and Achterberg (1989) were able to determine that cell-specific imagery was associated with statistically significant decreases in lymphocyte and neutrophil counts.  Additional studies have been conducted utilizing GI with specific health problems including psychiatric disorders, cancer, pain, and to reduce stress associated with medical procedures and hospital stays (Hart, 2008). Given the research that supports the use of GI as an evidence-based practice and its portability how do you see being able to integrate GI into your practice?
Hart, J. (2008). Guided Imagery. Alternative & Complementary Therapies, 14(6), 295-299. doi:10.1089/act.2008.14604
Trakhtenberg, E. C. (2008). The Effects of Guided Imagery on the Immune System: A Critical Review. International Journal of Neuroscience, 118(6), 839-855. doi:10.1080/00207450701792705
Van Kuiken, D. (2004). A meta-analysis of the effect of guided imagery practice on outcomes.  Journal of Holistic Nursing, 22, 164–179.


  1. I have had the pleasure of using guided imagery in many occasions working with my client in both individual and group
    settings. I ahve also used guided imagery in my own healing processes. I ahd not idea that it was actually an evidence-based practice but I know it work very well. I ahve had a client who was totally activated and was able to use the relaxation technique to calm her. I was later told by this clietn that when ever she is feeling upset, angry & anxious, she has used this technique to calm herself. I ahve learned to implement this practice for all my cllients.

  2. The pros and cons for CAMs and medical science are similar; I do not think one if more or less better than the other. It depends on the problem, your religious beliefs, traditions, or culture, and how you go about getting it treated.
    One of the problems with using herbal remedies is that people take them without having complete knowledge of its properties. For example there are several herbs and or combinations that are used to improve libido. Not all of these have the same affects with everyone, and some can be dangerous. For people with heart conditions some of these herbs could be fatal. An herbalist, acupuncturist, or other trained professional has more knowledge about all the dynamics of each herb or their combinations.
    In contrast to herb, medicine can also be misused, abused, or misdiagnosed. A friend with epilepsy was being treated for seizers. Her doctor prescribed Dilantin to control the seizures. However, she was allergic to Dilantin and almost died. The ER doctor treated her and told her that Dilantin was lethal to her. He also told her that before she takes any more medicine to treat seizers she needs to see a neurologist as soon as possible. She now takes Depakote—a another anti-seizer medication
    If I had a client who was interested in CAM or preferred them, I would first recommend that they talk with their doctor, provide them with information about both medical and alternative medicine, and the pros and cons about both, and if it is within the agency’s policies provide a list of CAM providers. It would be difficult for me to push European medicine on someone who did not trust it or their culture, traditional, or religious beliefs did not allow them to use it. Chinese medicine, acupuncture, and Ayurvedic medicine were practiced long before medical science began. One is not necessarily better than the other; it depends on the client and his needs. Training on CAMs can help build rapport with a client and gives the clinician a better understand of their client’s needs.


  3. I believe that Guided imagery is one of those techniques that can be used with patients of all backgrounds, even those steeped in Western medicine. People who are more comfortable with traditional medical treatments might be more open to it because it doesn't require adoption of a spiritual belief or any type of moral value. GI can be incorporated in many different practices. For example, CBT can incorporate GI as a tool to help ease any feelings that could prevent the client from discussing agenda topics at the beginning of the session. GI can also be used as homework to assist clients between sessions to help control automatic thoughts. -Amabelle