Having a conversation in imagery with a person who has died is a useful technique for addressing some loss-related appraisals and dealing with head-heart lag. For example, if someone feels guilty about moving on in their life or believes they should have done more to save them, it can be incredibly powerful to ‘hear’ the person say "I don't blame you" or "I want you to move on and have a happy life", even though they have generated the image themselves. To facilitate the technique, we suggests that the person ‘meets’ their loved one in imagery in a place where they often spoke. We ask them to visualise them as they appeared in life (healthy and injured) and ask them any questions that they have, or say whatever they feel has been left unsaid between them. This can be an anxiety-provoking experience for the therapist as we never know where the conversation will go although, in our experience, it has almost always been helpful. But, a few considerations will help prepare the ground for it to be a useful intervention.
Firstly, it’s helpful to have some understanding of your client’s relationship with the person who died. If they had a very complicated relationship or the person was abusive or critical towards them in life, we need to tread carefully. This technique may not be helpful in those cases. We can test the water by asking some Socratic questions in advance of the imagery exercise such as “what do you think they would have said about that?” and wouldn't progress to an imagery conversation if they respond with something unhelpful.
Often, negative responses do require some follow up questions to establish whether such imagined responses are based on genuine experiences or are distorted by the client’s own negative self-beliefs being projected into the words of another person. For example, the only time a very negative response occurred during one of our imagery conversations with a deceased person, the client felt guilty for not saving their friend and in imagery the friend did say “you should have saved me!”. We dealt with this by pausing the conversation and double-checking why the client thought they would get this response from their friend. In fact, there was no evidence that their friend blamed them for their death and an examination of the circumstances revealed it would have been impossible to save them. We used some other guided discovery techniques to address the guilt, including reliving.
We most commonly use the imagery conversation technique to address ‘stuck-points’ like guilt or being frozen in loss, but it can also be used to confront or apologise to someone who has died. So, even if your client has a lot of mixed feelings towards someone or their relationship was complex, it can be a means to express some of this or ask questions. For example, we worked with a client who was angry with his father for committing suicide - he wanted to ask him why he had done it and left the family to suffer. In imagery, his father explained that it wasn't because he didn't love them but he was in unbearable pain (he had been depressed) and couldn't live with it anymore. This re-frame for why he had done it was very helpful for the client. What is interesting about these kind of revelations is that they are generated by the client’s own mind – the conversations simply facilitate an experiential perspective-taking exercise, but they seem to lead to a far greater emotional shift than just asking “why might your father have wanted to die?”. This is a similar rationale to that behind techniques like chairwork in CBT (e.g. Pugh, 2019).
There are various ways we can adjust this technique if we have particular concerns. For example, if we are unsure how the person will respond, we can work first on writing them a letter to voice any of the pain/anger/guilt/loss and then progress to reading it to them in imagery. The client can then decide if they want to 'allow' the person to respond or if they just want them to listen. We can incorporate some creative rescripting elements to this too if it helps. One client wanted to confront her abusive ex-husband about what he had done because he had died without her being able to. She was worried her ex-husband would keep interrupting and was scared of him even in imagery. We did the conversation in an imaginary prison room where there was a screen between them and a guard behind him, so she was safe, and we imagined some gaffer tape over his mouth to shut him up - he just had to sit and listen and then she imagined him being led back to his cell. The idea of perpetrator confrontation (including those still alive) has, incidentally, recently been expanded out of the realm of imagination via deepfake technology in this fascinating article by van Minnen et al. (2022).
Key practice points
· Imagery conversations with people who have died can help address loss-related appraisals and correct head-heart lag.
· It is helpful to know a little about the client’s relationship to the deceased before the conversation; the technique may not be helpful if it was abusive or critical.
· Predicted negative responses may reflect the client’s own negative self-beliefs, which can be addressed with cognitive techniques prior to the conversation.
· Conversations can be used to express anger or regret as well as guilt and sadness.
· The basic technique can be modified in various ways to address individual needs or any concerns.