Pragmatic Conceptual Visualization

I have trouble imagining what I could do that’s beyond the practicality of what I can do. David Byrne

The Analects of counseling-based psychology are replete with therapeutic modalities and experimental interventions designed to address a wide range of mental maladies. From the reliable methodology of cognitive behavior therapy to the informed speculations of evolutionary psychology, the history of understanding how the electrochemical jelly in our heads can achieve optimum functioning has required decades of creative problem solving. How does one effectively communicate abstract concepts without compromising the educational components of the original theories behind them? What is the most efficient way to sustain a client’s interest when pursuing a multidimensional treatment approach? In an effort to augment the therapist’s arsenal of techniques, I would like to open the stage for Pragmatic Conceptual Visualization Therapy (PCVT).

The fundamental idea of PCVT is for the therapist to create useful analogies while introducing the client to visually accessible concepts and ideas that are recognizable, personal, and memorable. Encouraging the client to offer their own analogies may provide a sense of customizing the treatment process while developing an unforgettable image of the problem and proposed solutions. In addition, tailoring the analogies and therapeutic exercises to fit the interests of an individual demonstrates the therapist’s awareness of diverse aesthetic sensibilities and sociocultural values —thus allowing the therapeutic alliance to be established with a heterogeneous population. Looking at problems conceptually allows more participation during treatment sessions because the therapist and client become accomplices in determining what visual aids are needed to uncover the sources of frustration and the best approach for remediation.

PCVT has four basic components that can be used interchangeably.

1. Accommodation: Identifying accessible subject matter to describe complex problems based on the client’s personal interests. Example: The therapist can work with the client to determine how values, hobbies, recreational pursuits, and lifestyle choices could be explored to best explain the perceptions of life issues and subsequent emotional responses. Similarly, the client can discuss life experiences to inform the therapist of what they currently find meaningful.

2. Cohesive Foundation: Creating the visual representation of an emotional default position via episodic and procedural memory that is unencumbered by excessive anxiety, melancholic rumination, or impulsivity (developing a neurotypical range of experience for affective cohesion). Example: The client remembers what it feels like during periods of the day when they feel most relaxed (or what it feels like when they are confident and productive) and is encouraged to revisit that sensation when confronted with stressful stimuli.

3. Thought Experiments: Practicing the art of adaptive contemplation. Incorporating applied creativity to develop analogies, metaphors, and allegories to understand life problems from a panoramic perspective. Example: Acquiring objectivity through therapy is like being able to see the parade from a distance, whereas the subjectivity of being emotionally overwhelmed is what one experiences while being in the middle of the parade.

4. Practical Solutions: Visualizing and anticipating the achievement of realistic goals in the future by making incremental adjustments to present behavior. Example: Preemptive planning via Ulysses Contracts (always use an example the client can directly relate to).

It should be obvious that similar techniques and styles of conceptualization can be found in other types of psychotherapeutic approaches (e.g., free association, narrative therapy, stress inoculation therapy, guided imagery, and cognitive behavior therapy) and no component of PCVT is without the imbued influence of its predecessors. However, the main feature of PCVT is introducing, adopting, and comparing the various ways of conceptualizing life issues until a lucid and workable concept can be agreed upon (or until a complex concept can be simplified). In contrast to Cognitive Behavior Therapy’s “reconceptualization,” the primary component of PCVT is to first conceptualize the problem via creative analogies, metaphors, and allegories to understand how lifelong developmental influences act as an extension of the client’s emotional disposition, avocational interests, and desires. The therapeutic alliance is then facilitated by using the client’s interests to enhance their confidence while personalizing the treatment process. Subsequently, the client can take a more active approach in providing constructive feedback during sessions based on the open-ended nature of creative processing.

I’ve found Pragmatic Conceptual Visualization Therapy to be most useful for brainstorming with clients, developing trust for optimum receptivity, and as a supplemental approach to enhance the foundational components of other modalities. Most importantly, the application of PCVT should be all-encompassing and practical enough to relate to any client.

(This article originally appeared in the NPI newsletter, Summer edition, 2013).