The Imagery Edge--Part I

A story about using imagery to counteract pain

Posted Aug 16, 2015

Masha is feeling scared—scared of the surgery, of the pain, of the lengthy rehabilitation, of the lingering question of whether she’ll be able to resume her high-level tennis career. At age 19, Masha has, for the second time, experienced an ACL tear reparable only through surgery. (As always, although the elements of this story are true, I’ve changed a few details to protect Masha’s privacy.)

We started working together a month or so ago, when the surgery still felt sometime in the future. She wanted some psychological skills to cope with the various aspects of her injury, ones that she’d then be able to take on court when she resumed playing. As I typically do, we started with diaphragmatic breathing (see The Breathing Edge, Parts I, II, and III). Whether for decreasing anxiety or regulating tension, I think of diaphragmatic breathing as the most essential building block.

As an athlete accustomed to learning new skills, Masha practiced breathing for relaxation diligently. In this second session, she tells me that now she can comfortably and easily breathe down tension, whether it’s a school-related exam situation, tensions at home, or her general tendency to worry.

Although she’s found great relief through this method of calming herself, today the surgery is truly impending—only a few days away. There are, of course, all the “what ifs”, but what’s mostly upsetting Masha at the moment is her anticipation of post-surgical pain. She comments that it was almost easier last time because she didn’t know that it was going to hurt so much.

In hearing Masha’s concern, my job is to both be responsive to her feelings and if I can, suggest some techniques that may address the specific concern. Of the various psychological skills that might be most useful, I settle on imagery as a method that Masha can use to handle her post-surgical concerns.  

“Imagery” is sometimes described as “visualization.” I prefer the term imagery, though: Any or all of the senses may be involved; not everyone makes use of the visual element; and particularly for athletes or others with a lot of body awareness, kinesthetic sensations may be the most important.

Before we actually engage in imagery, I ask Masha a number of questions. I want to tailor the imagery to her specific situation—and the best way to do that is to elicit images that appeal to her. Instead of her prior experience being a barrier of fear, we use that knowledge for her to describe the pain she anticipates.

Masha says that the pain feels like a python squeezing her leg, tightening its grip. Her skin, swollen post-surgically, feels like a balloon, stretched almost to the point of popping. The balloon is bright red; the python, green. We then talk about what might help decrease the python’s grip and deflate the balloon.

We’re ready to begin. I encourage Masha to focus on diaphragmatic breathing so that she can become deeply relaxed. I invite her to imagine the day of the surgery and describe a few likely details, mostly setting the scene for the post-surgical period. I describe the python image to her—and then also describe the solution we’ve discussed: the python gradually releases its grip as she breathes into that spot. Perhaps the tail unwinds a bit, or the head, or the body, I suggest—whatever will relieve some of that sense of pressure. Likewise, the balloon gradually releases some of its air, the bright red softens in color.

While she is deeply relaxed, I encourage Masha to practice these images during the next few days. When she experiences these sensations after surgery, she will be able to make use of them as a way to cope with the pain, knowing, as she does, that over time, as healing occurs, the pain will dissipate.

Masha moves back from our imagery with a smile on her face. “That was so good!” she exclaims. “I feel as if I’ve been floating on a cloud. I know it’s going to be difficult, but I’m not feeling as scared any more.”

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