Martijn van Teffelen

Chapter 5 108 THERAPIST: “Very good John. You can keep your eyes closed. Now I want to ask you to visualize as detailed and vividly as possible what it would look like in a picture that your daughter did this on purpose to hurt you. I am not looking for a realistic image. The picture should adequately capture your feelings, not reality. It might even be a cartoon for example. Use as many details as possible. What does your daughter look like? How is she looking at you? What posture does she have?” JOHN: “Um, okay. It is like I am very tall, and she is very small. I am looking down on her. I see the picture of a scornful, sly little infant who is ridiculing me. She’s laughing like a little devil.” Intervention phase Cognitive restructuring When we identified a hostile belief and image, we wrote down a belief rating (i.e., the likelihood the thought is true) from 0% to 100% and proceeded with the cognitive technique evidence- gathering. Typically, this phase lasted another 20 to 30 minutes. During evidence gathering we asked participants to come up with evidence in support of and evidence against their hostile belief. To do so we asked participants: “What shows that your thought is true? Are there possible other events you have experienced that make the evidence stronger? What shows that your thought is possibly maybe not true? Do you have any experiences showing that the thought is not always true? Have you experienced something similar before, and if so, what have you learned from it that could possible help you?”. We wrote the evidence on the whiteboard under the headers “evidence for” and “evidence against” the thought. After that, we asked participants: “If you look at the evidence you have put forward, what would you conclude about your original thought? Could you think of an alternative, more helpful thought?” An example is shown in Table 2. Helpful image transformation At the end of the evidence-gathering phase, we asked participants to transform their formulated helpful thought into a helpful image. Similar to hostile image transformation, participants are asked to generate this image themselves. Examples of transforming helpful thoughts into images are shown in Table 3. After participants formulated a helpful image, we asked them to ‘install’ it. To do so, the therapist repeated the image that was described by the participant at the end of the imagery phase (i.e., the anger ‘hotspot’) and asked them to replace the old image (in the case of John, a scornful, sly infant), with their newly formulated helpful image (in the case of John, a timid little girl with Bambi-like eyes). It is our clinical impression that most of the helpful images included a degree of pity or empathy with the aggressor or acknowledgment of the unintended shortcomings of the aggressor. Last, we asked the participant what they feel when they look at this helpful image and ask them to open their eyes. We experienced that in many cases, the participants developed some sense of compassion for their ‘aggressor’.