Imagery Based Relapse Prevention

Having elicited motivation for change, the next part of FIT focuses on building confidence by anticipating potential obstacles, eliciting strategies for dealing with them, and developing a concrete plan for change that incorporates those strategies. It also gives the client experience of the power of imagery to strengthen motivation and self-efficacy.

Eliciting ideas about obstacles to change

IMAGERY EXERCISE: Ask the client to imagine carrying out their plan, taking those first steps, imagining how they will feel on the first day, and then what happens on the next day and the day after that. Ask how it went.

If the client does not spontaneously mention any obstacles, ask:

Interviewer: While you were imagining that, did you notice anything that might get in your way and make it harder to reach your goal?

We find that clients quite often imagine themselves carrying out their plan and realise, during the imagery exercise, that it won’t work.

Interviewer: How was that [imagery]?

Client: Well, I imagined I was making packed lunch for work, as I planned, but instead of making a small lunch, I kept imagining all the different things I could add – I ended up imagining an enormous lunch!

I think it is becauseI was imagining making tomorrow’s lunch at the same time as I was cooking dinner. All the food was out for preparing dinner and I was putting it all into my lunch box. It made me realise that I need to pick a time when I’m not hungry – perhaps I’ll make tomorrow’s lunch after dinner, when I’m not hungry and tempted to put everything in.

Interviewer: That’s a really good idea. Did that thought pop up while you were doing the imagery?

Client: Yes, yes it did. I hadn’t thought about it like that before.

This dialogue illustrates an important aspect of FIT. Through the imagery exercises, the client not only develops their motivation and plans for change but also learns through experience that imagery makes a difference to their feelings and ideas.

Evoking and using strategies that were successful in the past.

Having identified obstacles, return to talking about past successes. Explore what strategies worked in the past:

Interviewer asks: 'What did you do then to make sure that it would happen?'

or 'Can you tell me a bit more…is there anything else you did?'

IMAGERY EXERCISE:

Interviewer: Let’s re-create one of those memories in your imagination. Take yourself back to that time when you successfully [achieved goal].

Play the memory out as if you were living it again. Remember to use all your senses.

PAUSE

Remember how it felt when you did that…

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Interviewer: How was that?

Summarise the strategies used previously and ask if any of those strategies could be used here, to overcome those obstacles.

Elicit client’s ideas about which will work best.

Repeat the IMAGERY exercise.

Interviewer: Now try imagining yourself taking those first steps again to [achieve current goal], but also imagine doing those things you just mentioned, so it really happens.

This time keep an eye out for things that may get in your way and how you will overcome them.

How you will successfully work on your goal after all.

Now keep playing that image through to later that day or night. You’ve managed to stick to your goal of ... Focus on how you feel about that. Focus on your emotions, and physical sensations. Imagine how good you feel. See the positive effects.
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If cravings are an obstacle, use the cravings buster exercise to teach control over cravings. Ask the client to rate their confidence again.

Interviewer: How confident are you now that you could do that for at least a week? – On the same scale from 0- definitely can’t do it, to 100% sure I can?

Record rating. If higher than earlier:

Interviewer: That’s great! You are more confident than before. Just imagining past success and how you can use those ideas to succeed again helped you.

If above or around 60%:

Interviewer: Sounds like you’re pretty confident.

If around 40-59%:

Interviewer: That’s fine for getting started. You don’t have to be 100% confident- you just need enough to take the first step.

If under 40%:

Interviewer: Confidence often gets stronger once people see what they can do. Is that enough for you to at least take a first step?

Consolidating and committing to the plan

Ask the client to summarise their plan.

Interviewer: What do you plan to do now, to achieve your goal?

[if needed, prompt with:] How will you get started with that? or: What will you do, to stay in control?

If not moving onto the third FIT phase in the same session, end with an imagery exercise where they imagine their next steps as their own personal ‘mini-movie’ or ‘TV ad’ showing how they will succeed and how good they will feel.

Below are some sample scripts: