Memory Reconstruction in Complex PTSD: A Case Illustration of Guided Imagery in Metacognitive Interpersonal Therapy.

Abstract

This article describes the use of guided imagery within Metacognitive Interpersonal Therapy (MIT) in the treatment of a woman with a history of relational trauma and severe emotional dysregulation. The case of Alicia, a 49-year-old patient with disorganized attachment and longstanding interpersonal difficulties, is presented to illustrate how imagery-based interventions can facilitate emotional processing and change. Treatment focused on helping Alicia understand and manage intense emotional reactions that were often experienced as overwhelming and confusing. In one key session, a panic episode occurring in a supermarket-whose origins were traced to earlier experiences of humiliation and threat-was explored using guided imagery. The intervention aimed to help her remain present, access a sense of safety, and develop a more adaptive response to the situation. A session transcript shows how grounding, therapist attunement, and imagery work supported Alicia in moving from a state of helplessness to a sense of stability and control. Over the course of treatment, she showed improvements in emotional awareness, interpersonal functioning, and overall distress. This case highlights how guided imagery can be used within MIT to help patients access emotionally meaningful experiences and develop new ways of understanding and responding to them.