In imaginal exposure, you will guide the patient through multiple retellings of the trauma memory.
These should be conducted in-session, starting with session three and continuing through the end of therapy.
Each exposure should last 45-60 minutes, during which time the patient should tell the narrative as many times as possible.
The goal of imaginal exposure is emotional engagement with the memory.
In order to incorporate new information into the patient's fear structure, the fear structure must be activated. In other words, in order for emotional processing to occur, the patient must be emotionally engaged.
As such, it is beneficial for the patient to feel anxiety during imaginal exposures.
There are a few methods for encouraging emotional engagement:
Ask the patient to keep his or her eyes closed.
Ask the patient to use the present tense, as if the memory is occurring right here, right now.
Briefly interject to ask questions about what the patient is thinking, feeling, or perceiving.
However, if the patient is already emotionally engaging the memory, these techniques can be distracting rather than helpful.
Monitor the patient's SUDS by asking for SUDS ratings every five minutes. Keep a log of these ratings.
With the first one or two imaginal exposures, the goal is to get the patient used to telling the narrative, and to get the patient to keep telling the story even when she wants to stop.
As the patient starts to show signs of habituation, such as reporting decreased SUDS levels or volunteering more detail in her story, you can gradually start probing for more detail and increasing her engagement.
In the first one or two sessions, you will likely need to keep your questions to a minimum while the patient gets used to telling the narrative.
Soon after the patient shows signs of habituation, the patient should be telling everything in memory.