Imagery is currently a hot topic in the research and practice of cognitive behavioural therapy (CBT) and this excellent book will stimulate further interest in understanding mental imagery and how we can make use of it in therapy. The editor makes a convincing argument that our sense of self is inextricably intertwined with our memories and our imagined representations of ourselves. The book is a well-balanced mix of discussion of theoretical understandings of imagery and descriptions of practical applications of specific techniques. Although it covers many different disorders, the chapters are brought together by a consideration of how images and memories can be influential in shaping our sense of self and how therapists might be able to intervene to help patients develop more healthy views of themselves.

In the initial chapters the editor of the book, Lusia Stopa, a clinical psychologist who has researched the role of imagery in social phobia, gives an overview of current theories of imagery and the self, as well as the various uses of imagery in clinical practice. I found the idea of a “working self-concept” that might be activated in threatening situations (for example when giving a speech if socially phobic) or ever-present (for example if repeated experiences of failure create an underlying sense of worthlessness) to be particularly helpful. Chapter 3 (How to use imagery in CBT) illustrates techniques such as imaginal exposure and imagery rescripting with clear examples of therapeutic dialogue that will be of great help to the clinician. Many clinicians might have previously avoided using such techniques due to unfamiliarity with them or perhaps due to concerns about the high levels of affect that they can generate and this chapter might encourage such therapists to try using imagery in their practice. I liked Stopa's description of imagery rescripting as a kind of “mental time travel”, during which the patient is encouraged to keep one foot in the past and one foot in the present. She explains that “the self exists at a specific time and also as a series of past selves and potential future selves”. Through the creative use of imagery in therapy these different selves can be visited and interacted with to help the patient develop more functional and helpful views of themselves that are less threatening.

The remaining seven chapters address the use of imagery for treating specific disorders, each written by an expert in their field. Some chapters give clear guidance for using imagery interventions in those disorders for which the use of imagery has a well established evidence base, such as post traumatic stress disorder and social phobia. Other chapters provide ideas for how to use imagery in disorders where it has shown some extremely promising results, such as depression and eating disorders. Considered together, these chapters show what a powerful and flexible tool mental imagery can be for accessing and transforming meaning. Nick Grey illustrates how imagery can be used to update and elaborate trauma memories and gives many helpful clinical examples. The chapter by Hackmann, Day and Holmes shows how imagery may be used to access and address long-held beliefs about the self in agoraphobia. Paul Gilbert explains how imagery can be used to help depressed patients who are highly self-critical to develop a more compassionate way of relating to themselves. Two chapters (by Grey and Holmes and Butler) also consider the utility of patients using drawings in therapy to help them talk about and process traumatic experiences; to my knowledge this is not a subject that has previously been written about in CBT.

This book is written with real enthusiasm for the subject throughout and it is clear that the authors’ interest in using imagery in CBT is stimulating advances in understanding and treating psychological distress. However, it also highlights how little we currently know about the mechanisms of change that underpin imagery techniques, despite their sometimes dramatic clinical results. This book would appeal equally to researchers who are seeking to understand the phenomena of imagery in psychological disorders and to therapists who want to know how to use imagery techniques in their clinical practice.