Dear Belleruth,

I have a patient with complex, longstanding, posttraumatic stress from years of childhood sexual abuse. She gets panicky at the idea of closing her eyes to do her guided imagery.

She also has fears of “losing” herself – getting so ungrounded and dissociated during the immersive, hypnotic experience, that she’ll float out of her body and never come back, so to speak.

Any ideas for how I can structure this experience to make it feel safer for her? She and I both feel that the imagery would do her a lot of good, if she could get through it.  We just need to figure out how to make it so she can tolerate it.  All suggestions welcome.


Dr. James L. McMahon


Dear Dr. JLM,

Thanks for asking – this is a fairly commonplace concern, especially with longstanding posttraumatic stress, and the question comes up a lot.  Here are some things you can try:

  • Start her off with you in the room with her, sitting by her at the distance of her choosing.

  • Let her know that the pause button on her audio player is hers to commandeer, however she wishes.

  • For starters, give her short, simple relaxation exercises, such as the breath counting or mantra repetition exercises which can be found on the Guided Imagery Mix or Panic Attack or Stress Hardiness audio programs. These are emotionally neutral and non-threatening to start with.  And the fairly mechanical activity of counting the breath will help keep her grounded while she learns some simple self-soothing skills.
  • As she develops her capacity to experience these exercises, she can then move up to the more emotionally evocative guided imagery, such as Relaxation & Wellness; and then to the more targeted and in-depth healing imagery, such as Healing Trauma, Anger & Forgiveness, or Heartbreak, Abandonment & Betrayal.

  • Suggest she doesn’t have to close her eyes all the way.  She can drop her lids to half-mast, to help her stay oriented to her environment and feel safer.

  • If the experience still makes her feel ungrounded or dizzy or light-headed, she might want to try standing against a wall instead of sitting down.  This requires more body-orientation and awareness from her, and it might be just enough to do the trick.

  • Should she give you feedback that she’s starting to feel like she’s “losing” herself, guide her to some basic body awareness:  feeling the breath in her belly, the boundary contact of the chair with her body, the feel of her feet on the floor, the weight of her own hands in her lap.  

These little “tricks” have been known to make a big difference with this.  Let us know how it goes!  And best wishes to both of you.

All best,