Why therapists should know about aphantasia

Aphantasia is a newly coined term for the inability to visualise, or to see things with your mind’s eye. You can read about it in my previous post here, or follow the links at the bottom of this page.

Since aphantasia has been gaining some media attention, I have been pondering the implications for psychological therapies. I have recently started working in mental health, and have previous experience as a service user. An understanding of aphantasia is definitely important if you are working with people who experience this.

Why should therapists/counsellors know about aphantasia? I have a memory of sitting in a counselling room, my frustration increasing as my therapist insisted that I try to visualise a calm lake. As in previous sessions, I had said I didn’t want to do this as I knew it wasn’t helpful. He thought I should keep trying. I didn’t know at that time that some people could actually visualise, but I knew that thinking about a lake seemed a stupid way to try to relax. Relaxation visualisation is a technique which is quite often used by therapists, for example a “safe space” visualisation. This is going to be confusing, frustrating, and ultimately a waste of time if the client has aphantasia.

Visualisation techniques are used in a range of therapies. I have recently done several workshops in Acceptance and Commitment Therapy. Most of the presenters used visualisation exercises in their teaching, and to demonstrate exercises they did with clients. Examples include:

  • One “defusion” exercise in ACT involves visualising leaves on a stream. “Visualise yourself sitting beside a gently flowing stream with leaves floating along the surface of the water. Take each thought that enters your mind and place it on a leaf… let it float by.  If your thoughts momentarily stop, continue to watch the stream.  Sooner or later, your thoughts will start up again. Allow the stream to flow at its own pace…”
  • One presenter got us to visualise someone who had made us feel supported and uplifted. We were to imagine them looking at us, looking into their eyes and seeing them seeing us. Then we were meant to bring their face closer and turn it around and put it behind our own face, so we were seeing with their eyes.
  • Another presented demonstrated what it is like when our anxiety is taking too much of our attention. He held up a sheet of paper, and asked a volunteer to picture all of their worries on the piece of paper. He then held it right in front of their face.
  • One presenter talked about working with a veteran who was experiencing intense shame about not intervening when his co-soldiers desecrated dead bodies. The therapist had supported him to visualise himself in that scene, and looking at his own face he realised how young and scared he had been at the time.

Obviously, none of these techniques would be very effective working with a client with aphantasia.

As we did the exercises, I found myself getting distracted by trying to figure out what I was meant to do. What on earth does a thought look like? What are people placing on the leaves when they do the leaves on a stream exercise?

Recently I have also been looking into EMDR (Eye Movement Desensitization and Reprocessing). A lot of the clients I work with have PTSD, and EMDR is proven to be an effective treatment for helping people process trauma. I don’t know much about EMDR, but some of the descriptions I have read involve clients identifying “a vivid visual image related to the memory” and focusing on this image (and related emotions and sensations) while engaging in EMDR processing. To work with someone with aphantasia, a therapist would need to be able to adapt their approach so that they weren’t using visualisation. I have spoken to a psychologist who uses EMDR, and she thought it would be possible to adapt the protocols in this way. On the internet I came across an account of someone who had been a client with a therapist trying to use a visualisation based EMDR procedure. The client didn’t have knowledge about aphantasia so could not explain their experience, and the therapist became very frustrated that it wasn’t working.

Obviously there are implications for a number of therapeutic approaches, and it would be good if more counsellors and therapists had an awareness that this is part of some people’s experience. If client hasn’t heard about aphantasia, it might be difficult for them to explain why something is not working for them. Knowing about aphantasia will help therapists check whether visual techniques are helpful. I think the worst thing a therapist can do is deny that a client’s experience is “real” – which is what one therapist at the conference basically said to me. “You could learn to visualise if you tried hard enough.” If she’d been my therapist, I don’t think I’d come back!

Although Adam Zeman is keen for aphantasia to be understood in terms of a variation of human experience, rather than a disorder, it can cause some people distress. This is another reason it is useful for therapists to know about aphantasia:

One of the responders to Zeman, Tom Obeyer from Ontario, Canada, said, “It had a serious emotional impact. I began to feel isolated — unable to do something so central to the average human experience. The ability to recall memories and experiences, the smell of flowers or the sound of a loved one’s voice; before I discovered that recalling these things was humanly possible, I wasn’t even aware of what I was missing out on.”

Obeyer said that the condition has severely affected his relationships since he can’t visualize his partner unless they’re physically with each other. He also struggles with the inaccessible memories of his mother who passed away. “After the passing of my mother, I was extremely distraught in that I could not reminisce on the memories we had together. I can remember factually the things we did together, but never an image. After seven years, I hardly remember her,” he said.

(from Science Explorer)

I have been reflecting on my experiences as a young person. I was diagnosed with Borderline Personality Disorder. Some of the experiences associated with this include:

  • Frantic efforts to avoid real or imagined abandonment
  • Identity disturbance, such as a significant and persistent unstable self-image or sense of self
  • Chronic feelings of emptiness

I wonder now whether having aphantasia contributed to some of these experiences being painful. If someone abandoned me, I wouldn’t be able to conjure up a picture of them – they would be gone from my head! Likewise, when alone and experiencing emotional distress, I couldn’t conjure up the faces of loved ones as a source of comfort. I was alone with my feelings, and mental darkness.

I wonder if the fact I couldn’t visualise myself as a child, or visualise myself during past experiences, could have contributed to the sense that I didn’t have a stable sense of self.

I’m sure that it is possible to have these feelings and experiences without having aphantasia, but I wonder whether, for those of us who do, it adds another layer.

You can find out more about aphantasia here:

http://blogs.exeter.ac.uk/exeterblog/blog/2015/08/26/aphantasia/

http://www.sciencedirect.com/science/article/pii/S0010945215001781

http://www.bbc.com/news/health-34039054

http://www.nytimes.com/2015/06/23/science/aphantasia-minds-eye-blind.html

http://vanwinkles.com/what-it-s-like-to-realize-you-have-aphantasia

http://discovermagazine.com/2010/mar/23-the-brain-look-deep-into-minds-eye

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Can I picture this? Do I see what you’re talking about? No! An aphantasia Q&A

Scientists have come up with a word for the inability to mentally picture things. Aphantasia is the new term for having a blind mind’s eye. I’m very excited that I have a word to describe my experience, because it now means I can look up information about it, connect with others who have similar experiences, and point people to articles and interviews to help them understand what it is like for me to not be able to visualise. Kim Hill recently interviewed Adam Zeman, one of those who coined the term and has begun researching aphantasia. I wasn’t quite satisfied by some of his responses, so here are some of my answers to questions from that interview, as well as some questions that friends have asked me.

  1. When did you realise you couldn’t visualise?

I was sitting in a friends living room, with a few people who were talking about what came up in their minds when someone said the word “lake.” I started to think about lakes, the way I always think, in a soundless inner monologue. “Lake. Hmm. Which lake? I suppose the lake I have spent the most time around is Rotorua, but my favourite lake might be Waikareiti, I really enjoyed walking around it.” I wasn’t analysing my thought process, because I didn’t realise it was unusual. My description of thinking would be “it’s like you’re talking to yourself, but you don’t actually hear your voice with any quality of sound, it’s just, well, thoughts.”

Then someone said “I can see the word, and it’s blue.”

What? Huh? Wait, what… you actually see?!

Other people there said they could see a picture of a lake, rather than seeing the letters. Some had other sensory experiences, such as a sense of wetness. I was amazed! Until then, when people talked about picturing things, I thought they were just using an abstract metaphor. I think it was only hearing my friends compare their experiences of text versus pictorial images that I finally clicked that they were literally seeing something. In their minds.

After that conversation, I tried searching the internet to find out more about different mental experiences, but it is very hard to find answers on the internet when you don’t know what words to search for. I’m very grateful to those who came up with a term for my way of thinking.

  1. Can you picture your loved ones?

No, not at all. Now that I know that other people can do this, it makes me feel a slight sense of loss. Photographs of loved ones are very important to me, because without them I cannot see my grandparents or friends who have died. I know things about how they looked, but I couldn’t draw a realistic portrait of them – partly because I have not studied how to draw portraits, but also because the details are too complicated to describe and memorise. A face is more complicated and unique than a novel, and I couldn’t recite a whole novel accurately even if I had read it many times.

Please don’t be offended if I don’t notice you have had your hair trimmed – I have nothing to mentally compare it to.

  1. How do you recognise people or places?

Because they look familiar! It is hard to describe, but I know when I have seen someone or something before. Details of their appearance must be stored away as knowledge rather than as pictures in my mind. However I do struggle to recognise people I have only met briefly, or to recognise people if I see them in a different context. My partner has often teased me about how unobservant I am. I think it is hard for me to store visual information. If we go for a walk and talk to each other, I will struggle to remember what we passed by on the walk, unless I actively thought something about it at the time, but I will be able to remember a lot more about what was said.

I would be a hopeless police witness, as I could only recall details I had mentally noted, for example if I had thought that someone had funky hair, or noticed that their nose was unusually large. It would be hard to describe the exact shape of their nose. However, because I do recognise people and things when I see them again, so I would probably recognise them from a photo – although maybe not as easily as someone who had also formed a mental image.

  1. Could you tell me whether the green of pine tree is darker than the green of grass?

When I look at the world I can see differences in colour and lightness. I have noticed how bright the green of grass is, and how pine trees appear dark and gloomy even on a sunny day, so I know that the green of pine trees is darker. If you gave me 50 shades of green paint, I could look at them and recognise which colours were closest to the green of pine and the green of grass.

  1. Could you paint a picture of something if it wasn’t in front of you?

When I see things in the world, I notice details, and have thoughts and emotional responses to what I am seeing, which I can later recall. I can draw something well if I have noted enough details about it. For example, I could draw a fuchsia flower, because they are one of my favourite flowers (hence my blog name) and I have paid them a lot of attention. Since childhood I have thought they look like flower fairies, and I have noticed the way the outer petals curl up like a skirt and the stamens dangle like slender legs. I have not taken in as many details about the leaves, so I would probably need to erase and redraw them until they looked “right” or recognisable to me. I have not noted anything about the pattern in which the leaves grow on the branches, so I could take a guess or look at a tree or a picture of one before I could draw that accurately. Here, I’ll have a go:

fuschia

(I drew the first picture on the train, after hearing the interview on the radio and trying to figure out how to explain my artistic process. I hadn’t logged in to my blog and seen my cover image for a while!)

I quite like creating artworks which are imaginary scenes, or symbolic representations, rather than realistic images. I often include words in my paintings.

  1. How did you answer exam questions when you studied art history?

I recalled facts I had memorised about paintings. My inner monologue would recite facts I had read in books or written in my notes. It wasn’t my best subject in school, but I passed!

  1. Could you tell me how many letters of the alphabet have low-hanging tails?

Within my head I mentally sense the movement of holding a pen and writing the letters, going through the alphabet.

  1. Could you tell me how many windows are in your house?

Yes. In my head I mentally move through our house, and I mentally stop in each room and think about how many windows there are. I know where they are because I remember standing at the window or pulling the blinds.

  1. Could you decide what to wear if you weren’t standing in front of your wardrobe?

Yes, because I know what clothes I have. For example, I know that I recently bought some pants because I liked the mossy shade of green. I was a bit less certain about the pantaloon style, but the fabric felt nice and light for summer. When I bought them, it was hard to know whether they would go with the clothes I already owned. When I got home I held them up against my shirts, so that I could see how they looked together. Now I have retained the knowledge of which shirts looked good with the pants.

  1. Could you be an architect/designer/illustrator…

I studied at architecture school for two years. When I was designing something, I would have ideas about what I wanted, e.g. that I wanted it to be curvy, or to have grass on the roof. I could be inspired by other designers and architects and want to do something which resonated with their work. When I actually started on a project, I wouldn’t be able to visualise the final work. I would start by doing a sketch, which I would then erase and redraw until it looked good, or sometimes I would cut out pictures and arrange them into a collage and then draw something based on that. Aphantasia may caused me some disadvantage, but I managed to pass my papers. I got higher marks in physics, English literature and politics, which is one of a number of reasons I left architecture school.

  1. Do you enjoy reading books?

Yes! I love reading, and I enjoy writing poetry. The way I think about the world is in words – I guess the word pictures in books invoke emotions and memories, and sometimes I think “yes, that sounds exactly right… that resonates with my experience… that’s an interesting way of describing it.” Just as I can describe a scene using language, I can enjoy someone’s artful description of a scene.

  1. So, you wouldn’t ever get annoyed when the movie based on a book didn’t match up with what you had imagined when you read it?

No. I would only be annoyed if things in the movie actually contradicted what was written in the book.

  1. So you can’t fantasise about someone else when you’re (having sex/masturbating)…

No! OMG, do people do that? That’s seriously disturbing!

  1. Do you ever have any mental pictures?

Many people with aphantasia have involuntary mental imagery as they fall asleep, in dreams, when using drugs, or even just random flashes of images during the day. I think I am at the extreme end of the visualisation spectrum. Occasionally (maybe once a month?) an image involuntarily flashes in front of me as I fall asleep, but it is only ever very dim and impossible to focus on. Sometimes this is of something I have been looking at something for a long time, e.g. weeding a particular plant for an afternoon. Sometimes it is something random and slightly frightening, like a goulish face which wouldn’t look out of place in a Buffy scene… but weirdly not actually something I remember from Buffy (or anywhere else). My brain just seems to have invented it. Anyway, this gives me a vague sense of what visualising is like. Since finding out more about aphantasia I have been trying to catch myself in those moments and hold onto the image, but I haven’t succeeded yet.

I don’t think that I have visual dreams; I wake up with knowledge about what has happened in my dreams, very strong emotions, and sometimes a sense of movements. I don’t usually remember visual details.

So, that’s a little bit about my experience – others with aphantasia may answer the questions differently, so feel free to contribute in the comments. For those of you who don’t have aphantasia, it is as hard for me to get my head around your experience as it is for you to imagine what it is like for me. So I have some questions for you. I would love to know how you think! Leave your responses in the comments.

What is it like to not have aphantasia?

A. If you are reading a novel set in a country you have never been to, how do you visualise a landscape you have never seen? Or if a person is described in a book, how do you fill in the details which have not been described?

B. How can you keep reading the words if you keep having pictures appear in your head?

C. Do you have times when you are not mentally picturing anything?

D. If you are visualising something while your eyes are open (as I am told some people do), what happens to the things which are actually in front of you? Do they disappear behind your visualisation, or is the mental image transparent?

E. If you are visualising something you don’t remember well, is the image blurry or dim, or are there bits missing from the picture, or do you just make a picture up and later realise it was inaccurate?

F. If you played imaginary games as a child, could you see the things you were pretending to play with? E.g. if you were pretending to have a tea party, could you see the food? Could you actually see imaginary friends?

G. How is visualising different from hallucinating

H. When did you first become aware you were mentally picturing things?

You can listen to Kim Hill’s interview of Adam Zeman here: http://www.radionz.co.nz/national/programmes/saturday/audio/201778750/adam-zeman-aphantasia-and-consciousness

You can find out more about aphantasia here:

http://blogs.exeter.ac.uk/exeterblog/blog/2015/08/26/aphantasia/

http://www.sciencedirect.com/science/article/pii/S0010945215001781

http://www.bbc.com/news/health-34039054

http://www.nytimes.com/2015/06/23/science/aphantasia-minds-eye-blind.html

http://vanwinkles.com/what-it-s-like-to-realize-you-have-aphantasia

http://discovermagazine.com/2010/mar/23-the-brain-look-deep-into-minds-eye