Dr. Manoel Acioli

Five distinct components

Fiction provides the representational space. Narrative organises events, conflicts and consequences over time. Role-play positions the patient as an agent who produces choices and responses. Imaginal immersion describes experiential engagement with the represented situation. And symbolic enactment is clinically relevant action performed through a role.

Why a fictional context

Clinically relevant patterns become most informative when a person must respond to a demand — yet reproducing that demand in everyday life may be premature, costly, impractical or unsafe. Fiction reconstructs the same functional relationship while changing the surface content, so the therapist retains control over the clinical parameters of the situation: demands, information, uncertainty, consequences, pacing and safety.

Symbolic distance

The distance between person and character allows difficult content to be approached without literal autobiographical reproduction. The same observable choice may carry different clinical functions across patients — or across simulations for the same patient — which is precisely what the formulation specifies in advance.

The clinical sequence

Case formulation → functional reconstruction → therapeutic simulation → process-matched intervention → re-engagement → transfer to everyday behaviour. The model is situated within cognitive-behavioural and process-based therapy and draws on mental imagery, imagery rescripting, behavioural experiments, exposure, chairwork and role-play research, alongside emerging evidence on tabletop role-playing games.

Current status

IIT is an early-stage clinical model whose proposed components and processes require direct empirical evaluation. Its contribution is a testable method for using fictional role-play as an intermediate context between verbal processing, imagery, rehearsal and everyday action — with transfer to real-world behaviour as an explicit empirical requirement.