Imagery psychotherapy is not mentioned anywhere in the head trauma rehabilitation literature. Our experience at the Center for Living, Baltimore, indicates that imagery is useful for‘working through’the losses that result from head trauma and to create new cognitive and behavioural patterns both because it bypasses usual defence mechanisms and because it can be used to generate adaptive behaviour. This article discusses rehabilitation needs, why and how we think imagery psychotherapy is useful in head trauma rehabilitation and includes both a brief description of our programme at the Center for Living and case material to demonstrate how imagery is used in the recovery process.