While visual images have often been used in clinical assessments and diagnosis, this paper will explore how we may now utilize their unique capabilities to communicate unconscious, primary process material, to monitor and enhance ongoing long-term psychoanalytic psychotherapy within the framework of expressive analysis. This paper presents several clinical vignettes that illustrate this monitoring process and demonstrates how the clinical work can be deepened with the exposure and integration of creative images as the patient and analyst process these visual metaphors within the expressive analytic session. A variety of sensory motor systems and perceptions are monitored and explored. These examples will follow the expressive analytic model, clearly focusing on transference and resistance, while also bringing in more contemporary life issues through visual metaphors.