Many years ago our practice ran a peripheral maternity unit of about 100 deliveries a year until a new District General Hospital centralised services. Most of the time it was 99% straightforward and 1% sheer panic! Nowadays, all of the maternity care is done by skilled midwives and as GP’s we are peripheral to most of the action. The one area we can still be of assistance though is hypno-analgesia. This is not to say that childbirth should or could be completely pain-free – simply to offer another tool for the mum-to-be to have more control over the whole process of labour and delivery.

There are many things that an experienced hypnotherapist can use to facilitate a more comfortable delivery. One of the key things I introduce early on in a hypnosis session is “the feeling of no feeling”. This is a concept that most people can grasp straight off and begin to put to effective use. So just what is this feeling of no feeling?

It is a feeling we experience all the time, every day of our lives in every context we operate in. For example, most people wear a watch – yet most of the time, unless we pay specific attention to it, we are unaware of how it feels; the weight, the texture. The same with a ring, the shoe on your right foot, the feeling of the space between your big and 2nd toe, the jumper on your shoulders, the ear-rings, necklace, spectacles….and so on. So what does it feel like? And more importantly, what happens to the feeling when you are no longer paying attention to it? You know it must be there somewhere in the background, yet you can be blissfully unaware of it unless you focus explicitly.

In a sense then, your mind has learned over time to disregard many sensations so that you can get through your day being able to focus on something else instead. And that is exactly what we need to exploit here, how your brain generates the feeling of no feeling – and how to put it to useful work.

There are many ways to induce a hypnotic trance though the pregnant state seems to allow most women to drift easily no matter what induction you use. I usually do this process as a single one-2-one session somewhere between 30-34 weeks of pregnancy and am always amazed by just how quickly they deepen into a very relaxed state. Then it’s simply a process of reminding the brain that it generates the feeling of no feeling every day, to give many examples of this directly in trance, to get in touch with the spaciousness of that feeling even though they don’t know how they do that consciously, then begin to transfer it little by little, layering it in to where it can be of even more benefit – the birth canal.

You can then timeline this resource state so that it automatically appears just when it’s needed…

Of course as well as using both direct and indirect suggestions, there are other techniques that are useful in promoting analgesia such as time distortion, dissociation and glove analgesia/anaesthesia…we will look at these in further posts….

Until next time…

Lewis

PS
Of course these techniques can be used in a variety of other clinical presentations, both hypnotically and conversationally…check out Changing with NLP…

Recently I saw a patient who was very anxious about giving presentations. Not an uncommon situation you might think, yet something that for most people happens rarely because we rarely have to give presentations in everyday life. Not so for this gentleman. A large part of his job is to travel the world promoting a very special Scottish export – Whisky!

As a Whisky historian he is demand as a raconteur of the making of the “water of life” down the ages. And for the most part, he does just fine. Mainly because if his audience is made up mostly of strangers then everything seems to go just nicely. However, give him an audience of people he knows and especially if they are “superior” to him in some way (bosses, management, celebrities etc) then he visibly sweats a lot and stammers his way through to the bitter end. And more recently, he has been partaking of the “water of life” to “help” him get through such occasions. Hearing that I did “weird things” to help people get through problem issues he came to see me.

Wanting to gain more information about how his problem occurred I stopped him from telling me “all about it” (his reasoning and interpretations of why this had come about) and decided to do a contrastive analysis. A contrastive analysis is when you compare the submodality structure of an experience that goes well with one which hasn’t. It can give very useful information about how a person structures their experience and just what kinds of shifts might be helpful in sorting things out.

I asked him to think about a presentation experience that had gone well. He had been in the Ukraine speaking to a group of people that he didn’t know at all. When he remembered it fully the key structure was:

• Seeing from his own eyes with the scenario in colour…
• Seeing all of the audience in its entirety – panoramic…
• Able to look at one member of the audience whilst still seeing them all…
• Aware of what was behind him (table and bottle of water)…
• Feeling comfortable and “in the flow”…

Then I asked him to think about a presentation involving his superiors which didn’t go so well. Immediately things were very different, the keys being:

• Situated in the audience watching himself presenting (in colour)…
• Running commentary of very critical appraisal of performance….
• Seeing the rest of the audience watching him intently…

In essence then, he was 2nd positioning the audience rather than being in his 1st person self. I asked him to step into himself and experience things from there. This time he noted the following:

• Unable to see the audience clearly
• Tunnel vision with flashes of the people there
• A “blank” surround
• Unaware of what was behind him

From this perspective he felt things were going horribly wrong and didn’t think he was connecting with his audience.

From there I asked him to stand directly to the side (3rd position) and look at both himself and the audience. He felt instant relief and immediately commented that he saw so much more and had new information that he didn’t have in 1st position. He recognised with surprise that he was doing much better than he originally thought and that the audience were actually quite attentive rather than bored. (“I’m nowhere near as bad as I thought I was”)

I asked him to also remove his critical 2nd position self from the audience and put “him” on the sidelines. Then he stepped back into his 1st position self and re-experienced the situation once more from his own eyes. This time he was visibly relaxed, saw the audience as a whole, was aware of his peripheral vision, aware of what was behind him and felt comfortable and in the flow.

It was clear then that we needed to deal with his critical inner voice in 2nd position with audience. Given that the positive intention of this part of him was to help him do better we negotiated a settlement. This kind of settlement usually involves preserving the function of the part and sequencing when and how feedback is given. In future this voice would help him prepare for an upcoming event, “take notes” from the sidelines during it whilst remaining silent, and debrief him afterwards. Instead of telling him what had gone wrong it would focus what he did well and could actually do differently next time.

The proof of the pudding will be in the eating and he will report back after an in-house presentation to his company in January. In the meantime, you can find out more about how to use interventions like this in Changing with NLP.

Until next time

Lewis

Angry people can be difficult to handle – especially when they are directing most of it at you. I don’t know if you’ve had the experience of exactly that happening. Someone comes into your consulting room at almost “blowing their top” intensity – perhaps about something you have or haven’t done, something one of your partners should have but didn’t, some complaint about how someone else in the NHS system has treated them, or possibly just angry about a life situation that “shouldn’t” be happening…

When anger is directed face to face at you there are some automatic responses that spring up reflexly. I don’t know about you but I’ve certainly experienced an involuntary fear response when my stomach goes up into my mouth as my heart hammers away inside my chest. A normal defensive reaction, especially when they are seated between you and your consulting room door and you have no escape!

I’ve also experienced the other main response – an angry reply in return, where the words and body language erupt in a vituperative response that you instantly wish you could claw back as the stream of invective leaves your mouth for good…or bad! Either way, the consultation can quickly reach an impasse then deteriorate rapidly with both parties ending up not getting what they want.

So what is the function of anger? Well, I find it useful to think about anger as a reaction that occurs when we perceive our boundaries have been violated in some way – physically, emotionally. We are usually so deeply identified with our beliefs that an attack on what we hold to be true for us can appear psychologically and physiologically to be like a “death threat”. And we respond automatically with the evolutionary useful fight or flight mechanism which was great when dealing with the sabre-toothed tiger but not so great when the “dangerous animal” is a patient!

So, in a sense, anger is a message about re-establishing effective boundaries. The trouble is, we usually attempt to do so by violating the other person’s boundaries in return. So how can you deal with this kind of situation in a way that is respectful to all concerned whilst maintaining your own sense of self?

The first thing to understand is that when someone appears to be angry and is directing that at you, deep down it’s not really about you at all. It’s about them – more specifically, their representations, their views and perspectives that are driving the show. It’s not “you” that is the issue, it’s how they are representing and interpreting that “you” in their mind’s eye. And whilst that may be their “truth” it is not The Truth, simply one of a number of possible perspectival frames that could be used to interpret the current information.

Have you ever tried to stop a volcano mid eruption? Not an easy task. Same with an angry patient. So what can you do instead? What at first might seem counter-intuitive is in fact a very effective strategy. And that is to allow the volcanic eruption to blow itself out – without it harming you. So how do you do this?

I’ve found that no matter what they say the most useful thing I can say in return is a version of the following:

“That’s interesting…can you tell me more…?”

And to use that iteratively with everything they say until they have literally nothing left to say!

“So, you’re angry that you didn’t get what you wanted…can you tell me more…?”
“So, you think I’m an a**hole…can you tell me more….?”
“And you’re really angry with my partner too…can you tell me more…?”
“So, you think you should have been referred earlier….can you tell me more…?”
“So, you think you should have been prescribed X….can you tell me more…?”

Your voice tone and body language are important hear…Try saying this slowly and placatory…and notice how that escalates the problem! The key is to match their voice tone and energy levels at about 80% intensity…if you are the same level or above then this is likely to be perceived as an attack and things will usually deteriorate. If you are a little below their intensity you can then pace and lead this down to a more comfortable level.

My experience with using this in many situations is that people rapidly get to the point where they are literally speechless. When someone has said all they have to say whilst you ask them to tell you more then they have gone beyond words and their state usually changes for the better (not always though). This leaves the situation open to changing direction and there are a number of ways you can go with this….

Often I ask:

“So what is it that you really want/need now…?” (or some other outcome based question)

Or:

“Is it Ok if I respond now with my perceptions…?”

Asking permission in this way clarifies whether or not they really have emptied themselves of all they needed to say. And in return, it is important not to attack what they have said directly. One useful way to take things further is to say:

“I can see how this has been very frustrating for you and I’m sorry that it has caused so much upset…in your shoes I’m sure I may well have perceived this in an identical way….from my perspective, here’s what I think we should do next….”

This statement has the effect of agreeing with how they have come to see things in the way they have, saying the magic words “I’m sorry” for their predicament, yet at the same time not necessarily accepting that you are in any way responsible…unless of course there is something that you have contributed to the situation that has made it go awry, and in that case a direct apology may well be in order.

Once both your sets of perceptions have been clarified in this way it opens up the space for some constructive dialogue to take place and there are many NLP tools you can use to move forward (see Consulting with NLP )

Do let me know how you get on…

Lewis

Just to let you know I will be on hols and incommunicado (relatively speaking) from 17/07 to 08/08/10…

Please mail any queries to info@thenlpdoctor.com and I will get back to you asap when I return…

Best wishes

Lewis

I thought I would digress into a clinical interlude….

Recently, I saw 2 of the most severe needle phobics I have ever seen. Both were females around age 25. Both had childhood experiences which were traumatic. One remembers having an anoxic fit and being admitted to hospital around age 10. The other initially had no conscious memory but during our intervention “remembered” being admitted to hospital around age 3 and “being stabbed over and over again” with needles.

The first couldn’t even think about a needle or picture it in her mind’s eye without bursting into tears and sobbing uncontrollably. Successful in other areas of life, she had decided some 6 months after joining my practice that having this irrational fear didn’t fit with being the kind of person she saw herself as. Knowing that I did “weird things to helps people’s minds” she came to ask for help.

The second was pregnant and couldn’t bring herself to the point of getting the various blood tests she needed to monitor her clinical condition. She could think about a needle without getting panicky but couldn’t be in the same room as one in real life.

I had been playing about with the concept of “space” for a while prior to this and decided to use this as one of the keys to the intervention in both cases. One of the things that can profoundly alter our state is what we put our attention on and how we do so. Let yourself follow along with the next paragraphs and notice how you feel…

…Assuming you are sitting as you do this just let yourself become aware of the space that is all around you….pay attention to the space between you and the furniture and walls in the room…take a moment to notice the size of the space…the shape of the space….between the objects…surrounding the objects…notice the difference in the space off to your left side….compared with the space on the right…if you’re sitting on a chair, notice the sense of space beneath you…and imagine what it feels like to put your mind into that space…to get a felt-sense of what that space really feels like….

…Notice the space that touches the outside of your left forearm…the space between the inside of your forearm and your body…the space between your calf muscles…and the space that touches the outside of your calf muscles…notice especially the shape of those spaces…

…Now put your attention on the space behind you…between you and the chair you are sitting in…and the sense of the space behind that…the distance from the wall…the other objects…and even though you can’t see these things behind you …imagine you can get a feeling that connects with that space…a sense that you can put your mind into that space…behind you…and just let your attention rest there…

Now what we have just done is exactly the same as I did with both these young women when they both came for their specific sessions. I anchored the feeling of the space behind them both by looking at it and changing my voice tone as I spoke about it (projecting my voice behind them) and noticed their state changing into a much more deeply relaxed yet still very alert state of mind and body. The key to the intervention was to keep them paying attention to that feeling of the space behind them as we ran through a series of steps to change how they felt about needles.

For each, we identified several past needle trauma memories, culminating in the most severe. Staying in the “feeling behind” we projected each memory out into the space in front and to the left so that they could see themselves “over there”. Then we did some of the usual NLP steps; running the memory from beginning to end (and beyond the end to a point of being safe again), running it backwards at twice the speed, then back and forth at ten times the speed, then doing it again as a black and white dissociated movie.

Occasionally some of the more powerful emotionally evocative memories caused them to temporarily start to feel the negative emotions. All we did at that point was to stop the memory, reconnect to the space behind, put the memory a bit further away into the space on the left, and carry on where we left off.

When we did this with the most traumatic memory – which for one of them only became consciously apparent as we went through the process – we made sure that all the negative feelings had gone. Then we integrated that “younger them” by the following: “Just give that younger you a hug…and let her know that she need never go anything like that again…and as you allow her to reconnect inside you…inside your heart…she can know that everything is all Ok now…”

The proof of any pudding is in the eating. Or, in the case of a phobia, The Exposure! You can expose in 2 ways; the first imaginally and the second in real life. You can do all sorts of submodality shifts with how someone pictures a needle to change how they feel about it. However, in a Doctor’s office, real life needles are never more than a small step away.

For each woman I had already prepared three syringes of varying sizes with some sheathed needles attached so that the points weren’t showing. This is where the rubber really hits the road in terms of testing your work. Many NLPers do the imaginal exposure and trust that it will hold out in real life. Sometimes it does, sometimes it doesn’t. I like to test in real life if at all possible so that I can both see the reaction and have a chance to do something about it there and then if there is still a negative response.

So by a series of small steps, we brought the sheathed needles closer and closer, all the while paying attention to the space behind until they could touch and hold them and press them against their skin. At times we backed up a little as a negative response occurred before continuing. Then we did the same with the needles unsheathed starting with the smallest and ending up with a standard size for drawing blood which I put through the skin into a vein…Voila!

Both women had camera phones so I took several pictures of the different stages of exposure. This is the kind of thing that can act as a strong convincer of change. They can look at it over and over knowing that they succeeded and also get the social element of change back-up by showing it to friends and family. This is something I would encourage you to do especially when treating fears and phobias.

So what happens if you get a stronger negative response than you anticipated? Does that mean you have failed? Professor Isaac Marks has been an exponent of exposure therapy all his professional life. Despite what many NLPers may tell you, live exposure to a phobic stimulus that causes a phobic response can be curative in a very high percentage of people, uncomfortable as that may be for a period of time.

The trick (if there is one) according to Marks, is to remain in the experience until the negative feelings peak then subside. If you desperately avoid or run away before the feeling has hit a peak and subsided then that will certainly strengthen the phobic response next time you are exposed. And that of course is what phobics do naturally most of the time. If you stay until it has subsided then you have witnessed a natural state change which persists with further exposure.

What I believe NLP techniques bring to the table is the ability to speed up this natural state change and make it much more rapid yet far more comfortable for the patient. Both patients’ sessions lasted less than an hour. The process we have just gone through can be used for all sorts of fears and phobias.

Let me know what you think…

Lewis

The Stages of Change Model started off life in the late 1970’s as a model of how behavioural change takes place without the intervention of professional help. James Prochaska and Carlo DiClimente were interested in how change happens naturally so they studied a large selection of smokers who had quit, largely without outside help. They found that on average, smokers had 4 quit attempts before succeeding. Of course the old joke was that with professional help it took at least 6 attempts….

When they analysed their data they found that people passed through 5 specific stages on their way to success (see below). However this didn’t necessarily occur as a linear process. Often people yo-yoed back and forth or stagnated for a period of time. Sometimes they had success for a short spell then had a lapse or relapse which might see them spiral backwards several stages before starting all over again.

One of the key precepts of the model is that each stage demands different types of interventions. You can use your favourite intervention over and over again if you want but if it doesn’t fit the patient’s stage then not a lot may happen. Medical interventions are typical of this. As health professionals we often assume that patients are ready to take action and we prescribe our usual solutions, usually in the form of authoritative directives (stop smoking, drinking, eating too much, etc), then in the light of failure wonder why they didn’t “try” harder. Finding out the stage before we fit the appropriate intervention is paramount.

Another thing we tend to do is to go for too much too soon. We expect our patients to make big leaps and progress through the stages far quicker than they often do. A concept I subscribe to (which I got from NLP trainer John Overdurf) is to find the smallest next step the patient is capable of taking and nudge them towards that instead. Of course, once you match the intervention to the stage, using NLP technology can paradoxically help people make and sustain big gains very rapidly.

The Stages of Change Model has come in for some criticism from research that suggests it is too linear and rational in application and results may be no better than other methodologies. However much of this research is either underpowered or focuses only on one particular stage rather than the whole model. My experience is that when combined with NLP interventions which also incorporate unconscious processes and communication then exceptional results are possible.

One thing I do like about this model is that it is transtheoretical. It doesn’t promote any one particular change model or theory. It looks at the process of change and as such is a form of meta-model; you can use it as a lens through which to look at your favourite methodology and work out where to apply it best. Knowing the model can free you up to be more eclectic in your interventions.

Here are the 5 Stages as I use them:

• Raising Awareness

This stage is often called pre-contemplation and it is a common stage in general practice presentations. Essentially your patient either doesn’t know they have a problem or they are somehow dissociated from that knowledge; they may be uninformed, avoidant, defensive, in denial, etc, etc.

There are 4 different types of precontemplators, which I go into in more depth in Persuasion in Practice. These are:

1. Reluctant (fearful of change)
2. Rebellious (“don’t tell me what to do”)
3. Resigned (tried and failed before)
4. Rationaliser (always have an answer)

If you try to get people in this stage to action you are mainly wasting your breath! You want to stir up just enough cognitive dissonance to get them into the next stage. To do that you must get them to become ambivalent, in 2 minds about things – and often the best way is to create a problem for them to move away from.

A key question here is: “What is the worst that might happen if you continue on like this?”

(Whilst this is a very common stage in medical practice, most people who elect to go to an NLPer for assistance are usually at the next stage or beyond – but not always)

• Resolving Ambivalence

This stage is usually called contemplation. Your patient knows that a problem exists and is sufficiently connected to it emotionally to create feelings of ambivalence. This is the “will I or won’t I” of change. Or sometimes expressed as “I want to change…and…I don’t want to change”.

Ambivalence is a good thing, as long as you don’t stew in your own juices for too long. Miller and Rollnick, in Motivational Interviewing, state that if you don’t feel this push/pull feeling and really pay attention to what it is telling you then any change you make is much less likely to hold over time. They suggest that it is very important to fully explore the pros and cons of changing and not changing before planning to engage in taking any action. (Behavioural Diaries and Decisional Balance Sheets can be a great help here).

In NLP we call this feeling incongruence and it’s often expressed as a parts conflict…”Part of me wants to X and part of me wants to Y”. NLP has numerous techniques to explore both the conscious and unconscious mechanisms that keep people stuck and negotiate a congruent settlement that allows change to happen. An important perspective is that of unearthing the positive intention behind any so-called “negative” behaviour.

When people seem to be much further on in the process of changing yet still don’t have the result they want the problem usually lies in some hidden ambivalence or obstacle to changing that hasn’t yet been taken into account. So one question to keep in mind is: “What’s the biggest obstacle to you really getting what you want?”

Ambivalence is a very important and normal part of any change process

• Preparing to make changes

Once patients have largely resolved their ambivalence to changing a new state begins to emerge. That is a sense of increasing commitment to make something happen. Like all states, the degree to which it can be felt can come and go, yet it needs to be fostered, developed and pointed in the right direction.

Planning ahead for what you want to have happen is very important. NLP has lots of tools for helping patients set useful outcomes, decide which personal resources they need to sustain the change and bring them to bear just when they are needed. (e.g. Results, Reasons, Right Actions). Plus the ability to elicit and amplify any state is a skill you can learn easily. (see Anchoring and Circle of Excellence in the free downloads section)

The emerging field of Positive Psychology points out that paying attention to Signature Strengths, the things that are true of you when you are functioning at your best, is a key determinant of success. Reminding patients of their past successes and achievements builds an inner resilience and fosters a return to an inner locus of control which builds confidence and self-efficacy.

• Taking Action

This is the stage that many of us mistake our patients being at when they are usually at an earlier point in the process. In this case, pushing for premature change usually leads to failure. However, with the stages negotiated as above, and a plan of action in place, galvanising them to take action in their own behalf becomes paramount.

This is often an outwardly busy stage with much activity generated. However, equally important is the ability to maintain a good state and do something different if the going becomes tough. Developing pattern interrupts, where your patient can identify when they fall into a negative state and get out of it, is very important. So are some simple submodality processes to distance negative imagery and enhance positives – changing focus. Sometimes the ability to take a much needed timeout with a relaxation ritual is needed to reduce stress levels.

One action I often get patients to take is that of an external commitment. I may get them to write to someone in their life who is very important to them, telling them of the result they are committed to achieving. There are numerous other ways, such as tasking, that are equally useful. (A useful read here is Jay Haley’s Ordeal Therapy)

• Staying on Track

Behavioural change literature is full of the key problems of this stage – lapse and relapse. Staying on track is largely about consolidating the gains up until now and preventing stressful situations from derailing the process. There is a need to maintain commitment over time and have some tricks up your sleeve when dire emergencies crop up.

Changing a behaviour can lead to a sense of bereavement and loss, especially when the “problem” behaviours (alcohol, drugs, food, etc) previously led to good feelings. Identifying positive intentions can be useful even though a social transplant away from “well meaning friends” may be required.

In one sense though, a lapse or relapse is actually a sign of success. You can only have them if you have already made a successful change. Many NLPers fail to recognise that many problem behaviours are kept in place by myriads of contextual and specific conditioned responses which can, over a period of time and re-exposure, re-trigger unwanted behaviours. What is really important here however is that after relapses you get a chance to identify the specific triggers that caused them and devise particular strategies to deal with them as they will invariably recur.

You can, paradoxically, prevent a relapse from occurring by prescribing one! Mentally rehearsing a “blip” then getting back with the program can install a useful recovery strategy.

One characteristic that stands out from the Stages of Change Model is the increasing level of commitment to change that is generated as each stage progresses. You cannot persuade anyone to do anything on their behalf if they are not committed. More than anything else you need to pay special attention to eliciting, testing for, monitoring and strengthening this state as the sine qua non of effective change.

So in your next series of consultations, to begin to put these ideas into practice, I suggest you keep in mind the following question:

 “What stage are they at and how can I nudge them one step forwards?”

Until next time…

Lewis

In these first few blog posts I aim to cover some of the principals involved in helping people make changes. Following that we will get down to some specific interventions for a whole variety of clinical presentations. I want to make these posts both informative and useful for day to day consultations. I encourage you to feedback your responses and make requests for specific areas you would like me to cover in the future…

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I don’t know about you, but I have always been fascinated by how change occurs. And particularly by the way some people respond better to some approaches rather than others. You may well have experienced how one method bore no fruit whatsoever, yet another, coming from a completely different kind of mindset altogether, seemed to hit the nail on the proverbial head.

There are many, many different approaches to treatment, therapy and helping people make changes. In the last 50 years, (and especially the last decade alone), there has been an exponentially increasing number of interventional modalities, each with its own theoretical underpinnings, rationale and techniques of encounter. There is no doubt that many of these methodologies can help some people at some time with some problems…but not all.

I wondered just how such diverse interventions could get results with different people who shared similar problems…

Back in the late 90’s Hubble, Duncan and Miller in The Heart and Soul of Change pondered the same question. They suggested that all approaches shared four common factors through which all successful change is mediated. Rather than getting results by the explicit techniques that differentiates them one from the other, it seemed that these common factors catalysed the change process. They even allocated percentages for how much each factor played a part in the overall course of events.

• Patient, Person, Client (40%)

Even though our patients are coming to a consultation with a particular problem – or even set of problems – it is important to remember that they also have a personal history that is replete with particular strengths, resources and skills. All there just waiting to be unearthed.

Too often, in the pain of the clinical encounter, it is easy to forget that in other unrelated contexts of life our patients have often displayed commitment, focus, determination and resilience – the very stuff required to sustain change. The trouble is, they often overlook these things themselves and it may require considerable re-framing on our part to re-vivify and put these resources to good use.

Other key determinants are patients’ personal beliefs and values, how they’ve previously coped with and caused change to occur and how confident they are in their belief that they can change in the future – self-efficacy.

In essence, we must highlight and harness these strengths, putting them to work effectively.

• Therapeutic Alliance (30%)

No matter what the clinician’s theoretical position, all successful change modalities seem to require the presence of factors such as rapport, empathy, acceptance and encouragement. If we believe that it is possible for our patients to change then this can act as a self-reinforcing prophecy – and vice-versa.

It’s the patient’s perception of the degree of support that is important here. It doesn’t matter whether we believe we are being supportive – their view of how the alliance is going is paramount.

There is however a paradox that is worth mentioning. Very occasionally there may be someone who complains bitterly about how un-supportive and un-helpful we have been – yet they changed “despite” this. (More on this in a later blog).

Together, patient strengths and therapeutic alliance account for the majority of a successful intervention. We must pay close attention to both.

• Expectancy, hope and placebo (15%)

Whenever patients begin a process of changing they have certain ideas about how it may turn out. They may hope for one thing yet underneath it all expect something else to happen. Ideas can have a direct influence on how things will turn out.

As clinicians, we also have beliefs about the current therapeutic model we are utilising. The congruency with which we perform the therapeutic ritual is paramount. Yet it is not necessarily the particular methodology we use that gets the result. It is the belief that both parties share about the model that may be key.

The placebo effect is really a mix of different physiological processes that are present to one degree or another in every consultation. What they are and how you can elicit them therapeutically deserves an entire blog post to themselves – and this is something I will most definitely cover soon.

• Technique (15%)

Techniques are the specific rituals of intervention you use with patients to get the results they want. They provide ways to elicit and utilise particular resources so that you can direct them with finesse into current trouble spots. They provide templates which can help us not only see ingrained problems in a new light, but actually do something different about them.

Techniques afford both a rationale and convincer to patients that they can alter previously entrenched behavioural patterns thereby increasing their inner locus of control. There are many useful techniques in the various change methodologies and I encourage you to learn as many as you can. The more you have at your fingertips the greater your flexibility to get results across a wide spectrum of presenting problems.

THE NLP PERSPECTIVE ON THE COMMON FACTORS

Now, one of the great things about NLP as a premiere change technology is the sheer scope it gives to develop and amplify the effects of these four areas. One of the foundational principles of NLP is the presupposition that People have all the resources they need to change within or can acquire them. We can debate whether or not that is “really true”. However, adopting this as a belief in any change consultation can often catalyse almost magical outcomes.

NLP has numerous formats for identifying, optimising and utilising patient strengths in any clinical encounter. It is one thing to say that patients’ past resources are vital in the change process – quite another to have so many specific means of re-vivifying them and bringing them fruitfully to bear. You will find many of these very powerful formats and techniques in the free downloads section.

Many change methodologies strongly endorse therapeutic rapport yet have little specific to offer other than “adopt an open and inviting body posture and keep eye contact”. NLP has closely studied what happens when people are in deep rapport and has numerous matching and mirroring techniques to enhance it. Rapport is a state, with a set of beliefs and intentions that can be incorporated in any encounter. You can learn to develop this state to get the right depth of rapport for the current situation.

You can also be in rapport through recognising and utilising the information that people project into space all around them all the time. This is completely unique to NLP and opens up a fascinating world for bespoke interventions. It also means you can do so without getting embroiled in and taking on your patients’ negative emotions.

Hope and expectancy are particular constructs that have a specific submodality makeup for each individual that can be elicited, enhanced and used to even better effect. Knowing the key details that drive these constructs in differing situations can allow you to strengthen the impact of your interventions over time. Helping someone find something to live for can fuel re-mission.

One of the mechanisms of the placebo effect is through conditioning (anchoring in NLP terminology). Another is through the framing (and re-framing) of meaning. Both can be used to enhance therapeutic effects. Placebo effects have had a negative press in medicine for far too long. NLP skills can help you utilise them in many positive ways (more later).

One of the things that attracts people to NLP is the sheer number of techniques that can be used across the board of presenting problems. NLP is a meta-discipline: you can use it as a tool to code the interventions of other methodologies, strip them down to their essentials, and then rebuild them to be even more robust, powerful and elegant in their application. This kind of reverse-engineering means that once you have learned the basic model and toolkit, you can custom build your therapeutic interventions to suit any situation.

If there is one take home message from the above then it is this: key to any successful intervention is identifying and amplifying patient strengths within the context of therapeutic rapport. Keep this clearly in mind and you will stay firmly on track.

In the next blog I will take a look at Prochaska and DiClimente’s Stages of Change Model and how you can bring it effectively into change consultations using NLP.

Until next time…

Lewis