Practical NLP in the Ellesmere Port 
Cancer Patients’ and Carers’ support group
 
Ann Slack and Henrie Lidiard
 
The group was set up as a response to the needs of those who have been affected by cancer (as recorded in the Living with Cancer Project focus-group interviews). It aimed to provide support for those who have been diagnosed with cancer, their friends and relations and those who have been bereaved. In addition to providing a positive and supportive environment in which to discuss their concerns, the group also offered specific ideas and techniques which could help people to cope with the difficulties they were experiencing. As facilitators, we used our skills in Neuro-Linguistic Programming (NLP) and drew on ideas from a variety of different disciplines. 
 
The group was different from some other support groups in that it did not aim to provide information on cancer, treatment and its side effects. This was available to participants on an individual basis through the involvement of the Macmillan Information Service. It was also different from some other types of support group in its provision of opportunities to learn and practice new ways of dealing with some of the difficulties, which were discussed, in addition to talking with others and sharing experiences.
 
Participants
The group included people who were recently diagnosed; those currently undergoing treatment; their partners; those who had completed treatment and were still recovering from the experience of cancer; their relatives and people who had been recently bereaved. The group included a variety of age groups. On two occasions this included three generations of the same family!
 
Group Facilitators: Ann Slack and Henrie Lidiard
                                   
Macmillan Information Service: Anne Coles, Jill Littlewood and Anne Gregory.
 
Structure of the Sessions
The first session focused on getting to know each other and gathering information about what people wanted from the group. There was considerable interest in dealing with stress and difficult feelings and in having the opportunity to meet people who have had similar experiences.
 
As the group became established, a pattern emerged. This consisted of beginning by chatting, catching up with each other and getting to know new people. We then suggested some input, usually in response to concerns, which had been raised either in that session or at a previous meeting. The group was happy to try out particular ideas, at other times the suggestion led into further discussions and different suggestions. Techniques were often introduced to the group in novel or light-hearted ways, which generated interest and discussion. The input was always brief and practical in nature, providing tools, which people could use themselves.
 
When these ideas had been discussed, we took a leisurely break, which gave plenty of time for general conversation and to discuss individual concerns. We were sometimes able to help people with very specific issues, using insights and techniques from NLP to help to resolve difficulties. The nurses who provide the Macmillan Information Service joined us for the tea break. They were available to chat informally to those present and pick up on any needs that were identified. For example, when one lady had talked about a particular side effect of her medication, the Macmillan Nurse was able to contact her doctor and have the medication changed.
 
With information from the nurses we were able to link people up with those who had similar experiences and ensured that they had time and space to chat together. In running the group, we were able to monitor different conversations so that people had sufficient time to create relationships with each other.
 
The sessions usually ended by bringing the group back together to try out some form of relaxation. A variety of techniques were used, and these were very successful in helping people to relax, often to the surprise of those had felt that they were unable to relax.
 
We focused on creating rapport in a very diverse group and used specific language patterns so that the group were exposed to consistently positive and empowering language. We used our awareness of the importance of state and skills to influence state positively. The mind-body connection was a theme throughout the group. This helped people to appreciate that their thoughts and attitudes could play an important role in helping them to deal with difficulties. They were also given strategies and techniques to help them to become more positive. This is more helpful than simply advising people to ‘Be positive’. The emphasis in these groups was on solving problems and moving towards an enhanced quality of experience. Many of the processes are enjoyable and relaxing in and of themselves in addition to achieving a number of other specific benefits. They included:
  • The fight or flight response (explanation and ‘normalising’)
  • Brain gym techniques specifically for stress management (including PACE, hook-ups, positive points and exercises for releasing the Tendon-Guard Reflex) plus other brain gym exercises for problem solving.
  • Tai chi exercises (for increased arm-mobility after surgery and expanding the breath, relaxation and mental clarity)
  • Yoga breathing exercises (including mudras for enabling easier deeper breathing).
  • Conversational re-framing
  • Trances (for aiding restful sleep, solving problems, feeling more resourceful in specific circumstances).
  • How to create rapport (e.g. matching and mirroring with health professionals that they had previously found difficult and intimidating)
  • Phobia cure (enabling one patient to start swimming and enabling another to accompany their spouse on holiday on an aeroplane)
  • Anchoring techniques (so patients and carers could have resources available to them in different circumstances away from the group).
  • The grief resolution process (for a carer who was struggling with bereavement.)
  • Simple meditation to enhance sensory enjoyment and contact with the present moment.
  • Timelines for planning pleasurable events in the future.
  • Eye-movements for 'unwiring' recurring uncomfortable memories and for emotional 'first aid'.
  • Changing the 'internal representation' of difficult experiences (enabling comfortable access of the information with out being overwhelmed by distressing feelings.) 
  • Simple relaxation and visualisation techniques.
Results and feedback from the participants
Throughout the sessions people mentioned ways that they had used ideas from the group, such as affirmation and Brain Gym exercises. Some reported that they were feeling more positive, in one case this was mentioned after only one session. We observed individuals becoming more relaxed in their posture and expressions. Some people were able to smile and laugh more. Several of those who attended reported improvements in their sleep. A woman who had attended only one session told Anne Coles, that she had been able to sleep every night since she had attended the group and asked Anne to pass on her thanks.
 
Anne used a new assessment tool, ‘Cancer CAN’, with one of the course participants, shortly before she started to attend. The results of this assessment give some measure of the patients concerns and difficulties. Anne repeated the same assessment after the course and this showed considerable improvement. This woman was able to return to work and intended to take up part-time study. She was also very keen to learn more about NLP. It is interesting to note that improvements were apparent not just in her thoughts and feelings but also in some of the physical symptoms, which had been causing problems e.g. dizziness, fatigue, gastric problems   and sleeplessness.
 
Even those who attended only one or two weeks reported improvements. Some people did tell us that they had used particular ideas to help them to feel more positive. Others seemed to quickly take on board that their attitudes could either help or hinder them. For some the opportunity to talk about their experiences and to support others was clearly important. The group was able to be light hearted in spite of the serious difficulties they were facing. Many of the techniques were presented using humour and fun. The benefits of humour were also discussed.
 
Learning   
It was humbling and inspiring to discover that very brief amounts of input were enough to create very significant changes in the participants’ experience.
 
Stress was a major factor for people in the group. Through providing information on the ‘Fight or Flight’ response and the symptoms of stress, we were able to help people to make sense of their experience. One member of the group responded to the session on stress by stating that now she knew that she wasn’t ‘mad’. When people understand their symptoms, they tend to feel less frightened and worried.
 
It was clear that the relatives of people with cancer are affected by stress too. They can also feel unsure about how to respond helpfully. We emphasised the importance of taking care of their own needs without feeling selfish. Some of the information on stress also helped relatives to understand the feelings and behaviour of the person who had been diagnosed with cancer.
 
Brain Gym exercises proved very useful as they can very directly undo the ‘Fight or Flight’ response, and help people to feel relaxed much more quickly that they expect. Simple techniques, which illustrate the effect of thought on the physical functioning of the body, helped to emphasise the value of dealing with emotions in a positive way. Some members of the group responded to theses exercises very enthusiastically. They felt more motivated to remain positive as they had a concrete appreciation of its value. These ideas were not presented as ways to deal with cancer specifically but as part of helping to reduce additional stress on the body.
 
Conclusion
This type of group can clearly help people who are living with the effects of cancer. Those who attended responded well, with some showing very marked improvement in their ability to cope with their experience of cancer.
For some people, the opportunity to talk was a very important part of the group, others were very keen to learn and practice new techniques. These two aspects of the group needed to be balanced, week-by-week, in response to what was happening both for individuals and within the group. There also seemed to be a cumulative effect, with people becoming more positive in their attitudes over time.
 
 
The following interviews illustrate the effect that his group had on two people who regularly attended the group.
 
A carer’s account:
”NLP has added to my communication skills. I can talk to people in bad situations now. And I'm aware of how important it is to focus on the positive. My advice if you are talking to a cancer patient is to ask, "Where do you want to be in twelve months' time?" You need a target. It's important to have a positive attitude. I am much more confident talking to professional people. I enjoyed talking about our experiences of using NLP at the training session and am happy to do more. There were health professionals there and they were interested in what we had to say and wanted to learn. I can talk to consultants now, matching, mirroring, and thinking about the aspects I want to find out about and asking questions. NLP helps me think clearly and sensibly, and be aware of the language I use.
 
For me personally, NLP has made a difference by putting me more in control of my emotions. Following my illness ten years ago, I was having mood swings and suffering depression. NLP has helped me out of that depression. Since doing the NLP I have been a lot calmer.”
 
A patient’s account:
 “What a load of . . . . !” was my first reaction. “What have I let myself in for?” But I knew I needed something and the Macmillan nurse who introduced me to the support group had been so understanding. I later learned that she was an extremely clever person, her interests and role in the health service covered many different things, and she herself had been very sceptical at first. We both soon discovered that NLP really does work.

I needed something there and then because I had reached such a low point. I had kept myself so positive through all the treatment for breast cancer, and then suddenly my confidence was swept away as my friend and neighbour, whose experiences seemed to mirror my own, became terminally ill with secondary tumours. We had been through so much together, even having our operations on the same day. It was a great shock, I was frightened and very, very upset. 
So I joined the support group, and although it seemed strangely unfamiliar at first, the atmosphere was relaxing. I especially liked the Tai Chi. I noticed how the music lightened the mood and I found I could let myself go in the group. People were talking and sharing their different experiences.
The facilitators taught us how to relax, and now I’m able to just shut off for five minutes whenever I want to, and it gives me the oomph to carry on. I have shown my sister, who is housebound, how to do it, and she finds it helpful and enjoyable too. I have recommended the support group to other patients I have met at the hospital. Being able to relax can make so much difference.

The trainers were very skilful, they dealt with issues as they arose during the session and answered questions in just the right way. They helped me to see the differences between my illness and my friend’s and to focus positively on my own recovery. I look at things in life with a different perspective now. NLP has shown me how to be more positive, instead of looking down, look forward and onward.

NLP helps you to think clearly and sensibly and I recognise the importance of the language we use. I handle difficult situations much better now, I think first. I’ve got more confidence to talk to people, like the lady down the road whose husband was very poorly, like my sister-in-law when she was diagnosed with breast cancer. People don’t know what to say in circumstances like that, they want to avoid them, and I was just the same. Now I can talk to them with confidence and I know a few words can help someone else.

My relationships with doctors have changed. I used to say, “They weren’t listening to me”. I was brought up in awe of doctors, to show respect, never to ask questions, just to do as I was told. These days I find myself unconsciously mirroring their body language, I ask questions and I don’t forget the major points. And my doctor tells me things, gives me more details, explains more. I feel consulted.
 
Having a better relationship with medical people has given me more confidence in them. I can trust them because I know I’ve had a proper examination and discussion, mind and body are working together, and the doctor, the specialist and myself are all sharing control and are all taking responsibility for my well being. I feel better about myself.”

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