Living with Cancer Project: NLP Training - a summary of The Ellesmere Port NLP Diploma for health professionals.
By Henrie Lidiard and Ann Slack
The diploma trainings were designed in response to both the national research findings and also the local needs as identified by the research focus-groups. In addition the diplomas were always adapted by Henrie and Ann to the particular interests and needs of each group. The diploma encompasses the standard INLPTA diploma syllabus with two significant variations. First was the addition of a section of language skills drawn from the Milton model. Having researched placebo and nocebo effects, it seemed important to give health professionals an awareness of naturally occurring trance states (for example under conditions of strong emotion or shock) and the enhanced effect of their language on the recipients unconscious-mind at such times. Secondly we used a variety of mind/body approaches from the discipline of Brain GymTM.. These included rapid ways to release the stress response and specific exercises to promote relaxation and mental clarity.
The training took place one day a week for four consecutive weeks. This was for a number of reasons:
1. To enable cover for health professionals being away from their usual places of work as they trained. More than one day a week was too difficult logistically.
2. To allow integration of the learning.
3. Most importantly it enabled them to apply what they had learned back in their places of work. This built their confidence in their ability to use their skills and allowed them to develop their own relevant and convincing reference experiences for the results they could achieve when using NLP.
Opening frames, participants outcomes
What is NLP
Where did NLP originate from
The present-state to desired-state model
The six ‘legs’ of NLP Outcome/Sensory Acuity/Flexibility/State/Rapport and Action
Well-formed outcomes (including the concepts of Secondary-gain and Ecology)
Directing attention and building sensory acuity
Calibration of individuals to aid communication
Rapport (including matching/mirroring/pacing and leading)
The NLP Communication Model (including the processes of deletion/distortion/generalisation and the concept of ‘maps of the world’)
Stimulus response patterns and how helpful beliefs affect communication
The importance of recognising naturally occurring trance states (esp. associated with shock or strong emotion)
Soft language (including positive language, soft frames and positive presuppositions)
Sensory based language
Eye movement patterns
Uses for eye movement patterns in emotional first-aid and lessening the discomfort associated with ‘difficult’ memories
Other ways of utilising eye movements
Taster sessions of other techniques from NLP and Brain GymTM, that give a sense of how we can change our state and solve problems more effectively. These processes included: anchoring, changing an internal representation, the ‘Dennison laterality re-patterning’ timeline review process, positive points,)
Applying NLP in the work-place:
As part of the training process we required written examples of the ways in which participants had been applying their NLP. This formed part of a feedback loop vital in the development of their skills, quality control and accreditation. This also enables us to illustrate some examples of how health professionals are finding their new skills beneficial. As there seems to be a relative absence of written cases on the wider use of NLP in the health-care arena, we have included the following real examples which are extracts from their submitted work. We have selected examples that illustrate clearly the aspects of the syllabus we described above.
Well formed outcome:
“I used this with my partners at the practice to come to a decision re our practice management. This ended with one of our possible outcomes being realised!” GP
“Since taking part in the training I have started to look at body language both at home and at work. Whilst previously I had noticed how people responded and acted accordingly it has been very interesting to look as it with ‘new eyes’. I have taken on board how much of body language is non-verbal and how important it is to be aware of how much is being said without a word being uttered. I am now much more aware of how much can be communicated at how people dress, how they sit-relaxed-tense-etc. how they position their hands their feet etc, and then how different facial expressions can say so much. When looking at words and verbalisation I have taken more notes of actual tone and pitch and the way the speech is fast or slow, loud or quiet.
Overall I have found that using neuro linguistics has made communication generally easier and more interesting.”
- “It was certainly worth paying attention the patients facial expressions-it gave me more information about how the patient felt about what I was asking more quickly.
- The consequences of this meant that communication was enhanced and better rapport was established.
- The benefits mean that I am working more effectively
- The effect on me is positive, perhaps reduces time trying to find out patient feels etc.
- The effect how on the patient is beneficial because, hopefully, they felt I was listening more effectively.”’
Rapport, Pacing and Leading
“I received a referral from a colleague for a lady who has been experiencing extreme depression and was having a number of debt problems she needed help with.
I had to discuss the issue with the client by phone, as I could not meet up with her. When she first called she had a very low, slow voice and was not willing to answer the questions I had, she was answering mainly yes or no answers. I decided to stop the questioning for a while and had a general chat to her, adopting the same tone, pitch and speed she was using. After just a few minutes she began to open up a little more and was talking more freely.
As I felt I had her trust I began to change my tone and slowly increased my speed so that I sounded a little more confident and happy, after a short time, I noticed that her voice was beginning to sound a bit jollier, she was speaking faster and a slightly higher pitch. I began to ask the relevant questions again, this time she was answering more freely with fuller explanations and details of the issues. I was able to offer her appropriate advice and suggest possible solutions and outcomes.
At the end of the conversation she said that she felt much better for having spoken to me and that she had started to see a positive end to her problems where previously she hadn’t been able to see past them herself. In this situation, my knowledge helped me to bring around a difficult situation that appeared to be going nowhere to a very successful outcome by first building rapport and using ‘pace and lead’ to the benefit of both parties.”
Pacing and Leading
“An example of using this would have been during a meeting with someone who was concerned that he had let people down in the past and, therefore, felt that he was a selfish person.
Despite my immediate thoughts about his situation and the temptation to offer him a “result”, I visualised the connecting trains image- I had a toy when I was a youngster, which was a series of minute wooden carriages complete with hooks and eyes…. This made the mental picture of this process even easier for me.
I hoped that I was establishing rapport with this person, by giving him space to describe his feelings of selfishness. He questioned how the people he had apparently let down must have felt at the time and also, what he could do to make amends with them. By empathising with him I certainly did get a feeling of his connecting with his issues.
I was then able to tentatively question whether he thought that by concerning himself with the feelings of others, was he not behaving in an unselfish way after all? When he considered this, he appeared to have lightened and the more we explored this possibility, he became visibly less depressed about his initial concern.
I had originally worried that pacing and leading felt manipulative and directive. However, in this case, I learnt that, despite my suggestion, the client would only accept it if he felt right about it himself. That is, he felt he had a choice and an alternative option to the direction he had been taking in his thoughts over these issues. The suggestion, in turn, allowed him choice and empowered him to view the problem in a new light.”
Cross-over mirroring with pace and lead:
“I used this to help a colleague achieve a more resourceful state. She came in to work to hand in a sick –note and became very distressed on entering the office. We walked together to another room and I asked her to raise her eyes as I opened the window and let in a blast of cold air. She didn’t want to sit but stood and was moving her hands and feet on the spot. I stood to her side and matched the pace of her movements by rocking a chair backwards and forwards. I gradually slowed the pace of the rocking and much to my amazement her own movements began to slow down. She began to talk in full sentences. We were able to reframe her experience as being in the past at that point and it really did seem appropriate to have a cup of tea before we turned to the reason for our own meeting.”
‘Part of my job involves running Groups for parents. It is important to make them feel at ease at the first session so that they feel comfortable enough to come back. We have just started a new group and I used some of what I had learned to create a rapport within the group using statements that applied to everyone and developing a commonality amongst the group. This worked well and the group began to create their own rapport with each other.’
‘I felt that I learnt a lot from the session and exercise on breaking rapport. Sometimes I do need to bring things to a conclusion and this exercise made me realise how I might be able to achieve this effectively.
Visiting a patient who will talk for England I felt I would practice what I had learnt. When I felt I needed to bring things to a conclusion I adjusted my posture so I was not matching the patients. This in itself did not appear to break the rapport. I had to be much more overt about what I did-moving forward in my chair and gathering up my paperwork etc.. This then had the desired effect. However, I felt pretty uncomfortable about this as it goes against all my listening skills training. On reflection, I feel I did the right thing- we had concluded what we needed to discuss- this patient simply wanted to ‘chat’. I am sure she is quite lonely but there is a limit to the time I can give and I need to be honest and realistic about this.
- Thinking about the ecology
- It meant that I was making better use of my time
- I was clearly focused on what I needed to discuss
- I hope that patient was clear about my role and purpose
- I hope that the patient felt I was professional concentrating on what I was there for.
- I worked more effectively using my time more effectively.
- I felt more positive about the visit.’
A variety of physical exercises and activities are included as part of the training. NLP works with the idea that the mind and the body are an interactive system. Brain Gym exercises were used both as part of state-changing skills and in order to ensure that the group were able to maintain an optimal state for learning.
“ As a scientist by training it (this NLP training) is the first time that the mind-body interaction has been explained in a way that really rings true.”
‘I am just completing the last module of my ECDL computer course. I was having great difficulty trying to remember the specific sequences when trying to download certain information and so thought I would give the brain gym a try. So, I first of all did the focusing exercises as in the exercise sheet and particularly enjoyed the Cook’s Hook-ups. I then went on to relook at the down loading process and was more easily able to take it in. I then followed this up by reading it again and then once again about twenty minutes later to reinforce what I had read.
I then took the exam for the last module and got a score of 29 out of 30, Which truly amazed both my tutor and myself!
So I will be doing more brain gym in the future.’
1) “I had thought during last weeks session that I was immune to generalising, however this week I realised that I was wrong……. I received a referral from a midwife about a young girl of 17 who was 6 months pregnant and needed advice on benefits and housing.
I wasn’t aware of thinking anything about her before we met, but I became aware that I was speaking to her in a fairly patronising manner, treating her as if she knew nothing. I was suddenly jolted when I realised that she was a very bright and intelligent young lady who knew what she wanted to do but did not know merely because she had not been in that situation before. …… after I realised what I had been thinking I was able to change the way I was communicating with her and we certainly had better rapport and got a lot further in our outcomes.”
2) “This made me much more conscious of the need to explain things more fully, and also to check out with them their understanding because their map of the world will not be the same as mine. My practice has been to do this with patients quite often - however following this exercise I am going to ensure that during my first contact with them I check out their understanding and if necessary to expand, elaborate and clarify as necessary.”
Consistently throughout the evaluation of all the trainings one of the most frequently stated outcomes was around “not making assumptions”.
Shifting our perceptual filters:
“I’m working with a 10 year old girl who has panic attacks when she is on her own. I have now changed my focus from ‘where, when and how often she is having the attacks’ to how, when and where she experiencing good states. I have got her to keep a diary of these.”
1) “During my conversations with patients and carers I have been much more mindful of my use of language. Instead of saying ‘you must do the exercises that the speech and language therapist has given you’, I now say: ‘As you do the exercises given to you by the speech and language therapist you’ll notice improvements in your speech.”
2) “With a 10 year old girl who has panic attacks I have been using phrases like ‘ as those panicky feelings become less frequent and as you feel more confident even more often you will be able to ……..’ as I used these phrases I could see the pride come across her face as she started to believe that these things could actually happen”
Often we are asked about dealing with difficult people or conflicts. This is a brief example about how purposeful use of rapport and language patterns can help to achieve a good outcome for both parties. One student worked with a client who her colleagues had described as ‘very challenging’. This student describes how she created rapport and used soft language patterns to create an ‘agreement frame’:
3) “I asked specific questions to start off with to understand his map, e.g. how do you know that?, what leads you to that conclusion?, and who says so?... I was then able to lead him in agreement based on facts he had said to me by reiterating them with some soft language e.g. ‘as you rightly said…….. so you may want to consider……………… As you become aware of the facts you’ll notice that while x has occurred you can see with confidence that y will happen.’ I didn’t experience any of the behaviours and attitudes my colleagues had warned me about.”
4) “I have been working in a solution focused way for some months now and the use of language is something I have paid a great deal of attention to since the training. E.g. ‘ when your……. Is no longer a problem’. And I have also used the presupposition ‘As you start to use x you’ll notice ……..’ both with clients and my children and I have really noticed a positive difference in them, both in terms of their state and in terms of what they actually do!”.
5) “My client was in a state of high anxiety and was expressing feelings of being bull-dozed by professionals she spoke of being humiliated and bullied. She seemed to me to be in quite an internal anxiety-driven trance-state so I chose to use some soft language patterns. I deliberately avoided reflective listening and restating the powerlessness that she felt in the face of the professionals. Instead I spoke of how the meeting would offer her the opportunity to gather information, contribute opinions and then come away to gather her thoughts and weigh up options. I spoke of how I would be there too and we could share the responsibility of taking in the information. She could choose to take small steps and regulate the pace of change.
As we spoke I noticed her eyes return their focus to me and her sentences became longer and her face more animated. She later spoke of the meeting as an opportunity to contribute and listen.
I believe that the use of soft language has contributed to a lifting of my client’s anxiety”.
Deeper levels of skill in NLP
After the diploma Henrie designed two further days to extend the health professionals NLP skills to encompass two of the most powerful techniques in the NLP tool kit, namely the Trauma cure and also Clare Rushworth’s fast phobia cure (Rushworth 1994) The syllabus of these ‘top-up days’ was as follows.
The ‘chain of states’ model (bridging the gap between unresourceful and resourceful states)
Basic anchoring and
Stacking/collapsing anchors (having access to the kinds of emotional resources you want at the times and in the places that you want them)
Introduction to sub-modalities (the structure of our internal representations)
Contrastive analysis and mapping across (processes for making fast and helpful changes in the way we code different experiences)
The Trauma cure (double dissociation technique for phobias of specific origin or reducing the unpleasant after effects of traumatic events)
Clare Rushworth’s fast phobia cure (for phobias of non-specific origin and difficult situations where extra resources are needed)
The results of this further training are highlighted in a couple of examples taken from their ‘homeplay’. It is also possible to see how their skills are being used together.
State and anchoring
1) “I often deal with the elderly who can feel vulnerable and scared at the many medical procedures that they have to endure. One example springs to mind – An old lady who attends the podiatry clinic regularly was about to have a cataract operation and although she had been re-assured many times she still felt scared and frightened about the procedure. I knew she had a favourite grandson called Sam who she adored. I told her to imagine that he was with her throughout the ordeal. To imagine the things that he would say, the questions he would ask and to feel his hand holding hers. When she felt frightened she could imagine his hand squeezing hers as he would if he had been there. We laughed at this imaginary game and I could see in her face that it was an easy task to do. Next time I saw her she told me the experience had been fine, she had imagined Sam standing next to her and ‘pretended’ that he was asking the cheeky enquiring questions a six year old would ask and enjoyed ‘the game’. The perceived stress disappeared and she was calm throughout the procedure. I am sure the care of the nurses helped to reduce some of the fear but the amusement she had enjoying her ‘imaginary game’ had obviously benefited her through the experience. Was this N.L.P.? Something very like it!”
2) “I created myself an anchor to assist me in self-confidence. I have already put this to the test as I have a looming assignment for a course I am doing. I have had moments of doubting my own capabilities to complete the study. I have fired my anchor during these moments of doubt with definite positive results!”
1) “I used submodalities with someone who decided they wanted to stop smoking. After we had done the process on a particular trigger for her to have a cigarette she didn’t have a cigarette for the rest of the night. Also when I spoke to her a few days later she said she had smoked a lot less than she would previously have done. Next time we are together we could work on some of her other triggers to smoke!”
2)” I had a consultation with a patient who had a long history of benzodiazepine addiction. She had been taking large doses of benzodiazepine about once a week. A medication change she had been requesting for a long time had happened about 2 –weeks before and she had stayed off street drugs for a fortnight.
She came in looking bright-eyed and alert. I felt that there was a possibility that she might relapse so I asked her ‘how do you do your drug?’ After teasing out the trigger, when asked about her submodalities she said ‘it looks black and dark’. (I didn’t take her fully into the Submodalities as I felt this might put her back into her drug taking state.) I asked her about a time in her life when she felt really good about herself, that experience she described as being bright and yellow/orange. I asked her how she would like to feel this way in staying off benzodiazepine? When she said she would, we used the simple repeated installation technique to install the bright representation. After she had done as many repeats as she wanted – her eyes were bright and kept flicking up to where she accessed the new representation. I finished off with some positive presuppositions.
Previously she was a ‘heart-sink’ patient – now I’m looking forward to seeing her again and even if she relapses I feel I have other techniques that will help her.”
3) “I first used this with a young mum who felt isolated . She had begun taking her baby to a crèche and wanted to be able to get more involved in the mum’s group She found introductions and meeting new people difficult. Having checked her outcome and the ecology of making this change I asked her about a time when she felt confident in a similar situation (e.g. meeting a friend for coffee) having found a time, we did contrastive analysis of the submodalities and mapped the positive codes across to her representation of going to the crèche. We then used the installation technique and after chatting with her about other things for a while, I asked here when she was next going to be at the crèche and what she wanted to get involved in. She said she was going to ask about slimming/exercise classes that they ran. She later did this!”
4) “I worked with a counsellor for a rape and sexual abuse agency. She has said in the past that she does get affected by some of the clients she deals with. On this occasion however I could calibrate that something was on her mind.She admitted that she was working with a particularly horrific case and found herself getting emotionally involved and frustrated. We found out that her feelings were stemming from particularly unpleasant images. She described the images as brightly coloured and moving with no sound attached. I suggested she may feel better by altering some of the submodalities. She was happy to turn the picture into black and white and to capture a snap-shot still. I asked her to frame the new picture and to shrink it down to the size of a postage stamp, she achieved this easily. I then suggested that she may wish to stick that stamp on to an envelope and to post it into the outer-space rapid postal shute where it would instantly reach its harmless destination.
She looked immediately more comfortable and was amazed at the effect. She said that she felt more comfortable with the situation and said that she would like to use the technique herself if the situation ever arose again and that she may even use it with a client in future.”
Clare’s fast phobia cure
“Working with a girl who had experienced a bereavement in her close family. The family were planning a holiday but the girl has a phobia of flying which was putting her into more and more of a panic. She has had this fear for several years. Before working with her we spent about 15 minutes chatting and laughing”.
The student then described using Clare Rushworth’s fast phobia cure (a process that involves stacking and collapsing anchors, a visual anchor for the phobic trigger and a kinaesthetic anchor for the powerful resource states).
“The client chooses a bunch of plastic flowers as her visual anchor for the trigger., I can see her facial expression change as she accesses her state very briefly. We then took awhile to select some positive states. Eventually we anchor ‘feeling relaxed’, ‘making plans’, ‘laughing’, ‘feeling togetherness’ (like in a car), and being a ‘coper’.
When the client’s non-verbals were telling me that the negative anchor was collapsing I asked her about her experience. She said 90% positive feelings were coming through. We went on holding the anchor a little longer presupposing that that percentage could go up, she reported that it was at 99% and finally 100%.”
After the process,… “when we fired the visual anchor” that had previously been connected to a state of “tension, nausea with looking down and with an anxious look on her face”. Now the girl stayed “calm and relaxed and described ‘not feeling tense anymore’”
The student goes on to say…
“2 days later I had the opportunity to follow up with another member of her family. They mentioned that they had been talking about the holiday and that my client didn’t show any trace of anxiety or upset whereas prior to her session she had created a big scene whenever it came up. I’ll look forward to hearing about the holiday.”
VK Double dissociation Trauma cure
I worked with a young adult female patient who’s father had died suddenly.
In the A+E department. She was one of the first family members to arrive. Her memories of her father were dominated by the picture she had of him when she saw him in A+E after attempted resuscitation. She was experiencing anxiety, depression and feeling unable to enjoy her young family and cope with work as well. We used the trauma technique, she looked more comfortable immediatelyafterwards. When I saw her on a subsequent occasion and she was able to remember the event without the associated strongly upsetting feelings.
Rushworth C. 1994 Making a difference in cancer care: practical techniques in palliative and curative treatment. Souvenir Press London.