NLP Diploma training for health professionals (Living with Cancer Project)

 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.
Day 1
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)
Day 2
Directing attention and building sensory acuity
Calibration of individuals to aid communication
Rapport (including matching/mirroring/pacing and leading)
Day 3
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
NLP presuppositions
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
Day 4
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
Sensory Acuity
“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.”
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.”
Group Rapport
‘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.’
Breaking Rapport
‘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. 
Mind/Body Connection 
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.”

Brain Gym
‘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.’
Communication model:
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.”  
Soft Language:
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.
Day 5
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)
Day 6
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.

NLP support group for cancer patients and carers

 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.
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:
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.
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.
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.”

A case for using NLP in the NHS

 The Need for NLP in the NHS
By Henrie Lidiard  
(First published in NLP News: March 2005)

My own experience 
When my mother was in hospital and during her subsequent stay in a hospice, it seemed clear to me, both from her experience of care and from my direct experience of medical staff, that there were some areas that could really be helped by some awareness of NLP techniques.   When I asked staff directly at both the hospital and the hospice about areas they felt they would like some help in, three themes came up consistently.  They were:
1. dealing with high stress levels
2. ways of dealing with anxiety in patients and
3. ways to deal effectively with depression in patients. 
The only options that the nurses I spoke to said they had, were medication (and many patients in cancer wards are already taking a lot of drugs) or a sympathetic listening ear. They found that the latter didn’t always help patients and they didn’t always feel they had the energy to give it because of the toll on their own emotions. 

More and more change
The NHS in Britain is undergoing huge changes, not solely because of re-organisation of the way the Health Service is managed but also because of changes in the society we are part of.  
For instance: patients are in some ways better informed than they used to be (as a result of using the internet to research their condition). They may also, for similar reasons, have higher expectations than in the past. Patients also don’t seem to have such respect and deference for Health practitioners as they once did (RCGP 2002). In addition users of the health service seem to be becoming more litigious when things go wrong and cases are given a high profile in the media.
There are worrying life-style trends particularly amongst young people in Britain (for example binge drinking, poor diet, lack of exercise and smoking) which mean that problems such as obesity (and the attendant effects on heart disease, cancer and diabetes) are likely to put more strain on resources. Increasingly, as part of preventative medicine, doctors and nurses may be seeking to influence peoples’ decisions about the way they take care of themselves.
Stress and depression seem to have risen in the general population and prescribing for depression has risen to record levels. These factors combined with the aging population trend in Britain and difficulties in recruiting and retaining highly qualified staff suggest that there is likely to be more change ahead as we find ways to cope.

Stress in the health-care professions and its effects on staff and patients:
Stress seems to be an important issue for Health professionals. It isn’t only rising in the general population but it seems that it is increasing within the profession also. Some statistics suggest that 50% of GPs and a similar proportion of NHS managers and consultants are suffering borderline or more severe anxiety and a quarter of GPs have borderline or more severe depression (RCGP 2002). (I don’t have statistics for the mental health services but anecdotally the situation sounds similar). In addition, as a coping strategy 23% of GP’s drink to relieve stress and 7% are addicted to alcohol or other chemicals. (RCGP report 22). A BMA report 1998 found that ‘many senior doctors suffer high levels of stress and this impairs their health and also compromises their ability to provide high quality care to patients’.
Burn-out of medical staff is a recognised problem and can cause the following effects:

In one study of 16 Bone marrow transplant units half of all Doctors and nurses were sowing marked symptoms of burn-out (Molassiotis 1995).

There are potentially high costs associated with these levels of stress. These may include not only the suffering of the individuals involved but the costs of sickness absence, premature retirement, health-care and rehabilitation, even premature death. In addition as stress impairs performance a lowered standard of patient care can mean complaints, bad publicity, litigation and compensation (BMA 1998). It seems that there is a pressing need for medical staff to have access to effective strategies for managing their own emotional states and looking after their well-being. It is possible that if they had access to these, they might also be able to pass these on to their patients.
Some areas of the health service seem to work together more effectively than others. This is critical as research also points to an unequivocal connection between the impact of dysfunctional teams and patient mortality (Aiken et al 1994, West 2002). It is still all too common for breakdowns in communication to occur between different parts of the system e.g. between consultants and referring doctors (Tattersall and Ellis 1998 and Bain and Campbell 2000)
The needs of professionals in the cancer field:
This is captured in an excellent review by Sargent et al (2004). In summary, it seems critical that health professionals in the field of cancer care have access to ways of managing their own emotional wellbeing. The research also highlighted a need for  communication, inter-personal and
Psycho-social support skills in providing quality, patient-focused care. It also found, that despite official policy, health professionals were not yet receiving adequate communication and interpersonal skills training.

The needs of cancer patients/carers:
Patients value many things in their care, in addition to technical competence one study (Farrell 2001) found that they value:
These qualities and behaviours would all be harder to deliver if the medical staff were stressed, anxious, depressed or burnt-out. In fact descriptions of being treated like a symptom or a disease (a thing?) were all too common in the Patients’ and Carers focus group held in Ellesmere Port as part of the Living with Cancer research project (Sargent et al 2004).
It is interesting that where patients expressed views on how their care could be improved they do seem to mirror the symptoms of professional burnout.

The "Interior" beckons:
In short there are several areas where there seems to be an increasing need for skills in the health service, they include:
All of these needs reflect the "interior subjective" or the "interior collective" aspects of the system (Wilber 1988, 2001). This intangible aspect of our interior experience is the very one science has for a long time pretended doesn’t really exist because it is hard to measure. It is also the aspect of health-care that medical practitioners currently feel ill-equipped to deal with (Department of Health 2000).

NLP can help:
NLP can be of profound and practical help in this area as it provides not only a logical and consistent understanding of the structure of subjective experience but also a systematic and effective way of working with it to make positive changes. 

Aiken L.H. Smith, H.L., Lake E.T., 1994 Lower medicare mortality among a set of hospitals known for good nursing care. Medical Care 1994. Vol. 32: (8) p 771 – 787.
Bain N.S. .Campbell N. 2000. Treating patients with colo-rectal cancer in rural and urban areas: a qualitative study of the patients perspective.   Family Practice Vol. 17: (6) p475 – 479.
British Medical Association report 1998 by BMA Health Policy and Economic Research Unit. Work related stress among senior doctors: Review.
Department of Health 2000. The NHS Cancer Plan. A plan for investment. A plan for reform. Department of Health London.
Farrell C. 2001. There is no system to the whole procedure: Listening to patients views and experiences of NHS cancer services in NHS Cancer services. Supporting paper: 1 NHS cancer-care in England and Wales. London: Commission of Health Improvement.
Molassiotis A. ,Vander-Akker O.B., Boughton B.J. 1995. Psychological stress in nursing and medical staff on bone marrow transplant units. Erratum in Bone Marrow Transplant Vol. 15: (3) 328 .
Royal College of General Practice. 2002 Information sheet No. 22. Stress and General Practice. 
Sargent, P., Thurston M. ans Kirby, K. 2004   An evaluation of the Living With Cancer Project. Using NLP techniques to maximise the coping strategies of carers and patients living with cancer in Ellesmere Port. ISBN: 1-902275-34-9.
Tattershall M. and Ellis P. 1998 Communication is a vital part of are. Britishe Medical Journal Vol. 316: p1890 – 1893.
West M. 2002 A matter of life and death. Article in People Management magazine February 2002 p 30 – 36.
Wilber K. 1988 The marriage of sense and soul. Integrating science and religion. New leaf. Dublin.
Wilber K. 2001 Eye to Eye: the quest for a new paradigm. Shambala Publications Inc. Massachusetts.

An evaluation of the ‘Living with Cancer’ Project - Dr Miranda Thurston


Some reflections on research

By Dr Miranda Thurston, Centre for Public Health Research, University College of Chester
A lot of research over the last 10 years or more has indicated that cancer patients and their carers do not always experience high quality care. A recurring theme of much of this research has been that health professionals frequently have poor communication skills, which significantly undermine the quality of interactions between patients’ and clinicians and often leave patients and carers feeling uncared for and ignorant about their illness. At a time when both patients and their carers need empathetic support, it appears that they are often least likely to experience it. This has led to an increasing focus on the quality of cancer care in general, and a specific focus on improving the quality of interaction between patients, carers and clinicians through the enhancement of health professionals communication skills.
The Centre for Public Health Research was commissioned to evaluate the ‘Living with Cancer’ Project. It was clear at an early stage that the use of neuro-linguistic programming in cancer care was unusual. A thorough review of the literature revealed that NLP had rarely been used to support patients or carers in dealing with their circumstances, or to try to improve health professionals’ communication skills. What the literature review did reveal to me was that NLP was quite a different approach to the whole subject of ‘communication skills’, which seemed to often be viewed in terms of a set of technical exercises, somewhat divorced from the empathetic dimension of human inter-relationships. NLP seemed to offer considerable potential for health professionals to improve their capacity and capability to care for their patients through developing the affective side of communication and through this, be more responsive to patients’ and clients’ needs and desires, rather than making assumptions about what these were and risk behaving inappropriately.
At an early stage in the research project, considerable attention was given to deciding on an appropriate methodology. It was important for the study to be robust, so that the findings would have a better chance of being taken seriously. However, it became clear that the most appropriate methodology would be a qualitative approach, using focus groups and interviews. This would allow patients, carers and health professionals to talk at length, and in some detail, about their views of NLP. Qualitative research aims to explore matters in depth, and tries to understand things from the point of view of the interviewee: patient, carer, or health professional. Because of this, the findings tend to be based on relatively small samples and can not be quantified. This can mean that people view the findings as ‘anecdotal’ or ‘unrepresentative’ rather than as giving insight into the views of particular client groups.
In terms of health professionals, it was evident that many thought that NLP build on their existing knowledge of communication. However, it was apparent that some professionals were challenged by an alternative and different approach to communication (4 out of 55 according to post training evaluation records Lidiard Pers. Comm..) . Reflecting on this, it may be that many health professionals are too wedded to the biomedical model of practice, a model that does not tend to value the affective aspects of communication and values ‘treating’ above ‘caring’. This is unfortunate, because patients and carers who had attended the NLP classes were unanimously positive about their experiences and described the ways in which they had been helped to develop coping strategies in extremely moving terms. It struck me afterwards that it might be valuable for such patients to talk to clinicians about NLP.
Click here to read the full Research Report on the Living With Cancer Project