understanding and working with addictions
|
1. UNDERSTANDING ADDICTION - deconstructing
dependency: what it is, how it happens, and how to
understand it if you believe you've never suffered
yourself. |
|
1. THERAPIST OUTCOMES - including how not to get
addicted to helping. |
|
1. PERSON - how much of the client is involved,
and where? |
|
The material has been compiled from a variety of sources, including my own experience and imagination. A number of people are acknowledged at the end. Others are credited in the text and the notes. All client notes are part-fictionalised to preserve confidentiality. |
INTRODUCTION
I used to
feel insecure about working with addiction. Too much had been
written about it (2). There were too many kinds. I knew
something (though not enough) of my own addictive patterns, and
something (often too much) of those of my family, friends, colleagues
and clients, yet little to link them had emerged. I was in a
tangle - exactly the sort of metaphor that my addictive clients came
up with to describe themselves. (Figure 1)
The last couple of years of research has helped me exorcise my
addictive ghosts. This 3-part paper is not about particular
addictions, but about deconstructing the addictive process. By
'deconstructing' I don't mean literary analysis of the meaning of
words (though that will be touched on in Part II), but separating out
mental confusion. My Uncle Albert had a reputation for fixing
things - steam irons, vacuum cleaners, that kind of thing. He
confided in me that it was no great skill. He simply took
things apart and remembered where the screws went. This paper
is more or less about that.
Part I
(John Firman, 'The Primal Wound')
Let me come clean. I'll be offering some opinion and speculation here and there, and it's only fair that you know where it comes from. My personal therapy was psychodynamic (Jungian). Early training was analytical and humanistic, followed by neuro-linguistic (NLP). Influenced by my wife's transpersonal model. I've specialised in metaphor therapy over the last 5 years or so, and David Grove's model of clean language symbolises my beliefs and values about psychotherapy and the politics of change (3).
1. UNDERSTANDING ADDICTION
First I had to accept that addiction is not just about a substance or an activity, but about society. We learn addiction. Any one of our everyday addictions - to drugs, sex, gambling etc - is to me a metaphor for our primary addiction to the structures of authority and conformity in our lives which curb self-determination and foster dependency.
Keeping these patterns in place is what addiction counsellor Tina Stacey calls 'a network of supplementary dependencies'. People-pleasing, for example. Our need for approval. It's easy to get approval: follow precedent. I was brought up to be sexist, racist, homophobic and hierarchic, in a society which trained me as a technician to oil its wheels and help it run smoothly. To fit in, I acquiesced (4)
'Addiction'/'therapy'/'client'
That is the political context of this paper. When I use the word 'addiction', I shall be alluding not only to the usual suspects under the opening title, but also to our systemic dependency on external authority which keeps our authentic selves under lock and key.
And when I use the word 'therapy' I intend to discriminate between traditional psychotherapy, the effect of which has been to control the codependent relationship with the client through the use of interpretation, suggestion and the illusion of omnipotence (thereby reinforcing systemic dependency) (5), and postmodern psychotherapy, which aims to enable self-generated change and is an instrument for the transformation of society (6).
And when I use the word 'client' I mean me. You. Any of us who want to free ourselves and create another reality.
- "I ought to have done so much more. And what about those
who didn't even do that? Those who called out the name of
the president with erotic passion, who slobbered over his
photographs as if they were icons, who were obedient and tame
victims, but also brutal hangmen? Right now we need
self-knowledge and Serbian denazification. Otherwise we're
doomed forever." (Biljana Srbljanovic, Serb playwright,
May 99)
Victim-Persecutor
The victim-persecutor codependency is a prime example of systemic addiction. Each part needs the other for it to persist. Milosevic plays persecutor to loyal Serbs who become victims, who in turn become persecutors to dissident Albanians who become victims ... (Figure 2)
Rescuer
And so on until a rescuers appears. What happens now? The codependency extends. Nato plays rescuer to victim-Albanians, and in so doing becomes persecutor to persecutor-Serbs, who become victims in turn ... Are we doomed forever? (Figure 3)
- "Addiction is the fibre of our society. It produces the
victim-persecutor-rescuer cycle in which victims are addicted to
having persecutors to blame, and persecutors are addicted to
blaming victims. Victims seek willing rescuers, and each
becomes addicted to the other. Persecutors now have rescuers
to blame, and rescuers become victims in turn. Between
us we produce a vicious circle of codependency that justifies
nothing but itself." (psychotherapist Laurena
Chamlee-Cole)
Indeed, rescuers blame persecutors while telling victims they need help, which turns persecutors into victims and keeps victims as they are ... and so it goes on. It's not only Serbs who need self-knowledge. A Balkan dictator may have been a convenient reflector for our worst projections of ourselves, but we cannot displace our own responsibility for the democratic system which extends these tragic triangles of codependency (7).
Institutionalising
Psychotherapy is not immune from the addictive disease. Just as spirituality became systemised into religion, the practice of psychotherapy became systemised into institutions and procedures perpetuating what Anne Wilson Schaef (a 'recovering psychotherapist') calls 'the illusion of control and the myth of objectivity'.
The odd thing is that in this era of the search for a postmodern unity of science and healing, we are seeking to extend and legitimise these archaic structures of control. I can only see this serving to codify the imbalance of power in the codependent relationship that exists between most therapists and their clients. Institutionalising the human potential movement is an oxymoron - a contradiction in terms which (literally) points to its own foolishness. In the context of our addictive society, however, I suppose it will be well-supported.
You may say that cycles of dependency like this are none of our fault, that we're only playing the hand with the cards we were dealt. Well, one way into recovery is to stop playing the game, or at least change the rules.
Denominalizing
To get out from under my own addictions, I needed to denominalize the word (8). 'Addiction' is an academic subject. Addictive behaviour is something we do.
If addicting is a behaviour, then it involves choice. Addiction is not something we catch unwittingly, like flu. And as choice is centred in the individual, addicting has to be different for everyone. Every human being is unique in what they do and feel, its prompts, effects and underlying patterns. Addiction doesn't in itself define addictive individuals.
Abusing
It also helped me to correlate addiction with abuse. Addictive behaviour is abusive behaviour. Abuse may not be the aim, but therein lies addiction's 'double dysfunction'. The act does not serve the intent. The intent is to relieve pain, but the effect is to generate pain. This corrupts not only the lives of the sufferers, but also the lives of those who suffer with them. At its mildest it may only mean the addict is a bugger to live with on occasion. At its worst addicting may gather despair and degradation around it and end in death.
Unexceptional
Finally in my attempts to deconstruct addiction I realised that those of my clients who were addictive had other problems too. A compulsive gambler had a low anger threshold. A chocolate addict suffered from dyslexia. A lifetime smoker defined himself as a rebel against conformity. If once I had perceived addictive clients as esoteric, I now saw them as unexceptional.
The fact of their addicting gave them something in common, but there was more that made each unique. And just as I have learnt there is no one way of working with those other grand nominalizations 'schizophrenia` and 'depression`, I now know there is no one way of working with 'addiction'. There is, I believe, an underlying structure to the addictive process, but approaches to treatment and recovery emerge naturally from considering the needs and patterns of individual clients.
The quest
Are we addicts seeking God? Or are we all on a search for serenity? Someone told me that addiction is an attempt to compensate for inadequate breast-feeding. Someone else told me it aims to reinstate abundant breast-feeding (9). Others believe that 'addictive personalities' are on a predestined path to a predetermined end, and nothing will stop them (10).
The primal wound
Most of the research I have come across agrees that whatever other factors may be involved, most addiction is associated with early trauma, so I subscribe to the transpersonal view which says that addiction is aimed at resolving or distracting unresolved need.
Crucial to my personal understanding of addiction was my experience of annihilation. As a child I`d been left by my mother and felt the terror of 'non-existence' which transpersonal therapists identify as the state underlying all addiction. Fear of non-being is not a fear of death. Alcoholics and drug addicts prove time and again that pain or life-threatening illness is not enough to deter them. What drives them is something darker than death - an intimation of the extinction of self while alive. Overwhelming feelings, consciously recognised or unconsciously stored, of abandonment, powerlessness, hopelessness, worthlessness, insignificance.
In this scenario, addicting is a desperate response to the spectre of isolation and alienation that haunts the human condition. It begins simply as a means of seeking compensatory positive experience. The effects manifest in psychopathological patterns unique to every individual, but we can generalize: early abandonment may prompt a search for a better sense of belonging through relationship; powerlessness to the pursuit of power through alcohol or the control of others; worthlessness to a quest for self-acceptance through compulsive sex, and so on.
Addictive behaviour, like abusive behaviour, becomes a balm for the primal wound caused by the neglect or abuse, intentional or otherwise, of those with dominion over us.
An exercise in understanding
You'll be relieved to know that you don`t need to experience annihilation directly to understand addiction. We all possess the prerequisites for understanding: unwanted behaviours. Which may turn into habits. Which can in turn become addictive.
Schaef says, "A relationship addict can become just as insane as an alcoholic. It's the same disease." Arguably 'healthier', but Schaef is making a systemic point. Dictators with an addiction to power can wipe out whole populations, and that isn't very healthy for anyone.
Think of a personal experience of attachment or compulsion. A time when you were in thrall to some attitude or activity that you found difficult to control, even if it was against your will or better judgement.
-
Recall your excessive dependency on Mars bars, Marlboro or the
Lottery. Your continuing deference to parents, teachers,
bosses, gurus. That habit of scratching yourself. The
cherished fantasy about your partner's best friend. Your
lifetime collection of licence plate numbers. Or the lone
little ritual in your everyday life that you've never liked owning
up to - a need to count the spoons while watching the Nine O'Clock
News, say.
Go on. No-one will know you're doing this. Confront yourself.
You may have some intuition about what this idiosyncrasy relates to in your early life. Perhaps you grew up in a dysfunctional family, or went to a school where you were taught to distance yourself from others instead of relating authentically. If you joined the so-called helping professions as a result of an early experience of coercion or isolation you'll probably know a great deal about the roots of your particular dependency. But for now it's not important to know how it came about.
Just remember the negative feelings you experienced around your behaviour. Intimations of shame, perhaps, or anxiety, guilt, vulnerability, even invisibility.
Sense how any of these feelings taken to extreme might have led you (perhaps they did) to the pit of despair.
And deeper yet could have led to your self-destruction.
A fun exercise, eh? Well, hardly. But now you may have a glimmer of understanding of the death of self and extinction of choice that characterise the later stages of addiction.
And here's a suggestion: having acknowledged your own addictions, read the first section of this paper again. If you think you're free of addictions, haul yourself through this exercise in understanding again. And if after all that you still believe you're clean, do human evolution a favour: offer yourself for cloning and let your genes multiply.
2. A MODEL OF ADDICTION
Some addictions feel physical, but all addictions are mental.
My evidence for this model stems from the discoveries of neuroscience, particularly neural Darwinism, into the evolutionary structure of the brain. Recent findings in neurobiology and evolutionary psychology seem to me to be entirely compatible with the experiential constructivist foundations of NLP. Particular credit goes to neuroscientist Gerald Edelman for linking the realms of neurology and psychology in a way that Freud could only dream of (11).
As we go through this mental model, there are three things to bear in mind:
1. We will probably never know everything about the way the mind works. Although I believe that all our mental awarenesses (thoughts, feelings, memories etc) are the evolutionary outcome of physical (neurophysiological) processes in the brain, I don't believe they are open to deconstruction in the sense that 3 may be reduced to 1 + 1 + 1. The brain is capable of more combinations of connection than there are particles in the universe (many millions more when I last counted (12)), and in this context 1 + 1 is easily transformed into the conceptual equivalent of 3, or 99, or 1,000, as the flavour of a stew is always more than the sum of its ingredients. Thoughts, feelings, consciousness, sense of self etc are complex emergent properties of our extraordinary neural capacities. Precisely how that happens we may never fully know. However the fact that our minds already know so much about our minds is nothing short of miraculous, so who knows what we may yet come to know?
2. The model is necessarily crude, and you should be wary of defining anything in terms of it. There are obvious, subtle, delicate and complex differences between any model of human experience and the real thing.
3. When I refer to the brain, I don't know (and nor does anyone else as far as I can ascertain) whether the brain knows it all, or whether the body knows things that the brain doesn't. We can characterise the brain as diversity. There are billions of ego-intellects in the world and each one is different. The heart represents unity. It allows us heartfelt connection with every other being. The brain needs the heart and all the other organs of the body for full information. We don't use our brains disembodied (yet). So you could call this system the bodybrain or the mindheart, but here I call it the brain and credit it with somewhat more than mind-only awareness (13).
You may find this brain operation easy to follow, in which case stay with the text. If you want to make your life easier still, just take in the drawings and skip to the Summary.
Stage 1 Once upon a time
There was an external event. It didn't have to be sudden or obviously traumatic, like losing a parent or near-drowning. It may have been a pattern of sub-traumatic disturbance extending over years - low-level violence, constant carping, the exercise of arbitrary power, etc. The brain itself didn't 'see', 'hear' or 'feel' this event. It experienced an onslaught of stimuli from the senses and constructed a symbolic representation of the event in the physical space of the brain. And because every brain is different, with a uniquely evolved configuration of neuronal groupings and their synaptic and chemical connections, this particular brain made a subjective interpretation of the stimuli, prompting:
A bad feeling. An idiosyncratic series of neural connections resulting in an uncomfortable or unpleasant internal sensation experienced in the gut, heart, head etc. It may have been interpreted as anything from mild anxiety to utter hopelessness. An emotion. Arguably the most complex of all mental states, commingled as it is with every other mental process (attention, memory, consciousness, etc), and having historical, cultural and biographical connections.
It's possible to deconstruct this 'bad feeling' (or
negative-impact emotion) further:
* an idiosyncratic neural interaction arising from the individual's emotional history which gives a weighting or 'value' to the event.
The feeling is likely to be worse if the judgement includes a belief that the event was unjust, or that there was negative intentionality behind it.
The combination:
was experienced by the individual as a single event, and left:
A wound. Not a faithful reflection of the event, but
a subjectively constructed memory circuit, affirmed or repressed at
the time by other parts of the brain. Nerve cell signals may be
excitatory or inhibitory, and it is their complex interactivity -
there can be up to 100,000 individual synaptic connections per cell -
which determines what kind of signal is ultimately received by other
cells. So delicate may this balance be that it sometimes seems
almost arbitrary about whether the wound remains raw or is
partly-healed, whether it is obvious or not at any given time,
whether it may flare easily or be deeply protected.
Stage 2 Another time
There is a new event in the brain. A new thought or feeling, a remembered thought or feeling, or a response to another event. Some research suggests that this event is more likely to occur in adolescence, when there is radical disturbance generally. The event produces a new neural sequence, which triggers:
A bad feeling. Similar to the original one. Reminding the brain consciously or not of the original, and evoking:
A memory of the wound. A re-construction of the original memory, identified consciously or not. So far, so normal. But around this time another significant event occurs:
Doing X - smoking, drinking, sex etc - which has associations with positive benefit: assertion-of-self-against-authority, socialising-with-peers, reward-for-bad-experience, novel-pleasure, and so on. Many alcoholics remember their first drinking experience from this time in great detail. Many addictive gamblers experience a significant win at an early stage of their lives.
- For example, nicotine, heroin or cocaine entering the
bloodstream trigger the release of dopamine, a neuro-transmitter
associated with feelings of pleasure. Chocolate gives
fast-injection energy from sugar and caffeine; and mood
enhancement from phenyl-ethylamine and theo-bromine - a similarly
satisfying mindbody effect. Caffeine stimulates the heart by
suppressing the effects of adenosine, one of the brain's naturally
inhibitory chemicals, and this produces a perking effect.
The effect of doing X is to:
Feel better. Establishing another neural circuit, which has synaptic connections to the concurrent 'doing X' circuit (a circuit active at the same time), which itself has synaptic connections to the contemporaneous 'bad feeling' circuit (active in the same period of time), which in turn has synaptic connections to the primary 'bad feeling' circuit (the original).
Thus a neural pattern of association is formed.
Addiction is not necessarily a one-time learning, but a learning
over time.
Stage 3 The next time
There is a similar event in the brain, which triggers a similar:
Bad feeling. Now something new happens. The ready-formed neural pattern of association, consisting of the old bad feeling circuit, the doing X circuit and the feel-better circuit, is triggered at the same time. And so strong is this association that the brain finds it very difficult to separate out the constituent parts of the activity in order to know what's really happening. The result is an exceptionally intense, self-generated, hallucinatory experience interpreted by the brain as a 'craving', or:
Desire for X, in order to feel better. Followed by:
Doing X. Which results in a:
Good feeling. Which evolves into a higher-order feeling of apparent:
Satisfaction. The feeling that comes from having done something to solve a problem. In this case the problem was wanting to lose the bad feeling. The satisfaction, however, is actually self-deception. It's based on the perception that X actually solved the underlying problem, whereas the reality is that X was merely associated with relieving an immediate problem. This self-deception will have to be unpicked before recovery can start. At this stage it gives the illusion of:
Fulfilment.
The desire or craving of Stage 3 is a change in chemistry
experienced by the brain (given that the brain has already
registered Stages 1 and 2) as a need. To the addict it
may seem like a simple physical equation.
In fact what has happened is that the brain has coded the seeming 'satisfaction' of the apparent 'craving' and set up a complex pattern of association which has become a virtual 'memory' of:
Stage 2: 'I remember doing X and feeling better' and
Stage 3: 'I remember feeling the desire, doing X, feeling better and
getting satisfaction'.
This virtual memory is experienced by the brain as if it were
real, and is signalled to the body as a physical craving.
Philosopher of consciousness John Searle calls such events 'the
remembered present'. An immediacy which may be triggered by any
number of external physical events or internal mental events.
Stage 4 Subsequently
A brain event triggers:
Bad feeling, which fires:
'Need more X'. Doing X then becomes an activity with virtually automatic connections to the feeling of 'need'. The addict does X, not because it 'works' as it did in Stage 2, or because it became a habit, as it did in Stage 3, but because of a belief, given the virtual memory control loop, that it ought to work as it did in Stages 2 and 3, when it was a successful strategy. At this time the client may be building their life around X and nurturing it with other activities. There might even be no recognisable reward from X as there was in Stages 2 and 3. Choice is absent, and:
X is taking over.
In each case the pattern of mindbody activity has been encoded in the brain in a way that each similar subsequent experience only serves to reinforce, and a memory trace which once related solely to the desire for present positive experience as a reward for past negative experience has developed into an apparent 'craving' for X. Each revival of the memory (actually a reconstruction, never the exact original) will be triggered by cues in the present, which may be anything associated with X in the past.
Thus real sensations turn into virtual obsessions.
The desire for X is a mental cue triggering --> a physical
response which has --> a mental effect.
This loop generates an unconscious habit essentially no different to that of a concert pianist playing a complex arpeggio or an artillery gunner performing an intricate firing drill prompted by the word of command.
- When the clock strikes four I feel the need for a cup of tea
and a custard cream. Seeing someone take out a cigarette may
prompt another smoker to do the same. Entering a cinema may
trigger a sequence of events in the brain which may be experienced
as a desire for popcorn. The body experiences the sequence
as a craving. And what may have once been a feeling of
isolation or sensory deprivation becomes re-interpreted as a need
to smoke or drink, have sex, eat chocolate.
Internal or environmental triggers don't have to be obvious.
They're certainly not always simple. A withdrawal symptom from
addiction can itself become the bad feeling of Stages 2, 3 or 4,
triggering a craving and setting off a complex recursive sequence
that will be difficult to unpick.
Stage 5 Eventually
The circuits interconnect almost simultaneously:
Brain event --> Bad feeling --> 'Can't do without X'. Now:
X is in possession.
It may be very difficult indeed to separate out this structural sequence. The client's experience, after all, is of one event. And it will be very tempting for the client to assume that somehow X is controlling them, rather than that the simultaneity of events is being experienced by them as a lack of control. "It is at this stage", says addiction specialist Alistair Rhind, "that the spirit begins to diminish."
Thereafter illusion itself runs the loop.
Stage 6 Finally
There may be no respite from:
Emotional overload, leading to mental, spiritual and eventually physical:
Breakdown. The mind gives up trying to make sense. Rage and paranoia may overwhelm the personality, and suicide or overdose may result. It is a desperate irony that the addictive process which enabled the personality to survive its early experience of 'non-being' ends in the parting of body and soul which the addiction was originally designed to prevent.
Applying the model
As a therapist you could use this structural continuum in various ways.
1. To affirm for yourself and the client that addictive states of mind don't just come from nowhere, but are something we construct from our subjective experience.
2. To track where your client is in their present relationship to X.
3. To track back with them to likely points for intervention. There are specific examples of symbolic-constructivist (Grovian) interventions in Part II of this paper under Client Outcomes (Eleanor and Simon). And an experiential-constructivist (NLP) intervention in Part III under Pattern (Jane), where the client's goal was to deconstruct an unwanted neural sequence and construct a more useful one.
4. Therapists working in metaphor process might like to map across from the client's symbolic model on occasion. Sometimes while facilitating a client's metaphoric journey I feel as if I'm tracking a spaceship from a parallel universe, and it's nice to get a sense now and again of where everything is in relation to earth.
5. You could also use the model as a frame of reference for your outcome and the client's. We'll talk more about outcomes in Part II.
Summary
Physical, or neurophysiological, phenomena (the collection, connection and interaction of neurons, synapses, receptors and neurotransmitters in the brain) give rise to mental phenomena (thoughts, feelings, beliefs, consciousness, sense of identity, spirituality and the like). Mental phenomena are simply higher-level emergent features of the brain in the same way that heat is an emergent property of the motion of air molecules experienced by the senses and informed by subjective experience.
Conclusion
We can conclude that although some addictions have a physiological component and may be perceived as physical, all addictions are in fact mental. Therefore the process of taking control of addiction is primarily a mental one.
Although each stage of this continuum of addiction is at a higher level of mental complexity than the one before, and may be perceived by therapist and client as further removed from reality, each stage can be accessed neuro-linguistically. Ways you might do that are many and varied. There are hints about starting in Parts II and III.
Post-script: thinking
I don't mean to dismiss the notion of 'physical' addiction, only to widen its definition and question an addictive belief system which states that addiction is a physical process which can only be treated by physical, ie medical, means (14).
- "I am a thinking being, therefore I am a physical
being." (John Searle, revising RenÈ Descartes)
Descartes, of course, said, "Cogito, ergo sum." I think, therefore I am. Given two hundred years of research into human consciousness since Descartes, I'd like to suggest a small variation: 'Sum, ergo cogito'. I am, therefore I think. I am a physical being, therefore I am a thinking being. It is the physical fact of the evolution of the human brain which has produced our higher-order consciousness and our ability to think. And our ability to process a thought such as 'physical addiction is actually a mental construction' may help evolve our addictive thinking beyond what were once assumed to be physical limits.
Re-thinking
Before starting treatment I can think of no more important thing to think about in addiction than deconstructing addictive thinking.
Deconstructing supposes the possibility of reconstructing.
The brain is a living, changing, continually adapting entity. Brain cells make and remake their connections constantly, we are told (I have only to think about that to be convinced). They can alter the strength of their connections over the short term and the long term, and they can retain and continue new connections. Given that billions of neurons are doing this continously, and doing it on many levels, it is not fanciful to suggest that the landscape of the mind may be accessed and reconfigured in almost any way we will. We can adapt and change through thought.
Thought, according to Searle, is dependent on an individual's symbolic abilities, language, logic and inner dialogue. Any psychotherapy I can think of makes use of these capacities of the human mind. Obviously not all psychotherapies work through thought alone. And clearly not always through conscious thought.
The client in metaphor therapy utilizes symbol, language, logic and inner dialogue at many levels. The exquisite and particular logic of the Grovian therapist's clean language prompts an inner dialogue with the client's unconscious mental processes. This allows the client access to self-generated symbolic representations of neural patterns of association at the interface between the conscious and unconscious mind.
In Grovian process information 'pops up' into consciousness. The client is often surprised, but rarely rejects the information, because at some level it is recognised. Literally, through re-cognition, or knowing again. David Grove calls this new-old information 'tacit knowledge', or 'knowledge you don't know you know until you know it'.
As re-cognition feeds back into the client's system and re-associates, a process of multi-level re-thinking takes place when new neural patterns of association are formed. It is in these neural patterns of association where the neurochemical change necessary for therapeutic change takes place.
You'll find more about change in relation to addiction in Part II.
P.S. You should particularly read Part II if you're a therapist and want to help people. That's potentially addictive behaviour.
© 1999 Philip Harland
References - See Part 3
Notes
(1) Adapted from a client quotation in an article by Gillian
Riley, The Therapist Autumn 1997.
(2) Key in the word 'addiction'to Whitakers Book Bank CD-ROM and it comes up with 1,800 titles.
(3) Grovian metaphor therapy, originated by David Grove and further developed by Penny Tompkins and James Lawley. The therapist works at a symbolic level with clean language questioning to help the client (a) define (b) develop and (c) transform their problem state without interpretation or suggestion from the therapist. For articles about how it works see back numbers of Rapport or The Developing Company's website at http://www.cleanlanguage.co.uk/. See also Tompkins and Lawley's forthcoming book on Symbolic Modelling, which will surely become required reading for every therapist.
(4) For more about the addictive society read Anne Wilson Schaef (References above).
(5) Interpretive therapy: who are we to say that clients need more 'self-esteem', or 'balance', or 'unblocking', or have unresolved issues with their parents and pets? Therapists with an unresolved need to feel wise or wanted, that's who.
(6) My definition of postmodern : an open paradigm untrammelled by current established (antiquated) scientific, psychological and socio-economic beliefs and methods.
(7) Victim-Rescuer: even to believe there is some kind of intentionality to life - a force holding and directing us as evolution unfolds - seems to me to keep us in victim mode, albeit at a higher level where there are spirits, gods and mystic philosophers like Ken Wilber to rescue us.
(8) More on denominalizing in Richard Bandler and John Grinder, The Structure of Magic Volume I. Unrelieved use of conceptual nouns or nominalizations ('addiction', 'fear', 'depression') may indicate a stuck state in client or therapist. Opening up such a noun into a verb or activity can help mobilise stuckness. How do you do 'addiction', 'psychotherapy' etc?
(9) Breast feeding: the theory goes that if as babies we learn the world is bountiful, as adults we can wait for gratification. The alternative theory, of course, is that we can't wait.
(10) 'Addictive personality'. Some geneticists believe there is a gene which may predispose some people to addiction. As our 70,000 + genes all interact, it can't be said that any one gene causes anything. If there is a predisposition gene it wouldn't affect an addict's need to work with present effects. A few people may be genetically predisposed to nicotine addiction through carrying a gene (CYP2A6) which allows them to clear nicotine quickly from the system. A chainsmoker with this gene might be left craving the next fix earlier than other smokers.
(11) If you want to go further into mind as the product of neural evolution and explore how this affects the nature of memory, consciousness and language read Edelman and others (References above).
(12) Each individual brain has about 100 billion neurons. Each neuron has up to 100,000 synaptic connections to other neurons. One neuron may send up to 300 signals a second. The number of possible combinations of connection (10 followed by millions of zeros) is astronomically more than the sum of all the fundamental particles - electrons, protons and neutrons - in the whole of the known universe (10 followed by only about 80 zeros). Is it any wonder that the hyperinteractivity of this near-infinite number of permutations in the brain gives rise to all our mental experience, including a sense of self and belief in spirit?
(13) Bodybrain: mechanistically it used to be thought that the body performed functions of which the brain remained ignorant, and vice versa. Now we're discovering that everything is interconnected. Even proteins used by the gut have receptors in the brain. If every system in the body has two-way communication with the brain at molecular level, it becomes a systemic circuit where every element interacts with its totality.
(14) Drug therapy: as crude a science in its way
(trial and error) as is psychotherapy (largely guesswork). Many
psychiatrists do good work, and would be delighted not to give out
drugs if they had evidence that psychotherapy 'worked' for addiction.
It's the usual systemic dilemma. The philosophy and belief systems of
existing medical research models are unlikely to produce 'objective'
evidence about subjective experience, and the tenets and limits of
one-to-one therapy don't lend themselves convincingly to large-scale
randomised trials. We're all addicted to our own convictions. However
there has been more receptivity between medical and psychotherapeutic
practice in recent years, and therapists supporting substance
withdrawal do well to work closely with G.P.s, psychiatrists, staff
at specialist clinics and specialist support groups. Alcohol, heroin
and minor tranquiliser addicts receiving drug treatment for
withdrawal may still experience craving and relapse if the
psychological component of the addiction hasn't been dealt with. And
although I've heard the average withdrawal from substance addiction
described as 'about as bad as a bout of flu', drug therapy may well
be indicated if a person is very damaged or has severe symptoms.
First published in
Rapport
magazine, Issue 46, Winter 1999
INTRODUCTION to Part II: Limit of Desires
This paper aims to dispel some of the misunderstandings and mystique around the addictive process and to offer you a systematic approach for working with any of its multifarious forms and at any of its levels, from the apparently harmless to the obviously pernicious.
By 'deconstructivist' I mean separating out a complex aggregate
into its constituent parts. My version has an NLP, Grovian and
personal bias. It doesn't pretend to be definitive. (2)
(Epicurus, 'Principle Doctrines')
I said this in Part I and I'll say it again: I was raised to be sexist, racist, homophobic and hierarchic in a society which rewarded my conformity to patriarchal structures of power, separated me from my real feelings and kept me in a state of dependency. This is, I believe, the metaphor - the holding pattern - for all addictions, and the way most of us learn the systemic structure of addiction.
I used to excuse myself as a victim. In fact I was an active volunteer. I gave energy to a system that encouraged me to play victim and persecutor in turn. Thus do co-dependencies perpetuate. (3)
When I use the word 'addiction' in this paper, it is in that political context. I shall be alluding not only to the substance and activity addictions under the opening title, but also to the systemic dependencies which underpin them.
When I use the word 'therapy', I mean to differentiate between traditional psychotherapy, which has attempted to control the codependent relationship with the client through the use of mind-reading, interpretation and suggestion (thereby reinforcing systemic dependency), and postmodern psychotherapy, which aims to enable self-generated change and is an instrument for the transformation of society (4).
And when I use the word 'client' I mean me. You. Any of us who want to accept the limits of our desire for simple answers while remaining free of possession by any of the simplistic alternatives.
1. THERAPIST ISSUES
'Helping'
A client has to do what a client has to do (figure 1). Growth for me as a therapist has been about dropping my attachment to the client's recovery, just as for addictive clients it is about dropping their attachment to X. Co-dependents thrive on the dependency of others, and withdrawal from a co-dependency with the client will typically be difficult for therapists habituated to institutional status and institutionalised thinking.
That's because helping itself can be addictive behaviour. Needing to
feel indispensable; rescuing clients from our personal hallucinations
about them; pointing them in the direction we think they ought to
travel ... all the while believing ourselves free of any taint of the
condition for which we prescribe treatment ... in fact any activity
based on external authority, or what 'recovering psychotherapist'
Anne Wilson Schaef calls "the illusion of control", is an addiction
no different to alcohol or nicotine dependency, where the substance
controls the state and is a means of separating the individual from
their unique internal information systems.
Positioning
The postmodern paradigm of therapy is about detaching from this helping codependency with the client. Be warned: the addict's experience of withdrawal is known to include symptoms of self-doubt and confusion - recovery may be slow. Codependency is a normal relationship for psychiatrists and psychotherapists brought up, as most of us were, in families that found it difficult to distinguish between love and control, or love and rescue. As Schaef says, "Psychotherapists ... tend to migrate to professions where they can exercise the skills they learned at home." A therapist rescuing a client from hurt is merely exercising another kind of authority.
A controlling or rescuing therapist is likely to be stuck in second, or other-position, helping maintain victim client in first, or self-position. A therapist striving dutifully to be dispassionate and non-interventionist might be stuck in third, or observer-position. "All it takes to create any codependent relationship," says addiction counsellor Pamela Gawler-Wright, "is for one of the partners to be rigidly placed in any of first, second or third perceptual positions." A motorist in 2nd gear can shift into 3rd or change down into 1st. A therapist will ideally be in all three gears at the same time. (5)
Here's an on-the-spot codependency check I find useful: having sensed that the client is in difficulty am I trying harder? Am I doing more than half the work in this session? I think I should do about 10% and take the agent's fee.
Labelling
If we model the addiction rather than the individual, we end up classifying people as 'gamblers' or 'sex addicts' in the same way we label 'schizophrenics' or 'depressives'. Mental patients call this punishment by diagnosis. No one addict is like any other yet they tend to get treated the same, which is both insulting and ineffective.
There is a world in every word. The word 'addict' comes imbued with such massive cultural suppositions that using it indifferently could make us party to a self-fulfilling prophecy. We should save that for buying into the promise of 'Flash', 'Jif' and 'Vanish'.
A client referred by a psychiatrist told me in no uncertain terms, "I have periods of highs and lows, I'm not a manic-depressive." What he sought was escape from judgment. Freed from their wisdom of others, he could begin to know (and treat) himself.
Judgment is the inevitable outcome of a prescriptive society in
which illness is thought to be bad for you, whereas illness is of
course a great opportunity for self-exploration and growth. This is
still a revolutionary notion for most G.P.s, who continue to diagnose
people with dependency problems as addicts and hook them into a
medical support system which itself is heavily dependent on drugs.
Treatment with drugs can relieve some of the symptoms, but inevitably
reinforces the systemic structure of addiction by generating further
dependency (see figure 2).
do X 'good' feeling do more
X
problem with X take
Y
relieve X 'need' Y problem
with Y try Z
|
Knowing yourself
Addiction is individual and specific. A therapist classifying a client is quite different to a client naming themselves. Jesus said, "The truth shall set you free." Let's assume he meant a subjective 'your truth' rather than some catholic 'the'. It wasn't until I articulated my own addictions - some twenty years after my psychodynamic 'analysis' had ended - that I could even begin to think of myself in recovery. It's entirely possible for a person to label their X-dependency and take responsibility for their X-behaviours without believing their whole state of being is wrapped up in X. 'To know that you are more than your dependency', as a transpersonal therapist might put it.
If you did the Part I exercise in understanding addiction, you'll know the worst that can happen after confronting yourself is having to give up any notion of knowing what's best for your client. You might then find it easier to work with the individual rather than the addiction. Addiction, after all, is a concept. I`m not sure how you help concepts change. Indeed most of the concepts I know don't want to change, and I wouldn`t know how to help one if it did.
A therapist colleague of mine worked with a woman for over a year before discovering she had an alcohol problem. He realized he had worked conscientiously to help his client develop a strong enough sense of herself so that she was finally able to confront her prolonged denial, but he was personally devastated by the discovery and immediately formed an outcome for her of total abstinence with AA support. In doing so he almost certainly made an involuntary structural connection to his own family history of alcoholism. Stepfather, mother and sister had all been to AA. The neural sequence probably went something like:
neural pattern of
association with 'out of control' 'need outside help' neural
circuit 'total
abstinence/AA' memory circuitThe therapist's subjective experience may or may not have not included evidence that it's possible for people taught sensible drinking when young, or for those in the early stages of addiction, to learn how to control their drinking. He may simply have formed a reasoned belief from his prior knowledge of the client that her consumption was out of control and amenable only to quitting. I'm not saying he was right or wrong. (6) I am saying that when it comes to addictions therapists should know themselves particularly well. The conditions for dependency are present in all of us, and can evoke any number of counter-transference issues that other client conditions may not.
Working in clean language has built-in safeguards against unconscious projection by client onto therapist or therapist onto client. "There is no transference or counter-transference", says David Grove, "because the locus of attention is in the (metaphoric) space. It is the space that is going to be interrogated by the therapist and the client and there is not much going on conversationally between the two of them ... it is a subtle shift in the relationship but philosophically it makes a lot of difference." (7)
Defining
You may have an internalised definition of addiction which isn't helping, so first check out, not what, but how you define.
Do you go along with this W.H.O. definition of addiction: 'An uncontrollable craving with increasing tolerance (8), physical dependence, and harmful effects on the subject and society'? You may or may not agree with the definition, but how did you characterise your defining? Did you dispute the definition? Go along with it? Accept it? Perhaps you even feel attached to it. Look again at those expressions:
dispute
go along with
accept
feel attached to.
What have they in common? They are all metaphors. Our everyday language is riddled with metaphor (there's another just popped up - oops, and another). It`s unlikely you will have generated yours randomly. Your personal metaphor for defining will contain important information about your deep-structural pattern for processing, and that's pretty much guaranteed to be different from your client's.
I hope the implications are obvious. Know your own metaphors. And please don`t intrude them into your clients'!
Aligning
If you're unfamiliar with clean language your first ethical safeguard might be to align your defining with the client's. Agree at the start what you and they mean, for example, by 'quit' and 'control'. There's more about quitting and controlling under Client Issues.
If your client simply wants to control their X behaviour, but your personal belief about optimal client outcome states that quitting is 'better', is it ethically justifiable to continue working with that client? It might be if your views are held lightly, or if you're prepared to come clean with your client and remind them of their right of referral. Some client-centred therapists expect to share their personal preconceptions with the client as part of their own 'congruence' in the relationship. A classically client-centred therapist who believed in no intervention whatever in client process would, I suppose, find it very difficult indeed to say anything about themselves (indeed, say anything at all, or even blink) without influencing the client.
Intervening and interfering
It seems to me you have to decide how much of an interventionist you are, and to work within your own congruence. Addiction specialist Alistair Rhind sums it up this way: "I say as little as possible until I want to say a lot." Even in minimally interventionist clean language mode there are times when a Grovian therapist may want to try a few 'generic musings', as David calls them - wondering out loud, offering ever-so-slightly-dusty thoughts to the ceiling while pondering the next clean question.
There's a distinction between generic musing and suggestion. Suggestion, whether indirect or benign, is interference. A compensatory belief that your purpose is worthy isn't worth a teaspoon of salt. The moment any of us implies that we know what's right for another person we are on the slippery slope, wittingly or not, to controlling behaviour.
And controlling behaviour is addictive behaviour, as we have seen. It mimics the effects of any drug taken as compensation for unresolved need.
It can be tough sometimes, eh? I have to keep asking myself: do I think this client should quit X? Do I want them to quit X? Do I hope they will quit eventually? Want and hope easily shade into expectation, expectation into desire, and desire into will. I remind myself constantly of the political context of my work. My relationship with this client may be unique, but it's not taking place in a vacuum. Do I see my job as patching people up to send them back into an addictive society? To be free of one addiction only to be hungry for another? Well, yes and no.
It's worth repeating: a client has to do what a client has to do. Write yourself a note and put it under the pillow.
(Un)conscious outcoming
If you don`t form a conscious outcome, you`ll certainly form an unconscious one, and unconscious outcomes are likely to be laden with unwanted baggage.
My belief is that everyone knows what`s best for them at some level, so my conscious outcome is simple: to enable (in the sense of create the conditions for) clients to access that knowledge and move naturally towards well-being with the least possible interference from me. Which means separating my unresolved needs from the client's by wholly participating with the client's outcome and allowing the client political power. The rigour of metaphor therapy or symbolic modelling helps this considerably by requiring - nay, obliging - me to model the individual rather than the addiction. (9)
I wish I could say I always achieve this worthy outcome. It's easier if I restrict myself strictly to clean language. It's enormously difficult if I don't.
2. CLIENT ISSUES
(David Grove)
happening, otherwise unless they've been dragged along by a friend or
relative why are they here?" (Pamela Gawler-Wright)
Identifying
For an unwanted behaviour to become an addiction it almost certainly has to take hold at an identity level. "I am a guy who smokes, drinks, does wild stuff," a rock band manager client told me, "and my wife wants me to be a guy in a suit." He wanted to give up dope but not the rest of the wild stuff because, as he said, "I'm scared who I might turn out to be if I do some heavy change".
Most addicts identify intimately with their addictive behaviours and organize their lives around them. Have you ever wondered who you would be without your particular X? "I'm a workaholic." "I'm a woman who has to watch her weight." "I'm a man who likes a flutter." Without a secure sense of ourselves, our security often derives from what we do, or from things outside us - a new laptop, a lover, a packet of fags and a Bic lighter. My colleague who discovered after a year that his client was an alcoholic had been supporting her during that time to develop an in-dependent sense of herself (in- = within, internal; thus independent = reliant on internal resources). Only then was she capable of acknowledging and facing her erstwhile dependency on an external 'resource', in this case alcohol.
Presenting
Every case is different, and we can generalize. Here are four
typical addiction-related presentations. They have a certain
progression. Which comes nearest to your client's?
1. "I can take it or leave it."
Don't ignore the obvious. When Sue Barker asked Roger Black, "What does Jamie Baulch have to do to win this 400 metres, Roger?" Roger said, "He has to run very fast."
So why is this take-it-or-leave-it client here? What does your commonsense tell you? That they're probably concerned in case they can't take it or leave it. The compulsion to clean the cutlery every half-hour might be under control, but if there is an underlying structural issue the client hasn't resolved the compulsion may grow.
A reminder of the addiction continuum in the Part I model:
Stage 1 BAD FEELING
Stage 2 DOING X, FEELING BETTER
Stage 3 DESIRE FOR X
Stage 4 NEED FOR X
Stage 5 X IN POSSESSION.
Where would a statement like 'I can take it or leave it' place this client? In Stage 3, perhaps, DESIRE. Not quite shading into Stage 4, NEED. Or is it? In tracking back to a time when the original bad feeling became entangled with X you'll probably come across a belief that X actually fixed the original bad feeling - which it almost certainly didn't. So this is not a simple desire!
As you and the client track back you'll get a sense of likely places for intervention. Meanwhile I'm drawn to deconstruction: What kind of 'it' is 'it'? (We can't make assumptions.) Is the first 'it' the same or different to the second 'it'? (It may not be.) And symbolic modelling: That's a 'take it or leave it' like what? What is a symbol for 'take or leave'? (Aimed at eliciting a metaphoric container for the problem and making the information available at a more accessible level of organization.)
A classic NLP approach would be to explore an aspect of the client which might be objecting to a commitment to dealing with the problem. What is its positive intention and how can that be reframed? (10)
2. "I can stop any time I want."
OK, so why are they still here? Is this an example of addictive logic obscuring reality? Or does the client have an intuitive sense of another issue that the addiction is masking? What kind of change do they want? In what kind of way? My guess is that clients who talk this way have already begun to look into themselves. They may be at Stage 4, NEED FOR X, and getting concerned. 'Mirror-model' questioning would give them more on which to reflect. (11) What else is there about any time you want? How do you know you can stop? What would be the effect of stopping? Conversational questioning may be enough to shift a client's perspective if the questions are genuinely open. Leading naturally into a more structured process if, for example, a client metaphor for the problem comes up unforced. "It's like I'm on a motorway ..."
3. "I`m not hooked, you know."
Is the client in denial? AA calls alcoholism 'cunning, baffling, powerful ... and patient'. Or perhaps the client is right by their own definition. What do they mean by 'hooked' (or an equivalent 'at the mercy of X', 'devoted to' etc)?
On the 5-stage model the client is probably at Stage 4, NEED FOR X, perhaps on the threshold of Stage 5, X IN POSSESSION.
A client can be so deeply immured in the secret world of their addiction that they hide it even from you. Beware the addict who claims to have marriage problems not dependency problems. Do you want to challenge the deflection, or work with the other issues first? Look out for the addict who switches from one addiction to another to prove they're not addicted. Or the bemused client who comes back saying, "I find myself eating for the same reasons I used to smoke." An available aspect of them has come for something, an unfamiliar aspect stops them acknowledging it, and an inaccessible aspect is preventing them from getting it. (12)
I've been working with Ralph for a couple of months now. He's an entrepreneur. Clever, sharp and charming. He has identified "smoking and overwork" as problem behaviours, and claims not to be hooked on either. What smoking and overwork want for Ralph, he discovers, is "self-respect". Yet whenever Ralph gets a fleeting glimpse of himself with self-respect, something else butts in and stops him having it. What is this thing and what does it want? Each time Ralph sees the person he wants to be, he loses concentration and starts to think about work - at which stress kicks in and he "closesdown". Sometimes he can't continue the therapy and has to go outside for a smoke. This 'closing down' seems to be an even stronger habit than smoking and overwork, but refuses to give up its cover.
Gradually, grudgingly, over eight two-hour sessions of therapy, it allows him to name it. And its name is 'negativity'. So secretive and disapproving has 'negativity' been throughout Ralph's life that whenever he has started to open up and feel good about himself, he has found himself involuntarily closing down. And the paradox that has held all this in place emerges: 'negativity' has had a positive historical intention for him - an attempt to protect him from sickening violence and abuse when, as a child, he was naturally open and vulnerable.
We discuss paradox below and also later under Duality Thinking. Meanwhile with 'I'm not hooked' or its equivalent you need more information and a sense of the client`s deep-structure representations of their experience. Meta-model your client`s linguistic constructions (13). Or go a stage further and explore their symbolic sense of the addiction ('hooked', 'at the mercy of', 'devoted to' are quite meaty metaphors).
4. "I can`t give up and I must give up."
The classic Cartesian dilemma at the heart of many, perhaps most, dire dependencies. Here's a client trapped in the narrow strait controlled by those sea-monsters Scylla and Charybdis. Escaping the jaws of one leads only to one thing - being devoured by the other. A perfect paradox. 'Can't give up X' means the client is possessed by the monster. 'Must give up X' means they're still possessed.
Definitions first: does the client's can't mean 'don't want to', 'choose not to', 'unable to', 'don't know how to' ... ? Does must mean 'should', 'have to', 'need to' ... ? It could make all the difference.
And what kind of beliefs are operating here? Addicts and their codependents may be convinced that there is only one way of being in the world. From a biological generality that presumes people to be male or female, and a philosophical fancy that supposes the universe to be mind or matter, we have derived a cultural absolute: a duality value that says we must be one thing or the other. Right-brained or left. Stupid or smart. Well or ill. And creative scientists, transexuals, metaphysical-materialists and occasionally psychotherapists - anyone who's a bit of both, or can't decide, is outside the pale.
Excessive internal conflict can be created by these incessant 'must/can't' dualities. An enormous amount of energy is required to hold them in place. The resulting tension builds to a crisis that is usually resolved by the 'I that must give up' following the path of least resistance and giving up to the 'I that can't give up'. At which point a further paradox rears its ugly head, as addiction evokes the very affect it has been seeking to prevent: isolation, fear and pain.
The solution is now no longer in the presentation of the problem, the solution is the problem! Get out of that! (We shall.)
Deconstructing first statements
First indications of a client's outcome will be contained in their early statements. There is an enormous amount of information to be gleaned from a client's first words. (14)
Therapist: "And what would you like to have happen?"
Client (coughs): "Well I feel I've got to a certain point with my drinking,
now I want to go further without making any effort at all."
What do we know from this, and where can we go with it?
-
(a) The client has a feeling ... or more accurately
feels (where? what kind of feel?) ... or even feels
well("Well I feel") ...
(b) There's an 'I' that feels, an 'I' that's got to a point, and an 'I' that wants to go further (are they the same or different I's?) ...
(c) The point is certain (certain-particular? certain-unequivocal? certain-inevitable?) ...
(d) The client owns their drinking ... And so on. There's a surfeit of choice in the words themselves. Where would you start? The organisational pattern of the statement is interesting - movement, stop movement, desire for movement ...
Having recently done some personal work with David Grove in which he'd ignored everything I'd said and asked me about an 'um' I'd uttered somewhere along the line, I decided to go for the inconspicuous and asked this client about her little cough. And after a few more clean questions it took her back to a time long before any drinking began, to a time of unresolved need (for being held by her mother), for which many years later the drinking became an imagined solution; and in a time further back still she discovered a remedial resource (the radiance of the sun and the benefice of nature) which she was able to bring forward many years to apply to her need for inner warmth which she had tried to meet through drinking.
Defining
There's further information to be gained from exploring the client's own definition of their state and behaviour.
At this point you really need to suspend judgment about meaning and note their actual words. Don't paraphrase. Here are a few examples of addiction-related defining from my own client notes. Literal expressions like these never fail to entice me.
Strongly attached (smoking).
A physical craving (smoking).
An emptiness and a need to fill myself like a garbage can (chocolate).
Finding an escape (alcohol).
Blotting out (alcohol).
Running round in circles (idealism).
There's like a wall around me (anger).
Metaphors again. There`s no escape. Don`t try. Each phrase holds key information that can open huge doors to change. As Grove says, "Metaphor mediates the interface between the conscious and unconscious mind." These symbolic expressions of the clients` structural relationship with their addictions are plump with potential for self-generated change.
Quitting or controlling or ...?
As you explore first statements and definitions with your client, what happens to their outcome? Do you begin to get a sense of what they actually want? To confront X by quitting? Or to sidle up on X through some kind of control? Would that quitting be all at once or gradually? Controlling in small steps or big?
Or does your client just want to sit back and assess - ie think about wanting to do something, or consider whether to do something? Is the real desire for change present yet? If so, is the will? These distinctions may change over time as new information is recognized - you might like to think of that as re-cognized, or known again by the client - and re-enters their bodymind system.
Some alcohol and chemical dependency specialists consider that when consumption is 'out of control' or a person has reached 'rock bottom', the client's only option is total abstinence. Relationship and eating addictions are hardly amenable to total abstinence if you believe we must eat and relate to survive. The question then becomes what kind of control?
The issue of control should be approached with some caution. There are many accounts of recovering alcoholics who attempt a return to controlled drinking and fail, and few accounts of those who succeed. 'Controlled X behaviour' might only be a painful extension of the addiction if it sustains the client's expectation that X will resolve their underlying need.
There are questionnaires to help therapist and client make a subjective assessment of 'out of control', but the only way a client can form a reasoned outcome is to acknowledge the extent of their dependency for themselves. (15) Alistair Rhind quotes one alcoholic: "Am I drinking because of the wife? No, she left me. Am I drinking because of the job? No, I got the sack. Fuck, it must be me."
Modelling outcomes
Outcome setting is unlikely to be the linear exercise taught on NLP trainings. For the metaphor therapist it is less a sequential elicitation procedure than a relativity modelling process. The therapist models the client's subjective self-patterning in relation to their symbolic sense of space, time and perception - as opposed to their 'real' sense of space, time and perception - a qualitively different experience to the logical (and still in many circumstances enormously useful) linear NLP procedure.
Remember: a client has to do what a client has to do. Subjective modelling of what a client wants is really only effective in clean language. The therapist can question any part of a client's presentation in a way that allows the client to explore their ultimate goals intuitively. You may have to monitor the evolution of the client's outcome throughout, but it saves you trying to work out for yourself what it is they want, or feeling the compulsion to interpret what they say they want, or even, God forbid, kidding yourself that you have the slightest inclination of what they or anyone else might want in a month of Sundays. Clean language modelling inevitably increases the likelihood of the client getting what it is they really really want. (16)
Evolving outcomes
In any model of therapy the client's outcome will almost certainly evolve. Particularly if the addiction is related, as it almost certainly is, to other issues.
Brian is a barman who when first asked what he wanted said, "To sort myself out, there are a few things going on for me." "What kind of things?""My girlfriend had an abortion a few months ago, I've had kidney problems for 3 or 4 years, I'm depressed, I have a rashon my leg and back, light-headedness, flu, general ill health, I can't deal with people in crowds, I'm drinking too much, my girlfriend gets jealous when I talk to other women, and I`ve always felt alone." Apart from that no problems, I nearly said.
From this individual mixture of guilt, worry, depression, anxiety, agoraphobia, dependency,frustration and isolation, Brian eventually identified his priority as "To give up drinking." In the second session this evolved to "Controlling the depression." And in the third (by which time we were working in metaphor process): "Clear thinking. A filter for the impurities." He was able to identify that a filter for the impurities would lead to clear thinking, which would help lift his depression, which in turn would give him less cause for drinking. It didn`t matter to him which had come first - all he wanted was a strategy for getting better.
Taking the client through a well-formed outcome process or asking the standard Grovian opening question (And what would you like to have happen?) may lead to the unfolding of any number of issues. After all, the client is likely to be doing X as a substitute for authentic human connection, the lack of which could relate to any aspect of the human condition.
There's some debate about whether addiction is always a mask for other disorders or whether other disorders are a mask for underlying addiction. Academic. There's a simple answer to these chicken-or-egg questions: start somewhere! Finding out more about the chicken is your royal route to the egg, and vice versa. I wouldn`t worry which came first, or you'll be retracing your steps up your own ad infinitum.
And remember 'meta-outcomes': for what purpose does the client want their addiction-related outcome? What will getting that gain for them?
Separating out
Anyone who speaks in terms of must have or always do is probably well into Stage 5, X IN POSSESSION, convinced that their internal state is governed by, or dependent on, the external thing: substance (such as heroin) or activity (such as gambling). Their X-related behaviour is outside their control.
In fact what is happening is that a number of different events in the brain -
- is being experienced near-simultaneously, leaving the client no time for consideration and choice. And this produces the illusion of no control.
Every client whose outcome implies more choice will sooner or later have to learn to separate the external stimulus from the internal state from the external X, so that one is not in thrall to the other. Neuro-linguistically we have learnt to disconnect a (neutral) stimulus from a (negative) state in order to anchor a new (more positive) connection. In the addictive equation we need to go further and disconnect the (negative) internal state from the (expectation of positive) external X.
This separation is not in itself the resolution, but is the key to change in almost all cases.
What is it that actually connects the client's state of mind-body and X when they seem inseparable? In terms of the Part I model you could characterise it as an involuntary interaction of neuronal groupings in the brain acting on the primary motor cortex that sends impulses to certain muscles prompting specific behaviour. Or if you prefer: the client feels bad, does X. Which in the early stages of addiction, at least, leads to feel good.
do
X feel
'good'You will eventually be able to intervene in this sequence of body-mind interactions, but meanwhile the client who, step-by-step, can simply
acknowledge
get to know
own
take
responsibility fortheir addictive behaviours is already taking significant steps towards sorting them out. In some cases it could be that simple. In many cases we need to go further.
Duality thinking
The jaws of paradox grip many addicts. The dilemma of being caught between the polarities of aversion and attraction is the most typically addictive bind and the one most resistant to deconstruction. (17)
Eleanor is a manager in the middle of a painful divorce. Her first statement to me is, "I can`t give up my anger towards my husband and I have to if I'm to stay sane." An explicit 'can't/ must' polarity. Her aversion to giving up her anger is probably equal and opposite to her attraction to giving up her anger. Clearly Eleanor's addiction to anger is a mask for other issues. It doesn`t come from nowhere. But can I assume even that? Before I can intervene she continues, "I`m running round in circles." A confirmation of the bind. She pauses. I guess she's running in another circle right now. "And you`re running round in circles," I acknowledge. I stop to think. I could ask her what kind of circles, or what kind of running, or even what kind of 'in'. I suspect she's been stuck for some time, and hopes I have the answer. So my first outcome is to help her acknowledge the stuckness as hers, not mine, by reinforcing it. "And you`re running round in circles ... and you`re running round in circles ... and you`re running round in circles ... and when you`re running round in circles, what happens next?" "I don`t know. I can`t get off."
Well, an element of the metaphor has moved minutely and Eleanor has more information. If she can learn something about what she`s on (wheel? racetrack? orbit of the earth?) that she can`t get off, she may find a solution at a symbolic level that her unconscious will process and the dilemma may resolve. Meanwhile I can't even assume that she wants to get off - these circles may take her on a magical journey to riches beyond my imagination. And I suspect there may be a lot more running to do.
Binds like Eleanor's and Ralph's (the closing down client in 'I'm not hooked') have been in place for many years, have been well maintained and are functioning perfectly - as binds. Suddenly they metamorphose into a theoretically more accessible form - and what happens? Can they now resolve freely? If resolution is what they want. Some fear freedom more than the binds that tie them. Others yearn desperately for something to unpick their tangled patterns.
An obstacle many of us have to surmount before the mind-binds of paradox may resolve is our Western tradition of dualism. Two hundred years of faith in the Cartesian creed that said mind was immaterial and absolutely distinguishable from the body have led us to oversimplify our chaotic universe into elementary alternatives of Right or Wrong, True or False, Cause or Effect, etc. We have identified ourselves (thoughts, actions) as one or the other. We may on occasion cross from one side of this philosophical divide to the other - from being one thing to being the other - but this only gave us the illusion of freedom without the reality.
Duality thinking is addictive behaviour. Not surprisingly, given our addictive society. Duality thinking maintains our dependency on the systemic structure of the presentation of the choice. A structure that is both institutional and linguistic. Penny Tompkins says, "People will language choices for themselves until the cows come home."
Languaging duality
Duality is a linguistic lure. Language evolved to describe the mundane experiences of daily life, not the infinitely subtle and fluid experience of Life itself. Which has gotten us into another fine mess, as Hardy might have said to Laurel, for not only do we use language crudely to express thought - to our occasional benefit - we also allow it crudely to define thought - to our frequent loss. We are caught in a complex of cognition that is language-led.
"The mind is linguistically structured," says philosopher of consciousness John Searle. "For all but the simplest thoughts, one has to have a language to think the thought."
Without words I can be aware of the experience of sitting here at my computer, but I cannot think that I am in Ontario by Lake Kashagawigamog (yes) in a cottage rented by my wife, or that we plan on going canoeing later, or a thousand other connections to being here, without the words to describe these thoughts. To all intents and purposes language is defining my experience.
Take a thought-expressed such as 'I must give up X'. It would seem perfectly lucid to the thinker-speaker. This person probably thought they knew pretty much what they meant when they said it, and there's nothing here to say it's not entirely possible for them to do. Now separately take the thought 'I can't give up X'. Equally lucid. Neither of these thoughts may be simple, but both are fully functional. If independently each is feasible, how is it that together they become somehow insoluble?
Simon is a computer wizard addicted to overwork and unable to enjoy his own talents.
"I can't stop working," he might have said (OK, so what?).
"I must stop working," he might have said another time (OK, go ahead).
What he actually says is "I can't stop working and I must stop working." (insoluble bind).
Simon didn't need words to have a vague experience of exceptional difficulty, but 'thinkwording' it has meant making a huge number of mindlanguage connections in order to say the experience ("I can't stop working and I must stop working - dammit") - and thus to think that he knew that he had it. Result: a self-made prison of paradox.
In a metaphor process Simon identifies a 'twist' in his stomach. Elements of this 'twist' appear in other symbols. It is a recurring pattern. For homework Simon is invited to look up the word 'twist'.
At the start of the next session he reports on a Middle English derivation he has discovered - not of the noun, surprisingly, but of the verb. 'To twist' originally meant both dividing into two' and 'combining into one', which to the Middle English may have seemed perfectly logical, but isn't to Simon. To be both dividing and combining himself at the same time is an impossible bind. And if 'twist' is an activity (a verb) to Simon, how in his metaphor can it also be a thing (a noun)?
In the next session, Simon suddenly remembers the extreme difficulty he has as a seven-year old at junior school holding himself back academically so that he doesn't have to go to classes two years ahead of his friends. And over the next couple of sessions it comes to him: to combine with his peers he has been dividing himself - separating the gifted one who was intellectually superior from the social one who didn't want to be. He identifies this as a pattern in other areas of his adult life. Well, if that's the problem, what's the solution?
What assumptions does this last question, and the question before it, and the question I posed just before the example, make that makes them seem very troublesome, even irresolvable? The answer is the same as our philosophical tradition has long assumed - that categories of body and mind, matter and consciousness, thing and no thing, can't and must, want and not want, solution and problem, and all such apparent dualities, are mutually exclusive.
So what's a better question? Can Simon be freed from the limits of his desire for the obvious answer? And if he is, will he transcend the compelling logic of his bind?
The third and final part of this series is for those who like
concrete outcomes. We will consider SEVEN WAYS OF RESOLVING DUALITY
-
admitting third options
negotiating
double-binding
changing the rules
symbolic modelling
converging
and allowing.
So Simon is going to be OK, I hope. And we shall go through an ADDICTION AUDIT, a simple information-gathering and preliminary changework model for use in early encounters with any dependent client - whatever their dependency - whether to substance, activity, person, institution, or the codependency edifices of society itself.
This assessment model may be all you ever need to treat an addictive client. By the end of it the client should be treating themselves.
© 1999 Philip Harland
References
John Searle, The Rediscovery of the Mind, MIT Press 1994; Mind, Language and Society, Weidenfeld and Nicholson 1999
Gerald Edelman, Bright Air, Brilliant Fire; On the Matter of the Mind, Allen Lane 1992
Anne Wilson Schaef, Beyond Therapy, Beyond Science, HarperSanFrancisco 1992
John Firman and Ann Gila, The Primal Wound, a Transpersonal View of Trauma, Addiction and Growth, State University of New York Press 1997
Craig Nakken, Addictive Personality: Roots, Rituals and Recovery, Hazelden Foundation 1996
Chelly M Sterman, ed. Neuro-Linguistic Programming in Alcoholism Treatment, Haworth Press 1990
Sid Jacobson, A Summary of Important Considerations in Quitting or Controlling Smoking, South Central Institute of NLP paper 1997
Mara Selvini Palazzoli et al, Paradox and Counter-Paradox, Jason Aronson Inc. 1978
Tina Stacey, NLP Addiction and the 12 Steps, ANLP seminar 1998 and personal communication 1999
Laurena Chamlee-Cole, personal communication 1999
Pamela Gawler-Wright and Alistair Rhind, Working Successfully with Addictions seminars 1999
David Grove, Clean Language and Metaphor Therapy trainings and personal work 1996-99
Penny Tompkins and James Lawley, Symbolic Modelling trainings and supervision 1995-99
Thanks to James and Penny and my partner Carol Thompson for their creativity, support and suggestions.
Notes
(1) Adapted from a client quotation in an article by Gillian Riley, The Therapist Autumn 1997.
(2) The addictive process: Anne Wilson Schaef, John Firman, Tina Stacey, Pamela Gawler-Wright and Alistair Rhind are among those I have come across who have done interesting original work on addiction. If you want more references still check Whitakers Book Bank CD-ROM, which comes up with 1,800 titles.
(3) More about the victim-persecutor codependency in Part I of this paper, Rapport Autumn 1999.
(4) My definition of postmodern psychotherapy: a new paradigm untrammelled by current established (antiquated) scientific, psychological and socio-political beliefs, assumptions and methods. My example is self-generated change via the clean language questioning of Grovian metaphor therapy, originated by David Grove and further developed as symbolic modelling by Penny Tompkins and James Lawley. The therapist communicates with the deep structure of the client's non-conscious process without contaminating (attributing, characterizing, interpreting or attempting to control) their subjective experience. For a series of articles about how it works see back numbers of Rapport or The Developing Company's website at www.cleanlanguage.co.uk/.
(5) NLP Perceptual Positions are well introduced by Joseph O'Connor and John Seymour in Introducing NLP, The Aquarian Press 1990.
(6) Many recovering addicts swear by Alcoholics Anonymous ('the biggest support system in the world'), and some therapists agree to work with alcoholic clients only if they concurrently commit to AA. AA arguably plays the systemic dependency game by encouraging clients to swop one dependency (alcohol) for another (the support programme) - it doesn't teach you how to get out of the game. NLP trainer and addiction counsellor Tina Stacey has designed a 12-step - or '12-state' - substance recovery programme as an alternative to the AA approach. SOS (Secular Organisation for Sobriety) has developed a non-religious programme for people with alcohol, eating and gambling disorders. For recovering alcoholics who wish to avoid or face relapse there's certainly no substitute for AA's ongoing (global) support system, something no other counsellor or organization I know of can offer.
(7) Transference: from David Grove, Problem Domains and Non-Traumatic Resolution through Metaphor Therapy, 1998. You can read the rest of this paper on the Metaphor and Clean Language website (see note 4). Of course whenever two human beings come together there's likely to be some transference or projection of unresolved feelings. What clean language does is minimise its inhibitory, obstructive or intrusive effects. I suggest there's no such thing as counter-transference, by the way. It's not counter to any transference or projection of the client's, and there's nothing special about the way therapists do it. Some psychotherapies attempt to make the best of this by incorporating transference and 'counter-transference' into the work , which must put their practitioners in a dilemma: if they acknowledge that they may project feelings onto the client derived from the past, this surely undermines their raison d'etre as objective interpreters of the past.
(8) Tolerance has been defined as what happens when an addict seeks refuge from the pain of addiction by moving further into the addictive process. In other words, needs more to achieve progressively less.
(9) Clean language modelling. To be more precise, the therapist co-models with the client the unique internal information the client has about themselves and facilitates the client's self-discovery of internal sources and solutions, enabling the client's healing to be purely self-generated.
(10) See Richard Bandler and John Grinder, Reframing: NLP and the Transformation of Meaning, Real People Press 1982. Reframing an addictive so-called 'part' may be difficult if the client manifests what B & G call 'sequential incongruity', where the therapist has access to a sober, non-X 'part' of the client (which wants to change), but no access to the X 'part' (which almost certainly doesn't). B & G take you through a technique for changing 'sequential' into 'simultaneous' by separately anchoring X and non-X states, firing them simultaneously and forcing them to co-exist. Needs care!
(11) Philip Harland, The Mirror-model, a guide to reflective questioning, Rapport Autumn 1998. A model of conversational change which can be used to help clients stuck in a Present frame of reference shift their attention and learning into Context, Past, Future, Higher and Metaphor frames.
(12) New addiction replacing the old: Tompkins and Lawley, after Ken Wilber, would describe this as translation, not transformation. The story remains the same, it just gets told in other words (my metaphor). As Penny says, "A person may have to go through a series of translations before being ready for transformation."
(13) For the original book on the NLP Meta-model of linguistic challenge, see Bandler and Grinder, The Structure of Magic Volume I, Science and Behaviour Books 1975.
(14) More on deconstructing first statements in
Tompkins and Lawley, Symbolic Modelling
and the Emergence of Background Knowledge, Rapport Spring
1998.
First published in Rapport
magazine, Issue 47, Spring 2000
INTRODUCTION to Part III: The Physician's Provider
Some NLP theorists believe we should be able to move from present state to desired state without crossing too many borders in-between, but addiction is immense and untamed territory, with no reliable map and no easy passage. This present survey has a neuro-linguistic, Grovian and personal bias. It does not claim to be definitive, though anyone who finds themselves confused by the subject of addiction and seeks a way through will, I trust, find it useful. The paper has been divided into three parts, each arranged with a certain logic, a structure that does not completely honour the systemic inter-relatedness of addiction, but does offer a simple approach to getting familiar with its complexity.
Part III
Introduction
An addiction may be apparent or not. There may be secondary conditions and afflictions underlying the obvious. How can the therapist and client uncover them? How has the client constructed them? Part III proposes specific ways of eliciting information about any addiction, compulsion or dependency, and specific ways of motivating and inaugurating change.
AUDITING FOR X includes an information-activating and preliminary changework model in four frames: person, possession, pattern and preference.
RESOLVING DUALITY outlines seven ways of resolving addictive logic: admitting; third options; negotiating; double-binding; changing the rules; symbolic modelling; converging; allowing.
At the end is a summary of Parts I, II and III in the form of a checklist/cribsheet.
Auditor: one who learns by aural instruction.
The addictive X may or may not be obvious, but has to come from somewhere. It is the result of the structure of the client's experience. The client's complete account of this is unlikely to be available instantly. Some parts may never have been accessed or expressed before. How as auditor-therapist can you assist your instructor?
Stefan is a 31-year old entrepreneur who has come into therapy saying he feels helpless, he's never been able to concentrate, his marriage has fallen apart, and he hates himself. He's constantly distracted. He has to break off to go outside for a cigarette. When he returns, I ask him what he wants. He doesn't know. It might be to stop smoking. I try to elicit a metaphor for his helplessness so that we can work non-cognitively, but he doesn't understand my questions. I try to shift his attention from his present frame into the past, the future, a higher frame, but he has difficulty focussing on anything but the present. Finally I start to ask him very simple questions about the manifestly obvious - where, when, what and how does he smoke?
As we plod painstakingly through the most basic of basic audits of his 20-a-day habit, Stefan begins to reveal more about himself, and eventually confesses to something that has been troubling him for 17 years. Since the age of 14 Stefan has been consumed by a desire for revenge on an uncle who he believes cheated his father out of a multi-million pound business. But what is the underlying compulsion that has fuelled this desire? Several more sessions pass before Stefan can name it. After all he has had years of practice at denying it, diverting it, and depriving it of its dignity. Even now Stefan has difficulty describing the addiction that underlies his nicotine dependency. His voice drops. "It's anger. It's shameful, it's shocking. It's just not me. I've never lifted a finger against anyone." At the end of a difficult session he is able to say, "I've never acknowledged my anger before, it's never been heard. It's not necessarily bad in itself. I'm not really a bad person." His face is softer, and for the first time since we met the words aren't tumbling out of him like scared rabbits.
After my very basic audit of Stefan's smoking I decided to compile a slightly more sophisticated set of questions that I could use to explore any dependency, and I shall go into these in a moment. In Stefan's case the audit helped him identify smoking as an idiosyncratic distraction to a feeling of severe helplessness. (See figure 2)
Figure 2: No smoke without fire.
The helplessness resulted from the lack of resolution of a barely
expressed desire for revenge. The desire concealed a further layer of
frustration at the lack of resolution of an out-of-awareness
addiction to another deeply disturbing feeling - anger.
Every case will be different. Stefan went on to reveal a deeper
account of childhood abandonment that had a direct structural
relationship to his addictions. A client who has never sifted through
the history of X might uncover many layers. Some addictions are
obscured by unwanted behaviours. Some underlie secondary
dependencies. Where do you begin?
Starting
You can only start with what's there. Outcome forming (see Parts I
and II) may be an indispensable induction into changework, but as we
saw with Stefan the ability to form an outcome is not dependent on
the client's ability to clearly articulate what they want at the
start. Nor do they have to be able to name their particular X.
One of my clients almost raced into the room for her first session
crying, "I'm running round in circles." Another crept in, sat
hunched up, and muttered, "There's like a wall around me."
Metaphors of parturient potential such as these invite another kind
of induction: the gentle intervention of the Grovian midwife's
'And what would you like to have happen?'; a clean,
outcome-eliciting question that almost without exception puts the
client in intuitive control of their own process from the start. The
exception is the occasional client who will ask, "Do you mean now
or generally?" To which I invariably answer "Yes." (4)
However not all clients respond readily to the symbolic modelling of
Grovian (or Tompkins and Lawlian) process - or, indeed, to
psychoanalysis, hypnosis or crystal-gazing - so at the start it's
nice to have choice. If the client is in a generalised stuck state I
might use the conversational frames of the 'mirror-model' to help
loosen it. (5) If addiction is obvious or
indicated I will elicit information using the questionnaire that
follows. Often during this process the client will spontaneously
generate a metaphor for their problem or its solution, and we will
develop that on the spot or return to it later.
In any case, every client has to progress through a certain
self-reflective sequence before change can occur.
Changing
There are at least twenty separate but intimately related incremental changes for a client's bodymind system to make before true change can take effect:
(1st) naming X (the unwanted addiction, pattern or behaviour)
(2nd) acknowledging it rather than denying its reality
(3rd) accepting rather than hating it
(4th) thanking it for having had an honourable intention for them
(5th) blessing it for its attempts to secure that intention
(6th) loving it for its part in the survival of the whole
(7th) loving the whole for accomodating X
(8th) understanding that X is now out of date
(9th) discovering X's underlying need for the whole.
If the last step reveals a hitherto unacknowledged underlying
addiction (another X), the client must return to step 1 
. If
not, continue to
(10th) desiring to bring the whole up-to-date
(11th) allowing outside support on the road to self-reliance
(12th) being willing to change beliefs and behaviour to that end
(13th) intending to change.
Each of these critical transitions supports the crucial
(14th) deciding to change
(15th) committing to change
(16th) facing reality and pain
(17th) learning new life skills
(18th) monitoring the changes
(19th) testing them
(20th) maintaining them.
Those who work their way through this sequence are not merely ridding themselves of an unwanted addiction, of course, but improving their whole lives.
Activating
I remind myself that information is for the client, not the therapist. As a therapist I don't have to 'understand' information to activate it effectively.
"As soon as you start asking questions you start loosening stuckness." (Alistair Rhind)
"If you can reflect a client's problem undistorted, the client is relieved of the responsibility of holding it alone. The problem shifts and the system will spontaneously reorganize." (Charles Faulkner)
Richard Bandler once said that therapy is 95% information gathering and 5% changework. It's as true of NLP as it is of any model of therapy. It takes time for the bodymind to unlearn a learned addiction. There's no rush to technique.
Knowledge itself becomes the catalyst of change. As new information, or the recognition of existing information, feeds back into the client's system, the system will reorganize. (6)
The questionnaire that follows is designed to help addictive, compulsive or dependent clients account for, get to know and trust their own process. It is a participatory audit that takes the client into three frames of their present and past experience (person, possession and pattern) and one future frame (preference). Therapist and client co-model the client's addictive construct in each frame in such a way that deconstruction and change are inevitable.
"Self-reflective questioning can effectively assist someone to completely reorganize their cognitive/conceptual structure, with the ripple effect influencing 'deeper' organizing metaphors, embodied experience and neuro-chemical processes." (James Lawley)
You don't have to plough through every question in all four frames. The moment for a particular process intervention might occur at any time. But each question is a reflective intervention in its own right, and given the politics of self-generated change the distinct reappearance of patterns in response to different kinds of question will have its own re-educative effect on the client. As you work through these frames I recommend you embrace the obvious, welcome repetition, and bear in mind that any question could be the key. (7)
The presupposition of this audit is the client's need to separate internal state (+ve or -ve) from external X, so that one is not in thrall to the other. 'X' stands for the addiction, compulsion or dependency, or for the condition from which the addiction may emerge. 'You' or 'client' stands for the client or, if you care to take the Part I exercise in owning your own dependencies further, yourself.
PERSON
|
|
Client resources are available at each level. An intervention at each will support the client who needs to go one step at a time and experience the effect of small changes before making bigger ones. An intervention at a higher level will normally include and have a consequential effect on those below.
Primary level (self interacting with environment)
|
Q1 |
What has been the general context of [X] for you? And specifically? |
X has not existed in isolation. In what surroundings and with whom did X manifest itself? Home, work, school, alone, social situations, significant relationships, casual relationships? |
|
Q2 |
Were there influences outside yourself? |
In the environment, society, family, peer pressure, cultural expectation, advertising, availability of resources (wealth etc), non-availability (poverty etc). |
|
Q3 |
What help is available or possible for you in [Q1 & Q2 contexts]? |
|
|
Q4 |
What specifically may you change in [Q1 & Q2 contexts] so that they're more helpful? |
|
|
Q5 |
What specifically have you done in relation to [X]? And specifically how? |
Discounting for the moment any interconnection with other levels of experience, what did you actually do that caused the problem? The original error, after all, is to have done X because of feeling bad. (9) |
|
Q6 |
What may you actually do or do differently for change? |
Standard NLP 'swish' pattern may be used to change an unwanted behaviour. Requires client to identify the specific 'cue' behaviour. What happened just before [you did X]? Client works on this moment to generate a compelling alternative behaviour to the learned response. (10) |
|
Q7 |
Which of your skills/capabilities/resources/strategies enabled [X]? |
The assumption is that application and energy have been required, and in rehearsing these the client will be primed for answering the next question. |
|
Q8 |
Which of your skills/capabilities/resources/strategies will enable [X] to change? |
An appeal to client creativity. How can [Q7 answers] crossover into [Q8 territory]? What further skills etc may be helpful? Personal state control can be taught using NLP anchoring, submodality shift, stimulus-response pattern change, and various relaxation, breathing and self-hypnosis techniques. |
Secondary level (beliefs about self)
|
Q9 |
What beliefs or values did you have that supported [X]? |
Addictive beliefs may set up the system: 'I'm weak'; 'I thought I didn't need people'; 'I believed I didn't have to face up to anything I didn't want to'. Everday beliefs keep the system going: 'I needed to enjoy life/fit in with other people/be creative/do my own thing', etc. A particularly invidious belief is the one that goes 'I can't stop X because your therapy isn't working'. You may be able to nip that one in the bud at the start by not appealing to the weaker rational aspect of the client that wants to stop, but by siding with the dominant addictive aspect that is probably running the show (and doesn't expect appreciation). |
|
Q10 |
What beliefs/values do you have or may you rediscover to support change? |
Beliefs: NLP restructuring/reimprinting processes can help the client update old beliefs or establish a new belief system. (11) Values: client arrange in a hierarchy, identify if any need to be higher to more effectively support change; sub-modality work to make the value more compelling. (12) |
|
Q11 |
Had you identified yourself with [X]? With being a/n [X]? |
In addiction ther |