Neurolinguistic Programming as an Adjunct to Other Psychotherapeutic / Hypnotherapeutic Interventions

Neurolinguistic Programming as an Adjunct to Other Psychotherapeutic / Hypnotherapeutic Interventions
by Eleanor S. Field Ph.D
UPLOADED 17/10/2006

The therapeutic dissociative techniques of "anchoring" and "three-part dissociation," neurolinguistic programming (NLP) treatment paradigms incorporating the idea of division into ego states, are effective in crisis intervention and as a stimulus for catharsis. Using the anchoring technique in the first session, a patient w ith severe anxiety, manifested by episodes of hyperactivity, was able lo superimpose inner resources upon the situations which led to the episodes. Utilizing three-part dissociation, the patient experienced the hyperactive episodes "for the very last time" and terminated them permanently. Hypnotic exploration and ideomotor signalling were used with a patient presenting with uncomfortable feelings associated with intense anger. After the origin of the anger was determined, three-part dissociation produced an abreaction and catharsis. Interaction at a cognitive level integrated the feelings and knowledge into personal consciousness.

Spiegel and Spiegel (1978) describe the use of therapeutic dissociation in hypnosis. One result of dissociation can be the release of feelings and one's mastery of the content of that state through reassociation, resulting in new learning. Sanders and Hall (1986) state: ". . . controlled dissociation (deintegration) can lead to reintegration and to the reestablishment of cognitive and regulatory control."

Watkins (1978) and Torem (1984, 1986, 1987) described the concept of the division or dissociation into ego states or "subselves," which was conceptualized first by Paul Federn (1952). Eric Berne (1961) developed his theory of Transactional Analysis around the ego-state modality, and others, such as Hartman (1958) and Kohut (1971), discuss the same phenomenon.

Torem (1987) refers to one of the sources of ego states as being ". . . created through normal development." He states: "The self is being conceptualized as a .society of ego states that consists of various clusters of behaviors and experiences that may be partially dissociated from one another through semipermeable boundaries. This allows the individual to focus on each particular daily situation adaptively with minimal interference from nonrelevant elements of the personality."

I will describe two cases which demonstrate the therapeutic dissociative techniques of "anchoring" and "three-part dissociation" to release feelings, gain new understandings, manage new associations, and develop self-mastery and control.

Neurolinguistic Programming

NLP is the study of the structure of subjective experiences, and according to Dilts, Grinder, Bandler, and DeLozier (1980) it "... proposes to examine the correlates between what we experience as the external environment and our internal (or sensory) representation of that experience ... at the neurological level." NLP was created by Richard Bandler and John Grinder as they studied human behavior and organized its components into specific patterns of behavior based upon using the individual's naturalistic processes to generate behavioral change.

Dilts et al. (1980) view behavior as the result of neurological processes and behavioral change as entailing a three-point program described as one's representation of the present state of behavior, the desired outcome or target behavior, and the resources required to transport the indi vidual from the former to the latter.

Anchoring

Anchoring is based on the premise that people have all the resources they need for behavioral change. Anchoring evolved as a NLP strategy intended to elicit the sequences and reference experiences wherein lay the needed resources for behavioral change. According to Dilts et al. (1980), "... an anchor is, in essence, any representation (internally or externally generated) which triggers another representation..." These authors describe anchoring as "the user-oriented version" of the stimulus-response concept utilized by behaviorists. The process differs from that of the behaviorists in that the anchor can be established even if it is not reinforced by an immediate outcome. Anchors can be easily established in a single session with a patient.

Another important aspect of anchors, as described by Dilts et al. (1980), is that they may be established in any of the sensory modalities, whether internally or externally generated, and that one sensory representation anchors in another. These representations may be strung together to represent a strategy. By way of anchoring, the patient's experience of the world can be enriched by pairing resources from one experience to those of another. This is defined by Bandler and Grinder (1975) as the "collapsing" or "integration" of anchors. One thereby obtains an enriched and fuller representation of the experiences involved and ultimately a broader view of his "map" or view of his world.

Anchoring involves the deliberate association between a stimulus and a specific experience in order to evoke the internal resources and perception or affect which is inherent in that experience and to make the resources available where they are needed today. The stimulus can be the therapist's pressing on a knee, elbow, or wrist, or having the patient make a fist while he is experiencing the state. Anchors are meant to work without conscious awareness. They trigger the essence of what is needed in a situation by maintaining congruence between the paired experiences.

Interpreting the NLP techniques of anchoring and three-part dissociation through ego-state therapy is also useful. Using these procedures, the patient is brought, by way of dissociation, to reexpcrience one or more of his ego states of the past and to intensely focus on those selves or egos from the perspective of the present-day ego state. The patient is then brought back to the present-day self (reassociation). From the vantage point of the present-day ego state, the patient can access, by way of an anchor or stimulus, positive ego-state behavior and affect from out of the past and utilize these in order in order to facilitate modification of his present-day self or ego state. Using the anchor, these positive resources are paired with the present-day ego state, overriding the maladaptive behavior of the current ego, and resulting in more adaptive behavior, as well as "... increased permeability of ego-state boundaries and improved internal harmony" (Torem, 1987).

It could also be stated that the process causes the creation of a subsystem of the ego to occur and to be placed in the service of the overall ego (Gill & Brenman, 1959). According to Gill and Brenman, the ego never loses its control with reality, whereas earlier modes of feelings, memories, and experiences can be achieved. Considered from this viewpoint, anchoring can be seen as a hypnotic procedure, one which falls under the theory of hypnosis as "adaptive regression" or "regression in the service of the ego" (Gill & Brenman, 1959). In further considering anchoring as a hypnotic paradigm, Cheek and LeCron in 1968 stated that when a person reviews archaic material he slips into a state of hypnosis.

Charcot, in considering hypnosis to be a form of dissociation, or a "mental state of an individual, artificially induced by a second person and sufficing to bring about dissociation of personal memory" (Janet, 1919/1976, p.291), also endorses the idea of anchoring as a hypnotic modality. Further, Watkins (1978) describes hypnosis as "controlled dissociation." Erickson (1958) describes hypnosis as not requiring a formal induction and sometimes used evoking an inner resource as a simple introduction into hypnosis.

The specific process of anchoring involves the following:

The patient accesses his problematic situation while he internally or "neuro logically" experiences that situation with all five of his senses. The therapist then anchors that situation.
The patient accesses, with all his senses, a situation wherein he had the po tential and the resources lacking in his present situation. The therapist anchors that experience.
The patient accesses both experi ences at the same time while the therapist
activates both anchors simultaneously. This
causes an integration of the two situa tions, whereby the resources of one situ ation become paired or superimposed upon
the other.

Three-Part Dissociation

Three-part dissociation is a procedure originally described by Bandler and Grinder (1979) as a treatment modality for phobias. This is a double-dissociation technique which allows the patient to relive a traumatic situation from a remote vantage point, while the therapist utilizes herself/himself as an anchor or supportive ego, providing balance, strength, security, and permission as the patient encounters the regression.

In essence, subsystems of the ego are created in the service of the overall ego (Schilder & Kauders, 1926). The therapist acts as an "anchoring ego" (Murray-Jobsis, 1988) and joins forces with the patient's "monitoring ego" in order to create and assist in the regression. This adaptive regression is "in service of the ego" (Gill & Brenman, 1959). According to Murray-Jobsis, this involves the patient's reliance on the therapist's monitoring ego as an anchor to reality and as an added ego resource to facilitate the useful and safe hypnotic adaptive regression. Murray-Jobsis (1988) states: "... the patient gives over, in the hypnotic transference relationship, part of the monitoring and regulating role of the ego to the therapist." The patient and therapist are uniting their ego strengths to promote a "unified monitoring ego in the hypnotic relationship" in order to create and facilitate the regression.

With the aid of the therapist, then, the patient is able to initiate and terminate the regression, judge the safe and appropriate circumstances of the regression, and finally reinstate normal functioning. These aspects have been named by Murray-Jobsis as the three main criteria for adaptive regression. When the patient accesses the experience associated with the maladaptive behavior, he/she is asked to intensify the experience at a sensory-motor ideational level in order to achieve maximum effectiveness, awareness, and sensorimotor disorientation (Gill & Brenman, 1959). Emphasis is especially placed on the affective aspect. The therapist asks the patient to have his Younger Self or his "Child" ego state, the feeling component (Berne, 1964), experience the affect associated with the traumatic experience for the very last time.

The Adult Self acts as host ego state as he sits in the chair letting the Watching Self peer "through him" at the Child in the distance. The "therapist's anchoring ego" supports the Adult Self by offering a strong handclasp or arm-hold to the pa tient. Finally, the therapist asks the patient to reintegrate or reassociate the Younger and Watching Selves into his host Adult Self. The Adult Self is also asked to demonstrate appreciation of the Younger Self for reliving the unpleasant experience and to reassure the Younger Self that he, the Adult Self, will assist him in relearning and redirecting the energy of that ego state.

Case Reports

Case 1

V., a 32-year-old Caucasian male of Hispanic origin, came to therapy because of persistent and uncomfortable feelings of anger and negativity. His mood was dysphoric and he reported a lack of pleasure in his family, his work, and his social arena. His words conveyed self-reproach as well as negativity toward others. He was becoming increasingly distant from family and friends and had increasing difficulty in concentrating. The initial diagnosis was Major Depression, Single Episode (American Psychiatric Associa tion. 1987).

After a few sessions of working with the patient, concentrating on learning the origin of his anger, using ideomotor questioning and the seven causative factors to symptomatology (Cheek & LeCron, 1968), we were able to determine the source of his feelings. His affect was a direct reaction to his wife's affair 7 years earlier, during the time they had lived together prior to their marriage. In fact, V. was so jealous of her having "betrayed" him that in order to restore his macho image of himself he had insisted upon the marriage.

The strategies of hypnosis I used with this patient included automatic writing (Kroger, 1977), dream interpretation, and the "affect bridge" (Watkins, 1971) to increase his perceptual awareness of the incident and of the feelings and peripheral components involved. Using Ericksonian trance phenomena and metaphorical language, I presented V. with the metaphor of the 6 days and 6 nights God made the world and on the 7th day he rested. I used this to associate with the 7 years of the marriage, now being the time for him to rest and let go of the feelings of anger and guilt manifested in a situation of punishment of his wife and himself. V. indicated he was ready to give up his anger and move forward in life.

I obtained V.'s permission to utilize a three-part dissociation for the purpose of releasing and achieving mastery over his feelings of guilt and anger. At my suggestion, and for reasons of empathy and cognition, the patient agreed to have his wife present during the procedure. The session proceeded with his wife seated in a chair perpendicular to where he was sitting so she could observe him very closely. Without using a formal induction, the following suggestions were presented to the patient:

'What happened 7 years ago happened to just a part of you. It did not happen to all of you, just a part of you. And that part needs the help of other parts of you in order to achieve some new learnings. Focus on that part as though it were a picture before you now, and you are viewing it from a distance, V. Let's call him your Younger Self. See your Younger Self way in the distance, V., just prior to learning of the incident of 7 years ago. Really see how he looks. Now, V., another part of you is sitting comfortably in this chair, knowing that I'm next to you (I took his hand). Allow my hand to give that part of you, here in this chair, additional support (the hand is also used as an anchor) and comfort. Let's call this part your Adult Self, and your Adult Self can use all the strength and solidarity of his adult manhood, as well, to assist that Younger Self in the distance before you, O.K.?

All right, now allow another part of you to drift or float out of your body to somewhere behind you near the window. That observing part we'll call the Watching Self. And that Watching Self can see you here with me as you, in turn, watch that Younger Self, the self of 7 years ago, reexperience those feelings of rage and anger as that part of the past reexperiences that occurred so many years ago. Really allow that part to experience those feelings again, along with the occurring sights and sounds, as though a movie of that incident were being shown. And the Watching Self is watching you here watching that Younger Self way in the distance.'

In response to the procedure, V.'s body language revealed that the child ego state had returned to the scene of 7 years earlier, and he had an intense abreaction for about 20 minutes. Finally, the patient indicated by way of a very deep sigh that he had completed the affectual experience, at least for the moment. I then asked him to have his confident and strong Adult Self thank the Child Self for having relived in all its intensity and for the last time the dreadful experience which prompted his anger. Having accomplished this, I requested that he reintegrate the dissociated parts, one at a time. I also instructed him to allow his observing ego to transfer into a Creative Self in order to assist the Child Self in finding a more positive outlook for this self and for his marriage, based on, perhaps, love, nourishment, joy, or whatever aspects it chooses now that the child ego state has released the feelings of the past.

The patient left the session expressing his fulfillment and wishing no further discussion of what happened in the session at that time, saying that he needed time to integrate the experience into his total realm. At the next session, one week later, V. reported that he had accomplished a complete release of 7 years of negative feelings toward his wife. His wife reported a never-before-realized understanding of him and the feelings he had experienced for so many years. She also reported a significant change in their home life, in that he, for the first time in their marital relationship, appeared to have an interest in her welfare and that of the children. He was communicating with her and she felt the desire to return that communication. There was a deepening of feelings of love, never before encountered by either of them; even their young children had commented on the change in the household. Supportive therapy continued for six additional sessions, focusing on aspects of the same situation.

This case illustrates a situation of "controlled dissociation" (Sanders, 1986) and regression in the service of the ego to release feelings in that past dissociated slate (Spiegel, 1978) and to accept the essential content of that state; that is, the wife's affair and the patient's reaction to it. During a follow-up phone conversation 9 months later, the patient confirmed that the therapeutic effect of the three-part dissociation was indeed a breakthrough and positive turning point in his life and for his family.

Case 2

R., a 23-year-old Caucasian male, came to therapy when his wife called for an emergency appointment. The two had recently married and he had embarked upon a new job. His presenting complaint was "panic attacks." He had no history of treatment for either psychological disorder or physical condition.

At the initial interview, he appeared agitated and fidgeted in his chair. He reported running around the streets of his neighborhood aimlessly for one to two hours at a time and sometimes repeated this behavior at intervals of 20 minutes. These episodes were coupled with motor tension, difficulty in concentrating, and continuous worrying and rumination. It appeared that he was having great difficulty in adjusting to a multiplicity of life stressors, marriage and disengagement from his family of origin, as well as adapting to a new job environment. The initial diagnosis was Adjustment Disorder with Anxious Mood (American Psychiatric Association, 1987).

Although R. had manifested a loss of control over his environment, his reasoning appeared intact and there was no sign of amnesia. He appeared to be providing "... protection for his immediate problematic situations by a loss of control over his state of mind" (Spiegel, 1986). By dissociating from his new environment, that is, marriage, new job, disengagement from parents, it was evident that R. was expressing organ language (Cheek & LeCron, 1968) by "running away from his problems."

Immediate treatment of symptoms by crisis intervention was in order, and the methodology chosen began with a hypnotic induction with suggestions of "comfort." I then used anchoring followed by a three-part dissociation to reintegrate and re-frame the ego state which had heretofore caused the maladaptive behavior, that is, running from his problems.

R. was asked to experience comfort, because he had experienced comfort before and he could experience that feeling again. When I requested that he go back in time to a period in his life when he had experienced feeling in control, he was unable to do so. I then asked if it would be all right to experience the symptoms again. Having agreed to that, he accessed the experience of having an anxiety episode and became so agitated that he got up and began running back and forth the length of the office. I asked him to return to his chair and to allow the here-and-now self to watch, as in a movie, a part of himself continuing to run while he sat there observing the scene. I placed pressure on his left knee as he accessed the running experience. I then asked him to experience the ideosensory modalities with the following:

'Now look carefully at that part of you, R. Really view that R. as he runs clown the street. Just concentrate on him and the surrounding environment. Can you hear the sounds of his feet on the pavement? How about the "sounds in his head," his internal voice? What are his feelings as this is occurring? Really let him feel those sensations.

His present self focused on the other self in that situation for awhile as he appeared agitated and frightened. After a lapse of time, he appeared to have completed the experience as his body relaxed along with a deep sigh and a readjustment of his posture.

I then asked what causal factors might have resulted in a different kind of experience for him. He answered: "If only the boss hadn't yelled at me, if only my wife hadn't dropped the silverware on the floor, and if only there were no arguments at my parents' house during Christmas dinner."

After explaining to R. that all the aforementioned were examples of external cues, he was then asked again how he might have coped on these occasions by utilizing his powers within. At a cognitive level. and after much prompting, R. realized that feeling confidence and self-esteem, communicating his feelings, manifesting independence, separating himself from the behavior of others, and defining his inner boundaries to develop and maintain control and perspective in dealing with the actions of others could lead to different results.

I then asked the patient to access a period of his life when he experienced some of these aspects. He could not do so. It appeared that his life was indeed one of having been totally controlled by others. I asked him to imagine a picture of a person demonstrating these qualities and then asked him, after some time, to step into the picture and be that other person (Bandler & Grinder, 1979):

'This time, R., view a movie of someone manifesting confidence and self-esteem. Notice how he looks. Turn up the brightness on your picture and see that person in bright, clear colors. Notice his posture, his stance, the assured look on his face, the way he moves. Watch him in a crowd. How do you think he feels about himself? What is he saying as he communicates with others? Now step into that picture, R., and be that person. You are in a new world . See yourself, a bright, intense picture of you. What are you feeling? Do you have any internal dialogue? Are you smelling or tasting anything special? Can you hear what is happening around you? What does your voice sound like as you communicate with the others?

As R. did that, the self-picture was anchored by applying pressure on his right "resource" knee, allowing him to experience the feelings, sights, and sounds inherent in that picture, at the same time giving him a method for accessing the inherent resources by way of the anchor. Using both anchors simultaneously, the constructed picture was then paired with one of the anxiety episodes by applying pressure onto both of the patient's knees.

I told the patient that he did not need to bring forth the whole picture, just the confidence, the self-esteem, the assertiveness, and whatever resources and feelings were within and superimpose them on the present-day problematic situation, following several moments of intensification of this pairing experience, the patient indicated that the personal attributes he had bestowed upon himself had carried over to his internal representation of the problematic situation causing a more positive outcome. I then asked the patient to access, one at a time, the same external cues or stimuli which led to each of his difficult situations and give each one a title. The titles became 'Fight With Wife," "The Boss's Anger," and "Christmas Dinner Chaos." The resource picture was then paired with each one of these. The patient reported a different result subsequent to anchoring each one of the three situations.

I then asked R. to imagine a time in the future which may have in the past generated stress. Because of what he had learned during the session, this future hypothetical situation was to result in a positive experience for him, one in which he utilized capabilities he had never previously realized. The resource picture and original situation were again anchored, and then the anchors were released, while the patient completed experiencing this association on his own. I encouraged him to include the use of all his sensory modalities.

He then experienced a three-part dissociation with R. watching his Younger Self going through an anxiety episode for the very last time. R. responded with agitation and a flow of tears as his Younger Self completed that difficult experience. R. experienced no further episodes of hyperactivity after that initial session and his anxiety was significantly diminished. He remained in therapy for 7 months during which time we explored the origins of his anxiety, the inability to express his feelings, and the relationships with his wife, job, and family of origin and worked them through. Ideomotor questioning using the seven keys to symptomatology (Cheek & LeCron, 1968) assisted in the uncovering process. A significant factor in his behavior according to the patient was that neither he nor his sister was allowed to express themselves, either verbally or by
way of showing feelings, in the home environment.

At the completion of therapy, the patient felt in control of the various aspects of his life, including his relationship with his wife and functioning related to his work. He had disengaged somewhat from his family of origin. Follow-up at 3 and 7 months revealed no recurrence of the episodes of hyperactivity.

Discussion

Coupled with effective support from the therapist, the techniques of anchoring and three-part dissociation are useful for crisis intervention and the completion of unfinished business. These NLP paradigms incorporate the concepts of ego-state therapy and that of adaptive regression in the service of the ego. Leaving the patient with an anchor allows him immediate access to his inner resources to cope with stress provoking situations. Where the underlying motivation for the maladaptive behavior may be particularly traumatic for the patient to review, the three-part dis sociation technique provides an effective method for the patient to deal with that episode from a remote vantage point and thus avoids further possible damage to the ego. There is no need for discovery related to either hidden ego states or archaic stressors until after the patient's presenting symptoms have been relieved. At that point, the reduced level of anxiety, depression, and/or other symptomatology facilitates definition of the causative factors in subsequent therapy.

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Dr. Field is a Diplomate of the American Board of Medical Psychotherapists (ABMP), the American Academy of Pain Management, and an Approved Consultant of the American Society of Clinical Hypnosis (ASCH). She is the Founding President of the Los Angeles Academy of Clinical Hypnosis, a component society of ASCH and has presented at many conferences worldwide. She is a licensed psychologist, licensed marriage family therapist and hypnotherapist in private practice in Tarzana, California. In addition to presenting her own seminars and lectures around the world, Dr. Field has taught at UCLA and has developed and administered continuing education for health professionals at California Lutheran University. She is on staff at the AMI Encino Tarzana Regional Medical Center and co-author of The Good Girl Syndrome, published by Macmillan. Dr. Elly Field's web site is http://www.doctorelly.com