An introduction to NLP for clinicians
Although I described Neuro-Linguistic Programming (NLP) and The Stages of Change in previous articles, I’ll review them briefly here. Then, I will discuss a hypothetical scenario in which NLP techniques are applied with a client experiencing problematic behavior.
Continue reading to learn more, and join us for Q&A in the comments section at the end of the page. We welcome your questions and try to provide personal and prompt answers.
What is Neurolinguistic Programming?
Neurolinguistic Programming examines the fundamental dynamics between the thinking processes (neuro) and the words (linguistic), as well as how their interaction affects behavior (programming).
- communicate externally and internally
- process, store, and recall information
- alter communication to achieve desired results and goals
Practitioners believe human beings have an extraordinary capacity for flexibility, and there is nothing that happens mentally or spiritually they cannot learn to handle. The focus is on how a person formulates his or her thoughts and beliefs; those which maintain behavior and those which create change.
It is my belief that counselors must assess and understand a client’s willingness to change as they counsel him or her. The Stages of Change model assesses this willingness.
The Stages of Change Model
The Change Model applies to a broad range of behaviors such as weight loss, injury prevention, and addiction. Proponents of the model believe people don’t change in a single step; rather, they progress through different stages at their own rate. So, expecting behavior to shift by having a client attend “x” number of AA meetings in a certain time period, may not be effective.
Relapse can occur at any stage of change
Relapse to a prior stage can occur at any time during the process. For example, a person in the Action Stage may revert to the Contemplation or Pre-contemplation Stage. There is a need to continually evaluate a client’s level of willingness.
The following case will demonstrate one way to use NLP strategies work with a resistant teenager.
Hypothetical case with a teen client experiencing problematic e-cigarette use
Chris is a 15-year-old high school student who was referred for counseling by the Resource Officer at his high school. He and five other students were caught vaping in the parking lot.
Vaping is the act of inhaling water vapor through a gadget such as an electronic cigarette. The electronic cigarette is a handheld device that vaporizes a flavored liquid typically composed of nicotine, propylene glycol, glycerin, and flavorings. As the user inhales, a battery heats the liquid, which is atomized into a breathable vapor. Over the past year, Chris has become highly dependent on the nicotine and the vaping has caused several side effects. Side effects include the worsening of his asthma. While it may not be illegal for a 15-year-old to vape, the school has a zero tolerance for drugs on campus, hence the referral. The initial session began typically.
Five components of a typical first session
- Build rapport. To observe eye cues and listen to predicate phrases help identify and match a client’s primary representational system. Matching helps build closer relationships.
- Assess for willingness to change using the Stages of Change Model. A client who is not ready will resist all efforts to effect such a change.
- Identify the positive intent of the behavior. Once the positive intent is known, healthier options can be examined.
- Complete the Outcome Specification and Logical Levels exercises. This information provides a clear understanding of what a client wants to achieve and where best to intervene. It also helps develop a purpose-driven course of action.
- Ask Meta Model questions. These questions help transform problematic vagueness.
This approach is not set in stone and sometimes, as you will see, the components must be adjusted to meet the client’s needs and the situation.
Deciding on where to intervene
In talking with Chris, I quickly realized he was in the Pre-Contemplation Stage according to the Stages of Change Model. He saw no problem, thought the cop was a jerk, and was only meeting with me, an Addictions Counselor with NLP training, because he was forced.
My first task was to build rapport with Chris. He would not make eye contact, so; I listened to his predicate phrases as a way of determining his primary representational system. Phrases such as “I want to look cool,” and “I see others vaping,” led me to use visual words as well. I also matched the soft and hesitant tone and pace of his speech. Fortunately, he was an avid hockey fan, and because I knew a little bit about hockey we were able to begin a conversation.
After a period of time, I had an opportunity to ask Chris about vaping. I asked him how it worked, what it felt like, and how he got started. From that discussion, we moved into the Logical Levels exercise. My goal was to determine the best place to intervene.
The Logical Levels Exercise and Chris’s responses
1. Environment Level – Refers to what is around the person when the behavior occurs.
Chris: I vape when I am out with a group of guys or around girls.
2. Behavior Level – Refers to what the person does.
Chris: I smoke electronic cigarettes.
3. Capability Level – Refers to what a person is able to do.
Chris: I can afford e-cigarettes. They are safer than cigarettes. I look “cool.” Vaping is not illegal. It’s no big deal.
4. Belief Level – Refers to what a person thinks he or she can or should do.
Chris: The only way I can fit in with other kids or get a girlfriend is to do what they do.
5. Identity Level – Refers to what a person thinks of him or herself.
Chris: I am kind of a nerd and girls don’t like me very well. In fact, no one really likes me.
I decided to intervene at the Belief Levels. If I could change his thinking at that level using Meta Model questions, his behavior might begin to change, as well. For example:
……………….Chris: “I am kind of a nerd.”
……………….Counselor: “According to whom?”
……………….Chris “No one really likes me.”
……………….Counselor: “No one?”
……………….Chris: “The only way I can fit in.”
……………….Counselor: “Really, the only way?”
……………….Chris: “Girls don’t like me very well.”
……………….Counselor “All girls?” and “How do you know?”
The Meta Model questions began to weaken his beliefs.
Chris said the positive intent of the behavior was to fit in. The guys he wanted to “hang with” were vaping and he wanted to be part of the crowd. He also really wanted a girlfriend and vaping made him look “cool.” This information became the basis for the Outcome Specification Process.
The Outcome Specification Exercise and Chris’s responses
1. What do you want?
CHRIS: I want to have friends. Guys to hang out with and a girlfriend.
2. How will you know when you reached your goal?
CHRIS: When they call me or ask me to go places with them.
3. Why is your goal relevant and/or irrelevant?
CHRIS: The goal is relevant because it is important to have friends. Life sucks otherwise.
4. What stops you from pursuing your goal wholeheartedly?
CHRIS: I am a dork and I don’t know how to make friends.
5. What personal resources can you use to help achieve this goal?
CHRIS: I haven’t a clue. I vape.
6. What resources will you need to achieve your goal?
CHRIS: I don’t know – not be me.
7. How will the goal affect important people in your life or is there any risk associated with achieving this goal?
CHRIS: My parents would be happy because they worry about my asthma. The Resource Officer would get off my “butt.”
8. What daily actions would you need to take in order to achieve your goal, and what is the first step?
CHRIS: I don’t know.
9. Given everything you have considered to this point, is achieving the goal worth it?
CHRIS: Sure, everyone wants friends and to have a girlfriend, but it wouldn’t work. There is nothing I can do to change things.
It seemed as if Chris’s negativity and discouraging thoughts were very strong, so, I decided to move him to a more positive frame of mind. This seemed possible using the Default Mode Network (DMN) exercises.
What is the Default Mode Network?
The Default Mode Network (DMN) is an internal network in the brain that continually generates a wealth of mental activity and body tension. When the “task-oriented” brain is not focused on solving a problem, the DMN works overtime. While it does not filter information or attempt to protect a person in any way, it does generate endless mental and emotional data, as well as negative and scary thoughts.
To disengage the DMN, we used two NLP forms: the Stressor Map and The New Awareness Map. I asked Chris to write the phrase “Making Friends” at the top of the Stressor Map and to record thoughts that came to mind. He wrote the following:
- I can’t.
- I won’t ever get a girlfriend.
- Vaping is better for me than cigarettes.
- Other kids just don’t like me.
- The only way to make friends is to vape.
- I really don’t like vaping.
- Vaping makes my asthma worse.
- I have never had a good friend much less a girlfriend.
- I get so bummed.
- Everything I tried hasn’t worked.
- What’s the use?
- They always laugh at me.
- I don’t know how to talk to girls.
After he completed his list, I instructed Chris to look out the window and focus on the movement of the trees. This external stimulus created a break state and cleansed his mind. Then, I asked him to write the phrase “Making Friends” at the top of the New Awareness Map and to record everything that came to mind. Chris was surprised to find he had a very different set of thoughts. His responses were as follows:
- She is willing to help me, maybe that would make a difference.
- What have I got to lose?
- I know that vaping isn’t good for me.
- Maybe I could find something else to do rather than vape – but I don’t know what.
- I do have a couple of friends, that’s a start.
- I really want to have a girlfriend.
Now, he had moved to the contemplation stage, he was aware of the problem and was beginning to think of changes to make. I then asked Chris to humor me and play a little game based on the NLP strategy titled the Six-Step Reframe. My goal was to generate options that he might consider.
Chris’s responses to the Six-Step Reframe
1. We identified the problem behavior as using e-cigarettes.
2. The positive intent was to make friends. He really wants a girlfriend and admits this is the only reason for participating in these exercises.
3. I asked “If there were other ways of accomplishing this positive intention, would you be interested in discovering them? He said “I guess so.”
4. Together, we brainstormed ways to accomplish the positive intent other than vaping:
- Learn communication skills
- Build confidence
- Role-play conversations with friends
- Have interesting things to talk about
- Learn to say “no” without losing a friend
- Play sports
- Have something different to offer
- Get a coach
- Learn management skills
- Go to his doctor to help him with any physical addiction symptoms
5. The three choices Chris picked were to learn communication skills, build confidence, and practice conversations. So, we agreed I would coach him on those choices and he would go to the doctor for help with any physical symptoms if or as he decided to decrease his e-cigarette use.
Chris had moved into the Preparation stage of the Stages to Change model; he intended to take action. We committed to three more sessions. After completion of the three sessions, we agreed to assess whether or not the counseling was helpful and whether or not he wanted to continue. Before he left, I taught him three NLP strategies: anchors, dissociation/association, and building rapport. My goal was to give him tools to immediately begin building his confidence.
Anchors are stimuli that trigger specific physiological or emotional states or behaviors – an automatic reaction to something. They can be created intentionally (by pinching the ear when feeling very confident, so that pinching the ear triggers the desired feeling as needed.)
Association and Dissociation
A memory or emotional state can be accessed from within (association) or as an observer (dissociation), and both are useful. When a person wants to capture an effective way of being, such as feeling confident, recalling a time when he or she experienced confidence can enable a reproduction of the feeling in the present. Conversely, when the goal is to put distance between self and an unpleasant memory, viewing it in a disassociated way (as if watching a movie) helps lessen the emotion.
To observe eye cues and listen to predicate phrases helps to identify and match another person’s primary representational system. Matching helps build closer relationships as I discussed in building rapport with Chris initially.
This is one way to get started with a somewhat resistant teen. However, there are many other possibilities utilizing NLP strategies.
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