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Therapy Related Articles & Notes

When the PROBLEM IS SMOKING

This article is a response to a letter in the NCHP&HR Journal from Edward John McClurg. The parenthetic remarks in the article have specific relevance to Mr. McClurg, a tutor in Quality Management Systems, though others may find them illuminating.

I AM NOT GOING to describe a technique for dealing with smokers so much as a methodology: the broad lines of my approach. It should be clear as you read on why this is so.

In dealing with a smoker my first assumption is that I am dealing with at least two systems. One, which is usually the greater, is the part which has determined to stop smoking. The other is the system which is controlling the smoking.

(A business parallel is to take the former as an enlightened Management who has determined to implement a new BSI standard, and the latter as a department which is stubbornly sticking to the old "tried and trusted" ways.)

My first job is to ASK THE RIGHT QUESTIONS - a task I emphasised in my article on Diagnosis. I cannot make intelligent changes until I know the answers to the following questions. (The equivalent managerial questions are in brackets.) The order is not significant.

* How does it feel when you want to smoke, and how does it take place? (Could you introduce me to the department that is giving the trouble?) These stand for a whole string of questions directed at getting a firm idea of the smoking subsystem (the problem department) that has somehow to be changed.

* A further question on these lines is: Is the subsystem based on ideas, feeling or habits? I.e. Is it more like a voice saying, "You need a cigarette", or a feeling of needing one, or simply an habitual action. (Is the subdepartment acting according to rules, or on gut feeling or on sheer force of habit?)

* How have you tried to stop? (How have you tried to implement the change?) It is obviously helpful to try to discover what has been tried and WHY is failed.

* What are the advantages of stopping? (What are the advantages of implementing the standards?) This question must be asked of the non-smoking will and also the smoking subsystem (Management and the recalcitrant workforce.)

* What are the advantages of continuing? (What are the advantages of not implementing the change?) Again ask both parties.

It is possible that you will only get honest answers from the smoking subsystem in a trance. (You may only get an honest answer from the workforce when you have their trust and the Manager is not breathing down your neck.)

* How and why did you start smoking? (How and why did the current work practice originate?)

* What do your family/friends feel about the smoking? (How is the key department affected by outside pressures from other businesses etc?)

The above are simply a selection of the more central questions. I also devote time to getting to know other things about the person. Of particular importance are their interests, professions etc, because you can put things over much better if they are related to things they know about. (Just as I am trying to put the ideas in this article over in a way which I hope will mean a lot to Mr. McClurg, as a tutor in Quality Management Systems.)

Broadly speaking, you know the most important things about a person if you know the things to which they will respond, and how they respond. It does not matter if the response is favourable or unfavourable. Things they do not respond to are irrelevant in any brief therapy. (The important thing about a company or department is the things they respond to and how.)

There is a world of difference between a pregnant woman stopping smoking for her baby and an aggressive businessman stopping for his own health. Their minds are very differently organised; their motivations are very different; the similarity of goal conceals an enormous difference in the tasks.

(There is a world of difference between changing things in a company like The Body Shop and changing things in Saachi and Saachi. Their managerial structures and styles are very different; their motivations are very different: the similar goal of applying a certain standard conceals an enormous difference in the tasks.)

Only when I have spent at least half an hour on this preliminary task do I begin work. As I have been going along I have, of course, been noting down promising lines of approach. And many of my questions will have been devoted to checking out whether these will work or not.

(Only after a detailed study of the organisation and the problems involved in the company will a consultant begin to make recommendations. But he has been noting promising lines as he goes on, and many of his questions have been devoted to clarifying or eliminating these options.)

Discussion
I will then discuss what steps the client is able to take without needing much help. (Find out what the Management might be able to implement easily without much help.) Often there are obvious things which have been overlooked: for example suppose that a person smokes by habit in the toilet only since an ashtray has been installed. The removal of the tray will stop that part of the habit easily.

In many cases the bulk of the task lies in this area of things that can rather easily be changed by conscious effort, if you know how. (In many cases most of your changes are to management style rather than to the actual functioning of a particular department.)

Notice that there is no ONE piece of advice. Each person may have failed to notice a different specific point that could easily be changed. Erickson once noticed that a retired policeman always bought his cigarettes from a store next door. By getting him to agree that it would be better to walk across town to buy them he reduced the habit enormously. But it is unlikely that this specific technique would work for many clients.

Induction
I seldom waste time on inductions which focus on some irrelevant subsystem such as hand levitation, eye closure, formal relaxation etc etc.

(As a consultant I seldom bother to make changes to any systems other than those centrally involved.)

I will begin with a theme of great interest. This may well be smoking itself.

Just lie back comfortably, close your eyes, and start to think as vividly as possible about wanting a cigarette.

I will then ask detailed questions as the client goes through the whole process of smoking a cigarette, to hold his or her attention on the process.

On the one hand this gives great insight into the attractions of smoking - the only pleasure for one woman was the sight of the smoke in front of her eyes. On the other hand you will find it acts like any other attention focussing induction. All other subsystem close down; relaxation ensues; there is total absorption in the functioning of the internal system of smoking and the hypnotists voice; that subsystem opens up in the face of my non-judgemental questions.

(Just let the rest of the company have some time off, and let me just watch the way in which this particular department functions at present. The consultant then watches and asks questions. On the one hand he finds out in great detail what is happening at present. On the other hand he is at the same time getting the company functioning in a way which makes it easy to change. The subdepartment is listening to him; it is not distracted by messages from all other departments; it begins to open up and trust him.)

This stage may go on for five or ten minutes (five or ten hours) or longer.

I next start to make suggestions. (The consultant then starts to make recommendations.) My preferred style is not to use the bludgeon, but to put things in a way which seem perfectly natural to the particular systems I am working with. It is for this reason that there is no one way. For example, with a pregnant woman it is often very easy to get her to visualise the face of the unborn baby: this activates a very powerful system of protection for her child. When she thinks of smoking, the baby's face cries. When she stops, it laughs. You may repeat this several times. This "technique" obviously is quite unusable in a businessman.

(It is generally better, wherever possible, to get a consensus rather than to use brute force. There is no one recommendation that applies in all cases. In one subdepartment money is a powerful motive, in another it is job security, in another is may just be that intangible, morale.)

In practice, then, I never make the same suggestions twice in the same language: everything is subordinated to the overwhelming importance of the unique personality structure of the present client. (If I were a consultant I would never trot out standard recommendations: everything has to be tailored to the overwhelmingly important fact that each company is distinct.) I may use metaphors and images, evoke physical sensations such as nausea; represent true facts graphically: watching two drops of pure nicotine killing a labrador in five minutes makes a vivid picture, as does the fact that tobacco leaves make a good substitute for toilet paper in countries where it is grown; regress the client back to the time of starting to smoke; evoke feelings of love - for members of the family harmed by the smoke; arouse feelings of pride or ambition; use a desire for a clean house which may be linked to the idea that the body is a house for the soul; intensify a desire for a holiday or other good that can be saved for with the £700 or more that is going up in smoke each year and so on. To list all these "techniques" in detail would take up many volumes, even if I were simply to present a single script for the main line, let alone go through all the variations which are involved in modifying such a script to fit a wide range of subjects.

Tying it up
Towards the end I will normally incorporate a suggestion on the following lines.

You will be healthier, wealthier and wiser as a non-smoker. But it will not necessarily make you perfect. No-one is perfect. Anyone can make a slip. Neither of us can be certain that at some time in the future, near or far, perhaps at a party or time of uncommon stress or illness you will not find yourself tempted to smoke another. And it might well be that it would be the best thing to do at the time. All I want you to remember at that time is the thought: "YES, I CAN HAVE THIS IF I CHOOSE, BUT IT WILL COST ME AT LEAST £30!" (My standard fee in 1994)

I will generally talk a bit more about the above, pointing out that most people, if they start again, rapidly return to previous levels of smoking which will cost far more than the £30 another session will cost (£20 if on reduced income).

The purpose of this section is two-fold. The first is that the thought itself is a great deterrent. Few people would ever pay £30 for a cigarette. The second is to motivate a quick return to me, which will make stopping again much easier. There is commonly a feeling of guilt at failing, or a feeling of letting the therapist down, or a feeling that he could have been expected to give life-time cover: these are counteracted by the above.

Furthermore I very much want to know about anything that does go wrong, so that I can perhaps get it better next time. Failures are far more important than successes. Anyone, with any technique, can get some successes but you only improve by minimising the failures, which means making it as easy as possible for them to come back to you if they start again.

SUMMARY

1. Find out as much as possible about the two primary systems of interest, and all other systems, internal and external which are involved. (Study the business and its economic environment in detail.)

2. Decide on a strategy of changing these systems, based on their real nature in the individual, not on some abstract idea. (Plan realistic changes.)

3. Discuss and arrange changes which can be made at the level of conscious will. (See what can be done with the Management.)

4. Induce a trance which is tightly related to the smoking subsystem. (Get to talk to the problematic department.)

5. Implement the planned changes at that level also. (Change working practices there.)

6. Tie it up with suggestions of return if there are problems. (Arrange for further contacts if there are problems.)

* Throughout look for as much feedback as possible. (Ditto.)

Ecologically sound
Finally I would like to highlight my overall philosophy in hypnotherapy, which may throw light on the overall approach I have used above.

We all know of ecological disasters resulting from introducing, perhaps for good reasons, a new species into an ecosystem.

We may all know of instances where a new work practice or rule or law, introduced for a good reason, has had dismal consequences.

We all know how a person's personality may suffer from the undue influence of parental or other ideas which do not suit the person concerned.

HYPNOSIS PROVIDES POWERFUL TOOLS FOR INTRODUCING NEW SYSTEMS OF THOUGHT, FEELING OR BEHAVIOUR INTO THE COMPLEX SYSTEM OF THE HUMAN MIND. IT MUST BE USED WITH THE UTMOST RESPECT FOR THE EXISTING SYSTEM.

I am dismayed by hearing of hypnotists who forcibly slam into a mind powerful suggestions with no regard for their compatibility or otherwise with existing thoughts or patterns. I am as dismayed by the thought of removing a smoking habit by means of a forceful repression as I would be by the thought of dealing with a difficult workforce by simply locking them up in a room. Each may seem to work brilliantly in the short-term, but could have dire long term consequences.

Ideally I am striving to attain a sufficiently complete knowledge of all relevant workings of that system which is the client in front of me AND the even more complex social system of which she or he is a part, so that any changes that I make are in harmony with those systems while also being viable and able to flourish there. (I am striving to attain a sufficiently complete knowledge of all relevant departments of the business I am helping AND the even more complex network of business connections and the economy as a whole, so that any changes I make will harmonise with what is there while also being viable long term.)

That is what I mean by holistic, or ecologically sound, or simply doing a good job.

Reprinted from The Journal of the National Council for Psychotherapists and Hypnotherapy Register, Spring 94. (with the Authors permission)