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- Herausgeber: Hammersmith Health Books
- Kategorie: Ratgeber
- Sprache: Englisch
- Veröffentlichungsjahr: 2015
This is the second edition of this highly respected introduction to Medical Neurolinguistic Programming, which remains the official handbook of the Society for Medical NLP. Based on the work of Dr Richard Bandler, Medical NLP has developed to become a discipline in its own right, guided by Garner Thomson. Revised and updated throughout, significant new sections have been added on: priming, breathing, heart rate, sleep, relationships and cancer, and lifestyle diseases. This is a key resource for all health practitioners who want to understand and improve the effects of what they communicated, consciously and unconsciously, to their patients/clients.
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Support for the second edition
‘This second edition of Magic in Practice is a remarkable achievement. It is a dynamic, highly readable, well-referenced, practical guide to using Medical NLP in consultations, brought to life through the inclusion of numerous and wide-ranging fascinating case studies, all rooted in real life practice.
‘It incorporates new and exciting material drawing on the latest findings from neuroscience and also on the experiences of a vast range of healthcare professionals who are further developing the applications of Medical NLP in their work.
‘Since being trained by in this field more than a decade ago, I have used Medical NLP skills on a daily basis in my clinical work as a way of creating more powerful, rewarding consultations with patients. This new edition of the book is already energizing my work further, inspiring me to develop my skills to another level.’
Dr Arti Maini, General Practitioner, London, UK
‘I would say the first edition of Magic In Practice gave us tools to better look after our patients and improve beyond the bare numbers. This second edition moves the game on, using better and more powerful concepts. Every healthcare professional should read this.
‘We are in a position of great privilege where the needy seek our help. We owe it to them to maximize our impact on their wellbeing. For any treatment to work, one needs the patient to have belief that the intervention will work.
‘These tools have made a big impact both clinically and beyond in both my professional and personal life. The more naturally they are used, the more effective they become. Since becoming a doctor, they are the most useful skills I have learnt. To improve oneself is a time-limited choice, so use your time wisely.’
Dr Khalid Hasan, Consultant Anesthiologist, Birmingham, UK
‘Ever since I first attended a Medical NLP course run by Garner, I knew that his approach to wellbeing would change the way I practice.
‘I have worked as a consultant psychiatrist for many years and can truly say that his approach has helped me become a holistic therapist in every sense of the word…. I approach my patients in a completely new way and ‘listen’ to them in a way I never imagined possible.
‘I was so pleased to see a second edition of Magic in Practice. It is a well-crafted, clear and informative companion to my everyday practice.
‘It will undoubtedly change the way you work and the way you ‘see’ your patients. The way you approach health, healing and ‘dis-ease’ will become richer, and the way you help your patients will never be the same.’
Dr Leon van Huyssteen, Consultant Psychiatrist, London, UK
‘One of the most exciting things for me as a physician is to see patients I have been treating for years have their lives transformed using the techniques described in this book.
‘They are now far too busy enjoying life to come and see me and I am so grateful to Garner for equipping me with the skills to do this.’
Dr Liz Croton, General Practitioner and GP Trainer, Birmingham, UK
‘The authors are shamefacedly altruistic in this second edition where their personal insights and sensitivity to the experiences of patients and clients are neatly woven throughout the text.
‘The healing value of Medical NLP to the patient, client and practitioner is articulated in such a way that the reader wants to learn more, develop skills and an array of tools they can access during any consultation or meeting to enhance the patient/client experience.
‘Many of the tools discussed within the book have wider application: the support of anxious learners and novice practitioners, and, as such, the book should be on the reading list for all those involved in care of others who are keen to ensure the wellbeing of those they care for and optimize their own ability to be effective and sensitive care givers.
Sandra Bannister, Director of Undergraduate Programmes, School of Health Sciences, University of Stirling, UK
‘This excellent and thought provoking second edition of Magic In Practice explores, among other things, the paradox of seemingly increasing ill health, or at least the reduced sense of well-being, despite the impressive technological advances made in medicine.
‘Although remarkable progress has been made in our understanding of, and the ability to manipulate, the genome, the metabolome, the microbiome etc, many people’s illnesses and symptoms leave the medical profession baffled. The authors explore the underlying causes of this phenomenon and offer practical solutions.
‘It is an impressive piece of work, exploring and linking the mind, the body, their interaction and encompassing a study of human behaviour in relation to health outcomes. This book is an essential read for anyone involved in healthcare, and will benefit the patient and practitioner alike.’
Dr Shahid A Khan, Consultant Physician & Adjunct Reader, Director of Clinical Studies, St Mary’s Hospital, London, UK
Those who say it can’t be done should not interrupt the person doing it
–Ancient Chinese proverb
Magic in Practice
Introducing Medical NLP: The Art and Science of Language in Healing and Health
Garner Thomson withDr. Khalid Khan
Introduction byDr. Richard Bandler Co-creator and Developer of Neuro-Linguistic Programming
Second Edition Revised and updated
Contents
IMPORTANT NOTE
All diagrams, models, patterns and quotations relating to Neuro-Linguistic Programming (NLP)—including, but not confined to, the NLP information-processing model, eye accessing cues, submodality distinctions and phobia cure pattern—appear in this book with the express written permission of Dr Richard Bandler. This, and any other information relating to NLP and Medical NLP, may not be reproduced in any form whatsoever without the written permission of Dr Bandler, the authors and The Society of Medical NLP, whichever is appropriate.
Acknowledgments
Many people have contributed to both editions of this book in a variety of ways—but none more so than Dr. Richard Bandler, without whom it, quite literally, would have been inconceivable. His insight, intellectual honesty and wisdom have combined to create one of the most significant tools for human development in the past century.
Apart from his work, which continues to inspire our own, we are hugely grateful for the support and encouragement he has given to the foundation and development of The Society of Medical NLP. The number of doctors, students, and allied health professionals who have had the opportunity to experience and advance the power and potential of this extraordinary technology and to pass on the benefits to their patients is growing, and will, we hope, continue to do so as the years go by.
We thank those many doctors, students, and allied health professionals who have entrusted us with their training, and we applaud their courage in seeking to explore beyond the edges of their known maps. The discoveries and experiences they report back to us are a constant source of inspiration and delight. We are delighted to feature some of their experiences in this new edition. Of special interest to us are those health professionals who, armed only with the information in the first incarnation of Magic in Practice, went out, tried some of the patterns for the first time, and achieved notable—sometimes extraordinary—results.
Our appreciation goes to those researchers whose work we cite in this book. While they have inspired us in our search for explanations for the theories and principles we discuss, and the mysteries of the body-mind system, human relationships, and health, we emphasize that any interpretation placed upon their work is ours alone. Our thanks, too, to those writers and thinkers who granted our requests to quote their words or reproduce their diagrams. To those who have not and were, for whatever reason, unable to respond to our requests, we would appreciate it if they contacted us so we can include credits in later editions.
We would particularly like to thank Georgina Bentliff who originally commissioned Magic in Practice for Hammersmith Press, and who has so bravely taken on this second edition.
Finally, thanks to Dr. Naveed Akthar for his tireless help and meticulous approach in helping to proof-read this edition.
Comments on the Second Edition
From the earliest stage of publication, we have been touched by, and deeply grateful for, the unstinting encouragement, support, and recognition Magic in Practice has received from the vast majority of readers.
Reviews have been consistently enthusiastic in both online and print media; the book has found its way onto the reading lists of various universities and medical schools and we have been interviewed, and positively received, by some of the most respected publications in the world. We have been invited to address mainline institutions on the subject of ‘the language of healing and health’, and the subject matter has been validated for a number of continuing professional development programs for doctors and other health professionals in the United Kingdom and abroad.
Then there have been those people who attended Society of Medical NLP trainings, and went away to use and develop the principles and techniques they learned into new and even more effective interventions. Their experiences in applying the material have given rise to exciting results that are far beyond our original hopes.
Finally, there are our real teachers—the patients and clients who come to us for help, who challenge us by presenting complex and often extremely mystifying conditions. By accepting the Medical NLP tenet that every patient is unique, regardless of how much they or their illness resembles someone or something else, we find ourselves constantly pushed to the limits of our own understanding and experience. That is where we have learned to sit back and listen, watch and wait, and, sooner or later, the inner logic of the patient’s experience often emerges to instruct us how to proceed.
This edition of Magic in Practice has been some time in preparation. Although it will be easily recognizable to those readers who know the first edition, much is new.
In some cases the emphasis has shifted. For example, where in the first edition we were hinting at looming disaster in healthcare, we now believe the crisis is upon us. An estimated one in 10 patients admitted to hospital in the European Union is a victim of medical error. A disproportionately large percentage (a further one in 10) of these accidents results in serious injury or death.1
Furthermore, according to a report by Dr. Barbara Starfield of the Johns Hopkins School of Hygiene and Public Health, medical errors are now the third leading cause of death in the United States, following cancer and heart disease.2
Some of the original chapters have been slightly edited to make them more self-contained, so the reader may dip in and out of the book according to her whim of the moment, while a number of sections have been added.
These include new chapters on priming; breathing; heart rate variability; cardiac chaos and coherence; and how a minor change in sleeping patterns can head off an abundance of health problems. Additional evidence is mounting that people’s perception of their situation is at least as toxic as whatever condition they might actually be suffering—a real wake-up call to health-providers to pay attention to how the patient thinks about her problem, not just to what the problem allegedly ‘is’.
Some of the scientific research has been updated, additional examples, anecdotes, and exercises have been introduced, and we have included new material on a number of topics, ranging from the stranglehold of ‘WEIRD’ science; the effect of relationships on the progression of cancer; ‘lifestyle diseases’: the West’s newest export to the emerging world; how medicine can create or cure disease by the definitions it uses; how exposure to media reports can cause or worsen physical conditions; and even how the color of a cigarette pack can affect the taste of its contents.
We also include a seven-step, evidence-based guide to reducing the risk of death from any of the major circulatory or respiratory diseases by more than a third. Finally, at the request of many time-poor colleagues, we have included sure-fire techniques to control the wandering consultation and improve patient satisfaction.
Our only request to the reader is that he or she approaches this new edition with an open mind. We say this: explore the contents, then try them out for yourself and see what works for you and your patients or clients. Feel free to contact us with your questions and experiences at: [email protected] or visit us on Facebook at: The Society of Medical NLP.
Notes
1.NPSA report: Building a memory: preventing harm, reducing risks & improving patient safety, London July 2005 p53.
2.The Journal of the American Medical Association (JAMA) Vol 284, No 4, July 26, 2000.
Foreword to the Second Edition
Dr. Richard Bandler Co-creator and Developer of Neuro-Linguistic Programming
I am so glad to write this introduction to the second edition of Magic inPractice by Garner Thomson and Dr. Khalid Khan.
People often ask me if I am proud of what I have done by co-creating Neuro-Linguistic Programming. The answer is, I don’t really think about it at all. I’m very proud of the effect it has had on the fields of psychology, education, sales training and business … the list goes on.
However, at the top of my list are the authors of this book who bravely entered the field of medicine to provide doctors with new, easier ways to view their own research and draw on skills that would help thousands of patients.
I believe by updating their book they are responding to those they teach in the same way they ask doctors and healthcare professionals to update their views on communication in general.
Everything can be done better … that is why I never stop. Hurrah to this second edition!!!!
Dr. Richard Bandler
2014
Foreword to the First Edition
Dr. Richard Bandler Co-creator and Developer of NLP
All I can say is: it’s about time. This is the kind of book I hoped one of my students would write. What Garner Thomson has done, with Dr. Khalid Khan, is to take my work further and, with great precision, present tools for healthcare professionals, while at the same time offering all those in NLP a solid understanding of how the technology of NLP works in the brain.
I have for years been very good at modeling successful healers, but have fallen short on providing the science. I have used Magnetic Resonance Imaging since it was available to understand the mysteries of the brain. Now, these gentlemen have gone so much farther. I say thank you—and recommend that any Neuro-Linguistic Programmer read this over and over and over.
It seems obvious to me that the more we know about the brain and how it works well, the better off we will be. And the two most important applications of my work will always be education and health. My work has been accepted by psychologists and therapists. Over the years, I have trained thousands of doctors, teachers, and healthcare professionals. The American Dental Society claimed that NLP had the only cure for dental phobia.
However, I doubt that myself: I believe there are as many ways for the brain to learn better behavior as there is imagination in the world. What this book represents is a startling step forward in filling in details and applying technology. Rigorous, yet easy to understand, this is a presentation of powerful patterns of human learning. I believe that, 50 years from now, you will find it on every healthcare professional’s bookshelf.
So be one of those exceptional people who lead the pack and get it there now. I am proud to have been the inspiration for such an elegant and wonderful book. Having read it just once, I am now going to go back through it again. You should do the same.
The only other thing I can say is: Thank you!
Dr. Richard Bandler
Overview
Any sufficiently advanced technology is indistinguishable from magic.—Arthur C. Clarke3
Why, in the most scientifically, economically and socially advanced time in the history of our species, do we seem to be suffering from more depression, anxiety, and psychophysical problems than ever before?
Medicine has defeated most of the infectious diseases that shortened our lives 100 years ago; we are living many more years, with greater access to healthcare. And yet, between 25 per cent and 50 per cent of the problems for which patients now seek help have no evident pathological cause.4
Despite the almost daily promises of medical ‘cures’ and ‘breakthroughs’ in the media, the list of ‘functional’ or ‘somatoform’ disorders is long and seems to be growing. At the moment, it includes chronic medically unexplained pain, irritable bowel syndrome, chronic fatigue syndrome, non-ulcer dyspepsia, headaches, premenstrual syndrome, temporomandibular joint disorder (TMJD), a wide range of autoimmune dysfunctions, and environmental illnesses, such as electromagnetic hypersensitivity, and allergies.
Add to that, the ‘emotional’ disorders, such as depression, anxiety, phobias, obsessive compulsive disorder (OCD), and post-traumatic stress disorder (PTSD), and we can see why the health services are in danger of being overwhelmed, health professionals are becoming frustrated, and patient dissatisfaction is growing.
The changing face of disease
Lifestyle diseases—sometimes referred to as ‘diseases of civilization’—have taken over from communicable (infectious) diseases as the greatest health risk in the Western world.
These diseases, ranging from asthma and atherosclerosis, through certain forms of cancer, chronic liver, pulmonary and cardiac disease, to osteoporosis, obesity, stroke, and kidney failure, all have a strong behavioral component. In other words, the way many people are living in the ‘civilized’ world is now a major cause of chronic illness and early death.5,6,7
A research paper published by The Lancet points to the fact that diets in many Western countries changed dramatically in the second part of the 20th century, with significant increases in the consumption of meat, dairy products, vegetable oils, fruit juices, and alcohol. At the same time, large reductions in physical activity have been matched by a surge in obesity. An increase in many cancers, including colorectal, breast, prostate, endometrial, and lung, correlates strongly with diets high in animal products, sugar, and fat.
The fact that many people who move from one country to another acquire the cancer rates of the new host country suggests that environmental and behavioral factors are more significant than genetics.8 Furthermore, as increasing numbers of developing countries adopt Western patterns of work, diet and exercise, the incidence of lifestyle diseases is spreading fast.
Smoking, high-calorie fast food, and lack of exercise are expected to cost India an accumulated loss of $236.6-billion within a decade, while the resultant toll of chronic disease—all of long duration and slow progression—will seriously affect people’s earnings.
According to a report jointly prepared by the World Health Organization and the World Economic Forum, income loss to Indians as a result of these diseases, which was already high, at $8.7 billion in 2005, is projected, at the time of writing, to rise to $54 billion in 2015.9
Pakistan faces an accumulated loss of $30.7 billion, with income loss increasing by $5.5 billion to $6.7 billion by 2015, and China, the worst of all countries under review, is expected to suffer an accumulated loss of $557.7 billion. Loss of income will reach $131.8 billion, almost eight times what it was in 2005.
According to the report, 60% of all deaths worldwide in 2005—a total of 35 million—resulted from non-communicable (read, avoidable) diseases and accounted for nearly half the number of premature deaths.
Despite growing insight into the cause (and cost) of the mounting scourge of lifestyle disease, mainstream medicine’s response—to tackle the effect, rather than the cause—is proving singularly ineffective.
However, all this means that many of these diseases and a large percentage of deaths can be avoided by relatively simple changes in lifestyle, including dietary changes; increased exercise; stress management; and early detection of, and response to, fluctuations in health and wellbeing. In fact, an extensive Europe-wide study by Cambridge University researchers clearly shows that comparatively minor lifestyle changes can add a decade or more to the average person’s lifespan.
The study, part of the European Prospective Investigation and Nutrition (EPIC) study, involving more than 500,000 people in 10 European countries, reveals that
adding fruit and vegetables to your daily diet can add three years to your life;not smoking turns the clock back by four to five years; andeven moderate exercise can increase life expectancy by up to three years.10A follow-up study at London’s Imperial College has since confirmed that seven relatively simple changes to diet and lifestyle can reduce the risk of dying from any of the major circulatory or respiratory diseases, including stroke and angina, by up to 34%.11
These are:
Be as lean as possible without becoming underweight and by eating mainly a plant-based diet;Be physically active for at least 30 minutes a day;Limit consumption of energy-dense foods. These are foodstuffs and drinks high in sugar, fat, and refined carbohydrates;Eat a variety of vegetables, fruits, whole grains, and pulses, such as lentils and beans;Limit consumption of red meat to 17.5 oz (500 grams) cooked weight a week, and avoid processed meats, such as bacon, ham, and salami;Limit alcoholic drinks to two for men and one for women a day; andNew mothers should breastfeed their infants for up to six months.Further studies confirm that as little as 15 minutes a day spent exercising can significantly reduce the incidence of both cancer and heart disease.12
Physicians are familiar with patients’ resistance to ‘doing the right thing’ (quitting smoking, exercising more, stopping snacking on donuts), however much they are confronted with the challenge to their own mortality. It is therefore understandable that reliance on anti-smoking, fat- and cholesterol-busting drugs, and gastric-band surgery is on the rise, despite the risks and comparative ineffectiveness involved.
Our contention (and, the reason for writing this book) is that human behavior is more easily, and infinitely more safely, altered by the methods outlined in this book than by drugs, surgery, or well-intentioned advice. Our experience is that people’s capacity to program and re-program their beliefs, behavior, and, by extension, possibly even their biology, is far greater than they are usually given credit for.
However, while most sufferers of chronic dysfunctions accept that some kind of change is necessary for their recovery, few, if any, know specifically how to make that change.
Just as importantly, many physicians are equally mystified as to how effectively to help their patients.
Part of the confusion may be simply explained: the reductionist, molecular, biomedical, cause-and-effect model that proved so spectacularly successful in defeating the microbe is failing to address the more complex psychosocial factors responsible for the current rise in chronic disease and early death.
Cartesian Dualism, the separation of ‘mind’ from body, still affects training and research. Although the hunt for ‘causality’ has shifted from germ to gene, and while the prognosis for a number of fairly rare genetic disorders is improving, no gene is likely to be found for each of the scores of medically unexplained dysfunctions with which practitioners and patients wrestle every day of their lives.
Failure to find the cause (what is ‘the’ cause of depression? what is ‘the’ cause of cancer?) means in practice that the focus of treatment falls on the symptom. Therefore, our dependence on the trillion-dollar pharmaceutical industry is growing, and is matched only by the hopes invested in technological innovation as the rescuer of humanity in what is perceived as an ongoing battle with the ‘disease’ of life.
The problem of ‘mind’
The implication of all diagnoses of ‘functional’ or ‘somatoform’ disorders may be that they are all, or partly, ‘in the mind’. And ‘mind’ is not widely considered a matter of concern for the average medical professional.
Current treatment guidelines offer two main options: psychotropic (mind-altering) medication, and outsourcing the problem to a ‘talking cure’ professional (where these are available). Either way, the integrity of the patient-as-a-whole is compromised, or, Cartesian Dualism is reinforced.
Pause here and reflect on which cultures, aside from Westerners, subscribe to the ‘all-in-the-mind’ explanation for chronic conditions for which no obvious organic cause can be found. As it happens, there aren’t many. The reason? Possibly because they have no ‘mind’ in which ‘all’ can skulk.
English, as it happens, is one of the few languages that has a word for, and, therefore, a concept of, ‘mind’. Other health systems might speak of problems with your energy meridia; chi; prana; humors; spells and evil spirits. Or, they might point to environmental or dietary deviations from what is required by your innate prakruti, or body-type—but almost never of your mind. Even René Descartes, at whom holists (including ourselves, we must admit) continue to sneer for single-handedly creating the mind-body split, never actually said the ‘mind’, as such, was irrelevant, or even separate from the body. It just didn’t figure in the way of thinking at the time.
In his most famous works, Descartes spoke about amê and corps (and, sometimes, anima). Corps was easy enough to understand, but the translators ran into trouble with the French word, amê. The closest English equivalent to both amê and the Latin anima (which he also sometimes used), is ‘soul’. Just about everyone who believes in the concept of an eternal soul would be happy to declare it separate from the finite physical body, even though Descartes himself regarded it as anchored during life to the pineal gland. But, the damage to the deep complexities of human thought and feeling had been done. Body 1, Mind 0.
What was missed at the time, and continues to be missed, is that ‘mind’ is not, and cannot be, an entity in the same way a body can. Nor are the thoughts and feelings, the experiences by which people ‘know’ they have a mind, discrete objects that can be isolated, identified, and studied in the same way as an organ, a germ or a gene.
All experience is process. People attach meaning to process. Meaning, in turn, affects biology. Therefore, any physical experience we have must affect, and, in turn, be affected by, both the physical and the mental, in an ongoing, dynamic feed-back loop.
To suggest that a problem is ‘all in the mind’ reduces process, and, therefore, lessens the possibility of change. It is as useless and as semantically skewed as to say ‘the light is all in the wire’.
The delivery problem
Problems increase when we look at the ‘delivery’ of healthcare, as opposed to its application. For various reasons, some of them political, we have entered a period of cost-effectiveness, ‘quality-adjusted life years’, evidence-based medicine, and increasing bureaucracy.
As care becomes increasingly standardized—by the National Institute for Health and Clinical Excellence (NICE) in the United Kingdom, and insurance companies in the United States—the personal is giving way to the impersonal, compassion is surrendering to science and practitioners, patients and the economy are all paying the price. Doctors are increasingly required to practice medicine unquestioningly, according to a set of guidelines delivered from sources on high. If they don’t, they can face highly punitive consequences. In our opinion, this is not science; this is theology. Patients’ unhappiness with the care they receive is, in turn, reflected in the growing trend towards litigation.
It should be no surprise, then, that so many physicians retreat behind the barricades of professional detachment, from where they practice an essentially defensive form of medicine that places the effectiveness of the patient’s treatment on the other side of a mountain of bureaucratic obligations, legal concerns, official guidelines, and targets, as well as restrictions on treatment modalities, resources, and time. And no surprise that so many patients are responding negatively towards what they regard as a lack of concern, interest, and sufficient information by emigrating towards ‘alternative’ healthcare, or to the offices of their legal advisors with an intention to sue.
A crisis in the making
In the first edition of this book, we hinted at the possibility of a crisis engulfing Western medicine. Now, and with no sense of satisfaction, we report our belief that today’s healthcare is already in crisis. An estimated one in 10 patients admitted to hospital in the EU is a victim of medical error. A disproportionately large percentage (a further one in 10) of these accidents results in serious injury or death.13
Figures from elsewhere are even more worrying. According to a report by Dr. Barbara Starfield, MD, MPH, of the Johns Hopkins School of Hygiene and Public Health, medical errors are now the third leading cause of death in the United States, following cancer and heart disease.14
Under-reported statistics
Many researchers believe that the figures for medical errors may be significantly under-reported throughout the world, possibly for fear of litigation.15 Since no effective, mandatory, official system of registration of medical errors, no mandatory root cause analysis, and no systems to prevent the occurrence of medical errors exist in Europe, the figures may be even higher than one in 10. In contrast, motor vehicle accidents have been for decades routinely and systematically registered along with the recording of deaths and injuries.
Various studies blame a number of factors, including work stress in hospitals, limited consultation time, and reduced financial resources. But one of the recurring problems revealed in successive studies is defective communication—between doctors and nurses and their patients, as well as among health professionals themselves. Effective leadership, as well as effective clinical outcomes, is highly dependent on accurate, targeted and mindful communication.
Health professionals, too, are victims of the situation. A large body of evidence shows many doctors suffer high levels of stress as a result of their work, impairing both their health and their ability to provide quality care to their patients. The main sources of work-related stress and burnout among doctors, in both primary and secondary care, have been identified as: workload; the resultant effect on their personal lives; organizational changes; poor management; insufficient resources; constant exposure to the suffering of their patients; medical errors; complaints and litigation.16
We believe both patient and practitioner can benefit from an expanded model of healthcare—the patient by being seen and treated as a ‘whole person’, and the practitioner by having a choice of non-invasive, non-pharmacological tools and principles that, in the consultative partnership, can help to meet that need.
Whole-person healing
In many ways, this is an idea whose time has come. The Center for Advancement of Health in Washington DC is one of several influential organizations currently lobbying for changes in the approach to healthcare.17 Those organizations, and a growing number of individual campaigners, are broadly in agreement that:
Attitudes, thoughts, feelings, and behaviors must be recognized as important aspects of healing and health;The mind and body flourish or perish together. Therefore patients should not be sent to one ‘repair shop’ for sick thoughts and feelings and to another for sick bodies;Scientific evidence is overwhelming that how and where we live, who we are, and how we think, feel, and cope, can powerfully affect our health and wellbeing. To ignore this is irresponsible; andPatient care must shift to treating the whole person. This will result in healthier individuals, healthier communities and healthier nations.18Noble as these sentiments are, it is not enough simply to urge the health professional to begin practicing whole-person healthcare. What exactly is ‘holistic patient management’, and how might it be practically pursued in the context of the medical consultation? Indeed, although we have come to know a lot about disease, what exactly is ‘health’? These are just some of the questions this book seeks to answer.
Health as process
Our first presupposition is that health is more than an absence of disease. Rather, it exists along an ever-changing continuum between order and chaos. Our body-mind system is in a state of constant, dynamic interaction with both the internal and external environment, which itself is changing rapidly. The degree to which we are able to respond to these changes and can restore body-mind systemic balance (see our thoughts about autonomic coherence on pages 25, 253, 254 and 255) reflects both our current health and our ability to heal.
One purpose of this book is to unravel (as far as is possible at this stage in our knowledge) those elusive qualities that make up a ‘positive relationship’ between doctor and patient—and to share with our colleagues in the healthcare professions some of the principles and techniques that we, and many of the doctors and medical students who have undergone our trainings, have found to help facilitate the healing process.
The development of NLP
Neuro-Linguistic Programming, as its name suggests, refers to language (words, as well as other symbol systems, such as physical posture, gestures and related non-verbal forms of communication) as a function of the nervous system and its transformation into ‘subjective experience’.
Put more simply, it focuses on the way we use our five senses to create a ‘map’ of ‘reality’, which we then use to navigate our way through the world. It is a basic premise of NLP that the quality of our maps dictates the quality of our lives. In our opinion, NLP ranks as one of the most significant epistemological developments of our time. It developed—and continues to develop—out of Dr. Richard Bandler’s curiosity about the nature of subjective experience, especially that of individuals whose performance is outstanding in their fields. While most scientific research begins with investigation into how problems and deficiencies develop, Dr. Bandler’s question has always been: how do people achieve excellence?
His first subjects were a group of therapists, unrelated in their approaches, but who were nonetheless achieving results well beyond those of their peers. These included Dr. Milton Erickson, a medical doctor and clinical hypnotist, Virginia Satir, now widely regarded as the founder of family therapy, Gestalt therapist Fritz Perls, and noted body-worker Moshe Feldenkrais. Bandler observed certain commonalities in their work. Interestingly, none of the subjects of his study appeared consciously aware of these patterns, and they had never met each other, and even when they later came together, they were reportedly unimpressed by one another.
Bandler and his colleague, John Grinder, began to experiment. By identifying each sequence of their subjects’ approach, testing it on themselves and other eager volunteers, and refining the processes, they found that the effects could be replicated. Furthermore, these capabilities could easily be taught to others, with similar results.
These experiments led to one of the key presuppositions that have come to underpin NLP: Subjective experience has a structure. Following on from that is the corollary: Change the structure, and the subjective experience will also change.
It was widely believed at that time that, apart from drugs, interpretation and insight were the only means whereby effective emotional and behavioral change could be achieved, and that only with considerable effort and time. But Bandler continued to demonstrate, on a range of patients, including long-stay schizophrenic and psychotic patients, that changing the map could have a dramatic and immediate effect. In the introduction to his first book, The Structure of Magic, published in 1975, he wrote:
The basic principle here is that people end up in pain, not because the world is not rich enough to allow them to satisfy their needs, but because their representation of the world is impoverished.19
Two other key principles emerged from Richard Bandler’s essentially pragmatic approach. The first was that human beings act largely out of various permutations of patterned responses, and, the second, that each person has a signature way of ‘coding’ his experience by the use of his five senses.
Medical NLP and health
Medical NLP—the development and application of the principles and techniques of NLP to the specific needs of health professionals and their patients—is an internationally recognized and licensed model that formally integrates non-invasive, non-pharmacological, and clinically effective approaches with the existing principles and techniques of the consultation process. Training and certification by The Society of Medical NLP is recognized and licensed by Dr. Richard Bandler, the co-creator and developer of NLP, and his Society of NLP. It has also been approved for continuing professional development programs in both the United Kingdom and the Netherlands.
Supported by extensive research and clinical experience, it offers, for the first time, explicit principles and techniques applicable to a wide range of complex, chronic conditions that have symptoms, but no readily identifiable cause. In holding, as a goal, the physical and psychological coherence of the patient, and integrating seamlessly with any aspect of healthcare, it functions as a practical and continually evolving ‘salutogenic’ (health promoting and affirming) model of ‘whole-person’ healing and health in the spirit envisioned and advocated by Aaron Antonovsky.20
One of the central messages of Magic in Practice is that a fundamental component of an effective consultation is an equal and proactive contract between doctor and patient. The relationship functions as a therapeutic agent in itself.
Many practitioners will admit to being mystified by the fact that two patients with apparently identical symptoms will respond entirely differently to the same treatment. And many patients can recall encountering a physician, who, somehow, by some indefinable means unrelated to any specific treatment, just ‘made me feel better’.
Equally, some patients make unexpected, sometimes dramatic, recoveries against all the predictions of current medical knowledge… although these ‘spontaneous remissions’ still tend to be more of an embarrassment to orthodox science. ‘Anecdotal’ is the label usually attached to these events, which, sadly, tends to preclude any closer examination on the part of those people purportedly committed to unbiased scientific investigation.
If pressed, both patient and physician will agree that some factor, other than conventional medical treatment, is responsible for facilitating healing. The doctor may attribute this to the patient’s ‘attitude’, the patient to the doctor’s ‘bedside manner’.
The underlying dynamic undoubtedly depends on effective communication. To focus our students’ attention on the true process and purpose of communication, we draw attention to the origins of the word. It is derived from the Indo-European collective, Ko, meaning ‘share’, and Mei, meaning ‘change’. Communication in Medical NLP, therefore, is a Ko Mei process—a coming together, a sharing, in order to effect change.
We would like to emphasize, too, that practitioners of NLP and Medical NLP are not de facto ‘therapists’. As Dr. Bandler repeatedly asserts, practitioners don’t strive to ‘cure’ problems, but to help their clients (or patients) re-learn more resourceful physical and/or psychological behaviors that allow them to function more effectively. In Medical Neuro-Linguistic Programming, our cry is: treat the patient, don’t try to cure the disease. Therefore, a knowledge of, or adherence to, a particular school of ‘psychology’ or a specific medical specialization, is not necessary for effective intervention.
What is not in doubt is the fact that the quality of the relationship between practitioner and patient is at least as important as the treatment itself. Historical evidence exists that a number of treatments now discarded as ‘unscientific’ demonstrated a 50–70% cure rate when they were still regarded as mainstream.21 More recent research, specifically in the area of ‘emotional’ disorders (increasingly falling within the provenance of general medicine), suggests that as little as 15% of effectiveness results from the therapeutic procedure alone.22
Physicians who have been in practice for more than a few decades will not be surprised by this. For much of the first part of the 20th century, the relational quality between doctor and patient was emphasized in medical training and explicit in practice, even as science was advancing the knowledge and expertise of the health practitioner. This original commitment to partnering wisdom, human values with technological innovation, and respect for the patient was reflected in the mottos adopted by a number organizations and associations around the world.
In 1952, Britain’s Royal College of General Practitioners adopted the motto Cum Scientia Caritas (Science with Compassionate Care). The Canadian Orthopedic Association’s motto is, Pietate, Arte et ScientiaCorrigere (With compassion, skill and knowledge we set right), and the Association of Surgeons of Great Britain and Ireland’s is, Omnes Ab Omnibus Discamus (Let us learn all things from everybody).
We applaud the sentiments, but are unsure, in this age of stringent financial targets and controls and purely ‘evidence-based’ treatment, to what extent they are actually practiced today. Many people, not least patients, hanker after a ‘humanization’ of science—especially medicine.
As a modest contribution to this end, Magic in Practice presents key ‘mainstream’ NLP techniques applied in the specific context of healthcare, as well as new approaches developed in real-world situations out of the principles of observation, information gathering, hypothesis-creation, and some considerable clinical experience.
Although the principles and techniques presented here are not intended to replace medical consultation and appropriate treatment, they will be of interest to doctors in both primary and secondary care, as well as nurses, psychologists, counselors, and therapists—anyone, in fact, interested in developing a more integrative and effective approach to patient care.
Why ‘Magic’?
Since NLP’s emergence in the mid-1970s, ‘magic’ has been a word often associated with its practice. Where it functions as a ‘meta-psychology’, it focuses on structure and process (how we create and maintain our model of ‘reality’), rather than losing itself in detail and speculation. It demands behavioral flexibility on the part of the practitioner to accommodate the uniqueness of each individual’s patterns, and provides a systematic means of generating techniques specifically tailored to the needs of each patient or client.
The speed with which an elegantly designed and applied intervention can result in change can often challenge and mystify. The mystery is intensified when we consider that the primary tools of these interventions are non-pharmacological, non-invasive, and non-toxic, something that cannot be said for virtually any other current treatment in the field of medical care.
More than 30 years ago, the idea that neurological processes could be impacted and re-routed by non-invasive processes was largely speculative. Richard Bandler was one of the first researchers to apply neural scanning by magnetic resonance imaging (MRI) technology to explore the impact of NLP on brain function. Since then, as we will show in this book, neuroscience and psychology have evolved dramatically, to cast even more light into the ‘black box’ of brain and behavior.
We now know—and ignore at our own peril and that of our patients—that the brain constantly moves in and out of complex, interrelating dynamic equilibria, responding to the context or ‘meaning’ of its experience,23 is actively damaged by ‘negative’ data24 and can even alter its physical architecture.25 It follows then that communication within the practitioner-patient relationship is an important source of data for the meaning-making brain and the body with which it functions as an integrated whole.
Words can literally affect us for better or worse. It is surprising, then, that so little time and attention are paid to the quality and precision (what NLP calls the ‘elegance’) of the language we use. Substantial research supports the assertion that how a respected health professional says something can directly affect the patient’s physical and psychological wellbeing at least as much as what he says.26
Of course, communication works in different ways. Not only can clinical outcomes be affected for better or worse by the quality of the patient-physician relationship, but, in the event of medical accident, the patient’s decision to litigate has been shown in several studies to be based substantially more on the doctor’s ‘attitude’ and the quality of the relationship between doctor and patient than on the accident itself.27
We believe that at least part of the apparent ‘magic’ of Medical NLP derives not from any mystical properties of the methodology, but from the narrowness of the paradigm it is seeking to expand. To take Arthur C. Clarke’s Third Law further, it is not difficult to demonstrate that virtually any health technology would appear superior to one that regards the individual as merely:
a biomechanical ‘object’ whose thinking processes have little impact on his health or wellbeing;a product of purely Newtonian cause-and-effect processes;a closed system, largely uninfluenced by other ‘closed systems’;equal in every way to every other individual, benefiting only from standardized treatments;an organism that produces symptoms which require suppression or removal without any significant regard to the reason or reasons for the appearance of those symptoms; and‘fixable’ by the application of purely mechanistic rules in much the same way as a watchmaker fixes a watch.The placebo effect—or, the neurophysiology of care?
Any change for the better that is unexplained by scientifically approved treatment is often dismissed by the medical establishment as the placebo response. We are not unduly perturbed by this. So prevalent is the response at all levels of research and treatment that we are utterly confident in the declaration that something important is happening that deserves to be recognized and, wherever possible, incorporated into practical healthcare.
Furthermore, we believe that a greater awareness of this apparently inbuilt psychophysiological capability can renew hope for millions of people whose complex chronic conditions remain inadequately addressed by Western scientific knowledge. By this, we are not proposing a reintroduction of dummy pills and sham treatments, but, rather, consideration of the psychological and biochemical substrates that underlie the human body–mind system to self-regulate under certain conditions, the mechanisms of which are just beginning to be understood.
The problem faced by medical orthodoxy, as pointed out by Gershom Zajicek in a seminal paper in the Cancer Journal, is that nothing in pharmacokinetic theory accounts for the placebo effect. Therefore, rather than abandon current belief, the placebo effect is dismissed as random error or noise which should be ignored.28
Regrettably, the word, ‘placebo’ (derived from the medieval prayer, Placebo Domino, ‘I shall please the Lord’) has acquired pejorative overtones, suggesting deception, weakness, and scientific irrelevancy. But this is a semantic rather than a scientifically grounded shift. As we will point out throughout this book, the word for a thing is not the thing itself. We should not confuse naming or defining with understanding or experiencing. We do not make something invalid merely by labeling it as such.
Here’s another way of looking at the placebo effect (our way):
The placebo response doesn’t mean that nothing important has happened; it simply means that something which we haven’t been measuring has happened.
Indeed, so pervasive—and sometimes so dramatic—is the placebo response that some scientists have suggested reclassifying it. Suggestions include ‘the healing response’, ‘remembered wellness’, the ‘human effect’, and the ‘meaning response’, none of which suggests irrelevance or chicanery.
So powerful is the placebo effect that it is routinely employed (and abused) by the pharmaceutical industry. Placebos are routinely used as controls to test new drugs, and, once their purpose has been served, they are discarded.
Or, are they?
After claiming they have successfully eliminated the placebo effect, the pharmaceutical companies go on to market their products in carefully designed sizes, shapes, and colors, all of which are known to increase the placebo effect.29 They know that cheaper generics are less effective than expensive brand names, and that highly advertised brand names perform best of all (and certainly sell billions of pills), especially if advertised by well-known and popular celebrities.
Still, all that shouldn’t matter if the drug performs better than the placebo against which it has been tested, should it?
In theory, no. But, here are three important facts about placebos in research:
Most trials go through a ‘washing’ stage before they start in earnest. The purpose is to identify and remove the ‘high placebo responders’. The control, therefore, is far from randomized and is already slewed in favor of the drug being tested;While a placebo is described as ‘an inert substance’, no such substance actually exists. Even sugar, or the fillers used in a placebo pill, could have an effect on the person taking them; and, possibly most important of all…As pointed out in the Wall Street Journal health blog by Dr. Beatrice Golomb, associate professor of medicine in the division of general internal medicine at UCSD School of Medicine, placebos are not standardized, and their contents are seldom madepublic.30 Therefore, the concept of a truly randomized, double-blind control test exists more in general mythology than in scientific fact.In all its forms, the placebo is here to stay. Research into the effect is widespread. Taken together, the studies suggest that the placebo response is a product of a complex interaction of various processes that fall into three main classifications: ‘expectancy’, ‘meaning’, and ‘conditioning’.31
Briefly, this suggests that both practitioner and patient expect a positive outcome, and that the patient is able to understand and attribute meaning to his experience. Conditioning refers to the adoption and perfection of new, health-related behaviors and responses; to the linking of a specific stimulus to a new and healthful response—and, even to the therapeutic effect of receiving advice or medication from a trusted expert.
It would be difficult to study, or even identify, the placebo response, except within the context of relationships—those of the patient and his world-view; the patient and his understanding; and, crucially importantly, the patient and his practitioner.
All treatment outcomes are, in large part, a result of relationships, and relationships are made or broken by communication. We therefore respectfully offer this book for the consideration of all practitioners, regardless of school or specialty, who believe there should be ‘something more’ to healthcare than standardized interpretations and treatments. Conditioning, expectancy, and meaning are all processes that can be modeled, developed, and transmitted through the principles and techniques of Medical NLP.
Whatever we choose to call it, there is a whole vista of healing and health beyond drugs, surgical procedures or psychological counseling. As we will show, there is an increasing body of research that suggests that the success of many currently accepted procedures (up to 75% in one recent review of 19 depression therapy studies32) is unrelated to the physical treatment itself.
Whether we call it the placebo response, the human effect or the healing response, it is both ‘real’ and a valuable component of good medicine. Dr. W. Grant Thompson, a noted consultant on clinical trials and author of The Placebo Effect and Health, observes that, whatever the view, the placebo effect is a reality and modern medicine can benefit from understanding it. Wise doctors, he adds, know that it is a factor in every treatment and an essential part of their daily work.33
We do not claim to have definitive answers; we certainly have many questions still unanswered that continue to spark our curiosity. But, even at this stage, we can point to a substantial body of theory and research currently excluded from ‘evidence-based’ medical decision-making. It is also interesting to note how much of this now supports the observation and reasoning that prompted Richard Bandler and his colleagues to develop NLP more than 30 years ago.
We also present explicit principles and techniques that we and our Medical NLP-trained colleagues have found useful in our practices, together with anecdotes and case studies —some of them new for this edition of Magic in Practice—to illustrate their practical application. Certain details, of course, have been changed to maintain confidentiality.
We encourage you to develop curiosity and behavioral flexibility, to explore these principles for yourself, and to reclaim the status of the practitioner as co-creator of his patients’ health by actively enhancing and administering what Michael Balint referred to as the most powerful of all drugs—the practitioner himself.34
Or, as a senior consultant remarked at the end of one of our trainings, ‘If all this is the placebo effect, I want to be the best placebo I possibly can.’
Notes
3. Clarke A (1961) Clarke’s third law. In Profiles of the Future. London: Weidenfeld & Nicolson.
4. Olde Hartman TC, Lucassen PL, van de Lisdonk EH et al (2004) Chronic functional somatic symptoms: a single syndrome? British Journal of General Practice54: 922–7.
5. Vaillant GE, Mukamal K. Successful Aging. Am J Psychiatry (2001) Jun 1; 158(6): 839-847.
6. Fraser GE, Shavlik DJ (2001) Ten Years of Life: Is It a Matter of Choice? ArchIntern Med. 161: 1645-1652.
7. Steyn K; Fourie J; Bradshaw D (1992) The impact of chronic diseases of lifestyle and their major risk factors on mortality in South Africa. S Afr Med J, Oct, 82: 4, 227-31.
8. Key TJ, Allen NE, Spencer EA (2002) The effect of diet on risk of cancer. Lancet. Sept 14; 360 (9336): 861-8.
9.http://articles.timesofindia.indiatimes.com/2008-05-20/india/27759260_1_ lifestyle-diseases-couch-potato-cost.
10. European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection - http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=567660.
11. A-C Vergnaud et al. Adherence to the World Cancer Research Fund/American Institute for Cancer Research guidelines and risk of death in Europe: results from the European Prospective Investigation into Nutrition and Cancer cohort study, Am J Clin Nutr May 2013. First published April 3, 2013.
12. Chi Pang Wen, et al (2011) Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study, The Lancet, Early Online Publication, 16 August—http://www.thelancet.com/journals/lancet/ article/PIIS0140-6736%2811%2960749-6/abstract
13. NPSA report: Building a memory: preventing harm, reducing risks & improving patient safety, London July (2005) p53.
14.The Journal of the American Medical Association (JAMA) (2000) Vol 284, No 4, July 26, 2000
15. Bismark M, Paterson R No Fault Compensation in New Zealand:Harmonizing Injury Compensation, Provider Accountability & Patient Safety. Health (Milwood) 200; 25: 278-83.
16. BMA Health Policy and Economic Research Unit (2000) Work-related StressAmong Senior Doctors: Review of Research. London: BMA Health Policy and Economic Research Unit.
17. See www.cfah.org.
18. Adapted from Bakal D (1999) Minding the Body. New York: Guildford Press.
19. Bandler R, Grinder J (1975) The Structure of Magic. Palo Alto, CA: Science and Behavior Books.
20. Antonovsky A (1979) Health, Stress and Coping. San Francisco: Jossey-Bass.
21. Dixon M, Sweeney K (2000) The Human Effect in Medicine. Oxfordshire: Radcliffe Medical Press.
22. Lambert MJ (1992) Psychotherapy outcome research: implications for integrative and eclectic therapists. In Norcoss C, Goldfriend M (eds) Handbook of Psychotherapy Integration, Ch. 3. New York: Basic Books.
23. Scott KJA (1995) Dynamic Patterns—the Self-Organization of Brain and Behavior. Cambridge, MA: MIT Press.
24. Lipton B (2005) The Biology of Belief. California: Elite Books.
25. McEwen B (2002) The End of Stress as We Know It. Washington DC: Joseph Henry Press.
26. Dixon M, Sweeney K (2000) The Human Effect in Medicine. Oxfordshire: Radcliffe Medical Press; Horvath AO (1995) The therapeutic relationship. In Session 1, 7–17; Krupnick JL et al (1996) The role of the therapeutic alliance in psychotherapy pharmacotherapy outcome: findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Project. Journal of Consulting and Clinical Psychology64: 532-39.
27. Ambady N et al (2002) Surgeons’ tone of voice: a clue to malpractice history. Surgery 132 (1): 5–9; Levinson W et al (1997) Physician-patient communication: the relationship with malpractice claims among primary care physicians and surgeons. Journal of the American Medical Association277(7): 553–9.
28. Zajicek G (1995) The placebo effect is the healing force of nature. Cancer Journal8(2): 44-45.
29. de Craen AJ, Roos PJ, de Vries AL, Kleijnen J. (1996) Effect of color of drugs: systematic review of perceived effect of drugs and of their effectiveness. BMJ313: 1624-6
30.http://blogs.wsj.com/health/2010/10/18/when-is-a-placebo- not-really-a-placebo-maybe-more-often-than-you-think/
31. Brody H (1997) The Placebo Response. New York: HarperCollins.
32. Kirsch I, Saperstein G (1998) Listening to Prozac but hearing placebo: a meta-analysis of antidepressant medication. Prevention and Treatment (online journal): http://psycnet.apa.org/psycinfo/1999-11094-001
33. Thompson WG (2005) The Placebo Effect and Health. New York: Prometheus Books; Horvath AO (1995) The therapeutic relationship. In Session1: 7-17.
34. Balint M (2000) The Doctor, His Patient and the Illness. London: Churchill Livingstone.
1
Towards Healing and Health: a solution-oriented approach
We cannot solve problems with the same level of thinking that created them.—Albert Einstein
Problem-solving is an energy-intensive approach that focuses on deficiencies in the hope of identifying and removing them. Solution-orientation explores and develops options, choices, and possibilities with a view to re-orientating the individual or group towards flexibility and growth.
Problem-solving is reactive, remedial, and piecemeal. Solution-orientation is active, generative, and holistic.
Problem-solving looks at people as a collection of ‘parts’. Solution-orientation sees the person-as-whole.
Problem-solving is external to the patient’s experience (both ‘cause’ and symptom are regarded as alien invaders, disrupting the integrity of the patient’s body–mind system). Solution-orientation is internal to the patient (the person who exhibits the problem is unique, and is as important as the problem itself).
Many of the current problems in healthcare derive from a reductionist, mechanistic view of humans and human nature that is several centuries old. Still largely committed to both a reductionist cause-and-effect model and the enduring myth of Cartesian Dualism, the separation of humans into mutually exclusive domains of body and mind, mainstream medicine has little power over the rising tide of complex, chronic, and inexplicable dysfunctions that can result in lifetimes of debility and pain.
People are living longer, mainly because of science’s massive advances in the areas of infection and acute medicine, but they are not necessarily enjoying a consistently better quality of life. The nature of the problems we now face is changing. Disease itself is changing. But we—health providers and patients—are not.
