Category: Depression

Is there one best way of doing therapy?

I believe that over time, hypnotherapists tend to get stuck in whatever approach they were trained in. Some hypnotherapists use mostly regression. Others tend to focus on Direct Suggestion. I personally favor Metaphor approaches. However every therapist should be continually expanding their toolbox of techniques.

It is always a mistake to decide too quickly what the problem is, and then apply your standard tool. The basic problem is that humans tend to see what they expect see. We  ignore any evidence that does not fit our initial assumptions. Deliberately using one of more models of therapy will help to avoid that.  There is one well known model that you should use, or at least, consider when assessing clients.

Multi Modal Therapy

This therapy model sees people as having multiple ways of experiencing the world, and of reacting to their world.  The BASIC ID model asks you to consider each of seven modalities before deciding your approach.

B represents behavior, indicated by inappropriate acts, habits, gestures, or the lack of appropriate behaviors.
A stands for affect, which is shown by the level of negative feelings or emotions the client talks about.
S is sensation, or the negative bodily sensations or physiological symptoms such as pain, tension, sweat, nausea, quick heartbeat, etc.
I stands for imagery, evidenced by negative cognitive images or mental pictures.
C represents cognition or the degree of negative thoughts, attitudes, or beliefs.
The second I stands for interpersonal relationships, and refers to your ability to form successful relationships with others. It is all about missing social skills and support systems.
D is for drugs and biological functions, and examines the individual's physical health, drug use, and other lifestyle choices.

(Source: Wikipedia)

How to use Multi Modal Therapy

You listen to the client and as you interact, you note any words or behavior that indicates they are using one or more modalities. Each person will have a mix of modalities. Some people will be mostly cognitive. But they may be hypervigilant, or have negative thinking as well. Some people will be mostly visualizers, daydreaming or catastrophizing future outcomes, but also feel things strongly in their body.

When you establish what their dominant modality is, then you can discuss how to make the changes the client wants. A visualizer could be introduced to NLP therapies, or EMDR. A cognitive person might be offered CBT. A person whose problems are really lifestyle problems might be offered mainly counselling. Each modality suggests its own response.

Applying this model can help you avoid over-narrow thinking, and leave open to learning other psychological techniques.

Skin Picking Sexual Abuse

I saw this client previously and tried to help him with his skin picking psoriasis. He told me that there had not be much change. "I am still picking my skin." He does not see any change in the severity of his psoriasis.  He sleeps in a separate room from his wife because he doesn't want her to waken up with blood all over the sheets.

However, after seeing me, he decided he could do something about it, and has started seeing a counselor. "I feel the counseling is helping me."

In the first session he mentioned that he did not get on with his father. This time, he began speaking more openly about the behavior of his father. We spent some time talking about his family situation. He now talks to his father but does not talk about the childhood abuse. His brothers and sisters are still not talking to his father.

Therapy for Skin Picking

I decided that I had to focus on his abuse and to clear his feelings about that. I got him to think about the pain, the abuse, how he feels about it, everything to do with how his father treated him. He clearly didn't want to go there. But I kept at it until he obviously was feeling it. I began to see tears in his eyes.

I got him to focus on what the feeling was like. He was crying and withdrawing into himself, but he said it was "red, it was blood". I try to develop that. I asked him what it was like as an object. He said it was a box. Then he changed it to a cube. He said "it's made of clear glass, glass like a milk bottle. About one liter. It is soft and warm and smooth like skin". I asked him "and what happens to skin over time". He said "it gets old".

I developed the idea of changing the object so that the skin was "old and wrinkled and sagging" and the whole box thing was losing its definition.  Eventually I got it small enough that he wanted to hold it in his hand. It became clear that this represented his father. I asked "what do you want this thing to do?" He said "Say sorry". I try to get a dialogue going between him and the object but he just wouldn't do it. I asked him to ask the object why the behavior had happened. He said "I know why it happened. I was in the way".

Externalizing his emotional abuse

I got him to put the object into a chair. This got it out of his body and into something he could deal with. The thing started changing but he got very emotional about it all. I realised then that he was back to being that painful lonely little child. So I did inner child work with him. I got him to go back to the child, to hold the child, all the normal therapy progression. He did very well at this: he clearly was there, he was crying, he was holding the child, and he took that child away from there. I got him to tell the child "you did not do anything wrong. It was not your fault. You were born perfect. You are a beautiful deserving little boy."

I did more direct suggestion for strengthening his feelings about himself.

Outcome of Skin Picking therapy

By the end of our session he was crying freely and allowing his emotions out. I suspected this is the first time is ever done that. I asked him "when was the last time you cried in public?" He thought for a while and said "once, at a funeral".

He told me that this was the first time he had ever talked about his background to anyone else. "I thought that if I could keep it inside, I could avoid thinking about it, and avoid the pain". It is quite common for skin problems to be the result of unresolved emotional issues. His skin picking was a symptom of his inner turmoil. I told him that he had now started on a  journey that would end in catharsis, the release of his bottled up feelings, and a gradual end to his skin problems.

NLP Stop Smoking 

I don't often use NLP stop smoking techniques, but sometimes they are the best tools to use. After our previous session, my client had stopped smoking for just one day. But even then, she still felt cravings. A favorite aunt had a 90th birthday. Looking at a photo of the aunt,  she saw her ex-husband in the photo. This reignited feelings of resentment and failure in her. She started brooding on this. Then she ate till she felt uncomfortable, and that made her feel bad. Feeling bad made her reach for the smokes. As soon as she lit up, she felt better.

I explored why just deciding to smoke again instantly made her feel better. "I was so dominated by my husband. He made it all my fault, I was angry at him. Smoking was the only thing I had a choice about. Everything else was taken away from me. He made me feel ugly. I started smoking sometimes to show I could defy him. Smoking gives me control."

NLP Stop Smoking Picture Visualization

I got her to think about the resentment of her husband. How he got away with with it all, and she has ended up losing everything. I probed for a feeling. She said, "All I can see is his face." So used the NLP visualization technique. I got her to imagine some paint pots and brushes. I got her to visualize painting a big Ronald McDonald smile on his face.

Then I asked her to paint big clown eyes on him. I told her to then put big dangly earings on him. Then put him in a ballerinas tutu little short skirt. I told her to paint on his forehead the word that sums up how she feels about him. Then I told her to jam the paintbrushes up his nostrils.

Public Humiliation of your enemy

I told her to imagine him dancing in the street with his great hairy legs dressed as a ballerina. And all his family and friends were standing around laughing at him, pointing at him, mocking him. At that point I suggested that two large dogs came out and started barking and he started running away. The dogs chased him, and one bit him on each buttock and he was running down the street with these big dogs hanging off his buttocks.

Eventually he was lying on the street begging to take the dogs away. But all the people round about just pointed at him, and told him he was pathetic, a loser and they would never forgive him.

Public acclaim from your friends

Then all the people gathered round my client and picked her up. Two strong men lifted her on their shoulders and paraded her around and everyone was clapping and cheering and shouting out "you're the greatest. You're a hero." And then one by one, they all came up and asked forgiveness for being so horrible to her.

Then I gave her a visualization of seeing herself a few months from now, surrounded by friends and family. Acting as the matriarch, the role model, the one that everyone consulted. I gave her a visualization of being surrounded by her beloved grandchildren again. And somewhere in the background, tiny, her husband was still crawling around rejected, despised, miserable.

NLP Stop Smoking  Action Visualization

To make sure the visualization had worked, I asked "what do you feel about your husband now?" She said, "I can still feel something in my chest." I got her to focus on that feeling. I told her to imagine the feeling as a thing, and to imagine how she could change it. My plan was to do a standard metaphor transformation, but almost as soon as I started she said "I'm slicing him up."

Then she proceeded to tell me how she was cutting him up with a big sharp knife. She continued with what could only be described as "butchery". She cut off various parts of his anatomy and really had a good time destroying him totally.

She said she felt great. Now ready to make a new start. She told me that she was going to keep practicing the visualization idea. Every time she thought about him she was going to find another way to destroy him.

Combining the My Friend John Induction with Therapy

This client has a long history of emotional abuse by his parents. We spent a long time going over his recent past and his early childhood. He used to be a heavy drinker. Now he is ashamed of his behavior in the period when he was drinking. He still meets people from that time and feels embarrassed about what he did, and what they think of him. I think he is very afraid of any sort of public humiliation such as he had as a child.

On the other hand he doesn't like people telling him what to do. He said that he has "contrariness".

Clearing Feelings of Shame

I decided to do metaphor replacement therapy on his feeling of shame about his past behavior. He said it was like a purple cloud. Full of smoke. I asked him "and what do you feel about that purple cloud?" He said "sad". I got him to change its shape and I asked him "what happens to clouds over time?". He said they get smaller. I got him to imagine the rain. He said it was yellow. I eventually got the cloud to disappear.

He said that it was great to get rid of that feeling but he still wanted to be able to stop smoking. "Are you not going to do anything about my smoking?".

I felt I had to do something about his smoking even though we were well over time. I really wasn't sure what to do that might help him stop smoking. He smokes because he is trying to avoid his feelings. If we can eliminate the source of those feelings, we will eliminate the need to smoke at the same time. But he wants to stop smoking right now.

My Friend John Induction

I didn't actually have a plan at this point, so I did a simple relaxation induction. He kept squirming around and scratching and moving and clearly was not in trance.

So I decided to do a My Friend John Induction. As I started on the induction I realized that I had the option of changing it. At this point I had still not worked out what I was going to do in terms of getting him to stop smoking. It suddenly occurred to me that I could get him to tell himself to stop smoking since he didn't like being ordered to do things by other people. I could take advantage of his "contrariness".

So I suggested to him that it wasn't a stranger who was in the other chair. It was a copy of himself. I told him to imagine that another version of him was sitting on that chair and wanted to go into trance. I told him to repeat the instructions "get yourself into a comfortable position, allow yourself to relax, feel your breathing slowing down, et cetera." Then I continued with the rest of the My Friend John Induction until he was in trance.

My Friend John the Therapist

As soon as I was satisfied that he was in trance, I use the other copy of himself to do a sort of reverse My Friend John. I got the other "him" to tell him to repeat the instructions in his own mind. The instructions were along the lines of "You are ready to stop smoking. You know it is time to stop. You know that you can stop smoking. You are the kind of person who can stop smoking easily, quickly, and permanently." And so on.

Once again I learned, if you're unsure what to do, trust your unconscious mind, and it'll come up with what you need. I think this might become my standard way of using the My Friend John Induction and combining it with therapy.

Surprising benefits of Depression

I had a client come in to me today who complained of procrastination. He is a successful manager of an IT team with 50 people reporting to him. He is very well paid, and highly respected, and an expert in five IT disciplines. And he is very unhappy.

He told me that he was frustrated at not achieving enough. And yet at the same time, he feels resentful at the way other people take advantage of his success. Other people dump work on him, give him extra responsibilities, put him in charge of things. Because they know that he will get it done. And he lets it happen because he always puts other people first. He has no boundaries.

I have seen this client twice before. In our first interview, it became clear that he has dysthymia, a form of depression. This  is very common, but usually not diagnosed. People who have dysthymia just think that they are lazy or angry or withdrawn by nature. They are in fact ill. Dysthymia and anxiety underlie a great deal of the behavior that I deal with every day.

Reframing depression

This client had his 50th birthday coming up, and felt that his life was slipping away from him. He was working endless hours and felt that he was getting nothing but money in return. Even that didn't help. His wife was using him and spending the money as fast as he earned it. He told me that he "just feels empty".

I pointed out to him all the good things he had in his life. And he said "Yes, but think of what I could have achieved if I hadn't felt this way." He looked very surprised when I said to him "the reason you have your success at work, and your high salary, and your ability to run complex international projects is because of your depression. Depression is making you successful."

"What are you talking about? This depression has been the curse of my life." I then had to explain to him that in fact all of his professional success was a side effect of his depression.

Benefits of depression

Mild depression causes circular thinking. In circular thinking you go over the same things again and again. You over analyse things. You worry about things all the time. These are ideal traits in a project manager.

Mild depression also causes perfectionism. People with perfectionism are always looking to be better and better. And they get annoyed when they don't reach their own expectations. And this causes them to take action, to get angry, irritated, and to be moved to do something about it until it does reach their high standards.

Another side effect of depression is the inability to form deep and meaningful relationships. You are not unfriendly, but you are completely comfortable in your own company. Again, this is an ideal trait in a project manager. You can communicate well with people on a business level but don't get bogged down in social relations when you have to put the hard word on people.

Similarly, people with dysthymia are easily bored. They have to be doing something all the time. And need constant stimulation. So they check every last detail of whatever it is they're working on, and build checklists, and schedules, and plans, and everything else to keep their mind occupied.

The fifth main area of depression is around self esteem. People with depression feel not good enough, worthless. When things go wrong is always their fault. They get validated by achieving external results. They can perform extremely well on some external task, but when it comes to looking after themselves and their own interests they tend to self sabotage.

Accepting the benefits of depression

This is exactly what my client was doing. He is working himself into an early grave. He is getting lavishly rewarded by his employers, but inside it all seems pointless. And he still feels worthless.

I have met several clients were very successful in business because they need to check every detail, they're willing to spend endless hours at work, they are constantly striving to reach a level of perfection that is unreachable.

It is ironic that the thing that makes them unhappy is also the thing that makes them successful.