Spiegel’s method for stopping smoking

Herbert Spiegel was an American physician in North Africa with the US Army during the Second World War. He had learnt to use hypnosis clinically before the war. As an army doctor he had to deal with hundreds of soldiers who were physically injured, but also hundreds more who had what is now called PTSD. As always in any wartime situation he was short of morphine and other drugs. So he turned to hypnosis. He discovered that he was able to greatly reduce the amount of morphine by using hypnosis instead. He was also successful in using hypnosis to reduce battlefield induced psychological injuries.

Spiegel's method

When he returned to civilian life he began to apply hypnosis in his normal medical practice. He published extensively and his ideas on hypnotherapy were widely taken up in the medical profession. Spiegel moved hypnosis out of the area of stage hypnosis and into the area of proper academic study. He applied his hypnosis treatments to weight loss, depression, and in particular smoking.
He was able to claim consistent success with a single session hypnosis technique known as Spiegel's method. Spiegel's method encourages smokers to keep reminding themselves of three basic ideas. A) smoking is poisoning your body. B) if you keep poisoning your body you will die. C) if you don't want to die, then you have to respect and protect your body.

The method consists of teaching smokers self-hypnosis. The self-hypnosis installs a post hypnotic suggestion to encourage the smoker to repeat A, B, C every two hours, and any time they feel the craving to smoke.
The theory behind this method is that motivation is the key factor in stopping smoking. Spiegel believed that concentrating on preserving your own body is the key to changing any destructive behavior.

Testing Spiegel's method

Academics tested and repeated his technique several times, under scientific controlled conditions, and got consistently good results. About 25% of random smokers will be smoke free a year later.
However, a great deal of research and development has happened in the 40 years since Spiegel introduced his method, and modern hypnotists claim a much higher rate of success.
It would be interesting to go back to the motivation method, and see how today's smokers accept the idea, and whether it works any better now than it did then.

Source: Spiegel, H. (1970). A single treatment method to stop smoking using ancillary self-hypnosis. International Journal of Clinical and Experimental Hypnosis, 26, 22-29.

A surprise Easter egg

I had a client today who reminded me of the deep and complex psychology that our clients bring to us. When I went looking for the origin of this client's problems, I had no idea what I would find. This one brought me a surprise Easter egg.

This client came to me several months ago, and at that time I treated her for the anxiety she felt during meetings at work. She felt unable to speak up and was afraid of conflict. She said that she felt a tremendous change after the last session and felt it was time to change some more.

I asked what her problem was today, and she said that she has a knot of anxiety in her stomach all the time. Her constant anxiety means she overeats and drinks too much to deal with the stress inside her. She also eats too much when she is "bored".

Visualising the problem

The problem seemed simple enough. I got her to close her eyes and become aware of the feeling inside her body. She identified it quite easily and said that it was located in her abdomen. I asked to describe what it seemed like. To my surprise he said it is like a huge oblong egg. I asked her to describe it and she told me that it had a shell, with a mottled black and dusky gold surface.

When I asked her to describe it in more detail it told me that it was womblike, that there was something like a foetus inside it. This really surprised me. I have never come across anything like this before. It clearly had deep significance to her. It is not often that a client gives you such a powerful and direct metaphor.

Chair therapy

I decided that the best therapeutic technique would be to use the Chair method. I told her to imagine a chair in front of her. Then I told her to imagine taking that egg and placing it in the chair. She said she had done that:that was the most critical part of the therapy done.

I then told her to just regard it. Look at it, be curious about it, to think about what she felt about it. She said there was something inside it. I asked her what she thought it was, and she told me that the thing inside was the true essence of her. She felt that this thing inside the egg shell had been trying to get out for a very long time.

Breaking open the surprise Easter egg

The next job than for me was to help get this thing out of the shell. I told her to imagine leaning forward and putting her hands on the shell. Then I suggested that the contact of her hands would begin to transmit heat into the egg. I asked her what the thing inside the egg wanted. She told me that it wanted to come out.

I then asked what was happening in the egg, and she said that it was now warm inside. Then I told her to move her hands around on the surface of the egg to see if thing inside would begin to follow the movement. After some time she said that it was moving and that it was ready. I told her to move her hands closer together at one point in the egg and to leave a space between them. I suggested that between her hands she would begin to feel bumps and tremors and little cracks begin. Quite quickly she said that yes it's happening. Then with out any more input from me she said "it's out".

Keep the change

At this point there were tears in her eyes, so I decided to consolidate the experience. I told her to take this thing (and at no point did I ask her to describe it) and hold it the way she would hold a new baby. I told her to love this thing and allow it to love her, to open herself up to it, to allow it into her body.

This brought more tears, and I spent some time getting her to take it into her body, to feel it spreading to every part of her.

She needed to have this change impressed into her unconscious mind so I did a kinaesthetic confirmation. This consisted of suggesting to her that she send a message of gratitude to her own mind for having allowed this to happen. I suggested that she might get a message back. I told her to focus attention on her hands, and that she might feel a need, a compulsion to move a finger or perhaps the hand would move. She got a motor response in her hand. I told her that that was her guarantee that her mind had heard and would be applying the changes.

Visualise the outcome

I finished the session with lots of suggestions of her new ability to stand up for herself in meetings, ( the original thing she came for) and that she would no longer have any problems with eating or drinking.

She came out of the session saying that she felt completely changed. She said "I feel like I can do anything today".

I gently suggested that she would feel like that every day from now on.

Fear of earthquakes

I live in an earthquake zone, but up until today I had never actually had a client with a fear of earthquakes. My client was a young mother who had lived in New Zealand all her life. Earthquakes are a monthly occurrence here. But since the last big earthquake she had been getting more and more fearful. Her anxiety was now becoming a serious problem. To the extent that she was seriously considering moving her family to Australia to avoid earthquakes. Strangely, it was not the earthquake itself she was afraid of, it was not being able cope with the aftermath.

Not an irrational fear

She was very embarrassed about having such an irrational fear. She asked her husband if anyone else where he works was afraid of the next earthquake, and he said no. It was well is the fear is suffering from acute embarrassment.

I said that it seems to me like a simple phobia. She told me that her mother had also been terrified of earthquakes, and as a child, he had been disturbed by her mother's distress. It seemed to me that this might be a case of phobia by proxy.

I told her that as far as I was concerned, her fear of earthquakes was not irrational, although it was unusual. I told her that it wasn't irrational because it was actually based on a childhood fear that had never been dealt with. Something in the last earthquake had triggered that childhood fear, possibly about an earthquake, possibly about something else. And now, every time she thought about it, that childhood fear was triggered back into action. The way to treat her fear of earthquakes was to treat the childhood fear.

Treating her fear of earthquakes

She was easily distressed just by talking about it and so I explained about Gestalt metaphor technique. I talked her through feeling the fear and got her to feel it in her body. I developed it as an object. She told me that she felt something oblong in her stomach. It was black and wobbly and soft and cold like jelly. I asked what she wanted to do with it. She told me she wanted a stamp on it. Gradually, I got her to change the object until it became like a teardrop, but she could not change it any further.

I asked her if she had ever done any baking. I talked about rolling, spreading, flattening, twisting, to seed the idea in her mind. This worked and she said that it had now become like a balloon. I got her to expand it and expand it, until it popped. She then put it down the sink disposal unit.

Then I got her to think about the place where it used to be. I encouraged her to fill it with something nice, like a flower, or a candle, or a child's smile, or something else that she liked. He decided to fill it with the view from her new house.

Replacing the fear of earthquakes

I then deepened her into a safe place, where she had everything she needed, and felt safe and comfortable. I suggested that her baby was there with her. Together they were surrounded, protected, and loved. In that place they were not affected by what happened outside.

Then I added some personal resources for her. I suggested that she was the type of woman who shines in an emergency. The type of woman who takes control, the type of woman who is in charge of herself and everything else. I suggested that she was ready, and in control, and a survivor. That she was the type of person that other people rely on.

Then I allowed her to bring herself back to the present.

That she felt very tired, but now thought of earthquakes quite differently.

I guess we shall just have to wait for the Next Big One to find out.

Black and white thinking dogs

Over the last 15 years I have been trying to figure out exactly what is going on in other people's heads. And in my own. I'm beginning to suspect that a great many things that clients come to therapy for have to do with black and white thinking.

As I get more experienced in hypnotherapy, my ideas about what causes common problems has continually changed. When I came out of my hypnosis course many years ago my head was filled with NLP and Ericksonian Hypnosis and other good things. The approach to therapy was simple, obvious, and there was a solution to every problem.
Right from my first client, I discovered that this just was not true. Almost everything I had been taught in my course turned out to be simplistic and/or over-hyped.

Black and white thinking

I was reminded of this by a post on another forum that I occasionally visit. A woman there posted a story of how she had many years ago moved to a house near the beach. On her first night there she found it delightful to be lulled to sleep by the sound of the waves and a distant foghorn. On the second night she couldn't get to sleep because of the incessant barking of many dogs. She tried to sleep but the barking went on and on and annoyed her so much that she got up out of bed, got into her car and drove towards where she thought the noise was coming from. These noisy neighbors had to be sorted out once and for all. She was just not gonna stand for this.

Then she found the source of the noise. There was a colony of seals on the beach. They were all doing the things seals do, and barking at each other in the dark. It wasn't dogs at all. Sounded just like dogs, but it wasn't dogs. So she went home satisfied that wasn't dogs and went to sleep. The seals barked on many nights, but none of that barking bothered her at all. She just added it to the list of pleasant noises you get when you live by the beach.

Theories about perception

The story illustrated a point about how her feelings changed when her perceptions changed. She was wondering how it is that our perceptions affect our emotions. If we can find a way to change our perceptions, then perhaps that technique could be used in hypnotherapy. There then followed a discussion by many contributors about the nature of perception and how everything is perception.

I thought about this story. And I came to a different conclusion. I don't think her behavior, her ability to sleep after she knew the barking was seals and not dogs, had anything to do with perception. It is actually to do with black and white thinking. It is not that perception affects emotions, it is that emotions influence perceptions.

Personal Beliefs

The starting point for me, is asking why do barking dogs annoy her in the first place? Some people get annoyed by dogs barking, some people just ignore it. It's got nothing to do with the barking, and everything to do with our beliefs about barking. If you believe that dogs barking is just what dogs do, and it's meaningless, that a barking dog is just an unhappy dog, then it doesn't bother you.

If you have a personal belief that dogs should be controlled, that uncontrolled dogs are an indicator of bad training, and caused by inconsiderate people, then those people should be made to change. It is the compulsion, the call to action, that causes the emotions. The emotion is there to make sure you do something about it.

I believe that a great many people, who would be horrified to learn it, actually have black and white thinking. When I discuss it people often say "Oh no. I can see things in shades of grey." But what they don't realize is that they have many rigid internal rules about right and wrong. And those rules are tied to emotion. The woman in the story was so annoyed about the dogs that she got up in the middle of the night to go and sort out the people allowing the dogs to bark. This is classic black and white thinking.

Consequences of black and white thinking

The essence is: "This is wrong. I am allowed to get annoyed about this. I have the right to punish people who don't behave the way I expect them to". My theory is, that for this woman, this was one of her personal beliefs. She has a black-and-white rule about dogs barking. It mustn't be allowed, and it fires off anger inside her when someone contravenes that rule. Anger makes her act. It seems irrational, but it is in complete accordance with her internal rule. And every time it happens she reacts the same way.

She has a different rule about waves on the beach, and foghorns, and for all I know, seagulls and rainstorms and many other things. I would speculate that she has a rule that natural things might be annoying, but they are things that must be accepted, welcomed even.

Reframing the perceptions

Therefore when she discovered that the source of the noise was seals barking, she realised that her rule was not being contravened. There were no grounds for getting angry, and she could sleep through it. It wasn't her perception that changed, the noise was just the same as it had been. What had changed was the realisation that the rule didn't apply in this situation.

Probably, in that town, there were people who also believed that the barking of the seals was barking of dogs. But those people didn't get up in the middle of the night to do something about it. They have a different rule about barking dogs. So it is not about perception, it is beliefs about the rightness or wrongness of other people's behavior.

The woman in the story went on to ask about what she could do to alter her perceptions to stop her getting angry about various things. If she came to see me I would advise her instead to start searching her memory about what it was that created the rule in the first place. Change the rule, and you change the emotional response.

Self-diagnosis technique

I think I may have discovered a new self-diagnosis technique. My client yesterday was overweight. Overeating in my experience is normally associated with some sort of childhood trauma. However, after much questioning this client said that she could not remember anything about her childhood that was bad. She did say that she had lots of feelings but for the whole of her life she has just pushed them back, refused to deal with them.

I decided that the best approach would be to do Gestalt metaphor therapy. I used a breathing induction with her, and gently lead her into trance. As soon as I was sure that she was in trance, I began fishing for the dominant feeling in her unconscious mind. This involved suggestions such as "There is a feeling that you get, a feeling you have had many times". "It is a feeling about not being good enough, a feeling of being worthless, no good". "A feeling from long ago, and as you think about that feeling, as you get that feeling, this something will come into your mind about that feeling".

And sure enough, she immediately began to cry as the memory that she had tried to push back began to emerge. Gestalt metaphor technique is a way of dealing with the feeling in terms of a metaphor. It is a safe way of dealing with trauma, because you don't have to access the memory directly.

So I got her to express her feeling as an object. She told me it was like a white ball, then it turned into a jelly bean-shaped thing, hard and smooth and lodged somewhere in her chest. I then started the process of suggesting to her that it might change. Eventually it shrank and wrinkled and ended up like a deflated balloon. The next step was to ask if she had ever used a chopping board. That prompted her to imagine chopping up the limp balloon. Whatever that feeling or memory was it was now gone, for ever.

A self-diagnosis technique?

After she came out of trance, we discussed the nature of metaphor healing therapies. She is an intelligent woman, and is very interested in the process. So I decided to do an experiment. I told her I was going to teach her self hypnosis, so that when she was in trance in her own time she could explore her own subconscious mind.

I used a progressive muscle relaxation induction, followed by an eye catalepsy test. She, like many overweight people, had a rapid, shallow breathing pattern. So I deepened her until her breathing became regular and slow.

In this induction, I spent some time emphasizing the power of her own mind, and how strong it was. I told her that in trance her mind would open up to a large empty space and in that space perhaps her mind would show her something. Something to do with the feeling that she gets, something to do with that need to eat, something to do with why she is unhappy. This was something I had not done before. I really wasn't sure what to expect. My hope was that her mind would reveal to her something that she had spent a lifetime trying to hide, but who knows?

She came out of trance, telling me she felt a very profound feeling, unlike anything she had ever experienced before. We wound up the session and she still didn't say anything about seeing something or not. So I asked her if she had seen something. She said "Yes I did, but I'm not telling you what it was", and laughed.

It seems it did work. And I will be exploring this technique in future.

Do representational systems matter in hypnosis?

Do you need to pay attention to the representational systems that clients use? I was asked this by a newbie the other evening. He had recently finished a hypnosis training course, and was full of enthusiasm about NLP, wordplay, and the scientific approach to hypnosis.

Representational systems theory

What he was talking about was the old NLP belief that people tend to represent the world using one dominant representational system. These are generally known as VAK, standing for visual, auditory and kinaesthetic (feeling).
I was rather surprised that this is still being taught, or rather that it was being given so much importance. Even the founders of NLP have said publicly that is perhaps a little overdone.

Representational systems reality

When I started my hypnosis practice I was fully convinced that VAK was important to success. I used to start every session by asking the client to close their eyes and imagine a horse. Then I would ask them to describe their horse and note the type of words they use to describe it. I did this hundreds of times. Eventually I concluded that it was a waste of time. I could find no evidence for consistent VAK. Dominant primary representational systems do not exist.

I did get some very interesting answers. One woman told me that her representation was in fact auditory. What she was getting was something like a race caller's patter "and now the leader is rounding the bend, and the second favourite is coming up the outside…". Another woman told me that she could feel the horse. I said so you can feel what? Its back, its legs? "No, I can feel this much". And she demonstrated with her hands that she could feel about two palms width on any part of the horse she chose to. Another told me that what she got was patches of random colour in her mind.

Now these were all very interesting, in fact fascinating, but not really useful in therapy.
What I found much more useful was listening carefully for the metaphors that the client uses. In my opinion, these give a much more accurate representation of how the client is feeling and where their problems lie. And unlike VAK, they also give you a very good idea of where to direct your therapy.

Organ Language

Organ Language in the treatment of pain

I was asked recently about the use of organ language for the treatment of pain. This is something I had heard of but never used. The person asking had no idea what it was.

Theory of organ language

Organ language is a concept introduced by Leslie LeCron in his writings in the 1920s. The basic idea is that the language that you use, the words that you say, can affect the organs you talk about. NLP uses similar ideas about the power of words to influence feeling.
According to LeCron, if you repeatedly use a phrase such as "this guy is a pain in the neck" then saying the phrase over and over will actually give you a pain in the neck.

The theory is that constantly mentioning the organ in everyday phrases focuses attention on that organ. That causes it to malfunction. If your illness is being caused by the overuse of a metaphor such as "I'm sick of seeing my team lose every Saturday" then the answer is to stop saying it. If you change your language to something different such as "I'm really looking forward to our next win" then that will keep you healthy.

Overused Metaphors

Personally, I just don't believe this simplistic logic. Most of us use metaphors all the time, and we don't know the origins of them. These are known as lost metaphors and are basically a lazy way of speaking. These metaphors used to be bright and fresh and colourful but overuse has dulled them to the point where they lose all their force. Telling someone "I was taken aback" nowadays simply means that the speaker was surprised.

The phrase "taken aback" originally referred to a sailing ship. Sailing ships are designed to take the wind from behind. If the wind suddenly 'backs' to come over the bow then the masts get pressed backwards instead of forwards. Masts are not designed for that. They can snap. Being "taken aback" is very dangerous. The image is of immediate panic and the crew running around to save the ship. But that original colourful meaning of the phrase has been lost through time.

I suspect that someone saying "it's a pain in the neck" really is not thinking about the neck or anything else. All they're doing is substituting an overused phrase in place of original thinking. To suggest that someone using the phrase "I was taken aback" has in mind an image of a sailing ship suddenly plunged into danger is just not believable. Our minds are not as literal LeCron suggests.

Treatment

I think the truth is more straightforward. When someone says "I feel stabbed in the back", then they probably do feel that. It's not the metaphor that is causing the pain, is the pain that is causing the metaphor. And therefore the correct course is to use the metaphor to alert you to their pain.

Simply telling the person not to use the phrase again is not going to work.

Why hypnosis aversion works

Hypnosis aversion works.

All psychotherapy is aimed at changing behaviour. Hypnosis aversion is a very powerful technique for changing behaviour.

The basic theory of behaviour change is that people will stop doing things they get punished for but will do things they get rewarded for. This is the basis of behavioural therapy.

However, behaviour can only be changed while it's happening. For example, suppose you have a situation where a child is constantly interrupting adults while they talk. If your response is to remove the child from the room, then the behaviour is no longer happening. Problem solved.

But the child is learning nothing. The child may in fact be learning resentment or hatred towards you, which is not actually what you want. The child may in fact be reinforced by the bad behaviour. There might be things to do outside the room which are just as enjoyable. What the child is not getting is any instruction on how to behave while adults are speaking. You can only change behaviour during the behaviour.

External punishment doesn't work

That is why punishment seldom works. The first response to any kind of unwanted behaviour is to punish the person doing it. If that doesn't work then you punish them some more. If that doesn't work punish harder. However the basic problem with that approach is that the punishment is applied after the behaviour has finished. It is too late then. In the criminal justice system people are often punished long after the crime. The criminal may in fact have forgotten the crime by the time they get to court. It is the time difference between the behaviour and the punishment which is crucial. If your finger broke every time you stole something there would be a lot less theft. If your car refused to start after being illegally parked, illegal parking would soon die out.
It is the immediate link between the behaviour and the punishment which is critical. And the punishment has to happen at the exact time that the behaviour is happening.
That is the critical difference between hypnosis and behavioural approaches. When a bad habit is treated with Hypnosis Aversion a link is formed in the unconscious mind between the behaviour and a feeling. The feeling is usually disgust or fear or some other negative thing. The critical difference is that as soon as the behaviour starts the unconscious mind brings out that horrible taste or fear or whatever it is immediately. There is no delay. There is no gap between the behaviour and the punishment.

And that is why hypnosis aversion works.

Chinese Restaurant Phobia

I saw a client today with Chinese Restaurant phobia. This is one of the more unusual phobias I have come across. My client went to a Thai restaurant about two weeks ago and was enjoying the meal. But something in the ingredients set off an extreme allergic reaction. He ended up being stretchered out of the restaurant barely breathing and into hospital dangerously ill.

He was discharged two days later and swore to avoid Thai restaurants in future. However this week, when he went into a Chinese restaurant he immediately felt dizzy and frightened and had to go outside again. After ten minutes we went back in to join his friends. But again he was seized with an overwhelming fear and actually vomited when he ran outside.

It is interesting to see so clearly the process of how a phobia forms. His unconscious mind has identified something in the Thai restaurant as being associated with the sudden onset of a dangerous illness. It is therefore primed to protect him by forcing him out of any place where he might get harmed. It is now in the process of broadening out the possible indicators to include other types of Asian 'things'. Over time, if left untreated, his unconscious will start to include an ever wider range of possible indicators. It may eventually end up as a full size fear of any restaurant, or even of food.

Treating the phobia

I like to treat phobias by going directly for the feeling. I ask the client to think about the feared situation and feel the fear. If they can get the fear as a feeling in their body I can clear it immediately using Gestalt Metaphor Therapy.

In this case the client could not summon up the feeling, probably because it has not had time to create a strong repeatable feeling.

So I put him into trance and tested to make sure he was under. Then I suggested he think about the Thai restaurant and the Chinese restaurant and the feeling that he got there. The client turned to be one of these people who go corpse-like in trance, and give no indication of what is going on inside. I therefore could not do a question and answer session with him.

All I could do then was assume he had the feeling and try to remodel it without feedback. I suggested that the feeling could become an object, that it had a shape, a size, a color and so on. Then in several different ways I suggested that the object was changing, shrinking, changing color and transforming itself in ways it wanted to. I really had no idea what was going in his mind or whether he was experiencing anything at all.

I brought him out of trance and asked, a bit nervously, what object had looked like. "Oh, a big concrete square," he said, "and I crushed it".

Looks like the job got done.

Bored – a special word in hypnotherapy

Bored is a special word in hypnotherapy. When a client says to me "I [do something] when I am bored" this immediately sets off a warning signal in my mind. Then I know I am dealing with a case of anxiety.

Boredom is better defined as a lack of stimulation. When you lack stimulation one of two things happens. You either get up and seek external stimulation, or you allow your inner thoughts to come out. Both of these alternatives have good and bad aspects.

Seeking external stimulation is least bad of the outcomes. Some people get motivated to do useful things. Others just go aimlessly looking for something, anything, to do. The old saying 'the devil finds work for idle hands' applies here. Much petty crime is the result of too much time and not enough planned activity.

Allowing inner thoughts to intrude also has several outcomes. Some client are so afraid of their inner thoughts that they spend their life in frantic activity, keeping busy all the time. Other people so hate the thoughts that they play music all day and keep the radio on all night. Having an external noise drowns out the the disturbing internal thoughts.

Most people do not go to such extremes. But the fact that they are having these thoughts is disturbing, and makes them feel anxious. So they do something to fill the void. When things get quiet is often when people start on their bad habits. Snacking is a classic response to boredom. Smoking is another. As is hair pulling.

So when the client tells me that they do it when they are bored, I start seeking the cause of their anxiety. Fix that and you fix the behavior.

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