Re-Programming The Brain
Imagine being able to sit down with someone who has suffered serious brain trauma and guide them not merely to tie their shoelaces again, but to actually consciously direct the process of tying their brain back together.
The very name “Neuro-Linguistic Programming” implies that NLP ought to be able to assist in cases where a person has suffered neurological damage. But what do you actually do when confronted with the many real life problems such a person may face? As an NLP trainer, I’m often asked what I would recommend NLP Practitioners to do in cases of brain injury from cerebrovascular incident (stroke) and other internal problems, or from external trauma such as motor vehicle accidents. One of the original models studied by the developers of NLP, Dr Milton Erickson, worked extensively with such cases (Erickson, 1980, p 281-328), but there has been very little discussion of the matter in the NLP community since his work. In this article I want to go step by step through a format for working with such cases, based on Erickson’s work, on the recommendations of people who have recovered from brain injury, and on the recent research into the brain’s incredible adaptability.
I will structure my suggestions using the RESOLVE model, previously described in my book “RESOLVE: A New Model of Therapy” (Bolstad, 2004)
Resourceful state for the Practitioner
Open up person’s model of the world
Lead the person towards their outcome
Resourceful State For The Practitioner; Know That Change Is Possible
Milton Erickson knew from his own experience that the brain could relearn after severe damage. Erickson was paralysed after a polio infection when he was 17, and taught his body to walk again over the next year. “In my own experience with myself it seems to be a matter of learning to use muscles in a different way. When I was 60, I went for a physical, and the examining neurologist found that I had divided some muscles into halves, some into thirds. One-third of a muscle was realigned to pull against the outer two-thirds of itself. One-half of a muscle was pulled against the other half.” (Erickson, 1980, p 327).
Working with others who suffered such neurological damage, Erickson searched for a way to prove to other practitioners what he himself already knew from his life experience – the brain can heal. In the literature, he came across some ethically disturbing experiments which had been done using brain surgery on rats and monkeys. He explained “Seeking a possible basis and rationale for treatment, the writer called to mind Lashley’s research on maze learning in rats, with subsequent relearning after surgical destruction of various areas of the brain, as well as the implications of his research for the utilisation of alternate neurological pathways after brain damage.” (Erickson, 1980, p 315). Karl Lashley’s research in the 1920s was followed up by Michael Merzenich in the 1970s (Doidge, 2007, p 55-59) and by Edward Taub in the 1980s (Doidge, 2007, p 136-143). In 1981, thankfully in my opinion, animal rights activists intervened and Edward Taub was convicted of six charges of cruelty to animals for this series of studies. Taub responded by shifting to much more ethical studies with consenting human beings.
Before discussing the more acceptable studies with human beings, let me summarise what the earlier researchers had learned in their work with monkeys. The studies by Ashley and Merzenich showed clearly that a specific area of the brain which ran, for example, the outside of a monkey’s hand on one day might not run it the next day. If nerve connections to that part of the hand were severed, then within 24 hours the monkey’s brain would have reassigned those brain cells to give it a more exact ability to move a nearby area of the hand which still had connections, or to give better movement in the other hand. Edward Taub also showed that a monkey’s brain rebuilt any severed connections to the hand soon after surgery.
The question Taub then sought to answer in his human studies was: why do human brains not simply reconnect after a stroke has produced paralysis? He eventually demonstrated that the only reason this didn’t happen, was that the brain began to assume that the damage was permanent. If an arm was unable to be moved for a few days, the damaged brain would reassign those brain cells which used to run that arm, and have them run another part of the body more fully. Unless the person with a stroke actually tried very concertedly to move their paralysed arm again, it would simply remain “turned off” as part of the brain attempting to get the best use out of its cranial real estate.
In 2005 and 2006, Taub and his colleagues published studies on his method of actually constraining a person’s functional arm in order to “force” their brain to re-grow the neurological map of their “paralysed” arm. Even people whose paralysis had lasted many years were able to benefit from this process. In a similar way, Taub has people who cannot speak (due to damage to the speech centres in the brain) put in situations where their nonverbal requests are ignored. To eat, they must ask verbally. This is exactly what Milton Erickson did with post-stroke clients back in the 1950s and 1960s, as we shall see.
Since the 1980s, more and more precise ways have been developed to study neurological plasticity (the ability of nerve tissue to adjust like a plastic material) in the functioning human brain. In the 1990s Alvaro Pascual-Leone at Harvard Medical School used transcranial magnetic stimulation (TMS) to scan the brain of blind people as they learned to “read” Braille with their fingertips (Doidge, 2007, p 197-204). His studies showed that the more the person attempted to read Braille, the larger the area of brain devoted to their Braille-reading fingertips became. The changes happened overnight as the brain made continuous re-decisions about how much area to assign to each task.
The effective use of rapport with the person who has brain damage involves getting very clear that this person is not you. That means that they don’t need to get fixed in order to make you feel better. That means, on the one hand that you don’t need to be compassionately sorry for them, and on the other hand you don’t need to demand that they get their act together. You are offering likely, but not guaranteed, results, if they are willing to do whatever it takes to change their brain. Changing their brain is not something you can do for them.
Explaining his success with one client, Milton Erickson said “It is true that the patient’s progress might be attributed simply to the increased individual attention she received. However, it is also true that she had received an immense amount of individual attention from numerous relatives, friends, and her family, all of which did not prevent the development of a vegetative state. Also, she received extensive and highly skilled nursing and medical care and attention, all to no avail. But all such care and attention had been based upon concern, sympathy, fear, worry, helpful protective attitudes and a despairing concept of her as helplessly and hopelessly invalidated, despite the diminution of her hemiparesis. Such attention was always accompanied by sympathetic and encouraging assurances in the face of obvious and unmistakable disability and therefore was patently false and expressive only of the wishes of others and an unintentional emphasis on her invalidism.” (Erickson, 1980, p 308-309)
Gail Denton sounds a very clear warning to helpers about the simple “positive thinking” cure. “Some days there is the irresistible urge to think that if you could only get a jump start, you could get going again…. The jump-start is your internal wish to get on with it. The “bootstrap lecture” is what you get from people who don’t understand your experience. Because you look fine, there are people out there, the rugged individuals, who think you should be able to “get over it,” “get with t,” and “get on with it.” These people are clueless.” (Denton, 1999, p 182). A successful helper is offering real help, knowing that it will not be easy and that the client themselves will be doing all the real work! This is the difference between empathy and sympathy.
Specifying Goals: Assessment and Reassessment
This step of helping the person to set goals really involves two processes. The first process is the assessment of what is actually happening now for the person. The second process is the reassessment of what they actually want in life now. The first process is largely based on an evaluation of what has been lost and an attempt to return to the person’s previous way of functioning. The second process is based on a re-evaluation of what really matters and feels enjoyable to the person now, and is an attempt to create a new life which may be fundamentally different to the one the person had before. The difference between these two processes is poignantly demonstrated in the 1991 movie “Regarding Henry” (starring Harrison Ford as a successful lawyer, Henry Turner, who recovers not only physically but spiritually after a gunshot head injury). If you haven’t seen that film, get it out now.
Usually, when a person comes for NLP based coaching or therapy, they have clear ideas about what is not working, if not clear goals about what they want to achieve. The brain-injured person may not realise which tasks they previously took for granted and is currently having challenges because of the lack of realisation. The inability to think of the right word to say (a cognitive task) may appear as the inability to speak (a physiotherapeutic task). The inability to control frustration (an emotional task) may appear as the inability to explain ideas (a cognitive task). The effects of brain injury may show up in the following cognitive systems amongst others:
- Memory – forgetting what the person was doing, inability to remember life events before the accident or inability to learn new information
- Attention – difficulty concentrating especially when there are other noises or images occurring around, inability to follow a conversation or make a decision
- Language – difficulty engaging in a normal speed conversation, and difficulty thinking of words, pronouncing words, or writing words
- Vision – difficulty focusing the eyes or holding focus while moving, difficulty estimating distances visually
- Cognitive supervision – difficulty setting and achieving goals, monitoring errors, shifting from one task to another or anticipating the results of actions
- Emotional supervision – difficulty controlling anger, frustration, anxiety or depression, frequent emotional outbursts or changes in emotional response that others comment on
- Calculation – difficulty calculating change in a shop, adding numbers, following a map, or measuring quantities for a recipe
- Sequencing – difficulty managing time, following through projects to the end, replying to mail and emails, and keeping up with household tasks
- Consciousness of danger – forgetting to lock doors, keep appointments, keep alert while driving or performing other dangerous tasks
- Lifestyle changes – feeling overwhelmed or annoyed with people or experiences previously enjoyed, difficulties sleeping or eating, inability to enjoy a sexual relationship or to laugh
Clarifying the second process involves finding out what the person values and what they enjoy. These clarifications can be done as standard NLP values elicitations, asking for example:
- What’s important to you in life in general?
- Think of a recent time when you were highly motivated towards being alive. What’s important to you as you remember the feeling you have there?
- What things have you done recently that you really enjoy?
- What event would you most look forward to when you wake up in the morning?
- What things have you done recently that were fun?
Opening Up The Client’s Model Of The World; Redefining The Healing Task As Their Own
Frequently the brain damaged person comes to an NLP Practitioner with the hope that NLP will rescue them from their frustrating situation and return them magically to the remembered ease of their previous life. They expect the Practitioner to perform magic, whereas my plan is to show them how they can perform magic. Leading the patient to “See what I can do,” is much more effective than letting the patient see what things the therapist can do with or to the patient.” (Erickson, 1980, p 291).
Letting the client see what they can achieve through therapy requires allowing them to notice what they cannot achieve at the start. Anyone who has watched a little child learning to crawl and then to walk will be struck by the immense frustration which impels this learning process. We need not shelter our clients from the frustrating reality of their situation any more than we need to carry a child all the time; to do so would be to shelter them from much of the natural source of healing and learning. It would mistakenly encourage them to lean on our own non-damaged cognitive abilities, rather than developing theirs. Edward Taub’s constraint of the person’s functional arm (described above) “forces” them to move their “paralysed” arm. In the same way, Erickson’s therapy involved putting the person in cognitively frustrating situations so that they were “forced” to re-grow cognitive areas in the brain. Making the person more aware of their need for change paradoxically allows them to change. Erickson was able to do this with great empathy, because he himself had put himself in challenging situations to “force” his brain to re-grow after his own polio-induced paralysis.
Erickson gives many examples of this method of working with one woman suffering from a severe stroke. For instance “A newspaper was shown to her, and she was asked to read an account of her favourite baseball team. She futilely attempted to do so, whereupon the author read it aloud to her, actually paraphrasing it into a most derogatory account. She snatched the paper from the author and haltingly and imperfectly reread the article aloud correctly, half amused, half angry at the author. This measure served to convince her that she could read “if you make me mad enough”.” (Erickson, 1980, p 301)
Erickson concludes, “Therapy would be oriented about her helpless condition, and use would be made of every possible pattern of reaction and response that she had retained without regard for banal social conventions, and a demand was made that she give her solemn promise to abide by whatever therapeutic measures the author might propose. It was pointed out simply and emphatically, that to date all conventional therapies had failed, that there would be no loss entailed by new measures, and that a therapy designed to meet the actual reality she represented instead of the lost realities of the past might conceivably serve a useful purpose. (Later the patient stated that this frank, non-reassuring offer to give help, but a refusal to promise it, influenced her to take hope and to give and to keep her promise of cooperation despite the anger, frustration, and displeasure the author’s methods occasioned. As she explained later, “It didn’t make sense most of the time, but I couldn’t help noticing that I was doing better. But you did make me just awful mad, and after a while I discovered it helped. Then I didn’t mind how mad you got me. But it was awful at first.” (Erickson, 1980, p 303-304).
To convey a sense of how the person themselves will be in charge of what we do, I recommend using the pointing exercise: “Stand up with your feet slightly apart, and with space around you in front and behind. Bring your left arm straight up in front so it’s horizontal and pointing to the front. Now, keeping your feet still, turn your body to the left, pointing with the finger as far as you can comfortably turn. Be careful only to go as far as you can before it gets tight. Notice, by the point on the wall, how far round you are pointing when it’s tight. Next, turn back to the front keeping your feet still. Now, close your eyes and make a picture of what you would see if you turned again, but this time with your hand going 40 centimetres further round. Imagine where on the wall or window that would mean your hand is pointing. Sense what it would feel like to be that much more supple, so that your body just flowed around. Imagine what you would say to yourself if you could go that much further. Now open your eyes and physically turn again to the left. See how much further you have turned. Imagining yourself going further causes your brain to make the adjustments to create that in reality.”
In summary, at this stage I want to establish with the client a relationship where they will commit themselves to sustained action to achieve apparently magical results. These results emerge from the natural ability of the brain to adjust which brain areas perform which tasks, on a day by day basis, and not from some magic ability of mine.
Leading To The Person’s Outcomes
The person recovering from a brain injury can take advantage of many different therapies and use many different coaches. The healing modalities available include physical therapies, massage and acupuncture-based therapies, nutritional therapies, exercise therapies (including pilates, yoga and chi kung), surgery and other orthodox medical treatments, and other alternative healing methodologies. As an NLP Practitioner, I would encourage clients to utilise such other help, especially adding omega 3 oils (from flax oil or fish oil) and other brain nutrients to the diet, and doing chi kung daily.
There are four main ways in which time with an NLP Practitioner could be most effective using NLP within this range of intervention choices.
- Using precise in-session guided visualisations and trance work to initiate healing responses in the body
- Using in-session trance work to remove pain and create physical comfort while healing occurs
- Using in-session NLP to teach or reteach the person to run their memories and emotional responses effectively
- Setting up precise tasks for the person to complete in their own time in order to install the above skills more effectively in their daily life
1) Visualising Healing
Rebuilding nerve tissue and muscle skill need not be done by purely physical means. As Erickson himself was aware, simply imagining that healing is curing will stimulate healing in the brain and body. Dr Guang Yue and Dr Kelly Cole demonstrated in 1992 that imagining using a muscle (in the research the participants imagined contracting a finger 15 times) increased muscle strength by 22%, as compared to an increase of 30% from actually doing the exercise (Doidge, 2007, p 204).
The effect of visualisation is so precise that when students are taught to imagine their lymphocytes (white blood cells) doing one specific activity (in the research, they imagined the lymphocytes adhering to other cells better) then that specific activity will be enhanced and not other activities that white blood cells do! (Hall et alia, 1992). This means that your cells will follow very specific instructions to achieve exactly the results that are most important to you. To get these research results, scientists actually take lymphocytes out of the person’s body and place them in a test tube. What is perhaps most amazing is to realise that once the cells have been “given their instructions” by visualisation, they continue to follow them even when removed from the body, or even after several months in the body.
Gail Denton details eight different visualisations that the person themselves or their helper can guide them through to enhance neurological healing (Denton, 1999, p 149 and p 208-215). These are all best done in a relaxed or trance-like state, where the conscious mind is less likely to interfere with the healing results. She recommends resting the mind both before and after doing each visualisation, and repeating them on a daily basis. The names that follow for the exercises are Gail Denton’s.
a) Deblocking. Simply invite your brain to remember, and make available to you, “what you know visually, kinesthetically, and auditoraly, by smell and taste and by intuition.”
b) Orienteering. Imagine that there is a question that some place in your brain needs an answer to (Point A), and that the answer lies in another place (Point B) which is somehow blocked off from Point A. Invite a friendly team of your brain cells to find a new route from A to B, which may be more or less direct. Once you have imagined that happening, thank your team.
c) Phone Company. Visualise the two hemispheres of your brain connected by a telephone system. The communication is done by an old fashioned human-operated switchboard like those you can see in very old movies. When the lines are down, telephone service people work on the lines on each side of the divide, repairing connections so that messages get through. Take a few minutes each day to imagine this repairing happening.
d) Office Manager. Imagine an old style office manager in a room filled with filing cabinets, boxes, of papers, computers and other reference materials. This office manager runs your brain. Introduce yourself to the office manager and ask her/him to help you find specific information that you need. Watch the manager going about this job, and ask her/him to draw and provide you with a map to the office to help you find things faster.
e) Hall of Answers. Imagine yourself seated in a large, comfortable chair in a room with large double doors. When you are ready, walk to the doors and open them. They lead to a long hallway with many doors and walls full of drawers. The drawers are organised both alphabetically and in order of dates. Every door or drawer is labeled. Ask a question and search for the drawer or door with that label on it. Imagine opening the drawer or door and finding the answers.
f) Cross-crawl. Gail Denton recommends practicing real life cross-crawling movements (where your left hand touches your right knee and then your right hand touches your left knee, repeatedly, for example) to reconnect the two sides of the brain and train them in complex coordination. When you are lacking the physical energy to do such exercises, she suggests imagining going through the exercises step by step in your mind, feeling each movement is occurring fully and perfectly.
g) Progressive Muscle Relaxation. Scan through the body from the toes to the head, checking each place is fully relaxed, feels good and is serving you well.
h) I’m OK Today. Affirm that your body is healing and attracts energy which your body will use to heal your brain. Affirm that everything you are doing is contributing to this healing; both active exercises and resting, and that you will do what it takes to heal. Affirm that you are OK now, and that what you can do today is enough for today. Let go of any old beliefs and doubts that no longer serve you. Feel that you are lovable and attract loving support.
i) Inner Smile. As a chi kung practitioner, I would add to these processes the inner smile visualisation, which I teach on my Practitioner trainings. The script follows:
This Chi Kung exercise is usually done sitting on a chair. Sit on the edge of the chair with your feet flat on the floor. Your back needs to be straight but relaxed; an effect which you’ll get by imagining that your head is suspended by a cord from the crown up to the ceiling. Close your eyes and gently press your tongue against the top of your mouth. Clasp your hands together gently. Remember a time that you can feel comfortable recalling, when you felt caring or loving. Perhaps a time when you were caring for a plant, or an animal, or for a child. Imagine that you can see this time, and the gentle smile of caring it brings, as a picture about three feet in front of your eyes. Allow your forehead to relax, and draw the energy of caring into the place between your eyes. Experience it as a limitless source of caring energy flowing to this place, and from there flooding through your body as a smile.
Allow the smiling energy to flow across your face, relaxing it. Smile into the neck and throat, through the thyroid and parathyroid glands, which control your metabolic rate and keep your bone tissue balanced. Smile down to the thymus gland in the upper central chest area; the gland which co-ordinates your immune system. From there spread the smile back to the heart, allowing it to relax and blossom in a shining red light, transforming hastiness and irritation to joy and love. Flow the smile out on each side to the lungs, filling them with white light, transforming sadness and grief into the ability to discriminate what’s right for you, and enhancing their ability to take in energy from the air. On the right, flow the smile down through the liver, filling it with leaf green light, enhancing its hundreds of cleaning and organising functions, and transforming resentment and anger into an assertive kindness to yourself and others. On the left flow the smile through the pancreas, which assists in digestion and regulation of blood sugar. The far left is the position of the spleen which forms and stores blood cells, and here rigidity and stuck thinking are transformed to openness. Fill the pancreas and spleen with yellow light. On each side the smile now flows to the back at waist level, flooding through the kidneys which filter the blood, and the adrenal glands atop them which give your body the energy burst of adrenalin. As these glands relax, fill the kidneys with dark blue light, and feel fear transformed into gentleness. Finally, flow the smiling energy down through the urinary bladder, and through the sexual organs, including the glands (ovaries or testes) which balance the cycles of your life. Conclude by flowing the smile to a place just below the navel and a couple of centimetres in from the front. Feel the energy spiral into this centre, called Dan Tien in China, as storage for the day. As you flow this smile, check for the “feeling” that each organ is smiling back. Take the time it needs to allow this to happen.
Draw the smile again into the place between your eyes. This second time, flow the smile down your nose and mouth into the digestive tract; swallowing as you do, and imagining that the saliva you swallow is also full of smiling energy. Smile through the stomach, just below the ribs, and through the intestines. Having flowed the smile down through the whole digestive system, draw the energy back to the Dan Tien centre below the navel. The third time, draw the smile into the centre between your eyes (actually called “upper Dan Tien”) and circle your eyes nine times clockwise (as if watching a speeded up clock face right in front of your eyes) and nine times counter-clockwise. Draw the smile back through the brain itself, smiling deep into the brain tissue, where the glands which co-ordinate your entire hormonal system reside. Flow the smile down the spinal column, and through the neurons (nerve cells) out to every part of the body. Feel as your brain and neurological system respond to the healing energy that you have been generating throughout your body. As you continue to draw the smile into your body from an infinite source of love and healing, imagine the smile flowing out from your body into the air around you, and across the entire room. The smile, remaining infinite, flows out beyond the room across the whole area, across the whole country, into the oceans and across the continents, until the entire planet is filled with the smile. As the smile continues to expand, just check back in your body in the room. Check if there is anywhere in your body where there was an excess of energy (perhaps an area where there was some tension -just an indication of energy not flowing on easily yet) and draw the energy back to lower Dan Tien, feeling it spiral in there as a store for the day.
2) Removing Pain
NLP’s origins lie partially in the hypnotherapeutic work of Milton H. Erickson, whose ability to alleviate pain was studied by Richard Bandler and John Grinder in one of NLP’s first books (1975, p 26-50). As early as 1850, the English surgeon James Esdaile (1957) demonstrated that hypnosis could remove the acute pain of major surgery, reliably delivering an effectiveness comparable to chemical anesthesia. There have been plenty of experimental studies showing how and to what degree artificially induced pain can be relieved by hypnosis, but it is now well established that the clinical results of the method far exceed the experimental ones (Hilgard and Hilgard, 1994). Put simply, it’s a lot easier to stop the pain of a person about to be cut up in real-life surgery; than it is to stop the pain you have experimentally induced by asking a volunteer to plunge their hand into ice-water for a few minutes.
This fact alone tells us something extremely important about pain relief by “hypnosis”. It works best when the person really needs it to work. The technique of hypnosis is not a drug which will work regardless of the person’s attitude. It is a technique for utilising the person’s attitude. In fact, pain, as research shows, is heavily determined by a person’s attitude. Pain which persists or recurs for over six months is called chronic pain. Chronic pain seems to alter the processing in the brain, so that there is abnormal activity in the nociceptors (pain receptors) in the somatosensory cortex (the area of the brain that finally registers what kinesthetic sensations you believe occurred in what part of the body). When the brain is scanned using PET (positron emission tomography) this abnormality is clear. Studies by Pierre Rainville, Catherine Bushnell and Gary Duncan (2001) show that hypnotic suggestions can increase or decrease this abnormal activity in chronic pain, and hence alter the pain experience.
Other more recent studies, using FMRI scans (functional magnetic resonance imaging) show that the mere expectation of pain produces 40% of the response produced by “real” pain in the pain receptors in the cortex of the brain (Porro et alia 2002). Researchers Dennis Turk and Akiko Okifuji explain results of several studies showing that, “In chronic pain, pain-related anxiety and fear may actually accentuate the pain experience…. When people with pain symptoms are exposed to a feared situation (eg walking up a flight of stairs), some experience a cascade of avoidance responses…. Fearful patients appear to attend more to signals of threat and to be less able to ignore pain-related information.” (Turk and Okifuji, 2002, p 679-680).
Milton Erickson categorised 11 methods of dealing with pain using hypnosis (Erickson, 1980, Vol 4, p 240-245).
These categories, which overlap somewhat, are:
1) Directly suggesting that pain disappear.
2) Indirectly suggesting that pain disappear (as Erickson does in Bandler and Grinder’s original 1975 study of his work saying, for example on page 37 of that book “You know Joe, a plant is a wonderful thing, and it is so nice, so pleasing just to be able to think about a plant as if it were a man. Would such a plant have nice feelings, a sense of comfort….”)
3) Creating amnesia for past experience of the pain.
4) Creating numbness or analgesia in the painful area of the body. In traditional hypnosis this is done by teaching the person to create numbness in their hand and then “transferring” this numbness to the affected body part.
5) Creating a more total anesthesia by having the person imagine they are somewhere far from the pain.
6) Altering sensations of pain into sensations of itching, warmth, coolness, or other less disturbing sensations.
7) Displacing the pain to a more manageable area of the body (eg moving abdominal pain to a hand.
8) Dissociation, eg by having the person imagine that they are across the room observing themselves.
9) Reinterpreting the pain as a feeling of heaviness, pulsation or movement.
10) Distorting time perception so that a prolonged period of pain seems to go by much faster.
11) Suggesting that the pain will reduce itself very gradually; so gradually that the person cannot even monitor whether or not this is happening.
3) Teaching The Person To Run Their Memories and Emotions
NLP represents a user’s manual for the brain, and every client benefits from using the NLP skills to gain better control of the processes their brain uses to achieve results (the “strategies” to use the NLP jargon). This is even more important when the person’s own cognitive strategies have been damaged by brain injury. As part of recovery, the person may anticipate needing to relearn how to tie their shoelaces, and even how to speak, but these tasks were officially taught during childhood. There are many important daily cognitive skills which are not officially taught during childhood, and have been learned unofficially over the first few years of life. These may need to be relearned after brain injury. They include, for example:
a) Memory Sequencing. Keeping track of memories sequentially, so have to have some sense of when important past and future events have happened / are expected to happen. This is done by the hippocampus, an area deep in the brain, which provides us with a “map” of our life. Metaphorically we refer to this map in NLP as a “Time Line” and the person with damage to the hippocampus will often need to re-install this sense of sequential time. To install a time line, simply have the person list all the major events of their life (past events which they know happened, and future events which they anticipate) on a line, and create a written diagram of this. Now have them imagine this line extending away from them in one direction for the past, and in another direction for the future. Have the person practice floating up above this imaginary line and regularly exploring it to check where events are on the line. Have them practice setting more and more events on the line as they recall past events and as they plan future events. More detail about how people usually do this is given in the book “Time Line Therapy and The Basis of Personality”, by Tad James and Wyatt Woodsmall.
Evidence that a person can create a new time line to suit their needs comes from a rather odd source – the study of multiple personality disorder. In multiple personality disorder, the person has times when they cannot remember their previous life history because they are using another personality system which has its own “time line” in the brain. Psychiatrist Don Condie and neurobiologist Guochuan Tsai used a FMRI scanner to study the brain patterns of a woman with “multiple personality disorder”. In this disorder, the woman switched regularly between her normal personality and an alter ego called “Guardian”. The two personalities had separate memory systems and quite different strategies. The FMRI brain scan showed that each of these two personalities used different regions in the hippocampus to store memories. If the woman only pretended to be a separate person, her brain continued to use her usual areas of the hippocampus to remember events, but as soon as the “Guardian” actually took over her consciousness, it activated precise, different areas of the hippocampus and surrounding temporal cortex (brain areas associated with memory and emotion).(Adler, 1999, p 29-30)
b) Futurepacing. Setting up cues that will remind one to perform certain actions at certain times (called in NLP “futurepacing”). When people complain of memory problems after brain injury, they are usually complaining of one of two things. The first is difficulty sequencing events, which involves deliberately re-installing and practising the use of a time line. The second is not about memory at all. The person complains that they meant to pick up some bread at the shop on the way home, but they forgot. Most people do not solve this by having a “super memory”. They solve it by setting up a cue that will remind them, when they are passing the shop, to go in and get the bread. This needs to be relearned.
My friend Annette and I shared an office. Each time Annette came to work and saw my cookies, she remembered that it was nice to have a snack available for morning tea. She was committed to buying some to share, but in the meantime she shared mine. After some weeks, we realised that this was a problem of futurepacing. Annette’s good intentions (of buying cookies) were anchored to the office (where they were utterly useless our office did not have a cookie vending machine). I got Annette to imagine herself coming into her local store. I told her to see the things that she would see as she came in the door, and to look over to the shelf where the cookies were. I told her to imagine herself walking over to the shelf and picking up a packet. In this way, her good intention would be likely to be anchored to the naturally occurring sights and feelings of Annette’s real life, the exact moment before they were needed. Sure enough, the next time Annette came into the office, she reported success. She had walked into the deli to buy milk, seen the biscuit shelf, walked over to it … and realised she had no money in her pocket to buy biscuits! You get the idea though – it takes planning to be able to remember!
c) Controlling Internal Dialogue. Identifying when unpleasant internal thoughts and emotions have spiraled out of control, stopping them, and engaging in self-nurturing internal dialogue. There are two kinds of anger, frustration or unpleasant emotional response which the brain-injured person deals with and which others do not usually need to (Denton, 1999, p 312). The first is anger at the unfairness of what has happened to them. This is a legitimate response to an extraordinary situation. To let go of it involves the kind of processes that Time Line Therapy™ or the NLP Trauma cure offer within the NLP technology. The second kind of anger is the normal everyday anger that we experience when things do not always work out the way we expect them to. For most of us, this second kind of anger is usually dealt with by reframing (thinking about how the results we got, while not what we wanted, could still be useful) and reanchoring (remembering the other things in our life that are working out the way we want them to, and feeling good about that).
My colleague, NLP Trainer Lynn Timpany, has developed a comprehensive process for doing this. She calls it The Esteem Generator. Many of our students report that it has enabled them to end processes which have been resilient in the face of other interventions. The Esteem Generator has three steps. Firstly, it involves altering the sub modalities (qualities) of the unsupportive internal voice experimentally first, to loosen the strategy. Secondly, the process has the person identifying the positive intention of the internal voice and using a sequence such as Core Transformation™ (Andreas, 1992) to deal with the part that has been generating the voice. A critical internal voice may have the positive intention, for example, of motivating the person to be their best, or of protecting them from embarrassment. New, more effective ways can be found to meet these intentions. Thirdly, the Esteem Generator involves installing a new strategy which begins with the old triggers for the unsupportive voice, has the person say a key interrupt phrase (like “Think positive!” or “Hey wait!”), has them say something more resourceful to themselves, and then has them congratulate themselves and give themselves a positive feeling about how they changed their thinking. Lynn has the person run through this sequence with every example they can recall.
d) Trauma Cure. Distancing oneself from unpleasant memories and traumatic events, including the events around the time of the brain injury, and letting go of unpleasant emotional responses “anchored” (to use the NLP jargon) to incidental daily life triggers. Such traumatic responses hold back the healing process dramatically, and running the trauma cure frees up phenomenal brain energy. In his book “The Trauma Trap”, Dr David Muss MD documents his extensive use of the NLP Trauma Process with victims of PTSD: A policeman involved in the Hillsborough soccer disaster describes how his flashbacks (sudden horrific memories of the trauma), insomnia and alcohol abuse disappeared after two sessions. A patient (Barbara Drake) tells how one session with Dr Muss completely resolved flashbacks and other symptoms resulting from a sexual abuse experience. These and the other stories documented by Muss parallel our own experiences as trainers and Master Practitioners of NLP. Muss says “I know that it has worked for every patient I have dealt with so far, without exception.” (Muss, “The Trauma Trap”, 1991, p 10). Muss did a pilot study with 70 members of the West Midlands Police Force, who had lived through major disasters such as the Lockerbie air crash. Of these 19 qualified as having PTSD. The time between trauma and treatment varied from 6 weeks to 10 years. All participants reported that after an average of three sessions they were completely free of intrusive memories and other PTSD symptoms. Follow-up ranged from 3 months to 2 years, and all gains were sustained over that time.
e) Happiness. Identifying and moving towards pleasant experiences. This includes being able to find fun in daily life. Have the person laugh vigorously on a daily basis. One of our colleagues was working with a depressed and suicidal young man. He was discussing the hopelessness of his life in such somber terms, and for so long, that the situation began to feel absurd to our colleague. She began to laugh uncontrollably. Her client was first shocked, then puzzled. Finally, he joined her in laughing fully. When he stopped, his eyes lit up and he said “Thanks! That’s what I needed!” and left. Dr Robert Holden (1993) runs the Laughter Clinic at West Birmingham Health Authority in Britain. He quotes William James’ insight that “We don’t laugh because we are happy. We are happy because we laugh.” Holden cites evidence that laughter boosts immunoglobulin levels, restores energy, lowers blood pressure, massages the heart and reduces stress (1993, p 33-42). 100 laughs a day is the equivalent of 10 minutes jogging.
f) Reality Testing. Being able to assess which events are wished for internal dreams and hopes, and which events are real life memories and consensus experiences. During the process of growing up, our parents gently or not-so-gently guided us to discriminate between what we are saying that feels nice, and what we are saying that represents agreed on reality. The person who recovers from a brain injury may need to relearn this distinction. In his book “Time for a Change”, Bandler describes Milton Erickson’s process of teaching a schizophrenic client to make met distinctions between real and unreal (Bandler, 1993, p 7-9). The woman and her psychiatrist made a two hour trip by airplane down to Phoenix to visit Erickson. However, when Erickson said to her “And you left your house and drove here in a green station wagon and saw the countryside on the way, and how long did it take you to get here?” she replied “26 hours.” In this way, Milton determined that the woman was unable to distinguish between the images she made when he told her his story, and the images she saw when she remembered actual events. By contrast, Erickson had her psychiatrist review in his mind three things that he knew were true, and then go inside and make up three events. Erickson then asked the man how he knew which ones were which. The therapist said of the real ones “They seem square, whereas the other ones are vague and transparent and don’t have a shape.”
Erickson then shifted back to the woman. “He turned around and began to instruct her to review the events then occurring. He told her to put them into square pictures. Then he made up fantasies and told her to make them vague and transparent and without any shape. He began to instruct her unconscious mind to start to sort out all events this way. Nowadays, TVs being mostly square, I recommend you make sure you have other ways to sort real from not real.”
Based on your experience working with your client using the above processes, and on their assessment of the challenges they face and goals they want to achieve next, I strongly recommend that you give them tasks to practice between sessions with you, to ensure that they take responsibility for healing and that healing is not restricted to your sessions but expands through their daily life. Whichever tasks you decide to set in this way, there are some useful arrangements to have with the person recovering from brain injury, about how they approach tasking. Throughout her book, Gail Denton emphasises:
- Divide larger tasks up into a few smaller steps and clearly sequence them
- Set up clear cues that will remind the person to do each task – for example Post-it notes placed around the house as reminders, and timing of tasks to fit in with other daily events
- Encourage resting whenever a task becomes so physically tiring as to diminish results
- Accept that success will not follow a straight uphill pattern. What may be easy one day may seem impossible the next. Trust that healing requires both the sudden successes and the resting phases while the brain restructures
- Ensure the client can ask for help when needed and can make clear the transaction they are asking for (who will help, doing what, for what time, with what rewards if any)
- Accept that prioritising these therapeutic tasks may mean reducing the priority of other daily events and that a general “downsizing” of the person’s life may be a useful move in order to concentrate their energy on the most important goals
Tasks need not always seem rational to the person doing them. In fact, Milton Erickson frequently asked clients to complete tasks which seemed completely irrational, so that they could not control the results consciously at all. Furthermore, he often asked the person to do tasks which regressed them to a childhood time when learning was happening far more rapidly and with less analysis. For example, with one woman who had speech problems, he gave the following instructions:
“Slowly, the author went on to explain that this change of speech could be accomplished if she would paste on her bureau, dressing table and full length mirrors, typed in large letters, all the nursery rhymes she could discover that she possibly might or could have known in her childhood. Additionally, she was told to paste up the alphabet as well. Then she was instructed that she was to listen intently to special instructions and explanations that the author would give her concerning how she was to perform a certain important task. This task was the assignment as a duty for her to think and read visually the alphabet forward letter by letter, while saying it backward letter by letter…. Similarly, she was to think and read visually the rhyme “Mary had a little lamb….” forward, while repeating it all word by word backward.” (Erickson, 1980, p 318)
Verifying Change: Journaling
The process of validating change depends on remembering what things were like at the beginning of our work together and comparing that to what is happening now. This process itself is affected by brain damage and some of the despair that the recovering person may experience is due to their inability to track changes. The solution is to keep a journal of the changes and read it regularly. Gail Denton’s book (Brainlash) which I have referred to extensively here, began as her journal. She began writing her journal as a release for feelings of frustration and a way to make sense of the world again. She continued as a way to record her progress. She concluded it as an inspirational story to help others.
She urges, “Write down what happens to you every day. It may be a brief line, a paragraph, or a splash of run-on sentences. Be sure to record daily triumphs, agonies and subtle improvements. Talk about your general mood, and any nuances you may be feeling.” (Denton, 1999, p 239)
Ecological Exit: To Infinity and Beyond
There is an endpoint to the NLP coaching you do with the person who recovers from brain damage. That may come when they decide that they can carry on by themselves getting the kind of results you have supported them to get. But the recovery process itself merges into the discovery of life, and continues lifelong. It is normal for people to continue setting goals, and the person recovering from brain injury can be supported to treat this as a lifelong process. Gail Denton cautions, “My doctors told me my brain would do the healing it was capable of within two years. That I should not expect a lot of continued recovery beyond that two year time frame. While that may be a workable estimate for them, I continue to recover, develop, progress, enhance and reclaim function and memory well beyond that guess.” (Denton, 1999, p 253).
While healing continues for the rest of ones life, it is also true that the discovery of new meaning after brain injury is an ongoing process of revelation. Jeanne Achterberg explains, “In cultures that sanction the role of shaman, the potential healer goes through an initiatory period that sharpens sensitivity and insight. Sometimes this is unplanned, such as a grave illness that brings the initiate very close to death.” (Achterberg, 1988, p 117). Acknowledging that not all of her readers will want to consider this aspect of their recovery, Gail Denton says “”There are two kinds of people in the world: those who believe in psychic energy and those who do not. There are also those who, after a brain injury, come to experience paranormal phenomena, whether they believe in it or not…. Many times, a near death experience will bring with it other paranormal insights and abilities. Along with that may come spiritual, moral, or ethical revelations, bringing the person to live life from a different base of understanding.” (Denton, 1999, p 349-351).
Whether or not all this makes sense to your client who has recovered from brain injury, what is undeniable is that they now know aspects of cognitive reality that are hidden from others. While most people take their cognitive and emotional functioning for granted as part of who they are, the person who has experienced brain injury knows that who they are is being filtered through or even generated by the brain. Their experience has given them a glimpse behind the illusion of stable reality that our brain usually creates. It is like that moment when the DVD player jams and the viewer remembers that it was all just a movie. This is an extraordinary experience and honouring it assists the person in finding ongoing new meanings in their life, whatever their current level of recovery of technical skills.
Resourceful State: The first thing to understand about using NLP to assist someone in recovering from brain injury, is that the brain is constantly adapting and changes physically from day to day as we learn new physiological and cognitive skills.
Establish Rapport: The kind of empathy that works with people who are healing from brain injury, is empathy based on a respect for their challenges and their own ability. This requires stepping back from trying to magically heal the person.
Specifying Goals: At the beginning of your work it will be useful to check which areas of cognitive functioning has been affected by the brain injury (including memory, attention, language, vision, emotional management, calculations, planning, and lifestyle changes) and which things are most important to the person in terms of healing. The second issue with goal setting is to help the person re-invent their own values and goals for life.
Opening Up The Client’s Model Of The World: The aim of NLP is not to magically heal the person, but instead to show them how to access their own amazing inner resources. These resources include the energy that is generated by their frustration with their current ability.
Leading to the Person’s Outcomes: In the context of the many therapies that will be useful for the person recovering from brain injury, there are four main processes that an NLP Practitioner can contribute:
1) Visualising Healing. This includes general healing visualisations like the Inner Smile, and visualising the brain reconnecting using metaphors like the Phone Repair Service or Hall of Answers.
2) Pain Relief. Showing the person how to use trance work to remove pain, by methods such as indirect suggestion, creating numbness or analgesia, displacing or dissociating from the pain, or altering time perception.
3) Brain Retraining. Teaching the person to sequence their memories in a Time Line, to use Futurepacing to ensure they remember tasks, to control their internal dialogue in order to be self-nurturing, to clear traumatic responses with the NLP Trauma Cure, to enjoy life and to laugh daily, and reality test so as to separate hopes and dreams from shared reality.
4) Tasking. Setting any of the above methods as a task for the person to complete on their own involves ensuring the task is chunked and sequenced carefully, is futurepaced to everyday triggers, and is undertaken with an understanding that progress needs self-care.
Verifying Change: Keeping a journal allows the person to express their emotions, clarify what is happening, monitor change over time, and inspire themselves and others.
Ecological Exit: The coaching process is complete once the person can continue it on their own. Healing and improvement in functioning are lifelong experiences. The person who recovers from brain injury does so with a unique experience of what it is to be human and this may expand their future life immeasurably.