RECOVERING OPTIONS:
The Transformation of Addictive Processes
by John Overdurf, C.A.C. and Julie Silverthorn, M.S.

We went to school in the era of "overpopulated majors," so when we graduated from college with degrees in psychology, we weren't really sure if we would be able to find a job in our field. Luckily, our first "real" jobs were both in the Drug and Alcohol Treatment community. John was a counselor on the Detox Unit at a local hospital, and Julie was a case manager for the MH/MR/D&A program. That was 1979 and since then many things have changed, especially in the field of Addiction treatment.
Since we were both therapists we were always searching for the best methods for creating change. Julie utilized family therapy as a change model, as John continued with primary D&A work. In 1984 we began using NLP and Hypnosis in our work with clients and in the treatment of addictions. It's safe to say that, at least in our region, we were among the first to apply NLP and Ericksonian techniques to issues of addiction. When we say addictions we're primarily referring to dependence on alcohol and other drugs (nicotine, cocaine, amphetamines, opioids, minor tranquilizers, and cannabis). The paradigm we're proposing in this article is also applicable to other complexes of compulsive behaviors (such as sexual addictions, co-dependency, gambling, and eating disorders). Through years of educated trial and error (including the years when Julie stepped out of therapy into a business paradigm), we've formulated beliefs and approaches, which we believe are more effective than the traditional D&A techniques which we've used in the past. In 1989 we resumed our joint private practice and began training others in the use of NLP and Hypnosis.
Since this time we've often been asked, "What technique do you use for addiction?" To make a long story short, while there are some key features to working with addicts, there's not much we don't use. Generally when we're working with a real addiction, we're not looking at just a couple hours of therapy; although in best case scenarios this has occurred. When we work with someone we are assisting them on a biochemical/physical, psychological, interpersonal, and spiritual level. We can't always assume that making a change in one of these areas will automatically generalize to the other areas, the way it might with someone who hasn't bathed their nervous system in large quantities of powerful chemicals for extended periods. Working with addicts definitely requires a sense of therapeutic timing over the long haul, that would generally not be required for relieving such issues as a phobia or allergy.
In this article we present an overview of our approach to Addictions Intervention. The sequence is not as linear and procedural in its application, as it is in its description. The order which we describe is how the intervention typically occurs, although not much is typical when working with addicts. We assume that the reader has a basic understanding of the change techniques available within NLP and Ericksonian Hypnosis. We will be covering assessment, using Ericksonian and NLP approaches, another time although the information which we are sorting for is evident to the informed reader. Assessment is also briefly covered in the sections on tasking, strategy elicitation, and incongruities.

Step 1. Use therapeutic tasking as a prerequisite to the "actual therapy."

In life, often the "problem," itself, isn't the problem. The problem is how we try to solve it.

Seem confusing? Most problems are (confusing) when you're in them. Sound circular? It is and that's the point. The first step to any effective intervention is to interrupt the existing pattern. Addiction is really an amalgamation of smaller patterns. It can be a "meta" pattern or a metaphor for a person's life. How an addict goes about maintaining an addiction is usually more important than why or how it first started. The first step is to create an opening which can become a doorway for change. That's why we frequently use therapeutic tasking as the prerequisite for changework when we work with addictions. While the subject of therapeutic tasking deserves an separate article, we'll cover some of the high points to give you an idea of the thinking behind therapeutic tasks and what they can accomplish. (We caution the reader to use tasking as an intervention only after having adequate knowledge of your client and advanced training in hypnotic and directive techniques.)

What are ordeals, tasks, and living metaphors?

Therapeutic tasking, or prescribing living metaphors, is also known as "Ordeal Therapy," as refined and popularized by Jay Haley. Haley based this approach upon the "non-hypnotic" work (if there is such a thing) of Milton H. Erickson, M.D. (In fact if you consult Erickson's Collected Papers, Vols. I-IV you'll find that tasking and ordeals were his preferred way for working with alcoholics.) A brilliant analysis of this style of work was also done by Watzlawick, Weakland, and Fisch. Tasking, living metaphors, and ordeals are behavioral prescriptions given by the therapist to the client that are designed to transform the problem strictly from a process and/or structural point of view.

If it's such an ordeal why bother?

The fundamental purpose of tasking is to create a context for change, not only inside the therapy room, but more significantly outside of the therapy room where clients spend most of their time! Assigning a living metaphor also serves as an effective tool for motivation, assessment, and intervention. There are times when the therapist may never get to the other interventions which follow. In some therapies all we do is tasking. It's useful because, aside from gathering the necessary information to construct the task, delivering the task takes very little time. Tasks can be implemented and monitored over the phone, which is certainly cost effective for the client and really puts the client at choice.

How do ordeals, tasks, and living metaphors work?

The key to knowing how to design ordeals is based upon meta- programs, values, and strategies. The fundamental question when eliciting information for a task is, "What have tried to do (to solve this problem) that hasn't worked?" Exhaust all of the possibilities for this answer and write them down. Look at the sequence of events. What has to follow what? Think cybernetically. Set aside the notion of cause and effect and instead just think in terms of "loops," since "effect" feeds back to "cause" anyway. "Effect" causes the "cause." The result is that the point of intervention will not be directed at the source of the problem (the cause), but rather how the client attempts to solve the problem (the effect). Therefore, an effective ordeal will interrupt the feedback loop which had previously validated the existence of the problem. The client's attempts at managing the problem actually presuppose the existence of that problem. The intervention itself needs to be a behavior (not a cognitive or internal task) that presupposes either the outcome for therapy, or some other positive result which is different from the problem.

A Case Study: when performing is a pain in the........leg.

One of us recently prescribed this task and we cite it here because of its simplicity, although it is a non-addictive case study. Since this person does not live in the US, this intervention was during a series of very brief telephone calls. The client is a business trainer and an acquaintance of the authors. His presenting problem was that he would develop a mysterious pain whenever he began presenting a seminar. Since doing seminars was a major part of his livelihood it was important that he remedy the problem as soon as possible. He had it checked by a physician and found that there was no organic etiology. When asked what he had tried in the past, since he was well-versed in NLP, he mentioned a number of techniques he had tried with no success. Additionally, he had tried to teach through it; just acting as if it wasn't there. He explained that he could get through the presentation, although the pain would increase at first, it would eventually disappear. This left him with a concern about having to go through the pain again the next time he had to teach. When asked if the pain occurred at any other times, he said it did when he went out dancing with a particular woman, who was "important" to him. At that point there was enough information to construct the task. We hypothesized that the pain in the leg was causing him to seek certain solutions (the effect), which in turn only validated the problem (the pain) and set an expectation that it would occur again in the future.
The intervention began by telling him that there was something that he could do which would be positive for him and which could work. We then told him that it would be important for him to commit to doing the task before he knew what it was. After he heard it, he would still have the option of not doing the task. If he decided against doing the task then all deals were off and he would need to find someone else and create change another way. He agreed.
He was given a simple task. The next time he would teach or go out dancing he would first need to tell the parties concerned that at some point he may develop a pain in his leg, and he was then to carry on with whatever the activity was. It made no difference to the therapy what reason he gave to the parties for this admission, only that he would announce the pain before he started dancing or teaching and before the pain started. He said he would be going dancing later that week with the same person and would do the task at that time.
Approximately a week later he called and said everything went well and that he followed the task and no pain had occurred. He added that he was getting a lot of insights, realizations, and shifts as a result. A week or two later he called and said the pain was gone and that it did not effect his teaching, but it had occurred in another context. He was reminded what to do. On the final follow-up call he reported the pain was gone and he had more realizations not only about the psychological "source" of the pain, but also what to do about some related business opportunities he had been avoiding.

Why and how did this work?

A quick analysis of the relationship of the "problem" and its attempted solutions shows that all the solutions were attempts to keep the pain inside, or to keep it covert. The sequence was: be in a situation where he had to do something in front of important people; say nothing about it; feel the pain; have it eventually disappear and then worry about its reoccurrence the next time. The task made what was hidden or covert, overt. He had to acknowledge the pain, essentially telling the audience his worst fear before it could happen. This changed the loop and therefore the "problem," the physical pain was transformed into insight and decisive action on his part. As with many problems, the insights will be there after the problem is solved. Hindsight is always 20-20, but this time it works for the client.

Ordeal Therapy by Jay Haley; Change by Watzlawick, Weakland, and Fisch;
The Collected Papers of Milton H. Erickson, by Erickson and Rossi; and the chapter on Metaphor in Training Trances by Overdurf and Silverthorn are recommended for further study of ordeals.

Step 2. Elicit the strategy for the addictive behavior.

The main utility of eliciting the strategy is to create a baseline which can be used to evaluate the extent of change after the interventions have occurred. Also, the utility of eliciting a strategy for the addictive behavior is that it can be anchored for use later in therapy. During the therapy this state will be useful for bringing the "addict state" into the therapy room.

Using the trigger to intervene.

Additionally there are some basic interventions (anchoring, mapping across, and swish) which can be done at this point to change the trigger and/or the operations phase of the strategy. It's important to identify the common trigger, but it's more important (when the trigger is not a synesthesia) to elicit the operations phase. The operations phase will usually be common to many if not all of the triggers and doing this will save the time of having to future pace every conceivable external trigger.
Smoking is a good example of this. There are a lot of external triggers: driving, drinking coffee, finishing dinner, seeing someone else light up, and so on. A trigger common to all of these is the awareness [K(e) or V(e)] of the cigarette in his/her hand since that will eventually have to happen for him/her to smoke. This certainly is a great trigger to use in the case of a simple synesthesia. Our experience, though, is that the cigarette in the hand is a later TOTE (or a sub-strategy) in the overall strategy.

Operation: Intervene and Generalize.

Eliciting the operation phase usually provides a trigger which will occur across a greater number of contexts. Additionally this trigger may often be connected to a number of beliefs about what smoking will do for him/her (intention and possibility), and/or what kind of person they will be if they smoke (identity). This is the internal picture which the client has that amplifies the urge to smoke and creates the representation of what will happen when the he/she smokes. It is often a dissociated picture of them smoking, feeling good, and embodying certain qualities. Obviously all of this is valuable ecological information for later interventions.
If a limited intervention were to be done at this point a swish pattern would be a good choice. The operations phase representation (the internal picture mentioned in the above paragraph) serves as the cue picture (which is also the new trigger for the new strategy which is to be installed). This is a case where you would swish a dissociated picture into another dissociated picture, an obvious departure from the "textbook" swish which is an associated picture swished into a dissociated picture. The trick to making a swish like this work is to insure that the new outcome picture is more intense than the smoking picture. An easy way to do this is to elicit all of the positive states associated with smoking and make sure these states are represented in the outcome picture. Then add in new desirable qualities that the client expects to have by being a non-smoker.
For example, one of us had a client a few years ago who was an attractive, successful, business woman in her '50s, who had started smoking again after a long period of "healthy living." After races (she was a runner) she should go to a local pub and have a post-race drink with her friends. The external trigger was olfactory, (she smelled smoke from other people's cigarettes.) This trigger fired off an image of Betty Davis in her hey day. For this client, Betty Davis was an icon for many desirable qualities; she was independent, assertive, graceful, and sexy. When the client discovered this trigger she remarked immediately that Betty Davis was the reason why she started smoking as a teenager! Therefore we needed to include all of the positive qualities which she associated with Betty Davis and smoking, when we constructed the outcome picture of her as a non-smoking, healthy woman. This was the only step in the intervention and it was successful, in part because she been a non-smoker for many years. However in cases of long-term addiction to drugs and alcohol other steps need to be done.

Step 3. Transform the addiction from a sequential incongruity to a simultaneous incongruity.

This is the big one! Addictions are sequential incongruities. From an NLP point of view this is the main reason why most therapeutic modalities have only had modest success. Traditional therapeutic approaches are designed to integrate simultaneous incongruities. What's the difference?

Simultaneous incongruity: what you see is what you get.

A simultaneous incongruity occurs when an individual experiences a conflict between "parts" or states at the same time. A typical example of this is a client who verbalizes "yes" while unconsciously shaking his/her head "no." In this type of incongruity, what you see is what you get: the client is "all there." In most cases if the therapist assists the client in resolving this conflict in the session, then future paces the change to triggers which occur in real life, the changework will generalize.
Most traditional psychotherapeutic approaches are designed to work with simultaneous incongruities. These approaches assume that the client who comes to the office in a drug free state is the same one that is out on the street using substances. In most cases, the sober part is not the part of the person that requires extensive change. This part brings the client to the office and can even rationally discuss the consequence of his/her behavior. The sober part also sincerely expresses a desire to make a lifestyle change. It's also the part that makes "false promises," an AA and NA reference to the fact that this part is not usually around when the client is about to get high! This is a sequential incongruity.

Sequential incongruity: Now you see 'em, now you don't.

A sequential incongruity occurs when a conflict between two or more "parts" or states within a person are expressed over a period of time. Another way to think about this phenomenon is that certain neural networks are mutually exclusive. When one is on, the other is off. The dissociation is so great that there is little or no communication between the parts. Each part may have its own set of behaviors, feelings, attitudes, and beliefs. Although the addict may recognize that these two distinct states exist, the switch seems automatic. We remember a woman who was an overeater. She explained that late at night she would "cruise the refrigerator" and the next thing she'd notice was food in her mouth, while looking inside the refrigerator for something else to eat. When she described this there were dramatic shifts in her physiology (left/right body movements and facial contortions) that corresponded to her narration. Generally speaking the degree of dissociation seems to be largely contingent upon the length of time and the intensity of the addiction. The most subtle forms of sequential incongruities can often occur with more "socially acceptable" addictions like nicotine and food. In these cases, the dissociation isn't so obvious until the person actively begins to change the addictive behavior. So the moral of the story is unless you've got both parts activated simultaneously in the therapy room, you only have part of the story.

Transforming the addiction: apart from that there's only integration.

With the above in mind, it's important to make sure that the client accesses the "addict" state and the "sober" state when they enter treatment. This is why getting the strategy is so important (Step 2). There are a number of options available to temporarily "glue" these two states together. If the person is profoundly addicted, anchoring each state kinesthetically and then firing both anchors at the same time works well. It's important to use what you know about strategies and hypnotherapy to make sure you have both of the states securely anchored. Insure sufficient time with which to work with the client so the integration is clean and complete. The good news is that usually the client will go into a fairly moderate trance state as his/her neurology attempts to integrate. It's essential to hold the anchors for a period of time until his/her physiology stabilizes. As the physiological changes slow down or stop, release the anchors. At this point the client may express some discomfort, or at least different feelings, which will verbally verify the asymmetry. The discomfort indicates that his/her parts conflict is now in the present and is something which he/she does not ordinarily experience, i.e. a simultaneous incongruity. At this point we would use a standard visual squash or Alignment Therapytm to integrate the parts. In the case of an addiction which is not severe it may not be necessary to collapse the "addict" and "sober" anchors first. Alignment Therapytm or a visual squash handle sequential incongruities where there is minimal to moderate dissociation.
This phase is often the most significant piece to the intervention if it's necessary to go this far in the outline. One caveat is that there are times when it may be necessary to do this integration more than once. More than one integration may also be required if there are multiple addictions that have very dissimilar chemistries, such as cocaine and alcohol.
A final piece that we may do at this stage is to have the client disconnect symbolically with the object of the addiction. This can be very powerful as its own technique and at times it will occur automatically as a part of the integration. To highlight, ask for the client's representation of the addiction and use any NLP process that you would ordinarily use to resolve relationships. (See asterisk below.) In the case of an addiction, simply replace the "person" (in the relationship resolution paradigm) with the "object" of the addiction.

Step 4. Align the client's perception of the past with the new integration.

If Alignment Therapytm was used for the previous integration then this has already started. If a visual squash was used the integration may generalize automati