By Teresa Garcia-Sanchez
Estimated Reading Time: 4 minutes, 6 seconds
I begin all my treatments with the question: “What would you like to change today — and why?” The client M.T. answered, “I want to quit smoking because it’s bad for me.” (I find this is a staple answer for most people who are asked the same question.) I normally follow my question with a destabilization technique. This is intended to simultaneously create an increase in motivation to the point where the clients are almost demanding to be treated. It also brings about a state of confusion during which, taken aback momentarily, clients will look for coherence anywhere and therefore accept any suggestions they can understand; a little bit like clutching at a straw.
My response to M.T. was spoken quickly so he wouldn’t have a chance to analyze my words. I said, “So what? We’re always doing things that are bad for us! We don’t exercise; we don’t eat enough fiber; we don’t drink enough water; we don’t get enough rest; we load ourselves with stress, and we can change all those things whenever we want to.”
I delivered a positive suggestion at a time when M.T. was beginning to wonder whether or not I was going to agree to treat him. (And it looked as though I was not against tobacco). This was a receptive moment; a moment of request. My next step was to tell him that it would be necessary to do a farewell exercise to say goodbye to “good old friend tobacco.” I usually accomplish these farewell exercises with hand levitation where I suggest that the client’s rising hand is tied like a puppet on a string to a balloon that is filled with smoke. I then proceed to instruct clients to cut the string and watch the balloon go up, enjoying its ascent and feeling grateful for having been liberated.
When I got to this point with M.T., he frowned and a teardrop rolled down his cheek. He said, “I’ve realized that if I quit smoking, it will be like betraying my father and brother who both died of lung cancer.”
From that moment on, the treatment proceeded like traditional psychotherapy, although with a very different objective: the resolution of grief. Of course, quitting smoking constituted a “minor result” of the treatment, yet this was for M.T. the confirmation that he had overcome his most unsettling emotions, some of which he probably couldn’t have owned before the balloon farewell.
It is for this reason why we must not spurn any opportunity to allow the client’s unconscious to express itself, even though he may appear to seek therapy for a problem as secondary as nicotine addiction.
After having demystified several aspects of tobacco, including it tastes good (Did my client remember the taste of his first cigarette?), or that it’s relaxing (Did he know that one of the effects of nicotine is to increase adrenaline levels?), I asked M.T. to follow, to a tee, a smoking methodology, and, above all, to not make any effort to not smoke. I told M.T. to carry a pack of cigarettes with him because quitting an addiction means being able to remain indifferent when coming in contact with the addictive substance. If he feared a relapse it was probably because his need for tobacco had not completely dissipated. I told M.T. to carry a bottle of water and to drink every time he felt the need for a cigarette. After taking a few sips, he would be able to decide whether or not he wanted to give up his “freedom not to smoke’ or choose to light up a cigarette and take a few drags.
With this method, anxiety is reduced for three main reasons. First, because there is neither a prohibition nor a limitation; second, because it means there’s no chance to fail, which has probably been a fear factor present in previous attempts; and third, because the quitting is gradual and this keeps the withdrawal symptoms to a minimum—a similar effect to any aid of nicotine replacement therapy.
My client, M.T., received a recording for self-hypnosis, reinforcing the suggestions of well-being, of going for his goal, and of feeling satisfied after drinking water and being able to exercise his freedom not to smoke. He eventually began eliminating the cigarettes that he smoked automatically or out of compulsion.
M.T.’s ability to quit tobacco took place gradually, within about a week. Having attended hypnosis sessions every other day, there came a moment when he quit smoking completely, without struggling with the addiction. The goals of the second and third sessions were to consolidate all progress noticed and to prevent any possible relapses, including using food as compensation for not smoking. M.T. overcame his addiction and any possible relapses because the treatment given to him was rooted in managing anxiety, not generating it.
Instituto Erickson Madrid Director
Translator Claudio Vanini
This excerpt has been extracted from Volume 32, Issue No. 3 of The Milton H. Erickson Foundation Newsletter.
Tags: Acceptance, case study, Erickson Foundation, Ericksonian, hypnosis, Implication, LAMFT, LICSW, LMFT, LMHC, MDIV, Meaning, Metaphor, Milton H. Erickson, Pain, phd, psychiatrist, Psychologist, psychology, psychotherapy, PsyD, therapy, Trance, Utilization