Acuity Vol.4 55

Pointing to a New Modelling Perspective James Lawley

After more than a decade of searching for a satisfying analogy to describe the perspective I take when symbolic modelling I’ve finally found one right under my nose. It is the everyday act of pointing.

It wasn’t until I came across Raymond Tallis’ Michelangelo’s Finger – a whole book devoted to pointing – that I realised just how much mental activity is involved in this simple act. The moment I understood what the recipient of pointing has to do with their attention I thought: ‘That’s what we do. That’s how we model symbolically’.

Before exploring what pointing can reveal for us as symbolic modellers I will examine how pointing works and what both parties have to do with their attention during pointing.

Raymond Tallis explains what is involved in pointing:

What is pointing?

There is the producer (the person doing the pointing); the pointer used by the producer (usually the outstretched hand and index finger); the pointee (that which is pointed out); and, finally, the consumer (the person for whose benefit the pointing is carried out). The producer uses a part of his or her own body to establish an axis that joins the producer with the item being pointed out – with the pointee. The consumer is invited to follow the virtual line with her visual attention until it reaches the pointee. (Tallis, 2010 p. 7)

The index finger is the canonical referential gesture that makes clear what is present in other, less versatile, modes of bodily pointing, using the thumb, the arm as a whole, the elbow, the shoulder, the head, the torso, the eyes and even the foot. (Tallis, 2010 p. 11)

56 Pointing to a New Modelling Perspective

What does the producer do?

She has to be able consciously to use her body as a signal. This implies a special relationship to said body, one that is not found in animals. In addition, she has to have the capacity to be aware of another’s (different) viewpoint. This is a necessary condition of her being aware that she is cognitively advantaged compared with the other person, at least with respect to knowledge of the object being pointed at. The pointer pointing something out to another is to amend a perceived deficit in their knowledge, or experience, or awareness. The usual, and fundamental, occasion for pointing is to correct a lack: to draw attention to something important or at least interesting the other has not noticed or cannot see. In addition, she has to understand that the other’s comparative disadvantage can be set right. (Tallis, 2010 pp. 10-11)

What does the consumer do?

When you point something out to me, I do not consciously adopt the viewpoint of your body. I simply look ‘over there’ to where you are pointing. But I can take this short cut only after I have already acquired the skill that enables me, as it were, to triangulate between you, the object and me. (Tallis, 2010 p. 145)

The consumer has to cast herself in her imagination out of her own body and mentally look along the line drawn in space by the arm and index finger extending from the producer’s body. The consumer, that is to say, has to put herself in the producer’s place. (Tallis, 2010 p. 9)

This is a rather remarkable thing to do. As a consumer, you momentarily adopt the pointer’s perspective, follow the direction of their pointing, identify what is being pointed at (the pointee), and bring that awareness back to your own point of perception. By sharing their perspective your attention is drawn to the object of their attention. Aptly, the word ‘attention’ comes from the Latin meaning ‘stretching towards’. Once you have stretched yourself to what the pointer is pointing at, you can converse about it. (see Figure 1).

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Figure 1: The act of pointing

The mind-body process involved for a consumer of pointing is more than simply experiencing the world “from your own perspective” as in an NLP ‘first position’ (Dilts & DeLozier, 2000). Nor do you become the pointer. It is not “as though you were another individual ... in his or her skin” as in an NLP ‘second position’ since you do not give up your own perspective. And it is not an NLP ‘third position’ where you see yourself interacting with the pointer as if you were an outside observer. Instead, as the consumer you notice how the world must look from the pointer’s vantage point and use that to extend your sense of their world while maintaining your own perspective. I propose this is a new and different perceptual position.

Pointing to mind-body phenomena

Tallis describes a situation where the producer points to something that is outside the visual field of the consumer, e.g. “He went that-a-way.” But he does not mention a similar but more common case where people use their gestures and words to point to something within their body or mental space. Pointing to mind-body phenomena happens all the time in everyday conversation. But we are so involved in the content of what we are saying and thinking that we often have only the minutest awareness we are indicating the location and form of symbols in our ‘psychespace’ (as David Grove sometimes called it). And the same goes for the consumer of the pointing.

In a coaching/therapy context clients are continually pointing to things in their inner world of their mind’s eye, ear and feeling. Through their gestures and their metaphors they are pointing out where symbols are in their inner landscape and what form they take. As a coach/therapist I am the ‘consumer’ of the client’s pointing. The only difference with physical-world pointing is that I can never see, hear or feel what they are actually pointing

58 Pointing to a New Modelling Perspective

at. Perhaps because of this, in traditional coaching/therapy the information provided by a client’s indicative gestures is mostly ignored. I’m not talking about ‘body language’ and the interpretation thereof. I’m referring to what David Grove called the client’s ‘choreography’ – how the movement of a client’s body references the location and form of the metaphors in their symbolic world. Although I may not be able to see the symbols in a client’s private world, with careful modelling I can know where they are from the client’s perspective and attend to something like what they are attending to.

Clearly the physical act of pointing to is often used metaphorically to mean pointing out something nonphysical. But there is more to it than that. The process of a producer pointing and of a consumer identifying a pointee parallels the process of two people constructing and understanding a metaphor. Metaphors are the pointer that point out experience. Unlike physical items pointed to, we cannot know another person’s experience directly but we can infer it via the intermediary of metaphor (see Figure 2).

Pointing Metaphorising

Producer sees item Person A has an experience

Producer uses pointer to point to an item

Person A uses a metaphor to describe (point to) an experience

Consumer looks at pointer Person B hears/sees metaphor

Consumer infers location of item Person B infers kind of experience

Consumer sees item Person B has a sense of Person A’s experience

Figure 2: The act of metaphorising

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Symbolic Modelling

What makes the perceptual position of the consumer of pointing so unusual is that I can share the producer/client’s perspective while retaining my own perspective. By unconsciously working out the trigonometry involved I intuitively understand the relative arrangement of the three points, and how the world looks different from each. As a symbolic modeller I bring that intuition into my conscious awareness and make it central to my modelling of the client and their landscape.

The everyday act of pointing can be mapped on to the analogous act of modelling symbolically (see Figure 3).

Pointing Modelling Symbolically

Producer Client

Pointer (body part that points)

Pointer (body part that points)

Pointee (item pointed to) Symbol in client’s inner landscape

Consumer Symbolic modeller

Figure 3: The act of modelling symbolically

Being able to appreciate another person’s perspective while maintaining your own requires a special kind of modelling skill. Luckily one that almost all of us possess innately.

Previously I had described a symbolic modeller’s perspective as like being in the passenger seat of a car and being driven around an unfamiliar town by someone (the

60 Pointing to a New Modelling Perspective

client) who is pointing out all the places they know, “Look, that’s where I went to school.” But in the car metaphor the consumer does not have an independent location. Whereas the pointing analogy beautifully reflects the ‘split attention’ required by a symbolic modeller: I can simultaneously know the client’s perspective and muse on it from another perspective inside, outside or beside the client’s world (Lawley & Tompkins, 2002).

When the facilitator asks a clean question of what has been pointed to a switch occurs. Each clean question ‘points to’ or ‘points out’ some aspect of the client’s metaphor landscape. Metaphorically pointing means “to direct the mind or thought in a certain direction” and that is what every Clean Langauge question is designed to do (Lawley & Tompkins, 2000). The client now becomes the consumer of the facilitator’s pointing (see Figure 4).

Figure 4: The act of asking Clean Language questions

When the client answers the question the producer-consumer roles switch again – over and over. This very simple oscillation creates an iterative process that forms the spine of a Symbolic Modelling session. This is how Penny Tompkins and I facilitate the development of the client’s embodied psychoactive metaphor landscape.

I know of no other method of therapy or coaching where both the client and facilitator so consistently point to a single inner landscape – the client’s. If you are not trained in a clean approach and you are thinking this seems similar to how you facilitate, I haven’t made the distinction clear. In over 15 years of training this process I have never found anyone who can maintain the consumer- and producer-of-pointing roles consistently, without thoroughly retraining their attention.

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The triangulation involved in pointing enables the client, their landscape and the facilitator to engage in what David Grove called a ‘trialogue’; with the most important conversation occurring between client and their landscape.

A skilled clean facilitator can help amplify the pointing to and point out nature of a conversation. To do so they need to do two things: to create a ‘clean environment’ – one with a low level of contaminants from their own inner world; and to ask about the spatial aspects of the client’s verbal and nonverbal metaphors. Since most metaphors have an explicit or implicit spatial aspect, as long as your ears and eyes know what to listen and look for, most clients will give you plenty of opportunity to be a midwife to their metaphor landscape.

Then something quite fascinating happens. The client becomes aware they are pointing out things to them self. The client notices they are simultaneously both the producer and consumer of their own pointing. They become aware they are, to use a phrase introduced by French philosopher Maurice Merleau-Ponty (2005), embodied subjects

Gregory Bateson called this a “double description”. The effect is the inclusion of both descriptions into a transcendent third perspective – just as depth perception emerges from binocular vision. I believe most gestures and movements of the body are not communication to another person, but aids to our own thinking process. By noticing how our inner world works clients gain a deep insight into why they act and respond the way they do, and they start to notice choice points – places where their process could go in a different direction and result in a different outcome. When this happens the client is self-modelling (Lawley, 2012) (see Figure 5).

Figure 5: The act of self-modelling

62 Pointing to a New Modelling Perspective

Purpose of pointing

Tallis notes that pointing has two key purposes. First to rectify a perceived deficit in the consumer – we point out something they can't see or are not yet aware of and we "understand that the other’s comparative disadvantage can be set right". As a result we momentarily share a perspective, and fulfill the second purpose: we “make a world in common” (Tallis, 2010 p.132). Tallis suggests that the ability to perform this kind of mental gymnastics makes possible the kind of society only humans have:

If one subscribes to the idea that language originated out of gesture, then pointing, as the most versatile of all gestures, and the one that seems closest to the primary, that is to say the referential, function of language, we may argue that it is crucial to the beginning of truly social being (of a kind unknown elsewhere in the animal kingdom), of a collectivization of consciousness upon which community, discourse, civilization and knowledge are based." (Tallis 2010, p. 131)

The purpose of pointing makes sense when producer and consumer are pointing at different people, but what about, as mentioned above, when one person plays both roles? Then the client is, in effect, rectifying a deficit in their own awareness. They become conscious of what before was tacit knowledge, or they have a creative insight. In so doing conscious and subconscious share (momentarily at least) the same perspective. They establish a different kind of relationship. Not Topdog and Underdog. Not Master and Emissary. Not rider and horse. Not adversaries, nor even allies. Instead they are co-inspirers – they form a Necessary Unity.1

Concluding Points

I am excited about the pointing analogy because people instinctively know what to do when someone points and therefore it should be easy to transfer that skill to facilitating a client session. The challenge for the symbolic modeller is to maintain the alternating consumer and producer perspectives throughout a session. When you develop this skill it is much easier to set aside your own landscape and commit to working within the logic of the client’s landscape, i.e. to work ‘cleanly’2.

I will leave the last word to the Buddha who in the Shurangama Sutra says:

It is like when someone points his finger at the moon to show it to someone else. Guided by the finger, that person should see the moon. If he looks at the finger instead and mistakes it for the moon, he loses not only the moon but the finger also.

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Notes

1. ‘Topdog vs. Underdog’ a phrase Fritz Perls (1969), the founder of Gestalt Therapy, coined to describe a self-torturing game that people play with themselves. The ‘Master and his Emissary’ is from the title of an Iain McGilchrist book (2010). "Co-inspiration arises from the conversations we have with each other that are conducted in mutual respect for the other and it provides for a manner of working together in freedom." Humberto Maturana (legacy.oise.utoronto.ca/research/tlcentre/conf2004/process.html) A ‘Necessary Unity’ taken from the title of a Gregory Bateson book (1979).

2. The nearest scientific description of the pointing perspective I have come across is

that pioneered by Maturana and Varela (The Tree of Life) called "biological phenomenology" or the “view from within” since it attempts to describe the phenomenal inner world of the organism from the outside. Ken Wilber refers to this as one of "8 native perspectives". In this case, the perspective of an interior (of an "I") looked at from the outside, i.e. a third-person modelling of a first-person reality, from their perspective. www.kenwilber.com/Writings/PDF/ExcerptC_KOSMOS_2003.pdf

Biography James Lawley is a supervising neurolinguistic psychotherapist – registered with the United Kingdom Council for Psychotherapy since 1993. He has provided consultancy to organisations as diverse as GlaxoSmithKline, Yale University Child Study Center, NASA Goddard Space Center and the Findhorn Spiritual Community. With Penny Tompkins he co-authored Metaphors in Mind – the first comprehensive guide to Symbolic Modelling using the Clean Language of David Grove, and an annotated training DVD, A Strange and Strong Sensation, which shows them working in a live session. Their website cleanlanguage.co.uk contains over 200 articles.

References

Bateson, Gregory (1979) Mind and Nature A Necessary Unity – Advances in Systems Theory, Complexity, and the Human Sciences, Hampton Press.

Dilts, Robert and DeLozier, Judith (2000) Perceptual Positions 938-943, Encyclopedia of Systemic NLP and NLP New Coding. nlpuniversitypress.com/html3/SeSh.html

Lawley, James and Tompkins, Penny (2000) Metaphors in Mind, The Developing Company Press,

64 Pointing to a New Modelling Perspective

Lawley, James and Tompkins, Penny (2002) A Model of Musing: The message in a metaphor, Anchor Point, Vol. 16, No. 5. cleanlanguage.co.uk/articles/articles/22/

Lawley, James (2012) What is Self-Modelling? cleanlanguage.co.uk/articles/blogs/71/ McGilchrist, Iain (2010) The Master and his Emissary: The Divided Brain and the Making of the

Western World, Yale University Press. Perls, Fritz (1969) Gestalt Therapy Verbatim, Real People Press. Merleau-Ponty, Maurice (2005) Phenomenology of Perception, Routledge. Tallis, Raymond (2010) Michelangelo’s Finger: An exploration of everyday transcendence,

Atlantic Books. Tompkins, Penny and Lawley, James (1999) Clean Language Without Words, Rapport,

Issue 43. cleanlanguage.co.uk/articles/articles/8/

Acuity Vol.4 65

Made to Measure – Using Outcome Evaluation in NLP Practice

Gareth Evans

I want to start this piece by asking a couple of questions – “How do we know when someone has benefited from change work in NLP practice?” “What do words such as ‘evidence’ and ‘evaluation’ actually mean to us?” Initially following my training in NLP I would have suggested the answers to such questions as being synonymous with ideas such as sensory-based calibration, unconscious confirmation through non-verbal signals and physiological changes and the 2nd ‘Test’ in the TOTE (Bostic St Clair & Grinder 2000). Whilst all of these distinctions remain valid within the context of NLP practice and application (Andreas 2006), this is not necessarily how evidence is understood outside of NLP practice and this article is about considering these other perspectives on evidence and evaluation. It is also about suggesting why incorporating other ways of evidencing what we do (alongside our use of calibration, etc) may be useful, and from some perspectives, essential.

Within a larger scope of the field of ‘therapeutic practice as a whole’ there is something of a revolution going on with regard to what is meant by the term ‘evidence-based practice’. It’s about a move toward only recognising those models of therapeutic working that are ‘researched’ and shown to be effective by current standards of evaluation (Haynes 2002). In the field of research this is identified with the so-called ‘gold standard method’ that places meta-analysis, systematic review and randomised controlled trials at the top of a pyramid of what constitutes good evidence (Bateman & Tyrer 2004)1. Proceeding from this understanding of evidence and research are claims that some therapies are more evidence-based and by implication more effective and efficacious than those that have not been tested through clinical trials, see for an example of this, NICE (National Institute for Health and Clinical Excellence) guidance for depression in children and adolescents (2005) which lists only a few therapies deemed evidence-based and therefore able to be used in therapeutic work.

At the same time there are other psychotherapy researchers who express doubts as to whether this is the best or most useful way to measure the effectiveness of therapeutic work at all (Bergin & Lambert 2004, Duncan et al 2004). Much is made in this particular ‘tradition’ of research of what has come to be known as ‘Common Factors’ research2

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(Lambert & Ogles 2004) which identifies common elements across widely different models of therapy that account for their similar levels of effectiveness. Proceeding from this understanding of evidence and research are claims that no psychotherapy is any more effective or efficacious than any other in a statistically significant way because good client outcomes are due to the common factors that are the basis of all good therapeutic work.

Stepping aside from these important arguments for one moment we might still choose to note that measures of effectiveness – however arrived at – drive policy decisions in the UK, Europe and the USA (c/f health related advisory bodies such as NICE and the National Institute for Mental Health (NIMH). In the National Health Service (NHS) in the UK and in the managed care world of the USA these decisions about policy and practice increasingly dictate what is ‘in’ and what is ‘out’ in terms of what professionals are guided to do therapeutically (Roth & Fonagy 2006). In response to this increasing demand for evidence there are efforts under way in the broad NLP community (c/f www.nlprandr.org and www.nlpresearchdatabase.org) to collate research into elements of NLP practice. Naturalised small group trials of techniques such as the VK Double Dissociation Process (Koziey & McLeod 1987, Gray 2010), Anchors (Davis & Davis 1991) and Submodality work (Stanton 1996) have taken place. There have also been some small-scale non-randomised and randomised controlled trials3 into the demonstrated effectiveness and efficacy of Neuro-Linguistic psychotherapy and NLP Therapy (Genzler-Medlitsch & Schutz 1997, Stipancic et al 2010) and this is to be commended and encouraged further.

However, there remain challenges to using these particular types of research method to measure and evidence a process methodology such as NLP4 (Bostic St Clair & Grinder 2002, Bandler 2008). Aside from the significant cost, time and resource implications of undertaking randomised control trials, we in the NLP community might also want to question the very presupposition that one can isolate elements (i.e. techniques, etc) within a process methodology like NLP. The attempt to measure technique without somehow referencing for example the importance of context, non-verbal/minimal cue feedback loops and the meta-frames of language used within and around particular techniques is problematic. For process methodologies like NLP this is especially the case, as much of what is integral to NLP practice, i.e. sensitive and self-correcting adjustments to, and awareness of the cybernetic and systemic feedback loops, is potentially lost in such clinical trials based research.

There is though a way of embracing the idea of evidence-based practice whilst also allowing us to capture something (albeit minimally perhaps) of the whole process of NLP change work in action – the use of client outcome measures. Outcome measures are already utilised in research trials looking at how well particular therapies work with given

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types of presenting difficulty, i.e. depression, trauma, anxiety, etc. Outcome measures are typically administered at the start, middle and end of therapy and then again at 3, 6, 12 and/or 18 month review to measure quantitative changes in the severity, frequency and duration of the presenting difficulty. However they can also be used in routine clinical practice away from research projects to gain a client’s perspective on change and gains made with respect to desired outcomes and thereby demonstrate the effectiveness of particular therapeutic models in the naturalistic setting of day to day clinical practice.

There are several standardised and validated outcome measures in use within NHS clinical practice, for example ‘CORE’ – Clinical Outcomes in Routine Evaluation (Barkham et al 2001), ‘SDQ’ – Strengths and Difficulties Questionnaire (Schaffer et al 1983), ‘Beck Depression Inventory’ (Beck et al 1996), and ‘Honosca’ – Health of the Nation Outcome Score for Children and Adolescents (Gowers et al 1999) to name a few and all of these measures focus on subtly different elements of presenting difficulty and change. Implicit in the use of the outcome measures mentioned above is an emphasis on using diagnostic labels and categorisations as well as their tendency to record absence of difficulty as opposed to measurement of gain which may well be less helpful for practitioners of outcome-oriented models of change (NLP, Solution Focused Brief Therapy, etc). One set of simple measures that can be accessed for free, are validated by research and are client-focused and strengths-based, are those provided by Miller and colleagues from the Institute for the Study of Therapeutic Change (ISTC) – the Session Rating Scale or SRS (Duncan et al 2003) and the Outcome Rating Scale or ORS (Miller et al 2003, Miller & Duncan 2004). The SRS and ORS are four item measures that allow clients to provide immediate (recordable) feedback on their experience of change work. For example with the SRS, clients rate their satisfaction with the focus and quality of the session on likeard scales5 and the ORS is used to score changes in various important areas of experience.

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Diagram 1: SRS

Diagram 2: ORS

Individually (personal well-being)

|-------------------------------------------------------------------------|

Interpersonally (Family, close relationships)

|------------------------------------------------------------------------|

Socially (Work, school, friendships)

|------------------------------------------------------------------------|

Overall (General sense of well-being)

|-----------------------------------------------------------------------|

The ORS is completed just prior to the start of a session and is based on the client’s perceptions of how things have been for them in the week prior to the session. The SRS is completed by the client after a finished session and gives an immediate recordable form of feedback for how the session has been for the client. The items on both the SRS and ORS use likeard scales that can be rated along a 10cm line from 0 to 10 (i.e. worst to best). Clients are encouraged to put a mark somewhere along the likeard scale for each item (see

Relationship

I did not feel heard, |-----------------------------------------------------------| I felt heard, understood, and understood, and respected respected

Goals and Topics

We did not work on |-----------------------------------------------------------| We worked on what I wanted what I wanted to work on to work on

Approach or Method The therapist’s The therapist’s approach is not a |-----------------------------------------------------------| approach is a good fit for me good fit for me

Overall There was something Overall, today’s missing in the |-----------------------------------------------------------| session was session today right for me

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below for example) to rate how well they have been doing in each of the designated areas. Instructions on the ORS indicate that scores to the left represent low levels whereas scores to the right indicate high levels. The descriptions on the SRS (as noted above) in diagram 2 are self explanatory in terms of low and high scores.

For example on the ORS:

Diagram 3: Individually (Personal well-being)

|---------------------------------------------------------------------------------------------------|

So in the example provided above, this might represent a score of around ‘6’ on the Individual well-being scale. Dependant on the previous week’s score this could indicate anything from a decrease in personal well-being to no change to some improvement to significant change, etc. The client repeats this simple and brief scoring process for the other items and this gives client and practitioner a quick reference to how the client perceives they are doing.

Typically the ORS is scored immediately following its completion at the start of the session. This can be done with a ruler for precision or discussed more approximately with the client, e.g. “Is that more a 5 ½ or a 6?” Once all four items are scored they are added together to give a total score out of a maximum ‘40’. Data from research conducted on the ORS (Miller et al 2003) shows that scores below ‘26’ on the questionnaire are indicative of clinical difficulty with scores closer to ‘0’ being indicative of greater difficulty. Scores above ‘26’ are indicative of an absence of difficulty and therefore are indicative of when therapeutic work can be ended. For those practitioners interested in plotting out data scores and trends, the scorings from the ORS and SRS can be plotted out on simple graphs to provide a visual record of changes made during therapy.

Particular changes in scores that suggest movement toward change or alternatively, deterioration in presentation can further be linked to possible specific interventions or significant moments in therapeutic work as identified on a session by session basis. As an example of both of these situations we could note how for example, the specific resolution of a long-standing phobic response using VK Dissociation in session 2 leads to notable improvements in ORS scores from that point onwards. This allows the practitioner to ‘evidence’ the impact of a specific procedure in the context of all the common factors that contribute to therapy (as further linked to evidence gathered from scores on the SRS); Or a sudden bereavement in the client’s extended family system prior to session 3 links to a

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sudden deterioration in ORS scores until the grief is helpfully worked with, and positive change to ORS ratings begin to show again.

Individual and overall scores can be discussed, and with agreement with the client, particular areas could be agreed as targets for more specific interventions in session, e.g. deciding to work on the client’s perceptions of ‘Interpersonal’ factors if the client rates this scale as low using NLP techniques such as Perceptual Positions or exploring Meta Model patterns to help the client become more resourceful in a given area. Where positive change is occurring the practitioner can then amplify and encourage changes already made, linking such to future-paced scenarios, etc. Where change is not happening, or proceeding more slowly, this allows client and practitioner to take a more enquiring and curious position and seek further clarification and feedback about what might be impacting on the client at that time. This can lead to possible adjustments in choices of intervention, exploration for possible secondary gains or unrecognised and un-integrated purposes and intents, etc (Andreas 2006).

The use of the ORS in particular provides immediate feedback as the value and impact of the intervention used as clients who do not record changes in their ORS scores within the 1st six session typically do less well and/or drop out of therapy in the longer term (Duncan and Miller 2008). Practitioners who are sensitive to a lack of progress in the early stages of change work can use the scores on the ORS to explore the client’s experience of the work being done. This allows conversations about adjustments to the style or type of intervention to be had or for client and therapist to decide that things are not working as planned. Duncan et al (1999) have demonstrated that it is better to either change therapist or end therapy earlier than later to safeguard the client. Not only does it give the client and therapist a chance to do something different but also protects the client against such things as experiencing the failure of therapy as being their fault or concluding that they are beyond help. The SRS allows for a similar opportunity to calibrate change-work as it provides simple visual indicators as to how the client experiences what the therapist offers. Therapists who make use of this feedback on the quality of the therapeutic alliance, on whether they are working on what the client wants and their overall method get better outcomes than colleagues who tend to ignore client feedback and pursue their own ideas about what needs to happen (Lambert 1999).

Using outcome measures provides a succinct way of NLP practitioners and clients collaboratively reviewing progress together, as opposed to the practitioner’s use of calibration alone as a form of feedback. In practice this makes for a shared review of change work between client and practitioner where the client has the chance to experience their input and feedback as being just as privileged as that of the professional. They get

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the chance to offer an opinion on what is happening in sessions in the moment. As research into therapeutic outcomes suggests, the client’s rating of the therapeutic alliance is more predictive of a good outcome to change work than what particular technique or therapy is used (Duncan and Miller 2008). For NLP practitioners this allows us to take the outcome-oriented approach that has always been at the heart of NLP change work and extend this beyond notions of well-formed outcomes into using principles of feedback and review to guide both the change-work undertaken and how relationship between client and therapist develops.

Developing skills in this broader sense of collaborative working can allow us as NLP practitioners to continue doing good work whilst also becoming better able to demonstrate the effectiveness of what we do. Measures like the ORS and SRS can be incorporated alongside other distinctions we would routinely use to ethically shape and influence the client’s experience of the alliance and of the change work. This includes our ability to use language persuasively, to work with someone’s meta-program preferences, their goals, motivation and aspirations and other factors such as client-generated metaphors6.

Personal Thoughts toward the Future

To finish off I want to step away from the more discursive tone that has been used throughout this piece and move toward a more personal discussion of hopes and aspirations. I wanted to end by asking a few questions and then sharing some initial ideas for a way forward.

What would it be like if as NLP practitioners we began using outcome measures like the ORS and SRS for all of our new clients?

How useful could it be if we recorded this outcome data on a session by session basis and followed this up, where possible, with outcome measures completed 6 or 12 month post therapy?

I’d suggest that with a commitment to using simple outcome measures like the ORS and SRS we would be able to quite quickly step beyond anecdotal evidence for the effectiveness of NLP as a change-work methodology. Instead we could then build up a robust and consistent data base of the effectiveness of NLP change work as measured by our clients and recorded across different types of need and desired outcome. In addition to the work of individual practitioner, local research networks could be set up to coordinate the gathering, collating and recording of data as well as to problem-solve any teething issues that might arise along the way. For those interested, this could be linked to

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local NLP practice groups and the outcome data gathered could be pooled together and held by a central person identified as a ‘research lead’ for the group.

In clinical settings we could invite clinical trainees (such as trainee clinical psychologists who in the UK are expected to carry out small scale research projects as part of the requirement of their training) or for example, in the UK National Health Service, the particular Local Health Board or Hospital Trust’s Audit Office, to independently evaluate any data gathered and collate such into reports, presentations and poster presentations so as such can be more broadly disseminated. In non-clinical settings, designated ‘research leads’ could work to establish links with local universities to see whether there would be scope for the university to carry out independent analysis of outcome data.7

This type of local, active participation by practitioners in the NLP community could feed forward into presentations of evidence data at the NLP Research Conferences beginning to take place in the UK (linked to the Universities of Surrey, Cardiff and Hertfordshire, NLPtCA, ANLP, etc) and across Europe (linked to EANLP). The value of choosing a standard measure that everyone signs up to using is that it allows for comparative date analysis and consistency of recording across domains and types of difficulty and also builds up a more consistent and verifiable stock of research evidence.

With time and weight of evidence we could begin to more confidently stake our claim to the effectiveness and cost-efficiency of NLP as a change-work/therapeutic model. Doing this could potentially help make NLP more readily and easily available to those people who might need our help the most, e.g. those clients who cannot afford to pay for private change work, who have significant and challenging elements to their life experiences or who have significant mental health needs. These are the people who might significantly benefit from the help that, as a skilled community of practitioners, we could be offering to them.

Notes

1. For NLP practitioners it needs to be noted that local, anecdotal evidence (as in “All the evidence I need is right in front of me”) is least regarded and sits at the bottom of the research pyramid; polarity responding aside to this kind of imposed ‘wisdom’, this is the state of the field and how it is (and will continue to be).

2. These Common Factors and their relative weightings are: Extra Therapeutic Factors, i.e. friends, social connections, faith, leisure activities, etc – anything that is outside of the therapeutic work – which account for around 40% of what makes for positive

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outcomes as rated by clients; Therapeutic Relationship Factors – quality of rapport, trust, understanding, etc (30%); Hope and Expectation Factors – belief in therapy working, placebo, etc (15%); Model & Technique Factors – those aspects/techniques of therapy we can be so enamoured with (15%).

3. Small scale non-randomised trials are those with only a small number of research subjects who have not been randomly assigned to treatment vs. non-treatment (control) groups; Randomised-controlled trials are trials where people are randomly assigned to treatment or control groups so as to prevent researcher/therapist bias in any selection of clients to treatment.

4. For the sake of clarity I am actually discussing what John Grinder (2001) would describe as ‘NLP Applications’, i.e. the therapeutic use of NLP technology as opposed to NLP modelling of excellence. In this context I will also use the terms ‘therapist’, ‘change-worker’, ‘therapy’ and ‘change-work’ interchangeably and choose to ignore the potential differences between the meanings of these terms and the implications of proceeding as I am for the sake of brevity

5. A likeard scale is an analogue rating scale, i.e. rate from 1 to 10 how effective this session has been, etc. They can use numbers, descriptive words (Helpful, neutral, unhelpful, etc) or pictures – child versions use faces (smiling, neutral, ‘sad-looking’, etc).

6. Including opening up to the notion of sensory representations more as indicators as to how a person metaphorically constructs their ‘experience of their experience’ at an embodied level of cognition as opposed to revealing particular sensory preferences, i.e. ‘visual’ language about, for example, distance, time, clarity, movement, etc, having more to do with metaphors arising from early experiences of how that person related to space, location, movement, etc and how these became encoded in basic bodily and orientational metaphors and categories of experience, etc. See the work of George Lakoff and Mark Johnson such as ‘Metaphors We Live By’, ‘Women, Fire and Dangerous Things’ and ‘The Body in the Mind’ for further information on how perception, cognition, knowing, etc is rooted in embodied metaphor (metaphors about bodily experience and orientation). Their research would suggest that metaphor, rather than being something poetic and fanciful, is actually the very structure of all thinking.

7. This was successfully done in 2004 with the University of Chester, UK where data gathered from a pilot project around teaching NLP skills to carers of cancer sufferers – ‘The Living with Cancer Project’ – was analysed and written up into a comprehensive report by some of the University’s research staff. Notable good outcomes for carers and sufferers in this project were thus independently evaluated

74 Made to Measure

and recorded and provided a piece of robust qualitative data for the application of NLP in the NHS (Sargent et al 2004).

Personal Note

I would like to encourage any NLP practitioner who is willing to put their work to the test and play their part in demonstrating the effectiveness of NLP change work to access the ISTC website (www.scottdmiller.com), find the link to ‘Performance Metrics’ and download the SRS and ORS and begin using them.

Biography

Gareth Evans is a Community Mental Health Nurse and INLPTA trained NLP Master Practitioner. Gareth works in a community mental health clinic with children, adolescents and parents with common and complex mental health difficulties. Trained in various therapies, including psychodynamic, solution focused and cognitive behavioural models, he uses an integrative-eclectic approach underpinned by the use of NLP and Ericksonian principles and methodologies and based on the individual needs of the young people and families he works with. E-mail: Gareth.Evans6@wales.nhs.uk

References

Andreas, S (2006) Six Blind Elephants: Understanding Ourselves and Others: Volume 1; Fundamental Principles of Scope and Category, Moab, UT, Real People Press

Bandler, R (2008) Richard Bandler’s Guide to Trance-formations, New York, Health Communication Publishing

Barkham, M., Margison, F., Leach, C., Locock, M., Mellor-Clark, J., Evans, C., Benson, L., Connell, J., Audin, K., McGrath, G. (2001) ‘Service profiling and outcomes benchmarking using the CORE-OM: towards practice-based evidence in the psychological therapies’, Journal of Consulting and Clinical Psychology. 69, pp 184 – 196

Bateman, AW., Tyrer, P (2004) ‘Psychological treatment for personality disorders’, Advances in Psychiatric Treatment, 10, pp 378 – 388

Beck, A., Steer, R., Brown, G (1996) ‘Manual for the Beck Depression Inventory-II’ San Antonio, TX, Psychological Corporation

Bergin, A., Lambert, M (2004) ‘The evaluation of therapeutic outcomes’, in Duncan, B. L., Miller, S. D., Sparks, J. A. (2004) The heroic client: A revolutionary way to improve effectiveness through client-directed, outcome-informed therapy, San Francisco, Jossey-Bass

Bostic-St Clair, C., Grinder, J (2001) Whispering in the wind, Ca, J&C Enterprises

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Davis, D., Davis, S (1991) ‘Belief change and neuro-linguistic programming’, Family Dynamics of Addiction Quarterly, 1 (2) pp 34 – 44

Duncan, B., Miller, S (2008) ‘When I’m good I’m very good; when I’m bad I’m better: A new mantra for psychotherapy’, Journal of Psychotherapy in Australia, downloaded from www.heartandsoulofchange.com on 28/11/2012

B. L. Duncan, S. D. Miller, B. E. Wampold, & M. A. Hubble (1999), The heart and soul of change: delivering what works, Washington DC, American Psychological Association

Duncan, B., Miller, S., Reynolds, L., Sparks, J., Brown, J., Johnson, L (2003) ‘The session rating scale: Psychometric properties of a “working” alliance scale’ Journal of Brief Therapy, 3 (1), pp 3–12

Garfield, S., Bergin, A (2004) Handbook of psychotherapy and behaviour change: An empirical analysis, 5th Edition, p139 – 189, New York, Wiley

Genser-Medlitsch, M., Schütz, P (1997) ‘Does neuro-linguistic psychotherapy have effect? New results shown in the extramural section’, ÖTZ-NLP, Wien, Austria

Goodman, R. (2001) ‘Psychometric properties of the Strengths and Difficulties Questionnaire (SDQ)’ Journal of the American Academy of Child and Adolescent Psychiatry, 40, pp 1337 – 1345

Gowers, S., Harrington, R., Whitton, A (1999) ‘Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA): Glossary for HoNOSCA score sheet’ British Journal of Psychiatry, 174, pp 428 – 433

Gray, R (2010) ‘NLP and PTSD: The visual-kinesthetic dissociation protocol’ Suppose, pp 25 – 42

Haynes, R (2002) ‘What kind of evidence is it that evidence-based medicine advocates and wants health care providers and consumers to pay attention to’ Biomedical Central Health Services Research, 2 (3), p1-7

Koziey, P., McLeod, G (1987) ‘Visual kinaesthetic dissociation in the treatment of victims of rape’, Professional Psychology; Research and Practice, 18 (3), pp 276 –282

Lambert, M. J. (1999) ‘Yes, it is time for clinicians to routinely monitor treatment outcome’, in B. L. Duncan, S. D. Miller, B. E. Wampold, & M. A. Hubble (Eds.), The heart and soul of change: delivering what works, Washington DC, American Psychological Association

Lambert, M. J., & Ogles, B. (2004) ‘The efficacy and effectiveness of Psychotherapy’ in M. J. Lambert (Ed.) Bergin and Garfield’s handbook of psychotherapy and behaviour change, 5th Edition, pp 139 – 193, New York, Wiley

Miller, S., Duncan, B (2004) The Outcome and Session Rating Scales: Administration and scoring manual, Fort Lauderdale, FL, ISTC

Miller, S., Duncan, B., Brown, J., Sparks, J., Claud, D (2003) ‘The outcome rating scale: a preliminary study of the reliability, validity, and feasibility of a brief visual analogue measure’ Journal of Brief Therapy, 2 (2), pp 91 – 100

National Institute for Health and Clinical Excellence (2005) Depression in children and adolescents – Identification and management in primary, community and secondary care. London: NICE.

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Roth, A., Fonagy, P (2006) What works for whom – a critical review of psychotherapy research, 2nd Edition, New York, Guilford Press.

Sargent, P., Thurston, M., Kirby, K (2004) ‘An evaluation of the ‘Living with Cancer’ Project: Using neuro-linguistic programming techniques to maximise the coping strategies of carers and patients living with cancer in Ellesmere Port’ Chester, University College Chester

Schaffer, D., Gould, M., Brasic, J (1983) ‘A children's global assessment scale (CGAS)’ Archives of General Psychiatry, 40, pp 1228 – 1231

Stanton, H (1996) ‘Self-empowerment and the 15 minute solution’, Australian Journal of Clinical Hypnosis, 24 (2), pp 137 – 144

Stipancic, M., Renner, W., Schutz, P., Dond, R (2010) ‘Effects of neuro-linguistic psychotherapy on psychological difficulties and perceived quality of life’, Counselling and Psychotherapy Research, 10 (1), pp 39 – 49

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Levels and Loops of the Learning Organisation

Joe Cheal, MSc

This article is designed to introduce the reader to the concepts of the learning organisation & organisational learning and to explore the role and potential value of Dilts’ Levels of Change model (1996) in this context.

Organisational Learning and the Learning Organisation

Throughout the literature there appears to be a lack of agreed definitions of the terms ‘organisational learning’ and ‘learning organisation’ (e.g. Garvin 1993). Organisational learning is described by Dixon (1992, p29) as referring “to learning at the system rather than the individual level,” and that “learning in an organisation must necessarily occur through individuals, but also… that organisational learning is more than the sum of the learning individuals.” Does Dixon mean that organisational learning is gestalt or that is a paradox? Argyris (1977, p116) states that “organisational learning is a process of detecting and correcting error” which is also his description of single loop learning. Does that mean that organisational learning can never be double loop? Jones and Hendry (1994) define organisational learning in rather more pragmatic and measurable terms as “the sum total of learning taking place and its impact on the organisation and its activities” (p154).

Senge (1993) describes the learning organisation as “organisations where people continually expand their capacity to create the results they truly desire” (p.3) or “an organisation that is continually expanding its capacity to create its future” (p.14).

It would seem that although linked, the learning organisation is not the same as organisational learning. According to Jones and Hendry (1994) organisational learning is “an aspect of the learning organisation” (p157). If one is an ‘aspect’ of the other, this would imply a hierarchy of levels.

78 Levels and Loops of the Learning Organisation

Levels of the Learning Organisation

Working from the idea of Bateson’s ‘Levels of Learning’1, Dilts developed the ‘Levels of Change’2 model (in his book Visionary Leadership, 1996). Change is a key component of the learning organisation and so it would seem the model is worth exploring in the learning context. The model consists of six hierarchical levels comprising of Spirit (bigger picture purpose beyond the individual organisation) which is supporting and is supported by Identity which is supporting and is supported by Beliefs and Values and so on through Capability, Behaviour and Environment (see Fig 1). According to Dilts (1996, p22), one of the principles of the model is that “each level of change involves progressively more of the system... Each level involves different types of processes and interactions that incorporate and operate on information from the level below it”.

Perhaps Dilts’ model could shed further light on the learning organisation/organisational learning distinction: ‘organisational learning’ would appear to fit on the level of capability and ‘learning organisation’ would fit on the level of identity (for example “we are a learning organisation”). Table 1 (below) gives examples of the Levels of Change in the learning and development of organisations.

Table 1. Levels of Change of the Learning Organisation Level Organisational

Learning & Development Individual

Learning & Development If not supported by level directly above

Spirit For Whom?

Vision Statements eg.: “Learning to make the world a better place” “Learning to benefit the environment and community”

Transferable skills/knowledge to take outside work to make a better family/ community.

?

Identity Who?

Mission Statements eg.: “We are a learning organisation” “We are developing people” “We are an ‘Investors in People’ company”

I am a learning, developing self. Organisation is learning without a shared context, learning for the sake of learning.

Beliefs/Values Why?

Value statements eg.: “We value training and development” “Learning helps us to become more effective/competitive/ profitable” “Developing people is important”

Self belief & confidence: Learning and being able to learn makes me more employable and aid my progress. Learning keeps life fresh and interesting.

L&D Value statements are perceived as empty ‘management speak’, lip service (manipulation rather than motivation)

Capability How?

Appraisal/performance review leading to learning & development plans (individual and organisational) Effective training, coaching, facilitation on offer. Support from manager before and after learning event. Resources provided. People open to learning.

Improving skills, knowledge, experience in specific areas. Openness to learning.

L&D becomes valueless and aimless. Training and coaching may happen here and there but is not believed in. Appraisal, training etc. seen as a waste of time.

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Behaviour What?

People attend/turn up to training/coaching sessions Ground-rules set, people respect each other (eg. “no question is a stupid question”)

Attending courses, sessions, reading/listening to relevant material. Asking questions, listening, evaluating, Putting learning into practice.

Behaviours and skills learnt do not embed back in the workplace due to lack of support/resources/ time. People feel as if they have been sent as punishment.

Environment Where/When?

Learning environment (eg. Training room) away from distractions, safe, comfortable, stimulating, refreshments and breaks. Specific time allocated for learning & development

Appealing to individual’s learning style, opportunities:

to try things out to observe and discuss to draw conclusions and to plan,

… in a safe, comfortable, stimulating environment.

People may not turn up. People may be disruptive or passive/ disengaging/ unwilling to learn

When ‘chunked down’ in this way using Dilts’ Levels of Change, the concept of the learning organisation becomes more practical and realisable. It gives an opportunity to appraise the current situation and then set goals and actions at each level.

The Learning Organisation... Thing or Process, Goal or Journey?

Tosey (2005) suggests that the learning organisation could be perceived as a mythological thing. It is, at best, a journey but there seems to be no tangible destination. In this sense, it could be argued that term ‘learning organisation’ is a nominalisation (i.e. an abstract, intangible noun whose meaning is reliant on the mind and interpretation of the beholder). Perhaps we should leave the learning organisation ‘denominalised’ as a process.

Jones and Hendry (1994) also suggest that the learning organisation is a direction rather than a goal. The author would go further in suggesting that the learning organisation is represented by all the organisational Levels of Change moving from current state to desired state. Perhaps the current lack of clarity about defining a learning organisation is due to a lack of well formed outcomes (if it is a direction and not a goal) and also the more abstract ‘non measurable’ aspects of the higher levels (beliefs/values and identity). Fig 2 proposes a visual representation of a learning organisation using the Levels of Change as a framework.

THE LEARNING ORGANISATION

CURRENT STATE DESIRED STATE

Fig 2. Shifting Levels of Change of a Learning Organisation

80 Levels and Loops of the Learning Organisation

In figure 2, the change from one state to another suggests that Dilts’ levels move through time. This might also be represented as a triangular prism where time (‘when?’) becomes separated from the level of environment (‘where?’):

The Role of Values and Alignment in the Learning Organisation

“Implicit values that are deeply embedded in the culture of an organisation and are reinforced by the behaviour of management can be highly influential, while espoused values that are idealistic and are not reflected in management behaviour may have little or no effect.”

Armstrong (2001 ,p206)

As Armstrong (2001) notes, values need to be believed in and lived to produce results. An organisation may have value statements but if no-one buys into them or acts upon them, they are simply words on paper. Values appear in a variety of organisational models (e.g. Dilts 1996, Waterman et al 1980, Johnson 1988, Armstrong 2001) and are integral to the culture of an organisation.

In order for learning and development to be transferred, it must be seen and felt as important. If it is simply seen as writing on paper, learning and development will not be seen as a priority. Hence it will slip to one side and be regarded as a ‘nice to do, but not essential’. For an organisation to consider itself a learning organisation, learning and development must be truly embraced, valued and applied.

The Levels of Change model can be utilised in determining if there is alignment at the different levels and if not, diagnosing where the misalignment is taking place. Any task, change, project or objective needs to be aligned in order to serve the organisation; so does learning & development. Misalignment can cause interference, conflict and paradox within the organisation (Cheal 2012).

In order for alignment to happen and for values to positively affect transfer of learning, there needs to be organisation-wide clarity and awareness as to what the learning values of the organisation actually are. For more information see the ‘Levels of Change and Loops of Learning’ below.

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In practical terms, in order for learning and development to be aligned (and hence to take place):

x The organisation needs to give training opportunities x Training needs to be timely and relevant x Managers need to create opportunity for individuals to apply learning, so transfer of

learning can take place.

The Levels of Change and the Loops of Learning

The Levels of Change and the Loops of Learning (LCLL) model is a diagrammatic representation of how learning (and hence change) takes place. It could apply to an individual or an organisation, but for this exercise we are looking at an organisation.

The LCLL model is a dynamic model designed to show the movement necessary for learning to take place. Learning and change require motivation and the model should give the practitioner a tool to prepare and promote such learning and change by helping to show:

¾ the difference between temporary change and permanent change, ¾ where and how learning might get blocked.

There are two phases in the LCLL model, Re-evaluation and Revolution. The first phase is the realisation that change is desired and learning is required; and then motivation is gathered to create the change/learning. The second phase is the actual process of embedding learning (and hence more permanent change).

Phase 1: Re-Evaluation

The Re-evaluation Phase occurs when there is a desire to be different from the current state. It may begin at Spirit, Identity or Beliefs/Values. The desire will tend to be stronger and the learning/change more likely when the process begins higher up the levels. There is then a drive through the other levels down to Environment. Think of it like a six storey building with a water tank at each level. When water comes down from the top floor, there will be a greater pressure at the first floor than if the water came from the second floor. The stronger the pressure, the easier and more successful phase 2 (Revolution) is likely to be.

82 Levels and Loops of the Learning Organisation

As an example, the levels might be expressed: “The expectations of those we serve are changing (spirit) and we want to be the customer’s number one choice (identity). It is important to us to be of service (values) and so we need to be ready (capability) to deliver (behaviour) to a 21st century marketplace (environment).”

In the context of organisational change, the Re-evaluation phase would be the time for defining, planning, informing, briefing and involving. This phase alone however, without phase 2, will lead only to surface level, short term readiness for change and learning. If this is not followed up quickly by phase two, the motivation will wane and the process will be considered ‘lip service’ and without substance.

Key Questions

Once the desire has been established, there is a flow from top to bottom, where the following questions need to be asked and answered:

Spirit: Who are we here for and how are they changing? How is our purpose changing?

Identity: Who do we want to be? How do we want to be different?

Beliefs/Values: Why do we want to be that? What needs to be more important to us? What beliefs will help us?

Capability: How will we achieve that? What skills/knowledge do we need?

Behaviour: What do we need to do to get those skills?

Environment: Where/when will we do this?

It would also be wise to do an ecology check at each level. For example: “what could be the potential consequences, implications and risks of changing this level and how will we put contingency plans in place to cater for any foreseeable issues?”

Possible Blocks at Re-evaluation Phase The learning/change is likely to fail if:

¾ the desire or will is not really strong enough to drive all the way down to the Environment level,

¾ the ecology is unsound leading to negative reactions systemically. This could be for example, people/parts resisting or a contradiction created with other parts of the system.

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Phase 2: Revolution

The Revolution Phase consists of a number of loops that progress back up the levels. Each loop may need to be repeated a number of times in order for the learning to take place. In order for the looping to take place, there needs to be some motivation. This motivation usually comes from a sense of purpose, values, benefits or consequences of not learning. It could be said that the process needs to be driven by the ‘higher’ levels.

Loop 1: Practicing

¾ This loop entails action that affects the surroundings in some way. The result of the action provides feedback which reinforces success and allows correction of errors. This stage correlates to ‘conscious incompetence’. ¾ The process of going round this loop is called practicing. ¾ This process can be accelerated by time/opportunity to practice, effective instruction, direction, training/coaching and verbal feedback.

Loop 2: Developing Ability

¾ This loop entails using the practiced behaviours in such an elegant way that it is now considered a skill. The behaviours now become unconscious, though there is still consciousness of learning. This stage correlates to ‘conscious competence’. ¾ The process of going round this loop is called developing ability. ¾ This process can be accelerated by time/opportunity to develop the ability, management/trainer support, feedback and coaching.

Loop 3: Building Belief

¾ This loop entails the ability becoming effective enough that the internal belief grows. This may be belief in oneself, the organisation, the learning or the change. The learning also develops true value and becomes a part of the culture. Capability becomes unconscious leading to ‘unconscious competence’. ¾ The process of going round this loop is called building belief. ¾ This process can be accelerated by time/opportunity to build the belief, effective hands off coaching and support.

84 Levels and Loops of the Learning Organisation

Loop 4: Integrating

¾ This loop entails the beliefs and culture embedding to the point where it becomes inseparable from the organisation. The learning/change is no longer considered external as it is part of the system. ¾ The process of going round this loop is called integrating. ¾ This process can be accelerated by time/opportunity for integration, continued support and encouragement.

This model works for both active/applied/kinaesthetic skill development and passive/visual/auditory knowledge development. Knowledge development still goes through the same loops, where data (environment) becomes information (internal processing/behaviour) becomes knowledge (capability). Knowledge, in this context, would also include learning the unseen/unwritten culture and social rules of an environment. Sometimes, skill learning comes before knowledge learning and sometimes vice versa. This will depend on the individuals/organizations learning styles and metaprograms.

Possible Blocks at Revolution Phase The learning/change is likely to fail if:

¾ There is poor training/coaching or lack of support/resources provided, ¾ There is a negative experience in a loop that is strong enough to halt progress, ¾ There is a break or too great a delay in a loop.

Conclusion: Real-ising the Learning Organisation

“Yes, that’s all very well but it doesn’t help my particular situation.”

Charles Handy (1993, p.15)

Handy (1993) puts these words into the mouth of a pragmatic manager in response to the academic’s theories. Indeed, a general big picture criticism of the learning organisation literature and concept (e.g. Handy 1993, Senge 1993, Argyris 1977 & 1994) is that it is too general and big picture! Perhaps the very paradox of the learning organisation is that it is a big picture, big chunk concept. This can create abstract theories, jargon and metaphor. Handy’s pragmatic managers may not find any practical use in grand ideas like ‘learning organisations’ if they struggle to apply such concepts to their specific situations. This suggests a need for some small chunk steps of how to get from ‘a’ to ‘b’?

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For the ‘learning organisation’ to become a graspable reality (e.g. for Handy’s pragmatic manager), it needs to be chunked down to the level of:

x workable systems, x ‘common sense’ attitudes and ‘common practice’ behaviours, x knowledge and skills that are relevant, manageable and applicable.

Dilts’ model can help to bridge the gap between high level concept and practical action planning. Not only does it give us the opportunity to assess where we are and where we want to be, the model also allows us to explore the alignment between the levels and take appropriate action if necessary.

Notes

1. For more information of Bateson’s Levels of Learning, see Hall (2001) and Tosey (2006).

2. The Levels of Change model is a development of Dilts’ original Neurological Levels model (published in Changing Belief Systems with NLP, 1990). Dilts originally claimed that his model represented logical levels as outlined by Bateson (2000). A true hierarchy of logical levels is where the level above is a category and the level below is the collection of items that fit into that category. For example, the category of transport contains: cars, vans, bicycles, trains etc. Whilst the Neurological Levels model has been criticised for not representing ‘true logical levels’ (e.g. Hall 2001, Bostic St. Clair & Grinder 2001), it can be extremely useful when used as a tool for exploration and problem resolution, particularly in its developed form as ‘Levels of Change’ which is not defined in terms of logical levels (in this article at least). Whilst I agree with these criticisms, I am still happy to consider the components as hierarchical levels (like a hierarchy of criteria) or layers (e.g. of concentric circles like Satir’s ‘Self Mandala’ – in Satir et al 1991).

Biography

Joe Cheal has been working with NLP since 1993. As well as being a master trainer of NLP, he holds an MSc in Organisational Development and NLT, a degree in Philosophy and Psychology, and diplomas in Coaching and in Ericksonian Hypnotherapy, Psychotherapy and NLP. He is also a licensed EI practitioner.

He is the author of ‘Solving Impossible Problems: Working Through Tensions and Paradox in Business‘ and co-author of ‘The Model Presenter: Developing Excellence in Presenting and Training’.

86 Levels and Loops of the Learning Organisation

Joe is a co-founder of the Positive School of Intrinsic Neuro-Linguistic Psychology (www.psinlp.com) and a partner in the GWiz Learning Partnership (www.gwiztraining.com), working as a Management & Organisational Development Specialist.

References

Argyris, C. (1977) “Double-Loop Learning in Organisations,” Harvard Business Review, Sept-Oct, pp 118-119.

Argyris, C. (1994) On Organisational Learning, Blackwell: Cambridge, Mass. Armstrong, M. (2001) A Handbook of Human Resource Management Practice 8th ed., Kogan

Page. Bateson, G. (2000) Steps to an Ecology of Mind: Collected Essays in Anthropology, Psychiatry,

Evolution and Epistemology, University of Chicago Press Bostic St. Clair, C. & Grinder, J. (2001) Whispering in the Wind, J & C Enterprises Cheal, J. (2012) Solving Impossible Problems: Working Through Tensions and Paradox in

Business, GWiz Publications Dilts, R. (1990) Changing Belief Systems with NLP, Meta Publications Dilts, R. (1996) Visionary Leadership Skills, Meta Publications Dixon, Nancy (1992) “Organisational learning: a review of the literature with implications

for HRD professionals,” Human Resources Development Quarterly, Vol.3 No.1, Spring, pp. 31-32.

Garvin, D. (1993) “Building a Learning Organisation”, Harvard Business Review, July-Aug, pp. 78-91

Hall, L.M. (2001) Going Meta, NSP Handy, C. (1993) Understanding Organisations 4th ed., Penguin Books. Jones, A.M. & Hendry C. (1994) “The Learning Organisation: Adult Learning and

Organisational Transformation,” British Journal of Management, Vol. 5, p.160 Johnson, G. (1988) “Rethinking incrementalism,” Strategic Management Journal, Vol.9 pp.

75-91 Satir, V., Banmen, J., Gerber, J. & Gomori, M. (1991) The Satir Model, Science & Behavior

Books Senge, P. (1993) The Fifth Discipline Century Business. Tosey, P. (2005) “The Hunting of the Learning Organisation: A Paradoxical Journey”

http://epubs.surrey.ac.uk/1188/1/fulltext.pdf (accessed 17/05/2013)

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Tosey, P. (2006) “Bateson’s Levels of Learning: a Framework for Transformative Learning?” http://www.som.surrey.ac.uk/NLP/Resources/BatesonLevels2006.pdf (accessed 17/05/2013)

Waterman, R. Jr., Peters, T. and Phillips, J.R. (1980) “Structure Is Not Organisation” Business Horizons, 23, 3 June. pp. 14-26.

88 Distinguishing the Psychologies Between Psychotherapy and Coaching

Distinguishing the Psychologies Between Psychotherapy and Coaching

L. Michael Hall

There are two different kinds of psychologies. There is a psychology for people who need healing and peace and there is a psychology for people who need to be challenged and stretched. These very different psychologies study the needs, drives, motivations, life scripts, etc. of two very different populations of people. And from these two different psychologies come two very different helping professions. The helper in the first profession is a psychotherapist and his or her work is that of healing people. The helper in the second profession is a coach and his or her work is that of challenging people.

Now I’ll be the first to admit that the line between these two different psychologies, these two different populations, and these two professions is not the clearest of lines. There are some gray areas and there are some exceptions that make one or the other more desirable with certain people. In fact, the whole area of counselor seems to exist in that gray area between therapy and coaching. Sometimes a person in that gray area needs a bit of counsel, consulting, gentle acceptance and nurturing with a bit of challenge.

Yet in spite of this gray area and the ambivalence of where to draw the line, and the fact that there is a lot of confusion between therapy and coaching, I offer the following as one way to distinguish them.

The Psychology of Psychotherapy

Almost everybody knows about the psychology of psychotherapy. This is what people immediately think about when they think about “psychology.” They think about the understanding of people, of human nature, of mind and emotions, of memories and beliefs, etc. and how people can get hurt, wounded, and traumatized, and how “psychology” can help. And indeed, Sigmund Freud began his brand of psychotherapy as a way to understand and bringing healing to people in hysteria after discovering that medical science really was not able to bring much relief.

Therapy is about healing. That’s what the word means, “to heal.” And just like the body can be hurt, damaged, and traumatized— so can a person’s thoughts, emotions, sense of

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self, understandings about the world, expectations, hopes, and so on. Yet the “hurt” and “trauma” of the psyche (self or person) is not external and obvious as a physical hurt. So what really gets hurt? In our common language, we say that someone “hurts my feelings.” So what is hurt? We say that we have had some bad experiences and now we are disillusioned, depressed, unable to trust, unable to enjoy ourselves, fearful of people, etc. So what is this internal hurt?

What actually hurt is a wound or violation of our mental maps about the world. We had thought one thing, and then experienced something very different. We anticipated, expected, hoped for, wanted, desired, etc. one thing— but it didn’t happen, it was blocked, someone else got it. We didn’t expect the undesirable event (war, rape, mobbed, attacked, home destroyed by fire, bankruptcy, divorce, etc.) and so when it happened, we were not prepared, We didn’t know what to do. We didn’t know how to cope.

The hurt occurs and our emotions register that hurt as we experience the “negative” emotions— fear, anger, stress, frustration, disappointment, disillusionment, depression, anxiety, paranoia, shame, guilt, and a whole host of such emotions. And what these emotions register is that there is something wrong with our world (i.e., our sense of the world, our model of the world). Somehow, in some way, for some reason— our mental model of the world is not working as it “should.”

And if we do not have the ability to use the “negative” emotion to explore and adjust our mental maps about things, we get stuck in the symptoms— the negative emotions themselves, the negative states and experiences, and if we don’t understand how to cope effectively and to master the environmental situation— we can actually make it a lot worse for ourselves. We might drink to get rid of the pain. We might attack others thinking that will make us succeed. We might deny, repress, pretend, be a victim, and in a multitude of ways multiply the problem that creates the hurt.

Psychotherapy is the profession of choice to deal with all of this. That’s because when people get hurt in these ways, they usually lack the very resources that they need for self-healing. And this is all the more true when the hurt occurs during childhood or in the formative stages of young adulthood. Here are the basic factors that are generally true of this population.

∙ The person is hurt in his or her sense of self. They do not feel okay. They do not feel worthwhile, valid, honorable, important, a somebody, etc. a person may be wounded and hurt, even traumatized in his or her self-definition, self-confidence (sense of empowerment and competence), and self-esteem (sense of personal value and worth), and social-self (how they sense that others experience them).

90 Distinguishing the Psychologies Between Psychotherapy and Coaching

∙ The person is hurt in his or her understanding of what’s going on. They feel confused, overwhelmed, unsure, ignorant, mis-informed, etc. They want to know “Why is this happening?” “Why did that happen to me?” “What’s wrong with me?” “What’s wrong with them?”

∙ The person is hurt in his or her resources for coping. The person feels tired, worn out,

defeated, and without the ego-strength to keep facing and dealing with the situation. The person is hurt in his or her sense of time. The person seems to be living in the

past and not fully present to the here-and-now or to the future.

These are the conditions that generally refer to as the conditions that call for psychotherapy. Someone who is not okay in oneself, living in the past, without the ego-strength to be challenged, and feeling unable to change his or her beliefs really needs someone who will accept him, care about her, listen like no one has ever listened, support, help in enabling with new coping skills, help in finding new meanings, etc. In a word, the therapist loves and reparents the person back to health.

What does a person need to learn to do psychotherapy and what competencies does a person need? There are many, many “Schools of Psychology” for this. I began with Psychoanalysis, moved to Jungian, then to Adlerian which I really liked, then to Transactional Analysis which I stayed with for years and learned from some of the originators. Then I found Rational Emotive (Ellis) and Cognitive Psychology and it is in that tradition that NLP arose. In terms of skills— you have to be very patient and loving, able to diagnose, recognize personality disorders and be on the guard less a person do themselves more harm. The book that I wrote in unison with some other NLP authors is The Structure of Personality: Ordering and Disordering Personality Using NLP and Neuro-Semantics.

The Psychology of Coaching

By way of contrast, once a person achieves the fundamental goals of therapy and 1) feels good about oneself and is “okay,” 2) is living in the present, in the here-and-now and ready for the future, 3) has the ego-strength and the resources to ask, “What’s next?” “I’m ready for a challenge.” and 4) has a strong ability to unlearn what no longer works or is no longer relevant and learn new things in adjusting his or her mental maps— that person is ready for coaching.

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What’s the difference? The big difference is that in psychotherapy a person needs love, acceptance, understanding, gentleness, and homeostasis in stabilizing the world. But in coaching a person needs challenge, stretching, disorientation, and disequilibrium in shaking up the world and inventing new possibilities.

The psychotherapist loves the person back to health and wholeness and often by re-parenting the person by being kind of “authority figure” that the person needs in order to cope effectively in the world. The coach challenges the person to go beyond just meeting the lower needs of surviving, being safe and secure and stable, getting love and affection, feeling value and worth in oneself to moving up to the higher meta-needs of giving. These needs are just as innate as the lower drives, but the drive us to contribute— knowledge, meaning, justice, peace, love, beauty, mathematics, making a difference, etc.

So the population for coaching are those who are basically and generally okay and psychologically health. If they do not stretch to their next level of development, they can become unhealthy in a new and different way. They can lose the drive and joy of living a life of challenge that seeks to keep on unleashing more and more potentials. If they don’t move there, they can become comfortable and bored and focused on the lower needs of getting.

This psychology came into existence in the 1940s as Abraham Maslow and Carl Rogers began exploring “the healthy side” of human nature. In the late 1930s Maslow taught and wrote a book on Abnormal Psychology documenting all of the horrible ways that human life can go wrong. In that work he repeatedly made side-comments as he wondered about “the healthy side.” Later he choose his mentors Ruth Benedict and Max Wertheimer as two “wonderful, wonderful human beings” as “good specimens” of humans to begin his modeling of self-actualizing people— people living at the height of their potentials and passions and making a difference in the world. From that the human potential movement arose, Humanistic Psychology and Positive Psychology— all strength-based psychologies focused on the bright side of human nature.

What does a person need to learn and what competencies does a person need to be able to effectively coach? The psychology is that of Self-Actualization Psychology so I’d recommend Maslow’s works, Toward a Psychology of Being, Motivation and Personality, and Roger’s works on Client-Centered Therapy and, of course, my books, Self-Actualization Psychology and Unleashed.

92 Distinguishing the Psychologies Between Psychotherapy and Coaching

In Summary

The Psychology of Therapy is a Remedial Psychology that provides insights about how to nurture, support, listen, enable the expression of the person’s story, to facilitate transference, to avoid counter-transference, to re-parent and love the person back to health. It is a conversation of that involves an independent–dependent relationship moving the client to more and more independence.

The Psychology of Coaching is a Generative Psychology that awakens, disturbs, challenges, and stretches to unleash more and more potential talents and possibilities. It is highly confrontative, direct, and explicit. It is a dialogue of colleagues and involve inter-dependent roles.

The Therapist is working to develop okayness in the client, to get him or her up to okay, to strengthen the person’s ego-strength, to finish the so-called “unfinished” business of the past and get the person up to now— in the present and ready for taking on life’s challenges.

The Coach is working to move the self esteem to a totally unconditional status so the person does not have to prove anything to be fully and completely okay, and now ready for a new restlessness— a dis-equilibrium to think more, feel more, be more, say more, do more, have more, and give more.

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THERAPY AND COACHING Therapy Coaching Psychology of hurt, wounds, trauma. Psychology of challenge, disequilibrium,

unleashing potentials. Time: Clients living entirely or mostly in the past Clients living in the present with an eye on the

future State: Experiencing internal hurt, wounds, traumas. Experiencing an anxiousness and restlessness Experiencing the “negative” emotions. for more, internal well-ness, and health. Intention: Wanting safety, equilibrium, quietness, Wanting disequilibrium, adventure, challenge, peace. to be stretched. Self: Lacking ego-strength to face the world or a Has the ego-strength to face what is in one’s particular challenge, fearful of “reality.” world, a friend to reality, not afraid to candidly Fearful of what might be true. speak the truth. Lacks sense of value, worth and esteem for self. Has unconditional self-value and worth, or “high”

self-esteem even though conditional. Feels like a victim and has much or lots of victim Feels high level or completely at cause, talk and mentality. response-able and empowered. Power: Needs to be re-parented, easily experience Fully able to be an adult in thinking, feeling, transference to the helper as if a new “parent.” accepting responsibility. Needs “fixing” — remedy for problems of self. Does not need “fixing” or any remedial solutions,

wants generative change. Change: Resists change, fears to change, defends Embraces change, wants it, plans for it, gets self against change. excited about changing. Reactive, defensive, fears to be open, vulnerable. Proactive, open, disclosing, self-aware.

Biography

L. Michael Hall, Ph.D., doctorate in Cognitive Psychology with a minor in psycholinguistics, a psychotherapist in practice for 20 years, then became a modeler of psychological excellence using NLP and Neuro-Semantics, studied the modeling of Abraham Maslow in studying “the healthy side of human nature” in self-actualizing people and authored three books on Self-Actualization Psychology. Co-founded Neuro-Semantics and Meta-Coaching System, author of over 46 books.

www.neurosemantics.com; www.self-actualizing.org; www.meta-coaching.org.

94 Using NLP for Pain Management and Physical Recovery

First Person Life History Account of Using NLP for Pain Management and Physical

Recovery Post Traumatic Accident

Lisa Wake

Introduction

The aim of this article is to provide a first person case study of the applications and experience of using a range of NLP tools and techniques. I hope that this study will provide insight to others on how the processes described can be used in a clinical context. I provide a meta perspective on my experience through the eyes of a trainer and researcher.

The Clinical Picture

At the beginning of January, I had a ‘freak’ accident that resulted in severe dislocation and multiple fractures to my left leg. This necessitated air ambulance to hospital, 5 attempts at manipulation to reduce the fractures and ensure blood supply to my leg, 2 operations involving external fixation with a rather interesting meccano set and then internal fixation 5 days later, with 12 pins, 2 plates and loads of wire to hold my malleolus in place. Basically there wasn’t a lot of bone structure left so my leg is held together with a load of titanium.

The Psychological Picture

Prior to the accident I had experienced significant emotional trauma in the preceding year. During that time I had said to myself that I would give myself permission for my body to collapse once a specific milestone had been reached. In my place of ‘making the best choice at the time’, this was the only way I could stay focussed enough to get through the emotional trauma without giving into the emotions and in my world, ‘losing everything’.

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As the phrase goes: ‘be careful what you wish for’, because 36 hours after the milestone, my body literally collapsed.

First Person Case Study

Case study as a research methodology can be either qualitative or quantitative. Within qualitative methodologies, this study provides a holistic single case study and could be viewed as a life history case study based on the experience of just one individual. Plummer (1983) and Yin (2009) propose that first person phenomenological cases studies provide a humanist perspective on the subjective nature of individual experience. It is recognised that this study is not representative of any experiences other than those of the author and as such cannot be used to make generalisations. It is hoped that learnings can be taken from this case and that theory may be informed by this report.

Literature Review

NLP has a limited evidence base for its effectiveness and no Level A studies to date (Wake, Gray, Bourke, 2012). I have reviewed where possible and included research studies that are relevant to the processes of pain management, post trauma stress responses and rehabilitation.

There are two studies reviewing the effectiveness of NLP in pain management. Bowers (1996) conducted a randomised control study that was Cochrane reviewed, comparing NLP with regular chiropractic care of patients with acute pain. She used the Visual Analogue Scale to measure pain reduction across the two groups. Findings show a reduction of 6.2 in the NLP treatment group compared to the non-treatment group showing a reduction of 1.7 over the same period of time. Bowers discusses the limitations of this study being group size, lack of control on degree of patient participation and therapeutic judgement. Olson (1985) as part of their Masters thesis conducted a study looking at the application of pacing and anchoring in pain management. Full copies of this paper are not available therefore no comments can be offered as to the validity or the chosen methodology.

Other studies relevant to this case study include the extensive research into the use of submodalities, notably with post-traumatic stress and anxiety disorders (Ferguson, 1987; Hale, 1986; Koziey et al 1992; Krugman et al, 1985; Field, 1990). Gray (2010) has expanded on this work with his further development of memory reconsolidation theory working

96 Using NLP for Pain Management and Physical Recovery

with veterans using the V-K Dissociation protocol. Allen (1982), Einspruch and Forman(1988), Kammer et al (1997) and Liberman (1984) have all demonstrated the effectiveness of variations on the NLP phobia cure. Gray (2009) has also published research on the use of submodalities, anchoring and goal setting with offenders who also use substances.

Imagery for goal realisation (Hossack and Standidge, 1993) has been demonstrated to be effective. Weaver (2009) and Gray (2009) both demonstrate the effectiveness of utilising outcomes with clients, Weaver from a neurolinguistic psychotherapy perspective using CORE (clinical outcomes in routine evaluation) and Gray using the well-formed outcome frame to access future preferred states. More widely than existing NLP literature are the studies of Locke (1968) and Tubbs (1986), both of whom provide further evidence for the effectiveness of goal setting and motivational factors in enabling achievement of results.

Mirror neuron studies (Gallese 1996, 2007, Glaser et al, 2004), although not core to NLP, can be considered to underpin the modelling and rapport processes within NLP. Recognising that the discovery of mirror neurons occurred after NLP was developed and established, nonetheless their role is significant in rehabilitation work. Ramachandran (2009) has used the activation of mirror neurons in stroke rehabilitation and has demonstrated the role that mirror neurons play in the rehabilitation process. Swets et al (1990) proposed that modelling may be effective for development of motor skill.

From a wider rehabilitation perspective, NLP has been used with patients post cardiac incident (Sumin et al, 2000). The test group in this study demonstrated higher exercise tolerance and lower reactivity of central haemodynamics in exercise tests.

There are only a few books that discuss the applications of NLP in a health care context. Walker (2004) has written a highly accessible book on the applications of NLP in medical practice from his perspective as a General Practitioner. He provides an excellent context of the applications and makes suggestions on how NLP can be used to manage clinical disorders such as depression, anxiety, habit disorders, pain control and cancer

Submodalities, anchoring and pain

I experienced pain at a number of different levels during the immediate accident and recovery period. At the time of the accident, I was very aware that I was lying in a wet field, had only light clothing on and was a long way from help. My previous nursing experience enabled me to recognise that shock, lack of blood supply to my foot and

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hypothermia were my biggest risks. I was very keen to manage the shock and not allow this to take over my body and I knew that if I felt the pain I would go into shock more quickly. Interestingly I immediately recalled a programme about language, pain and swearing that I had watched with Stephen Fry and Brian Blessed on Planet World (http://www.bbc.co.uk/programmes/b01614w9). They demonstrated that if you swear, your capacity to tolerate pain is significantly enhanced. I also knew that dissociation would help. So for the next 20 minutes I bit my glove, stared into space and started swearing. This became like a mantra and as long as I stayed in that state, I felt little pain. My friend was excellent at staying dissociated and giving grid references to the emergency services. Two walkers who happened upon us were delighted that after 20 years, their bivvy bag was finally being put to use. It was also great that she was a nurse and he was a retired emergency services controller.

The air ambulance arrived 20 minutes later (the road ambulance had got stuck in a field!). When the paramedic asked me my pain threshold out of 10, I said 3. Medics use a scaling system to calibrate pain levels and to monitor for increasing levels of pain. I don’t think they believed me and suggested I should have IV morphine before they attempted to move me. I knew that the next period of time stabilising me and transferring me to hospital was going to be challenging, so I mentally calibrated the submodalities of my ‘3’ state so that I could return to that if I needed to. I also recall being very aware that the paramedic ‘Andy’s’ voice was incredibly calm and reassuring. As they attended to me and started to remove my trainer and turn me to apply a brace to my leg and put me on the stretcher, my pain level increased and I recall that the level 3 state had been small, far away and had a frame around it. It had now become fully associated, all encompassing and in full colour. I was able to shrink the picture and put a frame round it but could not move it away. I became aware of hyperventilating and shaking and at that point was given Entonox.

This eased the pain, however it also made me start to lose consciousness. As I began to ‘black out’, which is actually a misnomer for me, because I was being drawn towards a white light, I heard my friend’s voice panic as she called for the paramedic’s attention. I heard Andy speak and I used this as an anchor. I remember saying to myself that as I long as I stayed hooked to Andy’s voice I would be ok. I came around as they were about to put me onto the stretcher. My pain was back down to a 3 and I remember reframing myself ‘well girl, you wanted to learn about trust, here’s your chance’. This ability to reframe stayed with me and I can remember one of the 6 people who carried me on the stretcher to the ambulance asking how I could joke at a time like this in response to my comment “you’ll know how much Christmas cake I’ve eaten”.

98 Using NLP for Pain Management and Physical Recovery

As I was placed into the helicopter, Andy asked me if I wanted more morphine and I refused. I was determined to stay conscious and use my internal resources to manage the situation. I knew where ‘3’ was, I also completely trusted Andy and knew that if I could stay anchored to him, I would be ok. It took some time for the aircrew to decide where to take me (Harrogate landing site was flooded). A call was made to fly to Leeds as it was closer and my need for emergency treatment was pretty immediate. As the helicopter started up, the vibrations escalated the pain in my leg. I felt panic arise in me, I was frightened of blacking out again so I fixed my eyes on Andy. I stayed anchored to him, his voice and his eyes throughout the short flight.

As we landed and I was lifted from the helicopter I blacked out again. The details of the 5 manipulations, and failed IV propofol, a hypnotic amnesic drug, remain insignificant to this study, other than to say that submodalities and manipulation of a multiply fractured leg without anaesthetic do not work.

Anchoring remained a significant part of my immediate operative journey. I recall anchoring to certainty in people’s voices, the registrar in A&E, my friend, the anaesthetist. As long as I could hear certainty I knew I would be ok.

The next time submodalities played a significant part was in the 2-3 days post first operation. I reacted badly to the analgesia prescribed, experiencing hallucinations and muscular contractions in my leg. I also kept getting flashbacks of the accident and kept rerunning the video of it and also a video of ‘what if I had lost my leg’. My first priority was to stop the flashbacks. I used the VKD model three times over the space of three days and have only experienced one flashback since. It was easy to use and I included a process of spatial anchors for myself as I was both the operator and the client. This helped me run the process cleanly and anchored me into the right place to begin and end the movie. To the left of me was the end of the trauma, to the right was the safe place before it happened. I held a hand in each place and could use these anchor points to remind myself which way I was running the movie.

With regard to pain management, I elicited the submodalities of the present pain state and played with each one in turn to work out which one, if changed, had the biggest impact. As I worked out which one it was, I suddenly had a huge insight. That all that changing submodalities does is give you a conscious reframe on an unconscious experience. I was completely fascinated by this and had never before recognised that this was a reframing process between conscious and unconscious mind.

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The final place where I used submodalities was in the management of the hallucinations. Some of them were amazing and well worth the trip, e.g. floating inside giant chocolate Aero bubbles! Others were considerably more distressing. I recall one occasion when my bed was being moved and I suddenly felt as if I was on a cherry picker crane high above the sky scrapers of New York. I felt panic arise in me and I became very scared. The friend that was with me at the time unconsciously used a combination of auditory anchors (certainty in her voice and a here and now state) and submodalities, moving the image away, to ease my fear and bring me out of the hallucination. She has had some training in NLP, but was not consciously aware of deliberately applying it.

I continued to use submodalities to manage my pain throughout the recovery period. I have been told off by my physiotherapist for not taking pain killers. I genuinely didn’t need them and most of the time adjusting the submodalities has enabled me to manage well.

Mobility and mirror neurons

My leg was immobilised in a cast for six weeks. I was then given an airboot to use for a further 3-6 weeks. Once my cast was removed, I was very keen to walk again and regain full mobility as quickly as possible. I was required to use the airboot and crutches and gradually build up strength in my leg. Three days after having the airboot fitted, I was walking along the lane next to my house with a friend and my dog. I realised that I was limping substantially and that my left leg was using a completely different movement to my right leg. I set the intent to model what my right leg was doing and see if, by using mirror neurons, I could get my left leg to model my right. This took some concentrating, yet within a couple of minutes my left leg had modelled it. I was still using crutches and yet my stride changed and my friend had to ask me to slow down because I suddenly upped my pace. I decided to continue to use the process of modelling for all my walking back to full rehabilitation.

From a recovery point of view, at my 12 week outpatient appointment, I was walking with just a slight limp from torn tendons in the outer aspect of my ankle, my mobility is significantly further ahead than others who had a similar injury at the same time. At 4 months post-operative I was back on my mountain bike and walking 4 miles unaided. At 5 months, I walk with no limp, have 90% flexibility back in my ankle, I am up to 20 miles on my bike and 5 miles cross country walking.

100 Using NLP for Pain Management and Physical Recovery

Modelling

I researched and modelled what others who have had similar injuries have done. I changed my diet to increase my protein intake. I added antioxidants, chondroitin, glucosamine, Echinacea, to my supplement list.

Other components of recovery

Goal Setting – from the outset I was very clear that I wanted to return to the things that I love doing, hill walking, mountain biking, touring cycling and running. These are activities that I loved as a youngster, had lost during my time bringing up a family and had recently reconnected with, with great passion. I set myself goals very early on. Most of them were much too ambitious. I decided I would be walking around the house without an airboot after 1 week – it took me 2 weeks. I decided I would be back on my mountain bike by Easter, it took me a further week. I decided I would walk a mile on crutches with my leg in plaster and non-weight bearing at 3 weeks post-operative. I did half a mile. I kept setting myself stretch goals. I disappointed myself that I didn’t quite reach them, but surprised my friends, family and medical professionals that I have achieved the goals that I have. I have always believed that I can do more than I can in reality. This has always been a motivation for me and this ‘towards’ strategy seems to have served me well in this context, as well as my natural trait of taking responsibility for myself.

Values and Beliefs - My values and beliefs have changed beyond recognition as have some of my metaprogrammes. I felt that I had lost trust in everything and everyone because of the previous emotional trauma that I had gone through. I don’t do things by half measures – so I set myself a very valuable lesson in deconstructing trust to the level of survival in Maslow’s hierarchy of needs and literally learnt to build it up again. My beliefs in what I can do and what is possible if you set your mind to it have changed immeasurably. I thought I knew it before, I now know that I know it. My values in what is important to me and my life are now concrete and very real. I am making significant changes in my life and old established patterns of not being good enough; it being my fault; me not being important; me being wrong; being a workaholic; being scared of asking for what I want are all going or have gone.

Strategies – my strategies for who I am and how I behave and respond are changing.

Metaprogrammes – my metaprogrammes of introversion, sort for others, dissociation, auditory digital have all changed.

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Probably most importantly, I have learnt what true friendship and love for the sake of it, human to human, really is.

Acknowledgements

I would like to give a huge thank you to Yorkshire Air Ambulance service; the walkers and farmers who helped at the time of my accident; BBC camera crew for their non-intrusive and sensitive filming; Professor Giannoudis and his team at the Leeds General Infirmary; Nurse Becky at LGI; Phsyiotherapists Stephen, Claire and Ryan at Harrogate General Hospital; my daughter Rebecca who provided so much love and support and patience during my recovery that goes above and beyond the call of duty as a daughter; Mum for fussing over me, nagging me and loving me; friends across the UK who have shared their stories as ways of encouraging me; my partner Chris who’s limitless energy, authenticity and love got me through some very dark times; my clients and students who postponed or changed appointments, asked after me and put up with my hobbling and leg elevation.

To Richard Bandler and John Grinder, Steve Andreas and Robert Dilts for creating and developing NLP so that it can be used when it really matters.

Biography

Lisa Wake, Master Trainer of NLP, is accredited by the UKCP as a neurolinguistic psychotherapist and has an MSc in Advanced Clinical Practice focusing on the applied psychology of NLP. Lisa is currently studying towards a PhD in Psychology at Surrey University.

As a psychotherapist, Lisa has served as both Chair and Vice Chair of the UKCP Lisa’s recent groundbreaking publication, Neurolinguistic Psychotherapy: a Postmodern Perspective on the applied psychology of NLP is currently being utilised by the US and Canadian Military to inform the development of a programme to manage PTSD for the US Veterans Association. Her subsequent publication for the UKCP series with Karnac, The Role of Brief Therapy in Attachment Disorders attracted the support and contribution of Betty Alice Erickson, family therapist and daughter of Dr Milton H Erickson, renowned Psychiatrist and Hypnotherapist. She has added to her list of publications as Lead Editor for the Clinical Effectiveness of NLP, a clinical review book that required collaboration with leading NLP clinicians and academics across the world in bringing together a review

102 Using NLP for Pain Management and Physical Recovery

and critique of the clinical effectiveness of NLP. Lisa has also written a book for practitioners and trainers who want to be informed of the evidence base and applications of NLP in a generic business and coaching context, NLP Principles in Practice.

References

Allen, K. L., (1982) An investigation of the effectiveness of Neurolinguistic Programming procedures in treating snake phobics. Dissertation Abstracts International 43(3), 861-B University of Missouri at Kansas City.

Bowers, L.A., (1996) An Exploration of Holistic and Ontratraditional Healing Methods including Research in the use of Neuro-linguistic Programming in the Adjunctive Treatment of Acute Pain. Dissertation Abstracts International. 56 (11):6379

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Field, E.S., (1990) Neurolinguistic Programming as an Adjunct to other Psychotherapeutic/hypnotherapeutic Interventions. The American Journal of clinical hypnosis 32 (3) pp.174-182

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Glaser, D. E., Grezes, J.S., Calvo, B., Passingham, R.E., Haggard. P., (2004) Functional Imaging of Motor Experience and Expertise During Action Observation. University College, London.

Gray, R. (2009) The Brooklyn Program: Applying NLP to Addictions. Current Research in NLP: Volume 1. Proceedings of 2008 Conference pp.84-94

Gray, R. (2010) PTSD: Extinction, Reconsolidation and the Visual-Kinesthetic Dissociation Protocol. Traumatology.

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Hossack, A., & Standidge, K. (1993) Using an imaginary scrapbook for neurolinguistic programming in the aftermath of a clinical depression: a case history. Gerontologist. 33(2):265-8

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Koziey, P. W.; McLeod, G., (1987)Visual-Kinesthetic Dissociation in Treatment of Victims of Rape (Research and Practice) Professional Psychology: Research and Practice. American Psychological Association.

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Liberman, M. B., (1984) The treatment of simple phobias with Neurolinguistic Programming techniques. Dissertation Abstracts International 45(6), St. Louis University.

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Sumin, A. N., Khairedinova, O. P., Sumina, L., Variushkina, E. V., Doronin, D. V., Galimzianov, D. (2000) Psychotherapy impact on effectiveness of in-hospital physical rehabilitation in patients with acute coronary syndrome. Klin Med (Mosk) 78(6): 16-20,

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Weaver, M. (2009) An Exploration of a Research-Based Approach to the Evaluation of Clients’ Experience of Neuro-Linguistic Psychotherapy within a Private Practice Making use of the CORE Model. Current Research in NLP: Proceedings of 2008 NLP Conference. Vol 1. pp67- 83

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104 An investigation of the effects of using Clean Language to support employees

An investigation of the effects of using Clean Language to support employees

through organisational change Fe Foreman

Abstract

This study investigated the effects on well-being of using clean language to explore employees’ experiences of organisational change at its best in a UK Special Health Authority facing ambiguity and rapid change.

Following Lawley et al (2010) a clean language research methodology was applied to explore whether there was a connection between metaphorical exploration of organisational change at its best and well-being, whether the impacts of group and 1:1 interventions differed and whether patterns could be detected to provide insight about resourcing individuals through change.

The quasi-experimental study involved control, 1:1 and workshop groups in an interrupted time-series comprising initial, post-intervention, and twelve-week post intervention well-being measures. The study included exploration of lived experiences of organisational change and of experiences of the study interventions. The study provides evidence of clean language efficacy in a business change setting, providing practitioner guidelines for exploring metaphor.

Introduction

This study investigated empirically whether, and phenomenologically how, the exploration of metaphor using clean language impacted well-being during a period of organisational change. The current study was prompted by anecdotal evidence of the benefits of using metaphorical approaches during a period of change in an NHS Special Health Authority.

In the study organisation, internal change to improve efficiency and effectiveness had coincided with the implementation of radical change across the NHS and a challenging fiscal situation nationally that required deep, sustained spending cuts. The organisation was operating in an increasingly fast-moving, complex, and ambiguous environment.

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The organisation development (OD) team worked to support leaders in making sense of the changing environment both externally and internally because they were expressing discomfort and distress about the degree of change and how to lead others through it.

The OD team used metaphor repeatedly. This included facilitating individuals and groups to generate their own metaphors to make sense of their experience, introducing metaphors to elucidate concepts, and facilitating the sharing of metaphors between leaders and the wider organisation. Anecdotally, these interventions had a positive impact, individuals reported feeling more at ease, making sense of events more readily, and increased motivation.

The study informs the body of OD knowledge and contributes to psychotherapeutic understanding of the impact on well-being of using clean language. The study is relevant to NLP given that clean language is an approach modelled out using NLP techniques, and is closely associated with the NLP community, being featured at NLP conferences and as part of some NLP trainings.

Literature Review

This section briefly defines well-being and examines the impact of organisational change on it. It goes on to explore the meaning of metaphor and its centrality in human meaning-making, before introducing clean language and reviewing the literature about its efficacy in supporting well-being.

Defining well-being

Ryan and Deci (2001) note that well-being is usually described in one of two ways, as positive affect or happiness (hedonistic definition), or as finding meaning / fulfilling potential; the degree to which the individual is fully-functioning (eudemonic definition).

The two constructs refer to different aspects of well-being, the first how one feels, the second how one functions. In the workplace, Marks (2005) defines well-being for an employee as

“their experience of their quality of life” (pg 21)

and within this includes both satisfaction and personal development. This study follows Marks by considering well-being to encompass hedonistic and eudemonic dimensions of human experience.

The impact of ambiguity and change on well-being

There is literature that argues the point that organisational change can have a detrimental effect on well-being (Miller 2011, Cheal 2009a, Cheal 2009b, Jordan 2004, Schabracq and

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Cooper 1998) and that change management interventions can mitigate this deleterious impact (Fredrickson 2009, Kiefer 2002, Bridges 1987, Callan 1993, Martin et al 2005). This section provides a brief insight into this literature.

Miller (2011) provided results from an organisational survey indicating that job insecurity and the scale of organisational change is weighing heavily on the UK’s workforce. The report indicated 40% of public sector organisations were planning redundancies and that this was connected to employee stress and anxiety, negatively impacting well-being. Miller (2011) indicated that the most common public sector causes of stress are the amount of organisational change and re-structuring.

Cheal’s (2009a) study of the nature and impacts of paradox on people in organisations used qualitative methods to explore the experience of eighteen managers from a number of organisations. Cheal defined paradox as dilemmas, tensions, double binds, conflict and vicious circles. He found that paradox has a range of effects, and that the effects of paradox were without exception negative.

Cheal (2009a) connects paradox to change, noting that as the pace and amount of work rises more paradox occurs in the form of conflicting priorities and dilemmas that employees need to resolve quickly. Cheal (2009b) likens the impact of paradox to learned helplessness, which Seligman (2003) contends can cause depression.

Jordan (2004) indicated that change is an inherently emotional process, producing a range of feelings in individuals including excitement, enthusiasm, creativity, anger, fear, anxiety, cynicism, resentment and withdrawal.

There are a range of interventions that support well-being through change (CIPD 2011, Schweiger and De Nisi 1991, Litchfield 2011), including those that support resilience (Liossis et al 2009), and positive psychology interventions (Lyubomirsky 2007, Sheldon and Lyubomirsky 2006).

Metaphor, Meaning-making and Well-being

A strong theme running through the literature about effectively supporting well-being during change is meaning-making (Kiefer 2002, Bridges 1987, Mobray 2011). This section explores how metaphor is relevant to this.

Metaphor is defined by Lakoff and Johnson (1981) as:

“thinking of one thing in terms of another” (pg 5)

Classical theorists since Aristotle have referred to metaphor. Traditionally metaphor was seen as an expression of thought, rather than as the basis of thought itself (Lakoff 1993). Lakoff explains that the way metaphor is perceived has developed to recognise that thought is metaphorical in its nature.

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Lakoff and Johnson (1999) express this idea more strongly, saying that cognitive science indicates:

“the mind is inherently embodied. Thought is mostly unconscious. Abstract concepts are largely metaphorical” (pg 3)

Geary (2001) builds on this theme, observing that:

“metaphorical thinking – our instinct for not just describing but for comprehending one thing in terms of another, for equating I with an other – shapes our view of the world, and is essential to how we communicate, learn, discover and invent” (pg 3)

Thibodeau and Boroditsky (2011) conducted a study of the impact of metaphors on the solutions study participants suggested for reducing crime in a fictional case study. The study involved presenting the same data with different metaphorical frames (a virus or a beast), and explored the way participants responded to them.

Thibodeau and Boroditsky (2011) demonstrated that the metaphorical frame applied influenced the nature of the solutions participants suggested. A single word referencing the metaphor was enough to prompt processing that fitted the metaphorical frame offered. They found that the metaphor was only impactful if it was presented within the context of the study and that a metaphor introduced early was more impactful than one introduced at the end of the case study. Finally, they noted that participants were not aware that their thinking was being influenced by the metaphor used.

Lawley (2011) commenting on Thibodeau and Boroditsky’s study argues that once we buy into a metaphor we are constrained to follow its logic, and that we may not realise that our choices are limited to what makes sense within it. This concurs with Morgan (1997) who hypothesises that metaphors create insight and have strengths, but that they also distort. He notes that:

“the way of seeing created through a metaphor becomes a way of not seeing” (pg 5)

The author contends that this makes working with metaphor a useful intervention to explore in managing change.

Defining clean language and symbolic modelling

David Grove, a counselling psychologist, developed a clinical approach for resolving clients’ traumatic memories in the 1980s (Lawley and Tompkins 2000). Grove worked with clients in a way that honoured their choice of words rather than paraphrasing, devising questions which contained as few assumptions and metaphors as possible (Sullivan and Rees 2008).

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Grove’s approach enabled his clients to explore their naturally occurring metaphors, gaining an understanding of their inner world. Referred to as their metaphor landscape, Grove found that when his clients worked in this way, they could be at choice about whether and when to seek to change, and when they did it enabled the resolution of their issues.

Grove’s approach was modelled by Lawley and Tompkins (Tosey 2011). Lawley and Tompkins distilled the approach into the clean language questions to codify Grove’s work. Clean language questions presume only metaphors of time, space, form, and perceiver, the raw materials of symbolic perception (Lawley and Tompkins 2000), leaving all other metaphorical content to emerge from the individual’s metaphor landscape.

Grove (1998) indicated that the facilitator’s role is to visit the client’s model of the world and unfold solutions contained within the language and logical boundaries of that world. He believed that every ‘negative’ symptom has within it a solution that can emerge to become a resource. He summarised his approach by saying:

“clean language engages and interrogates symptoms until they confess their strengths” (pg 2)

Clean language is essentially a set of questions, they can be used in a variety of contexts from marketing to police investigations, anywhere that the benefit of eliciting information without introducing metaphors from outside is useful (Sullivan and Rees 2008). Given Thibodeau and Boroditsky’s (2011) findings about the ease of influence available through metaphor introduction, the author considers this approach potent for research and facilitation purposes.

Lawley and Tompkins codified and extended Grove’s work (Sullivan and Rees 2008) and called the therapeutic methodology they developed Symbolic Modelling.

The effect of clean language on well-being

Clean language practitioners claim that use of clean language has an impact on well-being (Lawley and Tompkins 2000, Tompkins and Lawley 2004, Doyle 2010, Sullivan and Rees 2008).

Lawley et al’s (2010) study employed clean language to explore six participants’ experiences of work-life balance. Participants undertook a one-hour session exploring their experiences of work-life balance at its best and not at its best. A follow-up session further explored their metaphor landscape, and their experience of the intervention.

While the study did not aim to make any changes in participant’s well-being, there were effects for participants. The authors found that some interviewees were deriving real benefit from the experience of exploring, describing and drawing their metaphor landscapes. Furthermore, the technique led to a growing awareness of work-life balance

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and some participants decided to make changes following the intervention. Lawley et al (2010) present qualitative data that makes clear that participants perceived that they derived benefits from their experience.

The literature about the effectiveness of using metaphor (Jacobs and Heracleous 2004, Abel and Sementelli 2005), clean language and symbolic modelling (Lawley and Tompkins 2000, Tompkins and Lawley 2004, Sullivan and Rees 2008, Lawley et al 2010, Doyle 2010, Walker 2006), tends to be qualitative, anecdotal, and not specific to an organisation change context. The current exception to this is Doyle et al (2010). The current research addresses this gap in the literature.

Methodology

This study deployed a combined quantitative and qualitative methodology. The quasi-experimental aspect of the study provided an interrupted time series with a non-equivalent control group to establish whether a significant relationship could be found between clean language interventions and levels of well-being. Phenomenological methodology was used to examine lived experience of organisational change by exploring participant metaphors and participant experiences of the interventions and their impact on well-being. Phenomenology is the study of how we experience the world, suggesting that reality is unknown because all humans have is subjective perception (Schulz 2004).

The study objectives were to establish whether there was a connection between metaphorical exploration of organisational change at its best and well-being, whether the impacts of group and 1:1 interventions differed and finally whether any patterns could be detected to provide insight about resourcing individuals through change.

Figure 1 provides an overview of the methodology. Three well-being measures were taken, before, after and twelve weeks after the interventions. Two intervention groups were engaged, one attended a ninety-minute clean language workshop, the other a sixty-minute symbolic modelling session. There was also a control group. Post-intervention three participants from each intervention group were interviewed about their experience to gather phenomenological data.

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Figure 1 – Methodology Overview

Measuring well-being

For this study, a well-being measure was sought that focused on positive functioning rather than a lack of well-being, encompassed both hedonistic and eudemonic aspects of well-being and was simple, face-valid for participants, and reasonably quick to complete.

The measure selected was the Ryff Well-being scales. Figure 2 provides a summary of the six constructs measured (Ryff 1989).

Self Acceptance: holding positive attitudes towards oneself and one’s past life.

Positive Relations with Others: warm, trusting interpersonal relationships, the ability to love and feel empathy.

Autonomy: self-determination, independence and regulation of behaviour from within, an internal locus of evaluation.

Pre-intervention well-being measure

3-month well-being measure

Post-intervention well-being measure

Control Group (17) One-to-one Group (5) Workshop Group (17)

Statistical and Qualitative Analysis

One-hour symbolic modelling “Organisation

change at its best’

90-minute workshop learning and using clean

questions to model

One-hour semi-structured interview with 3 participants

One-hour semi-structured interview with 3 participants

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Environmental Mastery: ability to advance in the world, to choose and create environments, active participation in and mastery of the environment.

Purpose in Life: purpose and meaning in life, goals, a sense of directedness and intentionality.

Personal Growth: continuing to grow, to develop one’s potential and expand as a person.

Figure 2 – Ryff Sub-scales constructs (Ryff 1989)

The Ryff scales used were the fifty-four item scale, with each of the six sub-scales made up of nine items. Participants answered each item using a six point Likert scale that has an ordinal scale for analysis. This results in a global measure of well-being based on the mean of the participants’ responses, as well as a mean score for each sub-scale.

One-to-one intervention

For the one-to-one group, the intervention was a one-hour symbolic modelling session. The study echoed Lawley et al (2010) by using clean language questions to explore experiences of organisational change at its best, but did not echo the previous study by contrasting this with exploring experiences of it not at its best. The hypothesis was that this positive focus might support well-being.

In this study, following the one-hour interview, the participants were asked immediately to draw a representation of their metaphor. This is standard practice in symbolic modelling (Lawley et al 2010).

Workshop Intervention

Groups of five or six participants were introduced to the basic clean language questions. The ninety-minute workshop comprised a short demonstration, and participants working in pairs supported by the author as needed. At the end of the workshop, participants were asked to draw a representation of their metaphor.

The workshop was designed using the 4MAT system of training (McCarthy 1990). First the context was explained and the benefits of learning about clean language were articulated. Next, learners were introduced to the clean language methodology. There was then a demonstration, before participants experimented, supported as needed. Finally the group explored how they might apply their learning outside the workshop. McCarthy (1990) notes that this cycle is a change cycle as much as a learning cycle, making it

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particularly relevant for this study. As with the one-to-one group, participants captured their metaphor visually at the end of the workshop.

The intended outcome of the workshop intervention differed from the one-to-one intervention. The one-to-one enabled exploration at depth. Having less depth, the workshop was designed to build skills participants could apply day to day to enable them to explore their own and others’ experiences. Rather than solely being modelled, this group was being given a succinct introduction to modelling.

Data analysis techniques

Quantitative Analysis

The data created was analysed to evaluate whether it supported the hypothesis that exploring metaphorical representations of experiences of organisational change would increase well-being.

To analyse the data, a well-being score was created for each of the six well-being sub-scales and the overall total. Data was analysed in an IBM SPSS statistical analysis programme.

As the score created was a scale measure there was a possibility of using parametric tests, which tend to be preferable to non-parametric tests. Each data-set was analysed to check which test result could be relied upon. Throughout analysis, significance was tested at the 95% significance level (p < 0.05) in line with standard statistical procedures (Field 2009).

To establish if the interventions affected well-being overall, an across-group analysis of the effects of the different interventions was performed. A separate variable was created for each of the six scales and for overall well-being based on the difference in means between the measurement points. Analysis was then conducted using an independent T-test (parametric) and Mann-Whitley test (non-parametric) to compare the intervention and control groups.

To compare the effects of one-to-one and group interventions, the first test completed for the control group and two intervention groups separately was for the movement of means over time. For comparing two points in the time series (T1-2 and T1-3) the parametric test used was the dependent t-test and the non-parametric the Wilcoxon Signed (Field 2009).

Given there were three groups, a one-way ANOVA (parametric) and Krustal-Wallis (non-parametric) was carried out to provide an indication of whether the change in means over time differed by intervention type.

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Qualitative Analysis

An inductive approach was taken to analysing the transcriptions of the semi-structured interviews, exploring participant experiences of the interventions to ascertain whether patterns and themes could be ascertained. In line with Cheal (2009a) individual comments were isolated, and then a process of sorting them into themes was undertaken by grouping together similar comments, and using commonly used words as labels for them.

Limitations

Study population

The study organisation was subject to a significant amount of change during the research, and unsurprisingly was taking steps to manage this change. This does mean that events outside the study could confound the well-being results. This limitation was mitigated as far as possible by randomising the three study groups.

The small size of the one-to-one group made quantitative analysis challenging. A larger study group would have been preferable.

Study Design

The workshop intervention used in this study involved teaching clean language questions, rather than using clean language to develop a group metaphor. The latter approach would have been more comparable with the one-to-one intervention. With hindsight, the contrast in interventions in the view of the author risked over-complicating the study.

Study robustness could have been enhanced by having the data analysis checked by an independent research statistician. In addition, the transcripts/recordings could have been vetted for the author’s adherence to the principles and practices of symbolic modelling and clean language. Lastly, the quotations extracted from the transcripts could have been reviewed for reasonableness of choice. Lack of budget prohibited bringing such resource during the study.

Researcher Expertise in using Clean Language

In their 2010 study, Lawley et al note that the competence of the interviewer in using clean language is important to ensure that the interview remains true to the methodology. The author in this study had spent eleven days studying clean language with James Lawley and Penny Tompkins. While competent in its use, the author did not consider herself to be an expert; this may have impacted the quality of the findings. This limitation was mitigated by seeking advice from Rupert Meese, a member of the Lawley et al (2010) team.

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Researcher’s dual role

During the study period, the author was an employee of the study organisation, working in the organisation change arena. Some participants knew the author and this relationship might have impacted their responses in questionnaires and during interventions.

These limitations have been mitigated by the author’s reputation as a coach within the organisation, and her demonstrating confidentiality and ethical consideration in relationships generally. In addition, written information explaining the study method and confidentiality measures and the use of clean language as a research methodology have a mitigating effect, because clean language avoids introducing researcher content into the dialogue.

Results

Quantitative Results Summary

In summary, the quantitative analysis demonstrates a number of significant well-being correlations:

12 weeks after the intervention, there was a statistically significant difference in the way overall well-being had changed for the intervention groups compared to the control group (p=0.047).

12 weeks post-intervention, Personal Growth (p=0.034) and Environmental Mastery (p=0.035) subscales demonstrated a significance well-being difference for the intervention group compared with the control group.

12 weeks post-intervention, the Positive Relations with Others sub-scale showed a statistically significant difference across the three groups, one-to-one, workshop and control.

Post intervention, the Autonomy sub-scale (p=0.020) showed significance in the change in well-being for the one-to-one group.

At twelve weeks, the Positive Relations with Others sub-scale was close to significance (p=0.058) when comparing the control and interventions groups. This was also true post-intervention for overall well-being for the one-to-one group (p=0.080)

It should be borne in mind that this study is quasi-experimental, and causation is not demonstrated by these results, they indicate correlations only.

In this paper, the quantitative results are presented graphically only. The full statistical results can be accessed in the longer version of this paper available online (Robinson 2013).

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Comparison of Control and Intervention Groups

Post-intervention control group overall well-being fell, and for the intervention group it rose, demonstrated in figure 3. Only respondents completing both measurement points are included in the data. This difference was not statistically significant.

Figure 3: Mean Difference, Group A and Group B for T1 to T2

Twelve weeks post-intervention, analysis was conducted including those respondents who had provided data at all three measurement points only. By this point, there was a difference in the way well-being had moved between groups; the control group’s overall well-being again fell, and the intervention group’s rose. Figure 4 illustrates this difference, which is more marked than at T2, and is statistically significant (p=0.047).

Figure 4: Mean Difference, Group A and Group B for T1 – T3

Breaking down the statistics to each well-being scale, there was a significant difference between control and intervention groups for Personal Growth (p=0.034) and Environmental Mastery (p=0.035). Positive Relations with Others narrowly missed significance (p=0.058).

This data shows that for the first study objective, establishing whether the interventions impact well-being, the data indicate that there is a correlation between interventions and changes in well-being.

-0.04 -0.02 0 0.02 0.04 0.06 0.08

A

B

Mean Difference, Group A and Group B for T1 to T2

-0.15 -0.1 -0.05 0 0.05 0.1 0.15

A

B

Mean Difference, Group A and Group B for T1 to T3

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Group A, B1 and B2 Results

Post-intervention, when analysing the intervention groups separately the only significant correlation is for Autonomy (p=0.020) for the workshop group. For the workshop group the overall well-being correlation significance was p=0.080, narrowly missing significance.

Figure 5 shows that mean overall well-being for the control group fell post-intervention (-0.272). The mean for the workshop group increased (0.0414), the mean for the one-to-one group also increased (0.1296). While the changes are not significant it is apparent that well-being has increased, and increased more for the group undergoing the more intensive intervention.

Figure 5 – Mean Difference in overall well-being from T1 to T2

The mean well-being score for the control group fell by twelve-weeks to a larger degree than it had post-intervention (-0.976). The mean for the workshop group increased (0.1173), the mean for the one-to-one group increased slightly more (0.1296). While the changes are not significant it is apparent that well-being has declined for the control group, and increased for intervention groups, with minimal difference between one-to-one and group interventions. Figure 6 shows these results.

Figure 6: Mean Difference in Overall well-being from T1 to T3

-0.05 0 0.05 0.1 0.15

A

B1

B2

Mean Difference in Overall Well-being from T1 to T2

-1 -0.5 0 0.5

A

B1

B2

Mean Difference in Overall Well-being from T1 to T3

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At twelve-weeks, the change in well-being is significant for the Positive Relations with Others sub-scale looking across the groups. This indicates differential correlations across the different interventions. Figure 7 illustrates this data.

Figure 7: Mean Difference T1-3 for Scale C (Positive Relations with Others)

In considering the second study objective, establishing whether one-to-one and group interventions have a differential effect, the data in this section indicates that while the overall well-being effects are not significantly different, there is a significant difference at the sub-scale level.

Qualitative Results

Six individuals were interviewed about their experience of the study interventions, three from the one-to-one intervention and three from the group intervention.

In the interviews, participant drawings were used as a starting point to revisit metaphor landscapes of ‘organisation change at its best’, and clean language questions were used to elicit information about participant experiences of the interventions.

Participant comments were analysed for patterns, this section summarises the themes. In the six semi-structured interviews, all participant metaphors had changed substantially. A case study is presented for one workshop participant to illustrate their experience and its effects.

Group Experience Effects Clean language workshop

x Openness x Listening x Safety

x Insight x Exploration x Positive well-being

-0.1 0 0.1 0.2 0.3 0.4 0.5

A

B1

B2

Mean Difference, T1 - T3 for Scale C (Positive Relations with others)

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(B1) x Connectedness x Challenge x Enjoyment

impact x Use of clean language

post-workshop One-to-one Symbolic Modelling Session (B2)

x Different experience x Revealing x Osmotic

x Insights x Positive Affect / Mood

Figure 8 – Summary of Themes from interviews

Case Study

The participant’s metaphor for organisational change at its best in the workshop was a trawler with a net of people being dragged along behind the trawler, many of whom didn’t want to come.

Figure 9 - Group B1 Workshop C Participant Drawing

In contrast, during the follow-up interview the participant talked about “allowing people to come along at their own pace” and being “just as comfortable with those people remaining where they are.”

The metaphor had developed into a “collective” of people who “have all got different skills” on a walk together in a landscape of “flat plains and high mountains” that “provides you with your own milestones and goals to just keep going.”

Figure 10 - Group B1 Workshop C Same Participant

Follow-Up Interview Drawing

Figure 10 - Group B1 Workshop C Same Participant Follow-Up Interview Drawing

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The metaphor change was transformative for this participant’s energy; she was much slower and calmer in delivery as she described celebration, warmth and sustenance as part of her new metaphorical landscape.

The participant described the brief clean session by saying:

“it un-clutters my messy mind and stops my racing thoughts.”

She also reported that she was picturing not thinking, this had an impact for her:

“my baggage comes in thoughts rather than pictures so my baggage instantly went.”

and as a result she felt:

“energised, happy, still but not dead.”

she reported that:

“it’s not an arrival, it’s just I’ve landed somewhere and there is something else out there.”

She was emotional in the interview, noting that:

“much as I am having an emotional reaction, it is a cathartic reaction.”

When asked if there was a relationship between the intervention and their well-being she said:

“absolutely, categorically yes.”

In the view of the author, the individual had experienced a noticeable shift in the way she made meaning of past change experiences between the workshop and the follow up interview. This is an sizeable impact from a twenty-minute exploration facilitated by a colleague who had just learned the clean language questions.

Discussion

Well-being impacts

Various studies have indicated that organisational change negatively impacts well-being (Miller 2011, Cheal 2009a, Jordon 2004). This study supports these suggestions. The control group’s well-being fell both post-intervention and at twelve-weeks post-intervention.

The negative impact of organisational change was apparent in two of the interviews, with participants exploring the personal impact of on-going organisational changes. One re-

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framed their experience through the intervention, for the other it remained a source of dissatisfaction.

The control to intervention group comparison demonstrated that while there was not a significant change in well-being shortly after the intervention, twelve weeks later there had been. Addressing the first question of this study, this indicates a positive correlation between metaphorical exploration using clean language and well-being. The difference was significant when the difference in groups was analysed, and not significant looking at groups in isolation. This is because of the control group’s well-being falling in contrast to the intervention group’s rising.

The positive well-being finding supports the case study reports in Tompkins and Lawley (2004), Lawley et al (2010), Doyle (2010), Sullivan and Rees (2008), and Walker (2006) which suggest positive effects of different kinds for intervention participants.

All six of the participants interviewed post-intervention had metaphors at this stage that were different to those they explored in the original intervention they took part in. It is interesting to note that well-being overall for the intervention groups increased at the same time as their metaphors were evolving. The connection between well-being levels and evolving metaphors is worthy of further research in the opinion of the author.

The evolution of metaphors over time fits with the pattern of well-being rising over a period of time rather than immediately. This reflects the finding in Tompkin and Lawley’s (2004) case study where a participant was experiencing positive effects from symbolic modelling some six months post-intervention.

Comparing the intervention and control groups after twelve weeks, Environmental Mastery and Personal Growth were significant correlations, indicating that participants were more positive about growing and expanding as a person, and their ability to advance in the world and choose and create environments. This supports Callan’s (1993) contention that the effects of organisational change are mitigated by empowering employees and encouraging them to take action.

The only significant result shortly post-intervention was for the one-to-one group, for Autonomy. This scale measures self-determination and an internal locus of evaluation. Given the focus of clean language described by Grove (1998) and Doyle (2010), holding that self-generated solutions and client wisdom are primary, this result is perhaps unsurprising. Group interventions were conducted by participants, not experienced clean facilitators, which may account for the lack of effect in this sub-scale when the workshop group participants are included.

A predominant theme in the literature was the need for assistance in meaning-making during organisational change (Kiefer 2002, Bridges 1987, Mobray 2011). Both the

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workshops and one-to-ones provoked thought and enabled insight, this was a strong qualitative theme.

Lakoff (1993), Lakoff and Johnson (1999) and Geary (2001) point to the power of metaphor to enable meaning making. Lawley and Tompkins (2000) indicate that symbolic modelling enables an individual to build a coherent metaphor landscape, this reflected the experience of a one-to-one participant who found that they “built up a story, a whole picture.”

This study confirms the potential for clean language interventions to support well-being in the context of organisational change; the author contends that its efficacy in supporting meaning-making is a prime reason for this.

One-to-one and Group Interventions

The second research question asked whether there was a difference between the effects of an one-to-one or group clean language intervention.

Post-intervention, the one-to-one intervention had a stronger correlation with well-being than the group intervention, but not to the level of significance. Twelve weeks later the effect of both interventions was positive and of similar magnitude, again not reaching significance.

Qualitative data reflected a positive impact on well-being for five interviewees, with the last one reporting no impact but presenting in a way that indicated frustration. Considering the quantitative and qualitative evidence this author contends that the magnitude of effects of the one-to-one and group interventions were broadly similar.

However, differential experiences were noted. Comparing the control and two intervention groups after twelve weeks, Positive Relations with others showed a difference between interventions, with the largest positive correlation in th one-to-one group. Stiles et al (2006) note the power of the therapeutic alliance in individual therapy; this may have been a factor in enabling the change in the scale measuring ability to form warm, trusting relationships. Workshop participants stressed creating a climate of listening was important in enabling openness and safety, accounting for the positive correlation seen in the data. However, they did not have the opportunity to connect for the period or at the depth experienced in one-to-ones.

The one-to-one intervention had a significant correlation with autonomy post-intervention, encouraging independent thought; the data do not show the workshop having this effect. In contrast, qualitative data revealed that the workshop intervention led to more conscious application of learning with participants using clean language while the one-to-one intervention provoked insights but led to only one interviewed participant consciously experimenting.

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The nature of the intervention differed, no new skill was being taught in the one-to-one intervention that participants could readily go and apply, their shifts were more in meaning than at the level of skills. This difference is significant in guiding OD practitioners, if personal insight and meaning-making is desired then the symbolic modelling intervention provides this, if behavioural change is the goal, this study found that the clean language workshop was more efficacious. Further research could combine the two approaches to see if there was an additive effect or not.

Intervention Guidelines

The final research aim was to identify any patterns in participant experience that provide intervention guidelines for those supporting others through organisational change.

Three significant themes emerged. Firstly, metaphors and meaning changed between the intervention and the follow-up interviews. This fits with the quantitative findings of the study indicating that well-being effects take time to emerge, and also with the usual pattern of symbolic modelling interventions, which usually happen as a series (Lawley and Tompkins 2000). The qualitative results suggest that interventions that recur are likely to be more helpful in supporting well-being. In addition, metaphors evolving happened concurrently to well-being being sustained relative to a control group, indicating that metaphorical work is a useful intervention.

The second theme that emerged was that themes occurred in the metaphors produced in workshop groups, indicating that individuals influence each other’s metaphors. The study also found that the themes across participant metaphors resonated with the metaphors used in the organisation before the study. The author has no way of knowing whether the similarity in metaphors is coincidental or causative, however given the findings of Thibodeau and Boroditsky’s (2011) in their crime study; recognising that the metaphors one uses have a marked effect on the way people process has implications for OD practitioners and therapists.

Lastly, in terms of the nature of the interventions, safety that enabled openness and came from listening were strong themes from the workshop group, with the one-to-one intervention providing guidance and enabling information to be revealed. These themes reflect Tompkins and Lawley (2004) in which the participant noted the process provided safety and support. In any intervention that may be a different experience for participants, which was the case in this study, this climate of safety, and openness will be important. The nature of clean language makes it ideal to create these conditions.

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Conclusions

This study has found that exploring metaphorical representations of organisational change at its best correlated significantly with increasing well-being during a period of organisational change; potentially mitigating the deleterious effects of change and causing a small well-being uplift.

It is clear that the well-being change took time to emerge, indicating that change management needs to take place over a period of time, supporting employee meaning-making.

Group and one-to-one interventions showed similar well-being correlations over a three-month period, indicating that either may provide some benefit during change. However, the nature of the effect was different, with insights and positive affect the prime outcome for the one-to-one intervention, and workshops additionally leading to experimentation with new skills.

There are four implications of this study for clean language / therapeutic practitioners. Firstly, clean language and symbolic modelling interventions are suitable as part of the change management mix to support employee well-being. Secondly, metaphorical interventions have effects over time, undertaking interventions over a period is recommended. Thirdly, creating an open, safe environment for exploration and insight is key to supporting well-being. Finally, teaching clean language will enable application of learning into other contexts. Using one-to-one interventions may require more sessions to lead to behavioural change.

Future Research

This study has indicated that clean language interventions may have a positive effect on well-being during organisational change. Future research areas to expand understanding could usefully include a study with varying numbers of interventions to establish the optimum duration and depth of intervention. In addition, using a different workshop format to facilitate exploration of the group together rather than teaching clean language skills directly to participants. Finally, a study with more diverse participants to test whether results can be generalised.

Biography

Fe Robinson founded Buddleja Transformations to support individuals and businesses in bringing to life what matters to them. Fe is a UKCP Accredited Psychotherapist as well as a Chartered Fellow of the CIPD, accredited member of the International Coach Federation,

124 An investigation of the effects of using Clean Language to support employees

and an INLPTA-trained Trainer of NLP. Fe, based in Durham (UK) sees therapeutic clients privately and in the NHS, and works independently as a coach and organisation development consultant supporting a wide range of organisations in the public and private sectors.

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