An Ericksonian Template for Smoking

Cessation
​ By JoeDowling in Uncategorized

Abstract (published in The Australian Journal of Clinical Hypnotherapy & Hypnosis)

An Ericksonian approach to smoking cessation is a four-session model utilising solution-focused

questions, strategic task assignments, and both conversational and formal hypnosis. This
model assists clients to change their experience of smoking, generating a pattern interruption
that gradually expands through the course of treatment, ultimately rendering the smoking habit
powerless. The subconscious mind creates a seamless transition that enables a client to
experience a resolution that is, most commonly devoid of irritability and other withdrawal
symptoms.

Jeff K. Zeig, PhD, a teacher of mine, once said, “Therapy is the art of changing patterns.” (Zeig,
2002) This model creates change from the inside-out, enabling a client to tap in to the endless
stream of healing energy that flows within the mind-body connection.

The Four Session Model

An Outline

SESSION 1

The history of the habit/assessment session relies upon solution-focused/strategic questions

which seed pattern interruption, intersperse therapeutic suggestions (Erickson,) and also seed
the elicitation of hypnotic phenomena in forthcoming sessions. Seeding can be defined as
activating an intended target by presenting an earlier hint. Subsequent response behaviour is
primed by alluding to a goal well in advance. Seeding establishes a constructive set from which
a future goal can be elicited. (Zeig, 2006)

The goals of this model target pattern interruption and hypnotic responsiveness, with each
working together to facilitate habit extinction. This article illustrates how
solution-focused/strategic questions serve to seed future interventions while also creating the
first movement of a changing (rapidly changing) pattern. Dr. Erickson once wrote, “I would like
to suggest to you that in the reading of my works you pay attention to… the snowballing effect of
a change in behavior.” (Zeig, 1985)

Examples of Solution-Focused/Strategic Questions with Corresponding

Interventions/Techniques

1. Which hand do you smoke with?

● Seeding of Pattern Interruption (O’Hanlon, 1987)

● Seeding of Symptom Prescription (O’Hanlon, 1987)
2. Which direction do you blow the smoke?

● Seeding of Pattern Interruption (O’Hanlon, 1987)

● Seeding of Symptom Prescription (O’Hanlon, 1987)
3. Exactly how do you PUT OUT your cigarette?

● Interspersal Suggestion (Erickson, 1966)

4. Do you crush, stomp, stamp, or flick IT OUT?

● Interspersal Suggestion (Erickson, 1966)

5. Have you ever seen yourself smoke?

● Seeding the elicitation of the hypnotic

● Phenomenon of dissociation (Edgette & Edgette, 1996)
6. How long does it take to FINISH SMOKING?

● Interspersal-Suggestion (Erickson 1966)

7. From the moment you wake up what do you do prior to your cigarette?

● Seeding of Pattern Interruption (O’Hanlon. 1987)

● Seeding of Symptom Prescription (O’Hanlon, 1987)
8. What were the circumstances surrounding the first cigarette you ever Smoked?
 ● Seeding the elicitation of the hypnotic Phenomenon of Age Regression (Edgette &
Edgette, 1996)
9. What will it be like when you are smoke free?

● Seeding the elicitation of Future Progression (Edgette & Edgette, 1996)

10. How will girlfriend/partner feel?

● Seeding the elicitation of Future Progression (Edgette & Edgette, 1996)

The client will next be given strategic task assignments, prescriptions to prepare him/her to stop
smoking that they will perform between sessions one and two. Tasks are individualized based
upon the unique history the client has provided. A case study from the work of Milton H
Erickson, MD illustrates his usage of strategic task assignments, symptom prescriptions and in
particular, utilization of the individuals strengths, in this instance motivation to follow direction.
(O’Hanlon and Hudson, 1990) The following case study will demonstrate.

“A retired policeman explained to Dr. Erickson that he was suffering from obesity, problem
drinking, and habitual smoking. Upon learning the man purchased two packs of cigarettes per
trip to the local corner store, (he also bought his groceries there, while buying this liquor at the
next store over), Erickson stated, “Now, your problem is very simple. You want to jog but you
can’t. But you can walk. All right, buy your cigarettes one pack at a time. Walk across town to
buy your pack. That will start to get you in shape. ….Go to a grocery a half mile or a mile away
and buy just enough for each meal. That means three nice walks a day. …you can drink all you
want to. Take your first drink at a bar at least a mile away. If you want a third, find another bar a
mile away.”

The man glared at Erickson, swearing at him as he stormed out of the office. Approximately a
month later a new patient came to see Erickson, he stated, “A retired policeman referred me to
you. He said you are the one psychiatrist who knows what he is doing.” Erickson explains, “The
policeman couldn’t buy a carton of cigarettes after that! And he knew that walking to the grocery
store was a conscious act. He had control of it. Now, I didn’t take food away from him. I didn’t
take tobacco away, I didn’t take liquor away. I gave him the opportunity to WALK.” (Rosen,
1982) Pgs 149-150 from My Voice will go with you.
Indeed, Ericksonian therapy is the art of changing patterns.

Examples of Strategic Task Assignments-Symptom Prescriptions

● Smoke every third cigarette with opposite (non-dominant hand).

● Time five cigarettes in order to determine how long each cigarette lasts.

● Pay attention with extreme focus, to the direction the smoke is exhaled. Do this with
three cigarettes per day.

● Perform morning pattern (individualized to client) differently prior to having first cigarette
of the day. (ie: smoke prior to walking the dog; have two cigarettes instead of one with
coffee; smoke on back porch while reading paper instead of in the basement).

● Smoke one cigarette in front of mirror before next session.

● Take a DEEP Breath in between each drag (do this with 3 cigarettes per day).

The first session serves simultaneously as an individualized solution focused/strategic

assessment as well as an effective intervention. Throughout session one it is of critical
importance to emphasize that this is a four session model. It is a process that is reliant upon
the individuals unique experience of a changing, shifting pattern. I frequently use the example
of an academic course that begins in September and runs through December…asking a client,
“would you ever request to take the final exam in mid October? Many clients return to the office
after session two (the first formal hypnosis session) and express disappointment that they are
still smoking. Ineveitably, upon further inquiry, their smoking pattern has been meaningfully
disrupted.
A client fo mine, a bright professional woman in her mid-50′s, presented as a three and a half
pack per day smoker. She was most engaing as well as enthusiastic about the prospect of
terminating her smoking habit. Upon leaving the office after session one, armed with her
strategic task assignments, she was the picture of motivation….Upon returning for session two,
she had the look of a deflated, disappointed soul. Her first words were, “I’m such a failure!” I
immediately believed that somehting in her personal world, far more significant than her desire
to quit smoking, had greatly impacted her mood. Her second statement was, “I’m still smoking
ten cigarettes a day, I AM a failure!” In a most quizzical manner, I then inquired, “OK, let me get
this straight, if your son, your beloved son, were to report to you that while working on an
extraordinarily important project, one that was perceived to be most difficult, he had improved
600%, would label him a failure?’ (3 1/2 packs=70 cigarettes minus 60 cigarettes, 600% pattern
reduction = 10 cigarettes per day).

Less dramatic examples are commonplace throughout the course of treatment. Clients report
changes in their smoking pattern that they have not experienced in decades. These shifts in the
experience of smoking (the amount, frequency, desire, taste, smell) are all examples of the
expanding pattern interruption that ultimately results in the cessation of the habit. However, an
expected obstacle attempts to sabotage the measurable progress that is unfolding. The
conscious mind becomes stuck on the fact that smoking, regardless of the significant changes,
is still occuring.

At this juncture I will often converse hypnotically, magnifying the progress, the pattern
interruption, as akin to coming atractions at the movies, sneak previews provided by the
subconscious mind of what it will be like to live a smoke free life, to be healthy, to have achieved
such a meaningful goal. It is of critical importance to reinforce that this therapy is a process that
flows and grows to a successful outcome.

SESSION 2 – 4
The client will return for session two within three to five days. Sesions two, three, and four
consist of formal hypnosis and ongoing solution/strategic therapy. The beginning of the second
session affords the client the opportunity to report on her experiences in relation to the
prescribed tasks. Upon learning about the impact of the tasks/symptom prescriptions, coupled
with the data received in session one, the clinician can now tailor the hypnotic interventions to
the uniqueness of the client. The therapist, as tour guide, may now lead the client into trance,
eliciting the hypnotic phenomena that best positions him/her for success.

The hypnotic phenomena of future progression (Edgette & Edgette, 1995) was selected with a
client of mine who was “read the riot act by my physician” for his five decade smoking habit.
Learninbg that this 70 year old man was completely enamoured with his 10 year old
granddaughter, I believed that eliciting a future memory would prove to be most therapeutic. An
excerpt from the hypnosis will illustrate:

“You can move pleasantly, or perhaps curiously forward into hypnosis….I really don’t know how
you can explore a healthy space, a time and a space, forward to the next best time…and you
can enjoy losing track of time, flowing forward, like a bodiless mind…. experiencing yourself as
having achieved a most meaningful goal. What is there to see? Can you smell the healing air?
Is that the sound of Allie’s voice? And what a time it is now, that sweet voice, ‘I’m so proud of
you Grandpa, I’m so happy you stopped….’ And on the inside you can FEEL THE
PEACE…that heavenly voice serenading you for now and later, all the time, anytime, you can
be free….letting go, going with your healing flow, and that’s so nice to know….”

The hypnosis continued with Allie as the anchor, the ongoing, never ending post hypnotic
suggestion. Sessions two-four allow the client to unleash the healing potential of her
subconscious mind.

The Non-Smoker who Still Smokes (NS-SS)

The NS-SS defines a client who is unaware that she has succeded. The NS-SS remains
habituated to the belief that extinguishing a smoking addiction is usually impossible and
normally excruciatingly difficult. The NS-SS is unwittingly trapped in a stuck zone provided by
the conscious mind, this limited thinking mind insists on ignoring how, for instance, a 1.5 pack
per day smoker over a span of thirty years is now smoking 4-5 cigarettes per day which are no
longer enjoyable and typically most unpleasant.

The NS-SS is the client who begins session three and/or four explaining that the program just
isn’t working, stating, “I just can’t stop…I’m still smoking, I just can’t stop.” At this juncture, the
clinician needs to question the client in the following manner. “From the moment you left the
last session what changes, however subtle, have occurred in your experience of smoking?
What do you notice regarding the amount/frequency, taste, smell, feeling about smoking? The
NS-SS will respond in a most interesting, revealing manner:

“I just don’t like it.”

“I go long periods of time without smoking.”

“It tastes horrible.”

“I feel like I’m choking.”

“I just don’t want it”

“But I’m still smoking four cigarettes a day!”

The clinician can now enable the client to bypass the grip of the conscious/thinking mind by
identifying, ratifying, and simplifying the real change, the transformation, the cure that has
occurred.

The following will illustrate: A client of mine began the fourth session of her smoking cessation
treatment describing herself as an “incurable smoking addict.” Upon engaging her with the
aforementioned questions, she stated that she “hated smoking,” emphasizing that she really
doesn’t like anything about it anymore. With intense certainty, I anointed her to the status of
NS-SS, a classification that guarantees an overwhelmingly positive prognosis. In order to ratify
and simplify her success, I inquired as to what food she totally detested, to which she replied,
“lima beans.” She then detailed her experience in eating lima beans in much the same fashion
she had described her experience of smoking cigarettes, “I hate the smell, I feel like I’m
gagging, etc.” I then suggested that she could stop at a restaurant and eat a bowl of lima
beans, then go to the market and buy 5 pounds of lima beans, then eat more lima beans before
bed and have even more for breakfast. She could eat lima beans four or five times a day
indefinitely…. or she could, “Throw out your cigarettes and enjoy your success!”

The infinite, benevolent healing power of the subconscious mind can completely bypasss the
understanding of the conscious mind. The NS-SS is thus created, performing a brief, but most
valuable role. The NS-SS is always welcomed by the clinician who can now identify, ratify, and
simplify the success of the client.

Four sessions are crucial to long term resolution in order to enable the client to acclimate to the
positive change/identity shift that becoming a non-smoker entails. This model begins as an
experience of slight, subtle, pattern interruption, evolves into meaningful, often unconscious
change, then rapidly cures.