NLP And Mirroring

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I try really hard to make my time with patients count. I talk to them just like I would talk to a family member or next door neighbor. Although this occasionally frightens them, they generally get pretty relaxed and ask me questions I can’t believe they would come up with. I think they do this — and I connect with them — because I do something called “mirroring.” Yes, you can try this at home.

I will always be happy that at some point in my residency I dragged myself to Kansas City to sit in some hotel function room and study Neuro Linguistic Programming, now known colloquially as “NLP,” with one of its originators.

At the time, I was one of only two mental health professionals in a room full of folks who mostly were professional sales people, and were looking for some magic way to “read” people and make them buy things they may or may not have needed. Me, I enjoyed myself immensely and seemed to have some mystical talent for most of the walking-and-thinking kind of exercises. The instructor just came up to me, when I asked about future instruction, and kind of smiled and laughed at me a bit.  Then he put his hands on my shoulders and kind of shook me, and said, I swear this is exactly what he said because I have been quoting this for years, “Estelle, you don’t need any more instruction. Estelle you are so damned crazy you can just go out there and cure people by being crazy.” NLP was certainly popular enough and they had enough people waiting for the course that he did not need me.  I thanked him.

I went on to read pretty much all the books available on NLP.  They were all transcripts of lectures and classes like I had been through.  He was right.  I did not need any of them. What I needed to do was simply to add another dimension to what I thought psychiatry was. I had to watch people’s bodies and read what their movements, even small movements meant. And I suppose there was another dimension, too.  I could hear a lot about what people felt about what they were saying by their vocal tone and timbre. The kicker is that I already knew how to do these things.  I just had not been paying attention to them. The night between the weekend sessions I went to a Kansas City pickup bar with the only other mental health professional at the seminar, and one of the saleswomen who appeared more honest than some of the other people present.  We tried to read people and respond to them in a way we had never tried before. In less than an hour or so, the three of us — none of us stupid and none of us beauty contest material even by the most liberal of criteria — could have picked up any man we wanted. Truthfully, the guys were swarming around us.  The trouble was, some of us were so successful that we had to keep each other out of trouble – mutual chaperones. I worked hard on those skills – the NLP, not picking up men — and practiced them diligently.  I am now convinced I can connect with any human being in English, French, or Spanish — and yes, the body language is different for different ethnicities. Like any other skill you learn – from riding a bicycle to juggling — I used to have to think hard about it. Now it is pretty much second nature. In one clinic in California, I saw a new patient who was hesitant to speak about himself.  He had some memory problems and could not speak about himself.

He spoke the dialect I had heard only in Oklahoma.  A student was in the room to observe me.  She sat with big eyes and in stony silence as I did a complete workup on this middle-aged cowboy (who left his hat on during the entire interview). I mirrored him. He was lanky, throwing limbs all over the place.  I did the same, sometimes mirroring him quite literally, sometimes doing things with the opposite limb.  He had, I am quite certain, no idea what I was doing. I let him talk — a lot.  Most doctors interrupt patients early on, and urge them to get to the point, like Jack Webb in “Dragnet” – “Just the facts, please.”  They watch the clock a lot, which can put some people off.  I only do that after they have spoken uninterrupted for a bit, so I can tune it in — maybe three to five minutes.  Hard for a doctor.  Hard even with a spouse or even a friend.

Try it.  Try listening — really listening — for that long with an oven timer or something.  I have used this as a first step in couples counseling.  Most couples can’t do it. He had panic disorder and it did not sound like things were going well at all.  He sounded like he was staying home and drinking. Halfway through, he said “You got character.  You ain’t like them other shrinks my wife made me talk to. And you know what you’re talkin’ about. I guess I’m gonna have to try the pills.  I haven’t yet.  I thought drinkin’ was doin’ just fine at givin’ me the courage to leave the house, but maybe I could do that with more pills and less drinkin’.” I tried not to look surprised, and gave him a pep talk.  He signed a release and we called his wife in and explained that drinking was not really a good plan here, and if he could not stop all together he ought to cut down plenty.  Prescription drugs and alcohol do not mix, have not been systematically tested together, etc.

Now the latter piece of info did not seem to impress him much.  He was a farm laborer and obviously had not hung around in one-tenth of the allegedly educational experiences I had.  But he did know if you drank too much you slept all day, and this was not a good thing.  He had already been trying to cut back. He signed an informed consent. Was started on a teensy dose (1/2 of 0.5 mg. clonazepam) only when he had to leave the house.  I only gave him a couple of pills at a time, and told him if he used them too fast I would “whoop” him.  He laughed and slapped his thigh.  Oh, and I gave him some sertraline (Zoloft). Pfizer had provided the clinic with a bunch free, and he had little money.

But most important, I gave him hope.  In return, he gave me a mighty handshake.  He is going to try. His wife (whom we agreed was a “keeper” after 43 years of marriage) was going to help him.

Not exactly a promise to go alcohol free, I warned him what alcohol withdrawal could be like and how and when to get to an emergency room, just in case he had been minimizing his alcohol consumption — something people often do when they are in the presence of doctors. I walked him to the front desk, so he could get an appointment to come back, directions to get some basic blood work done and to get those free Zoloft.

When I finally closed the door, and was alone with my student, she was wildly impressed to the point of flabbergastation (if that’s not a real word, then I claim ownership rights). She had never seen anything like that, not ever.  We easily agreed I had probably missed my calling, and could have been either a pretty good actress or an evil super villain.  Fortunately, I had chosen “Truth, Justice and the American Way.” Seriously, the truth is I studied NLP as best I could, and used it.  I have also studied improvisational acting. Initially for fun, informing those others who were in (and directed) the workshop of some of its psychological meaning, although frankly, I don’t think they much cared.

The people I know who use NLP the most and the best are the marketing folks I network with.  They surprise me, and are spiritual descendants of those people in the auditorium in Kansas City those many years ago who wanted to learn NLP for their own nefarious purposes. Do I have certain gifts?  Maybe, maybe not. I’ve taken a semi-professional turn on the stage at various times in my life and done some amateur-freebie things in the way of stand-up comedy, improve and plays.

But the truth of the matter is many, many people could do that stuff.  I think where I excel is that I love people.  I love talking to them and connecting to them. I told my student I think it is a skill any human who wants to learn, can. I think another factor here is how much somebody wants to connect. To me, all of these skills are part of being the best doctor I can possibly be.

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