A field that promises dramatic personal change has to answer a practical question: which people does it actually help? Confident claims about the mind are one thing. Working with somebody whose housing, relationships, health and everyday functioning are all under strain is another.
My early involvement in NLP and hypnotherapy took place alongside work in psychiatric and community settings. The contrast between those worlds shaped my questions about competence, money, status and the people whom practitioners choose to see.
From The Rainbow Machine: Tales from a Neurolinguist’s Journal by Andrew T. Austin.
Two very different starting points
In the 1990s, I had contact with inner-city services and received referrals involving people in considerable difficulty. Some had little money, some were taking psychiatric medication, and some moved repeatedly between institutions and the community. Their problems extended across many parts of life.
A person might need help with distress while also being isolated, vulnerable to exploitation, unable to maintain a routine or uncertain about accommodation. Even attending an appointment could be difficult. These circumstances were part of the work, not incidental details to remove before a favourite technique could begin.
At the same time, personal-development practice groups were lively and widespread. I enjoyed the opportunities to practise, exchange ideas and learn with others. But I noticed a difference between the clients many aspiring practitioners imagined attracting and the people I encountered through mental health services.
The attractive client and the limits of a business model
A familiar criticism of therapy concerns a preference for clients who are young, attractive, verbal, intelligent and successful. The point is the selection bias: people who communicate easily, arrive reliably, can pay and respond in ways that suit the practitioner are easier to accommodate within a conventional private practice.
There is nothing wrong with helping somebody who is functioning well in many areas. Nor does a job, an income or an articulate manner prove that a person has no serious mental health difficulty. The problem arises when results from a selected group are advertised as evidence of an ability to help everyone.
High fees and premium positioning make further selections. They affect who can enter the room before any therapeutic skill is exercised. If those excluded are people with greater practical instability, the practitioner’s experience will not represent the full range of need.
The business question and the care question are related but different. Which clients make a practice financially viable? Which people can the practitioner competently help? Which needs remain unmet? A candid answer to the first question should not be disguised as a universal answer to the others.
Status can influence what practitioners claim to treat
I once worked an agency shift alongside a highly qualified clinician whose work involved dentures and support for people with dental or facial difficulties. He seemed embarrassed by a specialty that did not carry the glamour of heart or brain surgery. I found that striking: work with substantial practical value could still be experienced as lower status.
Comparable status games occur in personal development. A fashionable diagnostic term or a prestigious client group can become part of a practitioner’s identity. The language on a website grows more impressive while the actual experience supporting it may remain unchanged.
A label in advertising should lead to questions about relevant training, assessment, supervision and outcomes. Working with a person who uses a diagnostic term is not necessarily the same as delivering an established treatment for that condition. The source and meaning of the label matter.
A referral that introduced a frightening possibility
Shortly before travelling to India, I was asked to consult about a young man who, as I recall, described intrusive imagery and difficulties resembling obsessive and compulsive symptoms. I referred him to a well-known trainer whom I hoped could help.
According to the young man and his father, the trainer raised the possibility of schizophrenia and referred him to a psychiatrist. The psychiatrist did not agree with that possibility. The practical help subsequently described to me amounted to a stress ball to squeeze when stressed. I found the sequence deeply disappointing.
The problem was not that somebody sought a psychiatric assessment. Recognising the limits of one’s knowledge and referring appropriately can be responsible practice. The concern was the alarming suggestion delivered before there was an adequate basis for it, followed by a response that appeared poorly matched to the difficulty described.
An uncertain label can travel. A client tells the next practitioner that schizophrenia has been suggested. That practitioner repeats it, and another eventually speaks as though it were an established diagnosis. Repetition adds familiarity without adding evidence. Careful records should distinguish the person’s report, a previous suggestion and an assessment by an appropriately qualified clinician.
Neither confidence nor appearance establishes a diagnosis
Intrusive imagery is not, by itself, a diagnosis of schizophrenia. Equally, an apparently relaxed person in a workshop cannot be declared free of trauma or psychiatric difficulty on that basis. A brief demonstration does not provide the history, assessment or follow-up needed to verify a diagnostic claim.
I have encountered people with severe phobic reactions whose difficulties were considerably more disruptive than the mild discomfort often demonstrated in training rooms. That experience raised questions about how representative such demonstrations were. It does not mean every genuine phobia must look identical or involve the most dramatic possible reaction.
The same caution belongs on both sides of the argument. Do not casually assign a diagnosis to increase the apparent importance of an intervention, and do not casually remove one because the person does not fit an expected performance of illness.
Respecting limits without abandoning people
The question of whether NLP practitioners are afraid of schizophrenia needs a careful answer. Lack of competence is a valid reason not to undertake specialised treatment. Fear of losing professional status, discomfort with an unfamiliar client group or disappointment that a person cannot pay are different issues. They should not be confused.
No practitioner needs to prove courage by attempting treatment beyond their training. A useful response may be to make a thoughtful referral, coordinate with existing support, explain limits honestly or help with an appropriate, clearly defined aspect of the person’s life.
Psychological help and psychiatric care are not mutually exclusive. NICE guidance recommends CBT and family intervention for psychosis and schizophrenia, with suitable specialist assessment and treatment. A claim to offer NLP does not establish equivalent clinical competence or evidence.
People and institutions need separate examination
Some institutional environments I encountered felt austere and heavily organised around containment. I was often impressed by individual staff members while remaining critical of the system in which they worked. A pleasant professional manner did not erase the restrictions and power imbalances that patients experienced.
It is possible to examine those conditions without declaring every form of treatment worthless or every professional uncaring. The useful questions concern what people can choose, whether help reaches them outside a crisis, how their priorities are heard and what outcomes the service is able to support.
For somebody returning to unstable accommodation and isolation, a technically competent session may be only a small part of what is required. Ignoring the wider circumstances can make limited results look like a failure of motivation rather than a failure to understand the task.
Before offering the favourite technique
A common forum question is: “I have a client with this problem coming next week. Which technique should I use?” Replies arrive from people who have met neither the client nor the practitioner. The suggested answer often reveals the responder’s favourite method more clearly than it reveals anything about the person seeking help.
Start with the information that is missing. What is actually happening? How has the problem been assessed? What support is already in place? What does the person want to change? What risks and practical barriers matter? What can this practitioner competently offer, and how will the result be checked?
Those questions may produce a less spectacular advertisement. They also make the work more accountable to the person who needs help, including the person who is unlikely to become a prestigious client or a profitable success story.