NLP in Psychiatry Success in the Making
In Berlin, NLP-based psychiatry has been evolving in silence since 1991. My acquaintance with it comes only through my knowing Wolfgang Walker. Wolfgang Walker
And it took me three trips to Berlin to realize how unique the
Prenzl Komm project really is. While teaching Social Panorama seminars over
there, I had the opportunity to meet forty of Prenzl Komm's co-workers and also Robby Jacob the director and initiator. Although Robby and Wolfgang are not
looking for publicity, I had a strong urge to let the NLP world know what they
are doing. This article is based on an extensive interview with Robby and
Wolfgang. The complete version will be published in German in Multimind
sometime in 2002.
In my practitioner training, six years ago, I met Jan and Piet, 'two senior therapists at a major Dutch institution for the detention of psychiatric criminals. And although the training started at ten, they were there at nine, busy discussing how and what techniques to use with their patients. In response to my expression of wonder, they explained: 'It's because our regular working day starts at nine, and since our clinic is paying for this course, we just come an hour early. You see?'
Two years later, both these men had lost their jobs: they had too enthusiastically tried to integrate NLP into their field. By so doing they had aroused strong resistance, and medical psychiatry had ejected them.
Over the years I witnessed at least twenty other psychiatric workers taking NLP courses. In the Netherlands at least, most of them became fully convinced of NLP's potential. However, none of them stayed long enough in psychiatry to really implement it. Just like Jan and Piet, these people all found medical psychiatry unable to cope with the necessary changes. And they point out that even at the level of legislation NLP does not fit in. But even more limiting is the hierarchical structure, with doctors at the top who may literally forbid NLP-trained nurses, art therapists, socio-therapists and others to make use of NLP. In a medical environment it is hard to defend a method without any statistical data and double-blind treatment evaluations. In addition, the very few NLPtrained psychiatrists cannot usually find the time to do timelines or submodality work. And when they do, it often proves to be much harder than in their practitioner training; they often voice the opinion that NLP only works with healthy people. To most psychiatric workers Erickson is no valid counter example. He may have been a psychiatrist, but he was also a unique genius and no NLPer. Others who have tried to do NLP in a psychiatric setting were discouraged by colleagues who distrusted them, as though they were members of a religious sect of some kind. In short, the treatment of psychiatric patients by means of NLP methods was unheard of until Prenzl Komm opened its doors in
Berlin in 1991
. Wolfgang and Lucas
Wolfgang and Lucas
NLP before and after the iron curtain
Before the Berlin wall came down in 1989, psychiatric treatment consisted primarily of pharmacotherapy and behaviour therapy. Social psychiatry and some kind of group psycho-analysis existed as a side issue. In 1990 the West German government decided that social psychiatry, which had been well established in West Germany since the late 70s, should also be made available in the former GDR. So some pilot projects were funded that were meant to pioneer activities in this area.
This unique situation gave psychiatrist Robby Jacob the opportunity to start something entirely new and realize a vision of his own. Officially he was supposed to develop a normal social psychiatric project, but he used the somewhat weird situation after the reunion of Germany to develop a project that aimed to be much more useful: an NLP-based centre for out-patient psychiatric treatment. This centre was to be not just a place where NLP techniques were applied. The whole organization itself was to be founded on what Robby saw as the most crucial principles of NLP. With funding guaranteed for three years, in
1991 he opened an office in the heart of what had been East Berlin.
Before 1989, Robby had studied NLP in isolation. With two friends he experimented with NLP patterns and read all the books he could get his hands on, but the iron curtain prevented him from attending an NLP training in Western Germany. When in 1988 he decided to devote his career to introducing NLP into the GDR by working as a doctor for psychotherapy, he found his professional objective obstructed - for political reasons - by the Stasi (secret police).
After the wall was torn down in 1989 the tables turned. Robby finally made contact with the West German NLP scene and took a real practitioner course. However, NLP in the West proved to be a disappointing experience for Robby. What he encountered was very different from the NLP he had imagined. The people he met were for the most part occupied with 'selling' NLP courses and treatment in competition with each other, but they themselves did not function, organize, learn and interact on the basis of the NLP philosophy. Because of his special background, it was clear to Robby that most Western NLPers considered NLP as just a product to be marketed. So to most of them the psychiatric market appeared very
. In the Prenzl Komm office
In the Prenzl Komm office
The goal is health
For Robby Jacob, the first consequence of applying NLP in psychiatry involved setting an unusual goal: psychiatric treatment was to be directed towards the regaining of health. The idea of guiding patients back to full health stood contrary to the common view of them as chronically mentally disabled. In the culture of most psychiatric institutions, 'treatment' does not mean working toward health, but trying to prevent things from getting worse. For Robby the primary goal of medicine is to return the physically ill and the severely mentally ill to full health.
To create a space for psychiatric patients to regain their mental health, Robby saw clearly that all those involved should take part in a long-term learning process on all the logical levels. It would require a totally different organization, with a different culture, with different belief systems and different skills. Robby put all his efforts into creating such an organisation, free from all the obstacles that keep the mentally ill from regaining their health.
Escaping the helper network
In regular practice a psychiatric patient gets caught in what Robby calls a 'helper network'. Various agents provide the patient with money, food, drugs, social contacts, legal assistance, lodging and coaching. The complexity of this network may totally occupy the patient's attention and keep him entangled for ever, losing more self esteem every day. Furthermore, the patient is liable to play these helpers against each other, and may even have to demonstrate his handicap to them to legitimize his role. This 'present state' of being a psychiatric patient is difficult to escape when there are so many vested interests.
Prenzl Komm is structured in a way that helps the patient out of this maze to continue a life without psychiatry. First of all, access to Prenzl Komm is made very easy for the patients. It is located in the heart of the city, and it owns a pub. Inside this pub clients can encounter the workers of Prenzl Komm and other patients, some of whom function as part-time waiters or waitresses. As soon as a patient wants to do something, he or she is given a counsellor. When the connection is made, the client meets more of the workers of Prenzl Komm and may choose the counsellor he or she likes to work with. The patient's role is defined as that of a student, who will learn certain things during his or her interaction with Prenzl Komm.
Love your job
The quality of the working climate is fundamental for Robby. Since those who work in an outpatient psychiatric clinic spend more t!me in there than most of the patients, it is essential that they should feel well and at home. So the regulations, tasks, and functions are very flexible. A talented and motivated worker can make a swift career. Working times are as flexible as the contracts. Formal professional qualifications and levels of education playa minor role. What's much more important is the willingness to learn NLP and to develop one's personality.
Prenzl Komm is a place where both worker and patient can freely develop themselves. A basic rule is that there should be no incongruence between the organisation and its task. Many of those who work at Prenzl Komm stay there for a long time; it has become a real working community with many intimate friendships. Central to this organization is Andrea Kiesinger, a former waitress and nurse, who runs the business side of it. Every penny, in or out, passes her scrutiny and she also has a great talent for public relations and fund raising.
Real life therapy
Formal psychotherapeutic sessions and pharmacotherapy are only a small part of what Prenzl Komm offers. Essential to the whole concept of treatment that Prenzl Komm has developed is a kind of NLP-shaped real life therapy. Beside stable yet flexible relationships between clients and workers, Prenzl Komm also offers a range of projects that provide different contexts for creating new experiences for the clients. Along with skilled Prenzl Komm workers, who can detect patterns, stimulate the clients' resources, and set useful frames for their experiences, these contexts provide numerous opportunities for the clients to become involved in interesting activities, meet people, and learn a trade.
Clients may participate in restoring furniture or help to build a ranch out of town, where Prenzl Komm takes care of a herd of about 120 wild horses. Others may become active in a boat-building facility where an antique yacht is being rebuilt. There is also a riding school, a computer workshop, and an old mansion at a lakeside site that is slowly being restored into a resort. Getting the patients involved in these activities is considered very important, because this will enable them to experience things that may help them to break away from the helper network. In these projects 'resource building' is the main aim.
In accordance with Prenzl Komm's basic design, these projects have another side to them. Many were developed out of the personal wishes of the people working on them. In combining professional needs and personal preferences in this way, they also created - and continue to create - working environments which they themselves want to live in and which enable them to follow their own aims in life.
In 2001 there are seventy-five people working at Prenzl Komm. Their ability to make rapport with people who are totally crazy is the prime criterion for selection. On the other hand people who seem to have been spoiled by the traditions of medical psychiatry - either because they have worked in psychiatric hospitals or because they believe in the doctrine of mainstream psychiatry and depth psychology - are discouraged from joining the organization. That is why many of the workers have very unusual backgrounds for psychiatric workers.
NLP-based therapy is practised by most of the staff, who differ in their level of experience. About thirty of them have trained to practitioner level or more. For several years Wolfgang Walker has functioned as internal NLP trainer. A psychologist with a great interest in the roots of NLP he helped to balance out Robby's ideas. Being raised in Western Germany and in contact with the NLP world, he provided Prenzl Komm with new input. For him it is a unique opportunity to teach people to apply NLP in a very demanding environment. The direct application of what they learn to 'real' and 'hard' cases has raised everyone's standard of practical NLP competence. They need procedures that can be executed under fire. NLP is put to the test at Prenzl Komm.
Prenzl Komm often functions as 'the last station before suicide'. And the patients that arrive at one of its doors come from all social backgrounds. Children find assistance just like the elderly. Most of them come from the Prenzlauer Berg quarter of the city. They may be diagnosed as having schizophrenia, affective or other psychoses, personality disorders, severe neuroses, borderline syndromes, fear-related disorders, eating disorders, severe psychosomatic symptoms and so on. Recently Prenzl Komm has also started to help youths from difficult social backgrounds. Drug and addiction-related problems are often part of their misery.
In the year 2000 about 200 patients were treated. That same year 70 were discharged. The Prenzl Komm criterion of success is: leaving the psychiatric world and living without medication. Ten percent of those who left entirely fulfilled this criterion; thirty percent almost achieved it. The other sixty percent may seek help again, at Prenzl Komm or elsewhere. Over the last three years the patient suicide rate at Prenzl Komm has been about two a year.
New NLP developments
Daily confrontation with psychotic, dissociated, violent, addicted or suicidal clients helps to fine tune some NLP tools. The exchange of experience among a large number of NLPers within the same environment starts to become productive. For instance, within the team they developed what they call 'the panorama of aspects', the most robust 'present state' versus 'desired state' format that I know of. It is used to organize the experience of chaotic clients into two simple categories; what they want and what they don't want. Every named aspect is spatially anchored until there is a clearly defined area in the room that contains all the present state problems and another that is devoted to how things are wished to be. The therapist continues to shift the client back and forth between the two spaces until they do not want to return to the present state any more.
Ecological relations with the rest of the world
All in all Robby sees Prenzl Komm not only as a psychiatric project, but as something far greater than that, as a kind of social, political and cultural endeavour. It tries to find out how NLP can be used to create a social and physical environment that enables all the people who participate in it (clients and workers) to develop their personal and social life to a higher standard.
Nowadays - after years when things were more complicated - Prenzl Komm has succeeded in building stable cooperative relations with its professional environment. In addition there also exists a productive relationship with the Berlin Medical School, where new paths for the education of medical doctors are being explored. Funding is relatively solid. To enable patients to fully profit from Prenzl Komm as a learning environment, a law has been changed. Previously the mentally ill were not allowed to take part in any type of formal education before they were discharged by the mental institution. Now a patient may learn how to work on a computer, or to repair furniture, and still be in treatment.
Robby believes that after ten years Prenzl Komm has reached ten percent of its potential. He is a man with great stamina and a timeline that reaches far into the future, where he envisions psychiatric patients cured with the help of NLP.
Up to now, Prenzl Komm has been trying to change the field of psychiatry on a local basis. The people who work and live there don't have the desire to travel around the world like missionaries. So this article is the first to publicize its existence. If things work out well, Prenzl Komm's principles, concepts, and methods will spread without any effort.
Lucas Derks 2001
Lucas can be reached at Van den Boenhoffstraat 27, 6525 BZ Nijmegen, The Netherlands.