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Why Treating Smokers is an Emergency

How and why to build a sense of urgency around the need to quit


We need to stop being leisurely when it comes to helping people quit smoking.

“Defer no time, delays have dangerous ends.”

– William Shakespeare

Sometimes we dive headlong into disaster – drive too fast on a wet night, place a ladder on uneven ground, dive into a tumultuous sea when the red flag is up.

Other times we sleepwalk into oblivion. We forget that the clock is ticking and we don’t have infinite leeway to play with our fate.

Therapists who help smokers stop ask me sometimes (see below) how many sessions I might spend helping a smoker escape the tobacco trap.

What I tell them, and you, is that we need to stop being leisurely when it comes to helping people quit smoking.

As I write this I’m in France, in a house that was built in the year of the French Revolution: 1789. There is a picture of an axe on the outside of the house because this house belonged to a magistrate, and a travelling executioner used to stay here while he cut off heads in the local vicinity.

Quite a thought, isn’t it! But it lends power, at least for me, to the following analogy, which I realise might seem a little crazy at first!

The rescue (an analogy for therapists)

Imagine you have an innocent friend who’s been unjustly imprisoned in a dungeon and sentenced to death. Only they haven’t been told when they’ll be killed.

Now imagine you find a way to rescue them. Do you delay your rescue? Dilly-dally, drag your heels? Tell them you’ll be back next week and may need a few visits to get it done?

What’s that you hear? The executioner already prowling about? Do you still try to reassure your friend that you can help them… but maybe not today?

Once you’re in there with them, key in hand, the time to get them out is NOW.

We also need to communicate this sense that NOW is the time to escape smoking to our clients.

There’s one with your name on it

During both world wars there was a grim expression: “There’s a bullet with your name on it!” What this meant, of course, was that it was likely that you and a certain bullet would meet at some point – but you had no way of knowing ahead of time which bullet it would be.

That one bullet would look just like any other bullet. Maybe it hadn’t even been made yet. But that one ‘special’ bullet was there, waiting somewhere in the future, with ‘your name on it’.

This is an idea I like to bear in mind when treating a smoker, and also communicate to the smoker. We simply don’t know which cigarette is going to be the proverbial straw that breaks the camel’s back. Which cigarette ‘has their name on it’. Which cigarette, on top of all the others, will tip their body over the edge.

We need to relay to the smoker that the idea that ‘just one won’t hurt’ is a lie.

Smoking Cessation Client Session

Discover How to Stop Anyone Smoking

Read more about Mark's approach to smoking cessation.

Click here to find out more

Not ‘just one’ anymore

The tipping-point cigarette with their name on it might be:

  • One they barely notice smoking, out in the rain, hurriedly, before going into work
  • One they savour and enjoy with a drink
  • One they smoke alone
  • One they smoke ‘socially’, at the end of a night out with friends.

The point is that it will be THE one, on top of all the other cigarettes they allowed into themselves, that may destroy them forever. We don’t know which one that’s going to be, but the executioner is growing restless and we need to get them out of there without delay – today, if we can.

So it’s never just one cigarette any more.

We use metaphor extensively in smoking cessation therapy, because we want to defamiliarize the pattern of smoking and therefore make it easier to leave behind. When a smoker starts seeing smoking not as smoking but rather an abusive agent (certainly not a friend), then they have new powers to chuck it out forever.

So with that in mind, I like to build this idea further with the following metaphor.

The self-constructed funeral pyre

I might suggest (with the client either in or out of hypnosis) that it’s never ‘just one’ anymore, because the one with their name on will sit on top of all the others, a mountainous pyre of cigarettes.

If they smoked 40 a day for 20 years, that’s getting on for 300,000 cigarettes. I will ask them to envisage all those old cigarettes they let into themselves. I’ll ask them to smell the mountain of cigarettes they’ve consumed in their lifetime, get a sense of them all together. Often a look of disgust crosses the client’s face at this point.

I’ll then suggest that every time they add to that pile (‘pyre’), it’s becoming more unstable – and when it collapses it may just bury them.

But…

If they walk away from that pyre now, they can still escape. If they go today! But if they have just one cigarette in future, they risk being dragged right back to that unstable pyre again – and it may topple onto them at any moment.

So the message is: Get out fast. It’s never ‘just one’ cigarette (unless it’s your very first cigarette!) because there’s a mountain of cigarettes behind and on top of every cigarette they have.

We, as smoking cessation practitioners, need to feel the urgency ourselves when working with smokers – and we need to communicate that urgent need to escape to our clients.

We, as smoking cessation practitioners, need to feel the urgency ourselves when working with smokers – and we need to communicate that urgent need to escape to our clients. Click to Tweet

It’s the way you say it

All this needs to be presented in the most effective way of course. Just reciting a load of analogies and metaphors to someone will have them switching off. As with all communication, timing is everything.

In fact, we can embed these ideas conversationally, almost whimsically, peppering them within a larger framework of communication.

And these are certainly not the only approaches I use with a smoker by any means. But I always strive to imbue the smoker with a sense that we just don’t know how long they can ‘hang around the execution chamber’ before the executioner shows up.

I sometimes almost playfully remind smokers of the irony that when they smoke a cigarette they turn it into ash, and of course it’s trying to do the same thing to them. It is not their friend.

Keep in mind the need for a speedy ‘rescue’

Remember, up to half of people who smoke 20 cigarettes a day are killed by the cigarettes.1 Eight million people are dragged to their tombs by cigarettes every year.1 That will be close to 1 billion souls by the end of the 21st century.

Many more will be injured – become older, weaker, more decrepit than they need be.

When you treat a smoker you are in the privileged position of potentially saving a life! Of helping someone stay on this planet for 10, 15, even 20 years longer with their loved ones.

Helping someone escape the death-row gaol of smoking is no small or trivial thing.

If you’d like to delve into this topic a little further, I’d direct you to the recording of my answer to a question I was asked on a recent Q&A call:

I had a client who has been off drink for two years; they stopped after their fifth detox in hospital. Now they smoke 40 a day. The first session went well – I used visualization and shifted some emotional issues, but they kept smoking. Next session I did parts negotiations, and some visualization suggesting a fork in the road to good health or to bad health, and the impact on their son. They reported back that it feels different this time. How many sessions would you recommend on average?

You can listen to my reply here, in which I touch upon the need to get on with it and work as fast as possible with smokers.

Remember, a client’s relationship with cigarettes always comes to an end at some point. Either they ‘end it’ with the cigarettes or the cigarettes ‘end it’ with them – often sooner than we might think. Everyone stops smoking one way or another.

How to Stop Anyone Smoking

Too often, treating smokers becomes a battle of wills – a battle the cigarettes inevitably win. Fast, permanent smoking cessation treatment requires a different approach, one that turns the smoker against the cigarettes and allows them to step out of the addictive trance the cigarettes have trapped them in. Read more about Mark’s online smoking cessation course here.

Smoking Cessation Client Session

Discover How to Stop Anyone Smoking

Read more about Mark's approach to smoking cessation.

Click here to find out more

Mark Tyrrell

About Mark Tyrrell

Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.

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