There is a whole industry devoted to taking money off young men who find it impossible to approach women for fear of rejection.

Much of the advice that is given to these young men is sensible and based on sound behavioural psychology principles, such as setting out to collect ten rejections from women and considering each rejection a 'success' of the project.  The idea is that by getting them to do the thing they fear, they will have some successes or at least become less distressed by the experience.

However the courses take months and cost thousands of dollars and don't seem to work very well. I wonder if a simple phobia treatment wouldn't work better, and a lot faster?

Procrastination is one of the hardest things to deal with since it is usually about not wanting to finish things for fear of being exposed in some way. Procrastination is based on the belief that whatever you do it will not be good enough. The problem is that even the client doesn't know what it is that they are afraid of, so it is very difficult for the therapist to identify the real issue. Sometimes the core issue is external: the client has been brought up being  told by others that they will never be any good; sometimes the core issue in internal: the client believes that they personally are worthless, so anything they try will also be worthless, so there is no point even beginning. Procrastination is a self fulfilling behavior - the more you fail at finishing things, the more you believe it is true that you can't ever finish things because you are useless.

The whole thing is made more difficult because there are other behaviours that look like procrastination but are actually from a different source. These are distraction behaviours that border on OCD and are associated with anxiety and a desire to do some mindless repetitive task so that the person can ruminate in peace. This type of person avoids doing things, not because they can't, but because they prefer to do some pointless, consuming, almost obsessive behavior such as playing computer games, reading novels or watching sport.

I had a client come to see me some months ago because she could not finish her masters degree thesis. She felt that whatever she did it would not be good enough. This was despite encouragement from her colleagues and students, and assurances from her supervisors that her work was in fact first class.

We met several times and each time she opened up a little more and revealed that procrastination was in fact only a small part of what was bothering her. She described how her life was dominated by illness, various forms of muscular spasms and arthritis type disorders that stopped her travelling, stopped her enjoying life in many ways.

I couldn't really find any source for her lack of self esteem apart from a generally unhappy childhood and unsupportive home life. In those circumstance I usually use a metaphor therapy in the hope that the generalized patterns in the metaphor stories will match something in the client's unresolved experiences and will trigger a change in their inner beliefs.

In this case I used the Crystal Mountain metaphor. I reasoned that the parts about going on a journey and releasing the figures trapped in various ways would have a good chance of finding some resonance with this client's problems. Part of the metaphor is about meeting a figure who goes through your mind and learns everything about you, and then tells you that your are accepted for what you are.

The results of this were astounding. The client came to see me the following week and said 'I have never told anyone this, but I had an abortion when I was a teenager'. Subsequent work revealed that she was holding on to the idea that she had murdered someone, and that if people really knew who and what she was they would reject her totally. She felt that because of what she had done, she had no rights to anything.  This inner belief is what had been dominating her life for thirty years. As long as she believed, deep down inside, that she had done something unforgivable, then she could not allow herself to succeed at anything, or to be allowed to enjoy a vacation, or to have any of the normal pleasures of life. This was she was racked with autoimmune disorders, why she fell ill on any holiday and why she could not finish her project.

Further work cleared the feeling, and she is now putting her life to rights. But for me it was an astonishing example of the power of metaphor in therapy.

According to a fashion survey, wearing black makes the wearer look authoritive, as per the Men in Black movie, and all sorts of clergy. It also makes the wearer look thinner, hence the enduring popularity of the Little Black Dress. And black clothes will match anything, and never go out of fashion.

However to a therapist, a client arriving dressed in black usually signals one thing only: they are likely suffering from depression. Just looking at how people are dressed tells you a lot about them.

Smokers who want to quit often do not think through what things will be like when they stop smoking. Smoking 20 a day takes up nearly two hours, that is a lot of time to fill.

In the same way, the smoker needs to find something to substitute for the action of smoking, because the desire for a smoke is often triggered by outside circumstances. People reward themselves with a cigarette when they finish something, when they get a coffee, when they just need to get away from a situation. And they need something that is socially acceptable, can be done almost anywhere, and takes about the same time as a smoke.

So they need something that will give them a stimulus in their mouth, something to do with their hands, and something that lets them move physically to some other place. The easiest thing to do is to get them to brush their teeth. The act of brushing their teeth means they have to put something in their mouth, and they get a tingle from the toothpaste. They also have to hold the toothbrush, so it gives them something to do with their hands for a few minutes. They have to go to a sink which means that they are removed from whatever trigger was reminding them to smoke.

This simple technique will help smokers get over the unfamiliarity of the first few days as a non-smoker, and leave them with lovely fresh breath as well!

It is often useful to recognise when a person does not have a real psychological problem, but is actually suffering from a normal physiological response to trauma.

This is particularly true when someone comes to see you for grief. Grief goes through a series of stages, and helping the client to understand that most people have to pass through each stage until they come to accept their loss.

Denial

The first common reaction to the loss of someone is denial, a refusal to accept that they are gone forever.

Anger

The next stage is often an unfocussed anger against everyone and everything, even against the person who died. Anger is the natural and normal outcome of the underlying pain, a way of dealing with it.

Bargaining

Then the grief sufferer sometimes starts to make bargains with themselves, that I will lose weight, I will take up exercise, if only this terrible feeling will go away.

Depression

The fouth stage is depression and despair. the realization that whatever you do they will not be coming back. The sufferer begins to doubt everything, to wonder if there is any point in going on, to want to just give up.

Acceptance

The final stage is a healthy acceptance that the person is gone, but that life must go on for everyone else, that the deceased would not want you to feel bad all the time and that death is  just a part of life that we have to deal with, each of us in our own way.

Not everyone goes through all the stages and sometimes people go from one stage to a later stage and then back again to an earlier stage. For some people the stages can last years, especially the depression stage.  But understanding how most people react to a loss can help you help someone who feels they just cannot cope on their own.

I was reminded the other day of the danger of reading out of date books. We were talking about the role of dreams in hypnosis and how they can be used in therapy. The person I was talking to said that every one dreams but not everyone dreams in color. When I asked what he meant by this he said that some people dream in black and white.

I asked him where he had got this idea from and he said that all his text books said that. A bit more digging and I learned that he had bought some books from a second hand shop and they were thirty to forty years old. He told me that it didn't matter how old the books were, since people have been dreaming the same way since the Stone Age, haven't they?

I had to point out to him that I had never dreamed in black and white and neither had he, and that there is a reason for that. When we dream we include in our dreams the most vivid, most dramatic events that we have experienced that day. In the olden days, the thing that made the deepest emotional impression on people was the movies. And those were in black and white. The most dramatic and disturbing events were therefore encoded in the same form as they were experienced. Later on, television replaced the movies as the main source of unresolved emotions and in the early days that too was in black and white. When these emotional events were processed during the night they were naturally also in black and white.

However, as color came to the cinema, and then to television, the tendency to dream in black and white has disappeared completely.

I don't know anyone who can honestly say that they dream in anything but pure color. And another thing, have you ever noticed that even though you wear glasses, in dreams you always have perfect vision?

I have a new client to work on here in who is loyal to people who are hurtful to her.   She described it as trauma bonding or a form of Stockholm syndrome. 

Parsing through the various scripts I bought from you I thought of using a few listed below.

1.  Letting go of the past
2.  Ending relationships
3.  Forget the past
4.  Ego strengthening
5.  Crystal mountain

Am I on the right track with choices above?   This trauma bonding has gone on for the most of her adult life, she is in her mid-30's now.
I'd like her to break the cycle she has in attracting people and keeping those that manipulate, hurt and then discard her. 

Suggestions appreciated

I think you are on the right track. I would start with Crystal Mountain, and then follow up with the Photo Album script.

Don't let the clients diagnose themselves and tell you what they are suffering from. If they knew what it was, they wouldn't need help with it.
This client at the core has no self esteem, and believes that she cannot be loved by anyone because she is no good. That is why she gravitates to unsuitable people, and sticks with them, because no real person could ever, ever accept her for herself. So she goes for the worst types because they are so bad that she might just be acceptable to them: there is no point in even trying someone normal and decent - they would just be disgusted by her.
She longs to be accepted, so she throws herself continuously at people who she sees as so low that she might just be able to crawl into their world. And every rejection just confirms that she is no good, so she will never be able to change by herself.

An interesting case.