Using the case study at the end of the module assess the client’s issues and describe your treatment plan. What ethical issues might arise
Miss E is a 29 year old female whose goal is to lose 2 ½ stone in weight. She has come out of a failed long-term relationship 6 months ago, and revealed that her former partner was very controlling and appeared to want her to remain overweight. Miss E has always struggled with her weight since she was a teenager (from the age of 12 or 13), and her parents constantly pestered her about being unattractive and eating too much. Miss E has tried various diets and invariably has always put the weight back on. She is going on an all girls holiday in 3 months and hopes to have lost the weight before then. Miss E also feels ready to look for a new relationship. Throughout my essay and based on the case study provided, I will intends to look at Miss E’s issues and I shall be describing what course of treatment i believe could be beneficial for her. I will also mention ethical issues as they arise before concluding.
Obesity is a major contributory cause of death in the UK, around one in every 11 deaths in the UK is now linked to carrying excess fat. Of all the deaths in the UK that were linked to excess weight, about 66 per cent were down to obesity, and 33 per cent to being overweight. Being overweight or obese leaves people at high risk of heart disease, diabetes, high blood pressure and osteoarthritis. It also makes them much more likely to develop several types of cancer. The difference between being overweight and obese lies in a person’s Body Mass Index.
The body mass index (BMI) is your weight in kilograms divided by your height in metres squared. if your BMI is between 25 and 29, you would be considered overweight if your BMI is between 30 and 40, you would be considered obese if your BMI is over 40, you would be considered very obese (known as ‘morbidly obese’). A lot of people insist they need to loose weight, whether they’re overweight or not. The truth is, very few people are happy with the shape and size of their bodies, regardless of whether or not they need to loose weight.
To enable further understanding of Miss E’s current situation i will need to gather additional information starting by her weight and height as well as her history about how she is relating to food from the childhood to now, her eating habit and her life style within any social environment, her belief system with regard to food. It is evident that Miss E wants to loose weight, but i am suspected that Miss E has deeper issues than this. Many peoples suffering from weight issues are related to emotional problems that can be acted out through their relationship with food. Binge eating can be one way to reduce anxiety frustration fears and unresolved issues.
Before assessing the case of Miss E, it is important to look at any relevant information about her life that could be used to formulate a successful treatment plan. Miss E has been overeating since she was 12 or 13 and also she had been struggling with it but was unsuccessful as she gained her old weight after every diets. It’s not unusual for people to get into a cycle of dieting, overeating, feeling guilty and dieting again. This is known as ‘yoyo dieting’ and makes weight loss difficult to sustain.
This means that she has a tendency to sabotage all effort gained. For Miss E, eating has become a habit and habits are ruled by the subconscious which is a very strong force and will usually win when in conflict with the conscious mind. Miss E’s parents badgered her of being unattractive and this became her self-image and develop low self-esteem and lack of confidence, this feeling was later reinforced by the behaviour of her ex-partner who wanted her to remain overweight. Hadley and Staudacher (Chap 4, pages 60- 62, Chrysalis notes from module 6 pages 6-7) suggested that there are five common causes for overeating. It will be vital to isolate the reason(s) for Miss E overeating in order to help her through the process of hypnosis.
Miss E’s hidden agenda that she is unattractive and not worthy established a secondary gain of being overweight, this mix of feelings reinforced the habit of over eating in order to replace the missing love, love of herself and from
others. This lack of love could be seen increased with the separation from her previous controlling partner which left her traumatised and anxious about having a new partner in her life. Miss E is going on all girls holiday but she is concerned about her weight, and she want to lose 2 ½ stone in 3 months. It is important to identify if this goal is realistic. The best way to sustain weight loss is to lose 2 pounds a week and based on my calculation the realistic target to be set up for Miss E’s should be around 1.85 stone (12.99 weeks equivalent to 3 months, times 0.14 stones ideal weight loss per week). If a realistic goal is not set up from the beginning of the treatment, there will be a chance for sabotage (again) .
Miss E is going on all girls’ holiday means that she has expectations, she likes to have and enjoy social contacts and changes. She wants to be slim and take pride of body and look into prospective better life and future. She is now looking for another partner this means that she is hopeful and wants to move forward.
It is clear that Miss E has low self-esteem, feeling of uncertainty, and need of love. As therapist our first task should be to boost her ego, self-esteem and confidence in order to ensure that her treatment for losing weight will succeed. Now let’s look into how to design a treatment plan for Miss E’s issues. To begin with, I would have to look at all information required in order to formulate an effective and individualised treatment plan.
First of all I will need to be sure that Miss E is a suitable for hypnotherapy, to be able to do so I will need to gather further information in term of her physical conditions, it would be necessary to identify if her overweight is due to genetic or metabolic factors, from taking any medications or suffering from any severe mental disorders like psychosis, a confirmation from her GP will be requested at this stage. if I realise that there are any physical or mental conditions or a contraindication from the GP to hypnosis, I should refer on Miss E to counselling.
I believe Miss E is suitable for hypnotherapy. I will need to look at her personality and look at her modalities. It is important to build up a good rapport for designing induction screed and to choose what therapeutic approach could be used, direct/indirect and authoritative/permissive. I will need also to understand her belief system and get the full history of her relationship with her previous partner, this information could be explored and ventilated to relieve any traumatic feelings and to give fresh positive meaning by giving it a positive interpretation. Also, by recalling memories of childhood, like her parents badgered her as unattractive and overeating, could be used to recreate and reinterpret rational and positive meanings to reprogram her hidden agendas.
It is important that, as a therapist, to not emphasise or reinforce any of her negative feelings about being overweight, instead, would engage in normalising them and consistently re framing her mind to be confident, to imagine herself with a slimmer figure, to replace the habit of comfort food to a non-fatty food, i.e. eating carrots instead of chocolate when felt lonely or stress. The use of metaphors, analogies, imageries about the benefit of slimness and eating less could be also very powerful. Anchor positive resources in the past and carry them to the present and then rehearse them to the future imaginative situations may give her less importance to food and of having the perfect figure. As discusses previously, i will need to explain that the Miss E expectation of losing 2 ½ stone is not realistic within 3 months time.
It will be primordial to set an achievable target and would incorporate new patterns of behaviour like adhering to new life style, taking regular exercise, an appropriate diet to follow etc… I will also explain to her the concept and principles of hypnosis and how hypnotherapy could be applied to address her issues. I will raise her awareness and help her have a control at her danger points. Danger points are where, when and why she overeat and what feeling and which places trigger her to eat more than her real hunger feeling, because she might be doing so as driven by subconscious that is unaware to self. I would then encourage her to change these danger points by replacing them with healthy means, and new behaviours by using therapeutic suggestions-screed. I would advise Miss E to start a food diary. This homework will again help her to take control over using food and have an idea about its relationship with emotions.
I will create an induction and deepening to match to Miss Es case, either using visual imageries or kinaesthetic modality, i will place her in a special place for therapeutic platform and metaphors like ‘Ugly Duckling’ to building self-esteem and to indirectly ingrain the suggestion of the transition and transformation for better into the subconscious. by carefully worded the script, i will explore Miss E’s reasons for overeating and suggest new ways of thinking through visualisations by reprogramming the subconscious into eating properly, make healthful foods more desirable and make fatty food less desirable and taking pride in her self-image, and to recreate a healthy relationship with food.
It will be the process of replacing the satisfaction or comfort that food gives to her with something that gives as much emotional satisfaction in return. I will also be using her wish to have a new partner and her wish to take pride of her body while she will be on holiday to increase her motivation. It would be also useful to describe the health risks of being overweight and the benefit of loosing the extra unwanted kilos. I will change her habits through direct and indirect suggestions, the suggestions I might use during Miss E’s treatment could be: envisioning the body she wants, imagining how she will feel with her new look and health, imagining how energised and confident she will feel.
These visualisations and many, many more are designed to empower her so that she can take control of her choices. Hopefully she will learn to enjoy the taste of healthy food and stop craving sugary, fatty things. She should also learn to enjoy her body and not see it as a source of anxiety. I will also use ego strengthening on self esteem and cognitive methods. It is important after the screed to get feedback from Miss E, this will enable me to adjust, personalise, prioritise and focus on specific aspects to achieve the best result, the treatment could last between more or less 4 to 6 sessions.
It is obvious by this essay that Miss E is coming to seek help to loose weight but is also suffering from deeper issue like low self esteem and confidence resulting from her parents and ex-partner behaviour. By redefining a realistic goal and by using therapeutic suggestions I am confident that I could help Miss E to achieve her goals. Although, i believe that hypnotherapy would be appropriate to her, it would be perfectly acceptable to advise Miss E to consult a nutritionist and eventually a personal trainer, as well as a counsellor alongside her hypnotherapy treatment.