Case Study of Mr X

ESSAY TITLE “Using the case study provided at the end of the module identify and explain the client’s issues and devise a course of treatment for him taking into account any ethical issues” Introduction – Mr X case study Mr X is 45 and has worked for the same company for 18 years. He is not married but has a “sort of girlfriend”. His mother is in a home and he visits her regularly, due to this he is unable to socialize with his colleagues.

He would like to apply for a manager’s job at work but feels like something is stopping him and he would also like to go socialise with his colleagues but feels that if he changed the day he sees his mother she would not understand. He would like to ask his sort of girlfriend to marry him but is worried that she will say no and that he does not have much to offer her at present. He worries about what people think of him, even though he is a nice person who thinks about the feelings of others. * Note from this point Mr X will be referred to as “him/he” The Initial Consultation

I would provide a free consultation with him prior to an appointment for treatment During this initial consultation I would look to build good rapport with him so he feels at ease. Ensuring that I gathered all possible information through my notation form and talking to him exploring the answers given in the form. Also to checking any medical or ethical reasons why I may not be able to work with him . I. e. Psychotic or depressive illness or attraction between therapist and client etc. I would explain what ypnosis is, how it works and that hypnosis is a natural state of awareness and that he will still be in control at all times and address any fears,. He can ask any questions at this stage. I would inform him that confidentiality respects the personal information disclosed and protects that information from disclosure to others as it is an important ethical requirement and without it therapy may be frustrated by a lack of trust and safety.. I would ask him what he hopes to achieve from hypnosis and the benefit of keeping the problem vs. the value of getting rid of it.

In his case there might be a hidden agenda or secondary gain to explore in the following areas. He knows he can do the Managers job and if he were to get it he would have more to offer his girlfriend so he could propose. Maybe he is using his present job as an avoidance technique. He could change the day he visits his mother if he really wanted to and socialize with the people from work. It may be that he fears interacting with them and uses his mother as an excuse. If this were the case then I would have to ask what he is gaining from it and get him to try and take responsibility for it.

I would give him an idea of the number of appointments necessary – in his case 3/4 sessions – but always ensuring that he is aware it might not be definitive as sometimes other issues can come to light. He will then understand financial implications of his treatment . At the end of the consultation it would be good to discuss goals and ensure they were feasible and for him to ask any questions. It is then up to both parties to agree a plan going forward. It is important to clarify that we are both happy to work together to achieve the goals discussed.

After consultation it gives him the time to decide if he feels able to work with me and gives me the chance to check with a supervisor if I was unsure about anything. I. e. If he is taking medication it would give me time to review and understand what it was for. I would also use this time to create a personalised induction and screed tailored to suit his preferred modality My view of his goal of therapy – expectation (according to information given) To gain confidence and be mentally stronger; to enjoy the company of his work friends and have the confidence to apply for the job as manager and ask is girlfriend to marry him. My aim as the therapist My aim is the find and remove any underlying fears that are causing low self esteem, and move him forward – building his confidence, so that day by day he will begin to feel better about himself and the small changes will enhance his sense of well being and self esteem. When I get him to learn to value himself, self-acceptance will follow along with confidence. He will then be able to make plans for his future. My Diagnosis from information given in the case study

He displays an inability to act upon any positive feelings or thoughts which arise, instead he shows, from the information we have, a habit of adhering to negative thoughts which maintain his status quo and underpin his fear of change and potential failure. As part of treatment it may be worth discussing why he feels more comfortable with the negative beliefs than the positive ones. We read that he “has stood in for the present manager many times. ” This is something that he needs to acknowledge as a real positive, his competence, his abilities which others will have observed.

He is not however demanding any recognition for this, a clear sign of his lack of confidence. It appears that quite a few of his beliefs are not grounded in reality and based more on emotion than fact “He says that all his office peers see him as a bit boring. ” It would be worth discussing as part of treatment, his ideas about himself. Does he see himself as boring, – if so getting him to realise that he can control this, both behaviour and thoughts about himself. This would be getting him to take responsibility for himself and his own life.

By placing emphasis on what others think, he is avoiding facing up to what he thinks and so can essentially blame any actions he does/ doesn’t take upon others. It seems the “something that seems to be holding him back” is himself, and would be worth exploring this with him. It would certainly be worth looking at as part of the treatment plan, any secondary gain or hidden agenda that may exist. The way in which he claims he would “love” to do things differently but is held back by other people and situations. However by remaining in these situations he avoids potential failure, rejection, and the responsibility, expectation and change to outine that would come with throwing himself fully into his life. Before any hypnotherapy begins it will be important to discuss these possible secondary gains with him as they may act as a barrier to successful treatment. It also appears from examining the case study that he has a tendency to see himself as a victim, as somebody who is ‘put upon’ especially his relationship with his mother “she would never understand” “she would pick on him even more than usual. ” This role may be a deeply ingrained one and give him a sense of identity, which whether negative or positive will be difficult to cast off.

He would no longer have that ‘role’ to fall back upon, or use as an excuse for various behaviour. He will likely feel feelings of withdrawal from this victim role because the subconscious is so powerful and does not distinguish between right and wrong. To the subconscious, taking away this identity will actually feel like a survival threat “the imagination will always overcome the will” – and this is the anxiety caused by the prospect of change. Examining his relationships with his mother and girlfriend would be a valuable part of treatment.

He is not creating boundaries or creating firm guidelines within them. This is indicated too, in the situation at work and with his mother. It would be worth examining this as part of treatment, communication issues and techniques to overcome any difficulties. A hypnotherapy screed which focused upon feeling relaxed and confident when dealing with other people would be useful for him. As part of counselling, perhaps attempting to ascertain if a problem with intimacy also exists, which may point to one of the reasons he lives within these mostly self created constraints.

His fear of “might say no” is balanced out by a fear of “might say yes” which appears to have taken over many important elements of his life – a general fear and lack of self esteem. Part of his treatment plan should involve examining his beliefs about himself and his relationships. It is important for him to stop placing the emphasis on what he does and does not do as a way for his life to improve and as a way of gaining My Treatment Plan based on information given in case study I feel (only working on the information given) that he needs to re-programme his thoughts about success by increasing his motivation, confidence and self esteem.

He needs to gain a positive attitude more optimism about achieving his own personal goals. The treatment will be aimed at all of these things and will help him deal with the fear of rejection, failure and the need for approval. Once he is strong and confident he will not be concerned by what people think about him and concentrate on being happy, relaxed, and at ease with himself. Hypnotherapy will help him make the necessary changes in his life. It can help him to stop the negative inner self talk, to change thought patterns and feel much more positive about himself thereby not needing to use others as an excuse for his own fears.

If he gains a more accurate assessment of himself and accepts himself it will help lift his self-esteem and thereby boost his self-confidence and guide him in ways in which he can help himself. He has been assessed as visual in modality so I have chosen a permissive/visual approach for both induction and metaphor screed as this is more accommodating and indirect – he will feel more in tune with what is being said – The metaphor will help him to become more imaginative and creative. and he will find it easier to explore his own unconscious mind for answers at his own pace. Session one

I would use this session to make him feel comfortable with my hypnotherapy process by using a permissive induction, then a deepener ( based on his preferences – which I would have determined at the initial consultation. Once in a suitable state of hypnosis I would install a relax now anchor followed by a relaxation script so that he felt comfortable going into future trances Session Two (for purposes of this homework) I would start my real work with him by inducing the trance state through Induction &deepener, then my Metaphor script, Re-orientation (copies attached at back of this essay). Following sessions

These would be determined by his progress and any other secondary issues that might arise. A hypnotherapy screed which focused upon feeling relaxed and confident when dealing with other people would be useful for him. But mainly self esteem and confidence work. Homework for him After the second session of hypnosis I would give him a personalised self – esteem CD to also contain affirmations so he could listen to this daily to reinforce the positive suggestions given during the sessions 3 and 4. He can use self hypnosis to achieve deep relaxation and have a focused tool that will facilitate access to his concerns and issues.

He can utilise this at any time he needs a confidence boost. Conclusions and recommendations It is not too late for Mr X to make a new start, to make changes become the person he wants to be, to value and accept himself. By coming for hypnotherapy he has taken the first step on the ladder. If Mr X is willing to take things on board and work to make changes in his life then he should start to feel much more positive. Once he has these in place he can begin to make other changes in his life and move forward replacing the negative concept with a positive one.

I would recommend that he continues to practice and use the personalised CD and what he has learned otherwise he is likely to forget his new behaviours. It could take some time for his new confidence to become second nature but he has made a step forward and I would recommend he comes back for hypnotherapy if he feels that it would assist him further. Bibliography Hypnosis for Change – Josie Hadley & Carol Staudacher Integration in Psychotherapy – Eleanor O’Leary & Mike Murphy The Art of Psychotherapy – Anthony Storr References Chrysalis course notes

Internet – The laypersons guide to counsellor ethics – Hypnotherapy-direct. co. uk – Self help. com -forward counselling. com Eye Focus Induction Would you like to make yourself comfortable now… and maybe get into a position where you can relax… you may wish to uncross your legs and rest your hands on them …… Now if you would like to look at that wall in front of you…. And lift your eyes up until you are looking up, higher than your normal eye level…. and now if you can let your eyes find something on that wall… some spot or corner or maybe a small object…. nd perhaps let your eyes rest on that …. and if you can hold your eyes open… and just look at that spot or that point…. for a few moments … keep focusing on that spot… and while you are keeping your focus on that spot…. you can become aware of the muscles around your eyes…. how they are holding your eyes up…. and your eyelids… and what they feel like…. and as you look at that spot you might see that it begins to waver… or maybe you see it blurring … or that image might start to get a sort of halo round it…. nd you might notice that those muscles are becoming tired… and as you think about those muscles… they are becoming more tired…. and you might need to blink…. and that’s OK.. that’s fine… you’re doing really really well (name)….. And you might wonder if that blink is slower than normal…. and you might like to think about how nice it would be to allow your eyes and eyelids to relax… and close those tired eyes… and your eyes are getting heavy now… heavier…. and heavier…… and you can feel those eyes now… getting heavier and heavier… nd that is telling you that your eyes are getting tired and maybe you are ready to close them … eyes so heavy and tired… when your eyes are so tired and heavy that you just can’t keep them open any more… you can just let them close on their own…. … that’s right… and it can be so good and relaxing to close those eyes… and closing those eyes means you can relax now…. really let yourself relax… deep… deeply, deeply relax…. That’s right…. ————————————————- Deepener In a few moments I’m going to ask you to imagine certain things.

Don’t worry if you can’t actually see the images that I’m describing in your mind’s eye, just let yourself remember, think about or create an impression of what I am saying. And I want you to think of a starry, starry night; imagine looking up into the velvety darkness and gazing up at the billions of glittering stars, only a few of which are visible to the naked eye. And up there in the dark night sky is a full, round moon. It is a beautiful big, full, round, white moon. You can almost see a face on the moon, and a halo surrounding it as it throws its light out of the black, night sky…

And now I want you to imagine that you’re gazing at a glorious sunset. The sky is aglow with beautiful colours – and you watch as those colours change from a soft pink into a warm salmon shade and then deepen to a rich crimson with a hint of wild purple. Just imagine that sunset over the horizon and see how the colours deepen and change before they gradually fade away. Now imagine a steely grey-sky with dark, heavy clouds sweeping across. Have you ever gazed at the sky on a windy day and marvelled at how fast they seem to move? Or have you noticed the shapes of the clouds?

Sometimes you may detect a face, or perhaps imagine someone lying across the sky, as though they are guarding the earth below. And coming back down to earth I want you to visualize a lovely soft green meadow. Scattered across the grass are patches of delicate white daisies with yellow centres, purple clover and bright yellow, egg yolk coloured buttercups. Different trees border the left-hand side of your view – you may recognize some as oak or poplar, elm trees or fir, depending on the types of trees that you are accustomed to seeing, each with different shaped and sized leaves – and you marvel at the various shades of green in nature.

Now imagine a lovely still blue lake, and you are lazing in a comfortable boat, sailing across this lake. Someone else is doing the rowing or driving the motor. The ripples on the water remind you of the ripples of consciousness, which surface your inner awareness. If you were at the bottom of this lake, on its bed, you could look up and maybe even see the underneath of the boat, or watch your thoughts fluttering across your mind, like young birds learning to fly. Perhaps you would notice shoals of brightly coloured fish darting here and there – and exotic plant life that can only exist under water.

In your boat, perhaps you can feel yourself swaying from side to side, gently rocking, from side to side, taking you deeper and deeper down, into gentle hypnotic rest. And you can go in and out of trance. You can go deeper and deeper down, into gentle hypnotic trance. .. You are now feeling even more relaxed, feeling more peaceful and calm, than you’ve ever felt before. Just enjoy this tranquillity and calmness, as you go deeper and deeper down… just imagine that the boat is a great big comfortable chair… you can totally relax now and just go deeper and deeper…. ++++++++++++++++++++++++++++++++++++++ Metaphor script. And as you drift deeper now I would like to tell you a story about a lady I once knew….. she worked very very hard…. and had been at her job for a while….. she desperately wanted to shine brightly and show others that she was indeed clever… but this lady felt sad because she did not have that sparkling confidence …. she saw in others…. so believing they thought she was boring ….. she withdrew a bit from her work colleagues … this meant that …. when her colleagues suggested a drink on a Friday evening after work …. he always found an excuse….. ….. she hid behind her Aunt’s illness…. you see her aunt was housebound and she had to look after her on a Friday night each week…. and if she was late….. her Aunt found fault with her and picked on her….. but at least she could use her Aunt so that her colleagues never knew the real reason she did not want to socialise with them. This lady had a boyfriend who she loved dearly….. but somehow she never felt quite good enough for him….. and because of this it appeared as though it wasn’t leading anywhere….. n fact her lack of confidence.. was dimming their relationship… she would love to get married and start a family… and she could imagine that with her boyfriend.. but she felt as though she was not worthy of him.. and this meant they had started drifting apart… If only she could appear confident… both in work and her personal life…. sometimes she used to dream about having more self – esteem…. she would imagine how she would look …. how it would feel.. in fact she often used to picture herself… sitting in the Executive Managers desk…. having gained a promotion… he felt powerful within herself…. she felt mesmerised by her confidence in that role…. the ease in which she could talk to others…. and not being continually worried that others might not like her…. she looked good, she felt good… and she exuded this onto others… in fact everyone became drawn to her… she would imagine her boyfriend telling her he loved her… even down to him proposing on one knee…. how wonderful that would be for her…. all of these things illuminated in her imagination… how grand life would be if it wasn’t just a dream… ut then she came back to reality and as usual it was easier for her to keep using her aunt, her colleagues and even her boyfriend as an excuse not to change within herself … and so she just kept on dreaming… she would dream for hours.. in fact it became a way of life and as the years rolled by… she suddenly realised at the age of forty that all she had done was waste her life….. her boyfriend had left her … and her aunt was demanding more of her time… and the people at work had long ago stopped asking her to go with them on a night out…… nd now she found herself very very lonely… she had no friends and no social life… and as she was taking stock of this and feeling really low……. she realised how much opportunity she had wasted…. just imagine how she felt… suddenly appreciating that she had had it all within her grasp.. and she.. yes she was the one who had thrown it away… because she only watched life from the sidelines…. it had taken a long time but she had finally seen the light… it was only herself who could make a difference to her life… it was only her who could change it…. he had to make those changes… and she determined that she was not going to spend another day dreaming …. but actually participating in life.. First she went to the hairdressers and had her hair cut and coloured, that made her feel so much better, then she went shopping trying on smart clothes for work and evenings out… she came home and looked in the mirror.. she gasped as she could not even recognise herself… she actually looked pretty okay – she now had a crystal clear focused approach… she was no longer.. a watcher of life…. on Monday morning she could not wait to jump out of bed… ut on her new clothes and walk into the office… was excited for them to see her new image… she knew from this moment on their opinion of her would change… Head up high and back straight she entered the office with a new confident air smiling and greeting everyone as she walked in … of course they were amazed but also delighted for her… people were talking to her and she was enjoying the conversations. During the day she heard the Manager was leaving and that the position would be offered internally… … she felt she could do the job as she had covered for him many times.. he would never have had the confidence to have applied for it before as she had felt that she would not be good enough or that she might actually have to change.. but now she vowed to try to gain the promotion … Towards the end of the week her confidence growing daily she heard that she had been shortlisted for the job… her colleagues asked her for a drink… and for the first time… she accepted…. she would get someone else to look after her aunt that evening… her aunt would have to start to appreciate that she could not always be there… and that she had a life to lead…

From that point on this lady never looked back… she gained the promotion….. could deal with people more effectively… was not worried by her aunt.. as she had managed to get care for the evening that she goes out with her colleagues and she sees her on the days that she makes time to do so….. but the best part is that she met her old boyfriend one evening with the new friends she had made… and they agreed to start seeing each other again…… that one day had changed her life… and all it took was for her to make those changes herself…. eing frightened of life had made her hide away from it…. fear change … but by moving forward and not being frightened of failure and what others think .. literally did change her life…… and now I am going to bring you back to the present by counting from 1 to 5 1 You begin to feel yourself gently stirring 2 Stirring more and more and aware of all the everyday sounds once more 3 All your senses beginning to come back to their normal balance 4 Your are starting to feel relaxed but refreshed 5 You are completely back now, you can open your eyes and have a good long stretch