“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?”
In this essay I am going to assess the client, Miss E’s, issues using the case study provided. I will then describe a treatment plan for Miss E with an attached script. I will also comment on the strengths and weaknesses of using hypnotherapy in these cases and will be noting any ethical issues that may occur throughout. Hypnotherapy is a popular form of therapy for people seeking weight loss. However, clients have often tried many other techniques and diets to achieve their desired weight before choosing to see a hypnotherapist.
It should also be noted that as a therapist, we should not jump to the conclusion that a client wishes to lose weight, as they may actually wish to gain weight and such assumptions could immediately damage rapport. To begin with I would have an initial consultation with Miss E. This initial consultation would be free of charge as it is an opportunity to assess whether I can treat Miss E ethically, for example being within my competency limits as a therapist, as well as identifying the personality type of the client in order to write a screed personalised towards them and their preferred modality.
During this initial consultation I would establish what the client’s goals are, and in this case, Miss E wishes to lose 2 ? stone and hopes to have lost this in three months time before she goes on holiday. At this stage the therapist would need to identify as to whether the time-frame desired by the client is actually realistic. For a sensible weight loss plan, the ideal aim is to lose weight at about 1 to 2 lbs per week. In terms of Miss E’s goal weight loss, this would mean a time frame of just over four months rather than the three that she was hoping for.
This would have to be explained to Miss E to eliminate any false hope and expectations that she may hold towards the effects of hypnotherapy, so as to avoid potential feelings of disappointment or failure when the weight loss is not achieved in the desired time-frame. The next step would be to find out a detailed history from the client about their relationship with food and dieting. For Miss E, she has always struggled with her weight since she was 12 or 13. She has also tried many diets but always seems to put the weight back on.
It is important to look at how food was approached when the client was younger and in Miss E’s case, it mentions that her parents “badgered her about being unattractive and eating too much” which would have influenced her eating habits. This point will be discussed further in the essay. Following this, the next step would be to ask the client how motivated they are on a scale of 0 to 10 to lose the weight, where 10 is very motivated. Clients answering between 8 and 10 will generally be more successful in their weight loss through hypnotherapy.
However those who answer a score lower than 8 will need to be investigated further to find out why they are attending the sessions and whether or not you can heighten their motivation, otherwise the hypnotherapy is likely to unsuccessful. For example, if a client is attending hypnotherapy because of someone else’s desires and not their own, then it will be unsuccessful as the techniques used require personal motivation which obviously would not be particularly high if they are there because of someone else. Miss E may be lacking in motivation from the many previous failures in weight loss from dieting that she has mentioned.
However, the reasons for this can be explained to her in a way which inspires her towards believing in hypnotherapy. For example, diets often use techniques relying on willpower or food supplements which generally only work in the short term, before they lose the willpower as its hard to sustain or eat normally after the food supplements have ended. Hypnosis on the other hand is not based on deprivation and focuses on changing the programmes currently used by the subconscious. Furthermore as a therapist, you would also need to enquire into whether or not the client has previously used hypnotherapy to aid in weight loss.
If they have then it is less likely to be unsuccessful because the client will have already built up the idea that it may not work again, which automatically puts a barrier between themselves and the therapist. I would then go on to the different reasons why people overeat and ask the client which one(s) they identify with and why, as the majority of people will be able to identify with at least one of them. One such reason is eating to lessen unpleasant experiences. This is something we learn from an early age, such as getting something sweet from a parent when we are in pain.
In later life we may be taken for meals out to cheer us up or be brought ‘comfort’ food such as chocolate and ice-cream after a break up, for example (Chrysalis, Module Six). Eating to get attention and gain authority is another reason why people may overeat. Larger people may feel like they are more important and command attention, though not always positively. They may be for example, making a point of telling people how much they are eating at a party, gaining negative attention in replacement of the harder to achieve positive attention.
People may also overeat for reward and entertainment, such as receiving a treat food for completing chores as a child, or giving and receiving chocolates and wine on special occasions later in life. However, treats are now common place in households and not necessarily used for special occasions. People can also use food for fear, overeating on unhealthy foods to help them deal with their fear. For example, a person may wish to lose weight, but actually overeat because they fear that they will get more sexual attention if they are slimmer and they feel that they wouldn’t be able to cope with this.
Lastly people may replace love with food, seeing food as a secure friend. As a baby, we receive closeness from the person feeding us as they hold us. The need to recreate this feeling may cause overeating. From the case study, I believe Miss E would identify with using food to replace love. I believe that this may apply to her because the case study states that around the ages of 12 and 13, her parents “badgered her about being unattractive and eating too much” which implies that they didn’t perhaps show the most affection towards Miss E. She may therefore have seeked such affection from her food as a replacement.
Miss E may also identify with food for fear. I believe that this may be a relevant category for Miss E because she may actually fear losing weight because she is “scared” of meeting a new partner. Therefore she might be overeating so that she doesn’t feel attractive towards people and therefore does not have to worry about attracting another controlling partner. This could have come from her parents telling her at a young age not to overeat because she would be unattractive, and has reversed their words because she actually wishes to appear unattractive and so overeats.
She may also be following the line of the self-fulfilling prophecy laid out by her parents by them constantly telling her she is unattractive and over weight. As a therapist it is very important to also look into the ‘danger areas’ for the client, the times and situations when they are likely to overeat, as well as identifying any hidden agendas that the client may have for overeating. This is important as an ethical issue, as treating a client for their weight loss may begin to uncover a more serious problem underneath.
If the therapist has not considered the potential for any hidden agendas before therapy begins then if they were to arise, the therapist would not be prepared for dealing with them, and this could be detrimental to the client. Any hidden agendas may well prove to be outside of the therapists competency level, and so ethically it is important that these are addressed before therapy continues, or the client referred on if necessary to avoid causing “damage to the person we are trying to help, to ourselves, and to the reputation of the counselling agency we work for” (Sanders, p. 4). From this case study, I believe that Miss E has a hidden agenda that she is sustaining by over-eating. I feel that she has problems with low self-esteem, caused in part by her parents words when she was younger along with her controlling ex-partner. Part of this low self-esteem is over-eating so that she isn’t attractive to potential new partners, as I believe she feels like this will protect her from being hurt again by someone controlling and also avoids having to go through a break-up with someone again.
Furthermore I feel that Miss E may have a deeper underlying issue with her parents and their lack of affection towards her, instead choosing to badger her about her weight during childhood. I believe that she may have some unresolved issues from this time in her childhood and this is now presenting itself at the age of 29 through her weight issues. Therefore she may not actually require any weight loss treatment, and instead needs help in building up her self-esteem. This would in turn help her to lose weight anyway as her habits change and she no longer needs to over-eat to to replace love or for fear.
If all of the afore mentioned steps from the initial consultation were addressed and the therapist felt that they would be able to treat the client for their weight loss and any hidden agendas that may have been identified, then the therapist would proceed by working on the positive aspect with the client. This would mean reflecting on some new options that the client could take rather than over-eating, as well as discussing the benefits that they may experience when they have reached their ideal weight.
The therapist would then go through the process of hypnotherapy with the client so that they fully understand what is going to happen and answer any questions the client may have. The therapist would then go onto complete the required number of sessions for the client. However, due to the nature of Miss E’s issues that I have assessed, this would not be the way I would progress. I feel that due to Miss E’s hidden agenda and underlying issues regarding her parents, I would not be able to treat her at my current competency level.
I would at this point speak to my supervisor to discuss the problems and with my supervisors help, refer Miss E on to someone who would be more experienced at working with clients with such issues. However, I do believe that Miss E would benefit from hypnotherapy that focussed on building up her low self-esteem instead of her weight loss, because, as mentioned earlier, any weight that she feels she wants to lose would be lost through the positive changes in her life caused by the boost in her self-esteem.
I would take this approach because treating her solely for weight loss would potentially only provide a temporary ‘plaster’ over the underlying problems and would not actually treat the root cause, and this can be a weakness of weight loss therapy. This would all be explained to Miss E before any therapy for her self-esteem is carried out. If Miss E is happy to continue in therapy focused solely on her self-esteem and my supervisor agreed with this approach, than I would proceed with the screed that is attached.
In conclusion, I feel that Miss E’s main issues involve her low self-esteem and not weight-loss itself. I feel that she would greatly benefit from a course of therapy focussed on building up her low self-esteem. As an ethical therapist I have recognised that she may have hidden agendas for sustaining her weight such as fears of getting involved with another partner, as well as underlying issues surrounding her parents which are currently out of my skill set as a therapist.
I would therefore refer Miss E on in order to get therapy to address these issues. References: Allen, R. P. (1997). Scripts and Strategies in Hypnotherapy, The complete works. Wales: Crown House Publishing. Chrysalis. Course documents, Module Six. Hadley, J. & Staudacher, C. (1996). Hypnosis for Change, 3rd Edition. USA: New Harbinger Publications. Sanders, P. (2002). First Steps in Counselling: A Students’ Companion for Basic Introductory Courses (3rd Ed). Ross-on-Wye: PCCS Books.