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?

Introduction
This essay will explore the issues Ms E presents and devise a course of treatment that will support her treatment goal of weight loss. Ethical questions will be discussed as will other issues raised as part of the initial assessment.

Background
Ms E is a 29 year old single woman who is looking to lose two and half stone in weight. She came out of a failed relationship six months ago and feels she is now ready to find another partner. Her previous partner of six years was very controlling and she believes her ex partner wanted her to remain overweight. This has left her feeling frightened about entering into a new relationship.

She has struggled with her weight since age of twelve/thirteen. Her parents badgered about being overweight and eating too much. She has a history of dieting and weight gain post diet.

She is planning to go on vacation with her girlfriends in three months time and hopes she can have lost weight by then.

Initial Consultation
The purpose of the initial consultation with Ms E was to ascertain her reasons for attending and to ensure she had a full understanding hypnotherapy as a treatment option. Heap (2012) describes the relationship between hypnotherapist and client as one of ‘warmth, trust and mutual positive regard’.

Heap goes on to state the importance of ensuring the client has a clear understanding of what hypnotherapy is and their reasons for selecting it as a therapy. This, Heap suggests, will enable the therapist to better understand how, or even if, to treat the client.

The first step in assessment was for Ms E to complete the consultation form. During this process I established the following:

* She does not take any prescription medication * She is currently not receiving any form of counselling or psychiatric treatment * She does not have a long term illness * She has not tried any other therapy, lifestyle or attitude changes prior to this * She has not been hypnotised or used hypnotherapy as a weight loss tool in the past * She wants to lose two and half stone in three months * On a scale of 0 – 10 where 10 is very motivated she gave the number 10 and confirmed that she is committed to attending six weekly sessions suggesting she is very motivated to achieve her goal. She also confirmed that she is attending the sessions of her own volition and not because she is be pressured by family or friends * She hopes that hypnotherapy will help her to lose weight * Her primary modality is visual. Individuals with this modality tend to be more imaginative and have a greater ability to use pictures as opposed to words when forming ideas. They may experience difficulty when putting their ideas into words. Lateral eye movements go up to the left or right and are likely to be defocused. When forming images their eyes will go up to the person’s right, and to the person’s left with remembering images. They will be very fast talkers with thinner body types and breath shallow, from the top part of their chest.

Hadley et al (1996) identify the most common reasons why anyone overeats as being: * For reward or entertainment * To lessen or negate an unpleasant experience * To gain authority or get noticed * When in need of love * When afraid

To better understand Ms E’s reasons for overeating she completed, prior to attending the initial consultation, the Pinpointing When, Where and Why Ms E Eats exercise followed by the Why, When, Where, Alternative Activities. The first exercise gave Ms E an opportunity to identify when, where and why she overeats. The second exercise asks Ms E to identify alternative positive activities she can do instead of eating or snacking. These exercises serve to cement Ms E’s commitment to achieving her weight loss goal.

Having confirmed her contact details, her GP’s contact details and after signing the consent form we continued with the initial assessment.

Initial Assessment
During our initial conversation I was struck by Ms E’s lack of confidence in finding a new relationship. She is clearly capable of sustaining a long-term relationship as she was with her previous partner for six years. However, she does say that she found her previous partner to be very controlling and seemed to want her to be overweight.

Hadley et al (1996) state that ‘the major cause of poor self-esteem is past negative programming that is the product of judgemental parents.’ From the initial consultation it is clear that Ms E’s parents have been critical and controlling of her in the past, badgering her about being unattractive and eating too much. As a product of a critical parent(s), Ms E now has a set of beliefs about herself that hinder her from achieving her weight loss goals.

I don’t believe Ms E is deeply depressed or suffers from deep underlying lack of self esteem. Whilst she does have a critical parent(s), she clearly functions well and she has group of female friends she is close with who she feels she can holiday with. Should it become apparent that Ms E does present with deep underlying lack of self esteem as treatment progresses I would recommend Ms E seeks alternative support from a psychotherapist with expertise in this area and discontinue hypnotherapy until such time as she has dealt with this underlying issue.

I am fairly certain Ms E does not have a hidden agenda as she appears to be very positive about the outcome of hypnotherapy in helping her achieve her weight loss goals. I suspect she has a secondary gain in staying with a controlling ex partner in that as long as he was not encouraging her to lose weight she had a reason to continue bemoaning her weight gain but doing little or nothing about it. It may be worth exploring with this further with her at future sessions.

She may not be aware of any hidden agenda or the secondary gains discussed above at this early stage and to suggest it may cause offence or hinder her progress. I will revisit this as her treatment progresses and introduce changes to her treatment plan if necessary and after discussion with her.

I am concerned that her weight loss goal is not achievable and it is important to identify a realistic goal for Ms E. The NHS recommends a loss of 2lbs per week. She is going on holiday in 3 months time, a weight loss of just under two stone is more achievable. In talking this through with Ms E I explained the benefits to her of losing two stone and how this would undoubtly keep her motivated to continue with her weight loss after her holiday.

Ethical Considerations
There are a number of areas to consider when discuss the ethics of the case study: * Ms E’s weight loss goal is one that encourages a faster weight loss than that recommended by the NHS. As her hypnotherapist I must encourage her to lose weight at a healthier rate. * To find out if she a suitable candidate for weight loss hypnotherapy I will need to ascertain if her weight gain is due to any medical conditions or medications she may be taking. If, during this process, we identify areas of concern she will need to get further help or get a letter from her GP confirming that she is suitable for hypnotherapy. * It is important to reiterate to Ms E that she will need to put in place a healthy eating plan and exercise regime to support her hypnotherapy. Hypnotherapy alone will not achieve her weight loss goal.

* I am not a qualified nutritionist so I cannot advise Ms E on the specifics of an eating plan or exercise regime. I can guide her to the NHS website which gives advice on healthy eating and exercise for weight loss.

Treatment Plan
Mr E’s treatment plan will centre on a weight loss script that includes elements of self-esteem/self confidence together with a set of affirmations designed to support her in building both her esteem and her confidence. I recommend she attends six sessions over a six week period. After this, we will review and evaluate her treatment plan and agree together how to proceed with future sessions. By this time I would hope to see her well on the way to achieving a goal weight loss of two and half stone in three months and an improvement in her self confidence and self esteem. I would also look to see an improvement in her ability to interact with her parents in a positive way that will enable her to be less fearful of them. As stated earlier, this may require further in depth work with a qualified psychotherapist.

Ms E’s screed is designed to bypass her Conscious Critical Factor (CCF) which acts as a filter between her conscious and subconscious mind, monitors what comes in from our senses, and rejects those beliefs that do not agree with an idea or concept that has been previously experienced or accepted. Hypnotherapy will enhance her suggestibility, allowing the CCF to be by-passed and making it possible to communicate directly with her subconscious. By doing this, I hope to both build her confidence and self esteem and introduce new habits and patterns with positive, empowering suggestions that will develop a belief system that allows her to achieve her weight loss plan in a more confident manner.

Her immediate need is to lose weight and the hypnotherapy sessions will focus on just this issue. In time, as her confidence and self esteem improve, she should see her ability to manage other areas in her life improve.

Hypnotherapy Script (see appendix i)
Having assessed Ms E as having a visual modality, the suggestions in the screed are designed to allow Ms E to visualise herself at her goal weight. It will also include statements that direct her to eat smaller portions of food and to eat slowly and with conscious effort.

Beginning with a visual PMR script to relax her physically and mentally, the next stage is to take Ms E into a deeper state of trance using a deepener, again with visual images. Once in trance, suggestions are made that will encourage Ms E to let go of old behaviours and beliefs. Heap (2010) state that ‘a suggestion is a communication by the hypnotist to the subject and, as with any communication; it is intended to alter the recipient’s feelings, thoughts and behaviour in a specified way.’

To support her treatment goals, I would recommend to Ms E use affirmations on a regular basis. ‘Clients can employ positive affirmations to assist them with change and help them to establish permanent change in their belief system’. (Chrysalis, module 4). In order for Ms E to use her affirmations, she will play a key role in developing the statements. This will ensure she is committed to them. Some examples to give her ideas include:

* I accept my body shape and acknowledge the beauty it holds * I let go of unhelpful patterns of behaviour around food * I let go of any guilt I hold around food choices * I am grateful for the body I own and all it does for me

Affirmations courtesy of www.mindbodygreen.com (2013)

I recommend Ms E repeat her affirmations, out loud, on a regular basis throughout the day. It will be helpful if she can say them whilst looking in a mirror as this will enable her to visualise himself in a more confident manner.

I will be recording her hypnotherapy session and will advise Ms E to listen to it once per day. This will help to embed the new behaviours and belief into her subconscious.

Treatment Outcome
In conclusion, my expectation is that, after four weeks, Ms E will see and feel a noticeable difference in both her confidence and self esteem and will be well on the weight to achieving her weight loss goal. I would hope that she will be looking forward to her vacation with her girl friends. I would also hope to see an improvement in her ability to accept a new relationship at some future point in her life. She should also begin to be feeling generally more relaxed and confident in her relationship with her parents. Although, I do think it may take some time to establish the required change in behaviours that will allow her to be more confident with these relationships.

Essay end

References
Josie Hadley and Carol Staudacher (1996)
Hypnosis For Change, Third Edition
New Harbinger Publications

Michael Heap (2012)
Hypnotherapy a Handbook
Open Press University

Chrysalis Module 4 Text (2013)

www.mindbodygreen.com
http://www.mindbodygreen.com/0-8370/15-affirmations-that-will-help-you-lose-weight.html