Quit_Smoking_Case_Study

Case Study for Miss K Abstract Miss K came for therapy wanting to quit smoking. She was a heavy smoker and had been for many years. She was aware that I was a an unqualified therapist and that she was volunteering as one of three case studies I needed to complete, in order to become a qualified Hypnotherapist. The treatment consisted of one session and although she did not achieve her goal of becoming a non-smoker at the end of it, she had greatly reduced her smoking and said she was very happy indeed with this as a result. Initial Consultation Miss K is a heavy smoker and desperately wishes to quit. She is a 49-year-old company secretary that works from home, who is happily married to her husband, and has two children, 26 and 23. She has smoked for 38 years and averages 30 – 40 cigarettes per day. She now has a smoker’s cough, whilst also being in desperate need to have extensive dental work carried out, but has been advised that this will not be possible all the while she is still smoking. Her gums have receded and the jawbone is deteriorating. This will continue all the while that she persists in smoking. Unfortunately, it is irreversible but further damage will be avoided if she quits smoking. Her Long-term plan is to pay to have permanent false teeth screwed into her jaw. The financial aspect of this is not a problem. She also told me that she wants to regain control of her life and make better use of her time. She originally started smoking to impress her peers, as she believed smoking to be a very grown up and glamorous thing to do at the age of 11. During her life as a smoker, she has attempted to quit approximately 20 times. She has tried group therapy, the drug “Zyban” and willpower. On one occasion, she managed to “give up” for 6 weeks but found it completely torturous and gave in. Miss K smokes from the time she gets up in the morning, before she has even been to the bathroom, to the time she goes to bed. She has even begun waking up during the night to have one. All her social events are planned around her habit and it greatly depends on whether there are smoking areas or how long she may have to go between cigarettes as to whether or not she will attend. She said she would never consider going on a long haul flight or even the cinema, as this would be far too long a period to go without a cigarette. There is no one particular place or time that she smokes more or less. She smokes in the car, whilst on the phone, on the computer, tending her garden and after every meal. Miss K has many different indoor hobbies and interests such as decorating, baking and craftwork but finds that even these are suffering due to the constant interruption of smoking. I asked Miss K on a scale of one to ten (ten being the highest) how she would rate the stress in her life. She told me it would be two, at the very most. Her children have both left home, are happy, and settled. As a couple, after 28 years of marriage, they are still very happy and have no financial difficulties or worries. Although Miss K is highly motivated about wanting to quit, she told me that deep down inside she does not truly believe she will ever be able to “give up” smoking. I explained that this was probably the main reason why she had always been unsuccessful with her attempts to quit in the past. If she sees herself as “giving up” something then see will automatically feel like see is depriving herself and not as it truly is, “choosing” to be a non-smoker. She said this was exactly how she felt, as if she was having something taken away from her. I explained to her it was not a punishment, and she would only benefit from having now made that choice to become a non-smoker. I told her not to feel guilty about any past failed attempts, that was then and this is now. However, to look forward into the future from this day on as a non-smoker. I believe that Miss K has a very strong and long, ongoing habit of smoking and due to her many failed attempts to quit in the past, now has very little confidence in her ability to become a non-smoker. She associates nearly every daily task or event with smoking. We spoke at length about possible options to replace the ritual of smoking during or after each of these. In addition, any cravings she may possibly experience, and what to do if necessary. We looked at the reality of the health risks and why she now suffers with a cough. Although she was aware of the harmful chemicals each cigarette contained, she appeared shocked when confronted with exactly what they were and even more so, that it was not only your lungs and teeth that smoking posed a serious health risk too, but all her organs. We also discussed whether she had any concerns about weight gain, as this can sometimes be an issue when someone first becomes a non-smoker. I explained the hand to mouth action that is involved with smoking could sometimes continue with food or just picking as this is a habit. Miss K told me she was aware of this and had already anticipated the possibility of this happening. I gave her some alternative options, such as peeling a grape and popping it in her mouth or having some healthy low fat, low calorie, snacks already prepared, and at hand, such as carrot sticks, celery sticks or seeds. Fortunately, her husband does not smoke and few of her friends do, but I impressed on her that from now on, whenever she sees a smoker she will see someone that is poisoning themselves and not someone that is doing something that she feels she would like to do but cant. I have assessed Miss K as being mixed modality. Ethical Issues and Contra-Indications Her doctor recently sent Miss K for a chest X-Ray as he had concerns about her cough, but this was clear and showed nothing sinister. He confirmed it to be a smoker’s cough and strongly advised her to stop smoking immediately. She does not suffer from Hypertension, Emphysema, Asthma, Epilepsy or Depression. She is on no prescribed or non-prescribed medication and there seems to be no other medical or ethical contra-indications or considerations, as to why I should not treat Miss K. Therefore, I do not feel it necessary to obtain a letter of consent from her G.P. or to inform him of our therapy session. Initial Treatment Prior to our initial consultation, I asked Miss X if she had ever had hypnotherapy before, for any purpose, and she said she had not. I asked her to consider her motivation for quitting smoking and whether or not there was any pressure from anyone else to stop. She was quite adamant that it was her decision alone, one to which she had come to without any outside pressure. I also asked her to think about her smoking history and habits before our consultation, as this information was very important to the success of the session. I advised her not to try quitting beforehand but to smoke her last cigarette before our session and possibly getting rid of any ashtrays in the house. I hoped this would reassure her that she would leave the session, and return home, a non-smoker. On the day of our session, after gleaning as much information as possible about Miss K, her smoking history and motivation to quit, I carried out a fixed eye induction, deepener and quit smoking screed. As Miss K had been very specific about her reasons for wanting to quit and these were to regain control of her life, time and health, I concentrated on these three issues in her personalised screed. She responded very well to the induction and deepener and there were a few occasions when I had to bring her back a little bit as she begun to snore. I achieved this by using her name more and slightly increasing the tone and volume of my voice. The induction, deepener and screed took fifty minutes in total as I repeated the last three paragraphs of the screed before re-orientation. When Miss K was re-orientated, fully alert and refreshed she said she felt confident and excited about now being a non-smoker. I gave her a few affirmations to repeat to herself, daily and regularly, to help re-enforce the fact she was now a non-smoker. I did not offer to contact Miss K to see if the session had been successful or not as I felt this may well have given her the impression that I believed it could possibly be unsuccessful, therefore encouraging doubt in me as a therapist and confidence in herself to become a non-smoker. However, I did say I would need to speak to her the following week so as to be able to obtain any further comments or thoughts she may have had about the session enabling me to complete my case study. The session took two hours and 30 minutes in total. This was slightly longer than I had prepared for but Miss K said she had not minded in the least and I had forewarned her this may have been a possibility. End of Treatment Results Miss K contacted me five days later and told me that by the evening on the day of the session, she had smoked a cigarette and that since then she has been smoking between three and five cigarettes a day. She seemed very pleased with this, as this was obviously a great improvement to the amount she had been smoking. She told me that she would like another session and was very confident that she would definitely become a non-smoker this time. Miss K told me that she had been thinking a lot about the reason why she had started to smoke in the first place and that the information she had given me was incorrect. She said she had not been deliberately misleading but went on to tell me she had been sexually abused from the age of ten until she was fifteen by a family member. Shortly after our session, it started to niggle her that she could not remember the exact event that triggered her smoking. The following day she then had a clear memory, one that she had not had before, of her abuser giving her, her first cigarette and telling her, now she was a grown up girl he wanted her to smoke with him. This would be another secret between them. She said this had not been a particularly painful memory for her and had not caused her any further distress. I congratulated Miss K on dramatically cutting her smoking down, but explained that due to the fact I was still training as a therapist, I felt unqualified to carry out another session with her in light of the information she had now given me and it would be unethical of me to do so. I asked if she had ever had counselling or thought it was something that she may benefit from. She said that until quite recently, she had never told anyone, but her abuser had now passed away and she had confided in her husband about the abuse. She explained she was finding it more and more difficult to block out the memory and the feelings it has caused within her. Although her husband has been supportive, I suggested that it might well be a good idea to speak to her GP for advice or possibly seek help from a psychotherapist. Miss K agreed, saying that it was something she had been seriously considering over the past few months but just needed to pluck up the courage to talk about it as she had kept it a secret for the larger part of her life. She now felt that time had come. Limits and Flaws Although Miss K is extremely pleased with reducing her smoking from thirty to five a day, I am not confident that see will sustain this, and believe she will eventually increase her smoking until she is once again, a heavy smoker. I may have helped her temporarily reduce her smoking but she has not achieved her goal in becoming a non-smoker. On reflection, if I had been aware beforehand that she had been abused as a child, and that her abuser was the person whom had given Miss k her first cigarette and encouraged her to smoke it, I would not have used Miss k as a case study. My knowledge and experience does not extend to complex issues that may surround sexual abuse. This may or may not have had a direct effect on the success of the session and Miss K becoming a non-smoker, but I feel that if I had been more experienced and qualified around this subject, I would possibly have had more success. I certainly would have been more confident about proceeding with a second session and adjusting the screed accordingly. Conclusion Miss K was a heavy smoker wishing to quit. She had tried on numerous occasions to quit using many different methods, all unsuccessful. After a two hour thirty minute session consisting of information gathering and hypnotherapy, she said she felt focussed and positive about now being a non-smoker. Unfortunately, after five days she contacted me to let me know she was smoking three to five cigarettes a day. I also advised her to seek further therapy for unresolved issues which she thought was a good idea and was now ready to do.