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_

Having read through Miss E’s case study, it becomes apparent quite early on that alongside her desire to lose weight, the extract also depicts the client as having quite a strong underlying issue in regards to a lack of self esteem. Although the therapist can establish weight loss as being the main priority for the client, it is also evident that there are contributing factors that may also need to be addressed in order for her to obtain her goal. When a therapist is dealing with any form of weight loss it is essential that each case is dealt with an individual outlook in accordance to the client’s needs. ‘While there are standard psychological causes for overeating, this does not mean that all overweight people overeat’. Nevertheless, in cases where this type of eating example is prominent, (overweight due to overeating) people may be under the misconception that they have a slower metabolic rate, where in fact, it is most likely to be accountable to the subconscious mind. It is very common that when people have dieted and reached their ideal weight, to suddenly find that when they have stopped, many old eating habits begin to re-appear. When your conscious mind is in the forefront, it ‘serves as a military force to keep your hunger habits from invading’, although people do not always account for how strong the subconscious mind is in comparison to the conscious one, so ‘while the subconscious mind is no simple power to grapple with, it is only through permanent changes in this part of your mind that you will experience permanent changes in your life’. In order to create these changes, you will need to explore what is causing the behaviour to begin with. There are many different factors to account for when looking into people’s weight. A phrase that has been employed by authors such as Crasilnesck and Hall (1985) reference ‘empty habits’ which is generally used when many habitual and even near-compulsive behaviour patterns emerge and would account for people who eat due to conditions like anxiety, stress or even boredom opposed to when they feel real hunger. On this particular occasion the client has been forthcoming in providing the therapist with information that may be relevant to her weight struggle. However, not all clients will be as open (particularly in an initial meeting) or even necessarily aware of any other issues that could be affecting them so it remains imperative that the therapist’s perspective needs to be ethically equipped to deal with their client’s individual circumstance. For instance, should it be established that overeating has stemmed from a way of dealing with some form of bereavement and the therapist happens to also suffered from a similar situation, this could affect the treatment process or possibly re-awaken problems for the therapist personally. Looking at it from another point of view, if at any point the therapist feels there may be any further issues on Miss E’s part, or believes they are dealing with deeper problems than first disclosed. It may be feasible to suggest the input of another professional (such as counselling). As noted earlier, the client presents several factors that could be potentially influencing her inability to lose weight. Looking firstly at the comments with regards to her previous partner, it is evident that the relationship was based on an uneven scale with her partner being ‘very controlling’ and ‘seeming to want her to stay overweight’. Although the therapist is not given the particulars in terms of the breakdown to the relationship, being subjected for over 6 years to quite an overpowering, domineering presence can potentially create a negative impact on the overall perception you have of yourself. Miss E also states that ‘She has tried many diets but always seems to put the weight back on’. Had her partner been reluctant for her to lose any weight, diets may be something that subconsciously holds negative connotations for her, either from being told not to bother with them or that they were a waste of time. There is also the possibility of her never acquiring the discipline to stick to a particular diet plan. Any attempts Miss E made to change her eating patterns were overlooked by her partner, so once started on a diet, she may not have always felt compelled or able to continue, knowing he did not approve. This, therefore, could result in the idea that diets do not work for her on a long term basis. Creating an understanding for the roles which other people play with regards to either the success or downfall of weight loss, will enable the individual in question to be more equipped in both recognising, and consequently dealing with, any negative feedback they may be subjected to by friends and family. It could be that the unsupportive attitude of Miss E’s ex partner towards her effort to lose weight may be down to his own insecurities, believing that the change in her appearance could lead to people finding her more attractive and potentially, have her stray away from the relationship. Having explained this type of scenario will put into perspective for Miss E the amount of influence which loved ones have over the overall outcome of attempted weight loss (without them even necessarily realising). From reading the section on Miss E’s beliefs of her parents’ feelings towards her, it automatically brings up contradicting ideas from those of her previous partner. From being in a situation where she seemingly felt compelled to stay overweight, her parents ‘badgered her about being unattractive and eating too much’. Having ‘struggled with her weight since she was 12 or 13’ she was obviously trapped in a vicious cycle. Self esteem is a prominent aspect with for Miss E in regards to her parents. Although our self esteem should come from within, it is noted how we are also influenced by many other external factors. However, if we are made to feel fat and ugly as a child by our parents, we accept this as being our identity, turning our own inner confidence elusive and taking on board the ideals of someone else. Without going into too much detail as this is an assumption based on the information given, the fact that her parents reinforced the idea of her being unattractive, could have played an influential part in the position she was in with regards to her ex partner. She may have been more willing to allow him to exert such a large amount of control over her appearance because he was prepared to accept her for how she was. Despite her personal wishes to change, perhaps Miss E believed that she needed his approval. This obviously had its own downfalls in regards to the impact it would have on her self confidence. Many people have weight issues which are related to some form of emotional problem and are acted through their relationship with food. Eating can become, and is often used as, some form of coping mechanism in order to deal with anxiety and unresolved issues. The use of hypnotherapy for Miss E could be a very useful tool in enabling her to achieve her goal. I would make a point of noting however, that although the target weight of 2.1/2 stone could be attainable in the long run and well worth the aspiration to aspire to. It would not be wise to make the target weight a complete focal point (particularly if she is basing her weight loss purely for her holiday). For someone wanting to lose weight the recommended amount to lose is two pounds a week in order for them to try and sustain that new weight. Should Miss E not be able to lose the intended amount in the required time it could lead to the undoing any positive improvements that she has managed to gain by having quite a high expectation! As the therapist I would try and devise a plan for Miss E that reflected a structured and realistic idea regarding weight lose. So far she has received conflicting ideas about herself from her parents’ negative comments regarding her appearance, combined with her ex partner’s reaction whenever she attempted any form of weight lose. This would be one of the first aspects I would like to address. As noted earlier, it is extremely important that the client becomes aware of the role which other people can play in their successes but also their failures, to help combat any issues of low self esteem. My second suggestion would be for Miss E to keep a food diary. This will not only enable her (but also the therapist) to see any correlations that may emerge (whether it is at certain times of the day or related to specific places/circumstance) so these can be examined and suggestions on how those particular situations can be dealt with and discussed. It is a common misconception by many dieters that to lose weight they need deprive themselves of food. By cutting out regular meals, the body goes into ‘starvation mode’ where your body starts to store fat as it is unable to ensure when it will get its next food intake. Not only is this extremely dangerous from a health point of view, but is also very ineffective as a dieter. There should be an amount of encouragement from the therapist to suggest eating regular meals to prevent this type of situation from occurring. The amount you eat and the way in which you use food is a pattern that has been established in your subconscious. In order to change your negative eating habits, a new habit must be created. This will require you to reprogram your subconscious, which can be achieved through the use of hypnosis. When giving up any form of habit, suggesting incentives for achieving certain milestones as a reward can be quite beneficial. Not only does it encourage the client to keep on track whilst aiming for the end result (final weight loss) but by rewarding yourself for the changes you make. Your subconscious will start to associate these positive rewards with your new habits, so the way in which you begin to perceive these new habits will become connected with these new and positive changes. Having looked through and examined Miss E’s case study, I believe the course of action that I have taken will be constructive and effective in her effort to lose weight.