Chrysalis Year 1 module 6

“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
The purpose of this hypothetical case study is to demonstrate my knowledge and understanding of treating a client (Miss E) who has a desire to lose weight. I shall identify and explain Miss E’s issues, then, compile an outline plan of therapy in order to support her.
In order to contextualise this, I shall use a variety of presentation methods including my treatment plan to clearly show how to proceed with Miss E. I will refer to my background reading to support my own opinions and planning.
I shall also endeavour to highlight the ethical issues that are presenting themselves herewith and any strengths and weaknesses that may be a factor in deciding how to proceed with Miss E and her wishes.

THE INITIAL CONSULTATION
Having allowed Miss E to present her reasons for coming for hypnotherapy, which I have outlined below, and completing my own Initial Consultation Form which will ensure that I am ethically happy with Miss E’s current circumstances (drugs, medication, psychosis etc...) then I would move to discuss with Miss E how I felt we could progress with the treatment.
Before we begin, I would make it very clear to Miss E that she must be honest with me and that I am not going to judge her in any way. Many overweight people are ashamed by their overeating and as shame is such a huge emotion to deal with, they tend to act in secret, believing that if they over indulged in public then they would be judged. This sense of shame often comes from their childhood experiences;
‘if your parents frequently degraded or devalued you, especially if they implied you were never good enough, you’re likely to grow up feeling a deep seated sense of inadequacy and failure’. (Koenig, 2007, p. 88)
Indeed I suspect that Miss E subconsciously feels she was judged by her parents and it is very important for Miss E to know consciously that this is not the case with me. This is especially true if I am to ask her to keep a food diary or pinpoint when overeating may occur. Overeaters can be consummate liars about when they eat, if they feel the need to protect themselves. This belief system also needs to be addressed at some point within the hypnotherapy sessions.
In fact, this raises one of the weaknesses of only using hypnotherapy with Miss E to help her lose weight. One of the supporting factors that Miss E might need is guidance on healthy eating, working together to look at good eating habits, understanding her own metabolism, thinking about what to eat when moments of temptation arise. Therefore it might be advisable for her to think about seeking psychotherapy alongside the hypnotherapy. It would be unethical for me to prescribe good eating practices as I am unqualified to do so. I can only make suggestions.
From here, I would move on to explaining how hypnotherapy works; confidentiality as outlined in the Code of Ethics and that the relationship between client and therapist as a partnership, therefore independent work such as NLP techniques will be important. If Miss E were happy to continue I would then begin unravelling what her issues are and how I can support her through hypnotherapy. The strength of hypnotherapy as a tool to use with weight loss; is it bypassing the conscious and all the learned behaviour patterns and re-educating the subconscious.
I would begin this process by using the questionnaire found in Hadley and Staudacher (1996, p. 63) which identifies when, where and why people overeat. I feel this is a good starting point as it will help me to focus my screeds onto relevant points where she is currently overeating and suggest positive alternatives for her. I have decided that I would like her to sit quietly and complete this on her own in order to focus her own mind on her problems. Meanwhile, I would use this short reflective period to determine how to proceed.
On reflection of this case, I have broken down her rationale for being at hypnotherapy and added what I feel is really presenting itself based on my own developing knowledge of the subconscious mind.
Lose 2 ½ stone in 3 months – holiday (unrealistic time frame)
Looking for a new relationship – scared (lack of self confidence)
Previous partner controlling & seemed to want her to stay overweight (perceptions supporting own belief system – possible feeder)
Struggled with weight since 12 or 13 (poor body image)
Parents badgered her about being overweight & unattractive – eating too much (low self esteem & shame)
Tried diets (demotivated by past experiences)
I have highlighted the problems that, I feel, may act as either inhibitors or that may need addressing alongside the weight loss work.
I would also discuss at this point that 2 ½ stone (35lbs) in 3 months is an unrealistic target, as people lose between 1 – 2 lbs a week when on a weight loss programme, therefore it is mathematically impossible to achieve.
DESIRE
REALITY (maximum)
35lbs ÷ 3mths = 11.6lbs per mth
11.6lbs ÷ 4wks = 2.9 (3)lbs per wk
2lbs x 4wks = 8lbs
8lbs x 3mths = 24lbs (1 ½ stone)

Even these figures are not totally accurate as they do not take into account her age, bodily structure, metabolism, gender. She must recognise how these factors might affect her weight loss e.g. her monthly cycle.
I would talk about the fact that everyone has wishes but this is not a ‘well defined target for clinical intervention’ (Yapko, 2015, p. 163). I would then suggest that we need to work together on a healthy weight loss programme that suits her in the longer term.
Another weakness that arises when only considering hypnotherapy as a support mechanism for weight loss is the ‘motivation/relapse prevention’ (Heap, 2012, p. 156) problem. Unlike any other addiction which can be ceased completely, we all need food to survive. As a hypnotherapist, I could not suggest to my client that they ‘quit eating’! Therefore, it will be necessary to ensure that Miss E is prepared for the fact that there will be a need for the motivation/relapse prevention problem to be addressed. I would incorporate into my plan motivation and relapse prevention screeds
I would explain to Miss E that I believe that the best way forward for her treatment is a ‘two pronged attack’. In hypnotherapy we will start with weight loss scenarios, then work on building her self esteem and self confidence, whilst giving her independent tasks to do that focus her conscious mind on losing weight. I feel that this approach is the best long term scenario for her and ethically the right path to follow.
‘By focussing on what the client can achieve relatively quickly, a momentum for greater responsiveness to the therapy gets established’. (Yapko, 2015, p. 164)
In this case, Miss E will be focussing on her weight loss and any actual loss at the scales will give her a feeling of positivity and she will respond more openly to the positive suggestions and a greater rapport will be created between us. The weight loss issue has a time frame placed against it (the holiday) and therefore she is more likely to be responsive if this is where the work starts.
I would also feel very unsure about taking her money simply for her weight problem when that cannot be solved on its own in the long term.
However, if Miss E only wishes to focus on weight loss then I would suggest a 4 week programme with a review after that. Hopefully, in this time Miss E will come to recognise that it is necessary for her to deal with the issues that sit beneath her eating patterns.
At the end of our initial consultation, I shall complete a PMR in order to get her used to the experience of hypnosis and then set about creating her treatment plan. I shall ask her to complete a food diary whilst reminding her that this is a non-judgemental task, as mentioned earlier.
I do feel that Miss E needs time to come to terms with the concept that we are going to change her whole lifestyle choices rather than just focus on losing weight and therefore, I would hold back on my discussion about healthy eating until she came for her first session. I feel that she needs to feel in control of the experience and do not wish to overwhelm her with facts. Whilst it is important that she is aware of the facts ‘Obesity causes around 30,000 deaths in England a year and is only beaten by smoking.’ (Chrysalis, 2014, p. 3) It is also necessary to recognise that habitual eaters are unable to use such statistics as the over-riding reason to lose weight. The subconscious balances such statements with counter arguments which soothe the overeaters’ guilt. Phrases such as ‘but my granny was 92 and enormous, she still had a good life...’

THE TREATMENT PLAN
I have decided on a course of 8 weekly sessions. (or 4 +4)
WEEK
FOCUS
TIME (mins)
INDEPENDENT WORK
1
Weight Loss 1
Full PMR
60
Food diary thoughts – healthy eating pamphlets - alternative rewards (the money pot). Self hypnosis (SH)
2
Weight loss 2
Full PMR

60
Food diary 3/meal planning - Affirmation statements - SH
3
Motivation
Rapid Induction
60
Physical diary – list of challenges. SH
4
Relapse prevention
Rapid Induction
Review work so far
60
weight loss star chart (Chrysalis, 2014, p. 11). SH
5
Self esteem
Rapid Induction
60
Affirmation statements – Photos of Miss E – SH
6
Self confidence
Trigger
60
Affirmation statements – SH
7
Fear of the Future (visualisation)
Trigger
60
‘Thought Record Sheet’ – SH
8
Fear of rejection
Trigger
60
‘It Takes Two’ – preparing for the holiday.

OVERVIEW OF THE SESSIONS
WEEK 1
Based on the food diary she brought in with her, I would focus on getting her to think about how she may have felt when she was eating. From here, I would begin the hypnotherapy work. As independent work, I would suggest that she began researching healthy eating options, kept a 2nd food diary; this time with thoughts and maybe an alternative to food, thought about alternatives such as a Holiday Money Pot. I would also give her a copy of the PMR. I would like her to get used to going into full relaxation and to be able to use the PMR as an alternative to snacking if she feels the need. Being relatively short, she shouldn’t feel that impounds too much on her day but does abate the ‘trigger’ moment for food.
WEEK 2
This would be the 2nd week of focussed weight loss work. Again, I would start by looking back over her independent work. At this point, she may start putting barriers, excuses etc... in the way for why she may not have done the work and this needs to be monitored as it may be the start of any hidden agendas coming into play. If she did have any excuses then I would listen to when the barriers were arising. Is it friend or family related? Is she receiving mixed messages from people who may be aren’t supporting her in the right way. I would then look to address this during the motivational/relapse prevention stage of her therapy. For her independent work, I am suggesting meal planning
‘To keep your mood stable, make sure you eat regularly. A good pattern is breakfast, mid-morning snack, lunch, afternoon snack and dinner. If you have difficulty sleeping, a small late night snack of nuts and seeds might help.’ (Jaloba, 2014, p. 14)
WEEK 3/4
After her feedback time, this week will turn her attention to dedicated physical activity. Hopefully, she will be in tune enough to go into a trance after a rapid induction. That way, more time can be used on suggestibility as well as discussion time. My screeds will be about motivation and relapse prevention, which I believe will keep her focussed on her goal. The screeds will incorporate images of her being active, feeling motivated to get up and move about. The independent work will support this.
At this point, it may be necessary for Miss E and myself to decide where to go from here, depending on her initial decisions on the timeframe. Whilst I have my treatment plan in place and feel that it would be a useful tool to progress as described, this must be her choice. I will discuss with her the bathtub concept (Geary, 2001, p. 10) and get to her to think about whether she feels that she is in a place to cope with the emotions that bring about her bathtub overfilling. This will help to decide whether she wishes to continue with further treatment or not.
CONCLUSION
Hopefully, after the initial four sessions I would have seen good progress in terms of weight loss, and that Miss E wanted to continue the work that will guide her to a new healthier lifestyle working on her issues such as self esteem, relationships etc...
I would expect to hear her feeding back positive experiences from her weight loss, not just reiterated by other people but from within herself.
I feel that this treatment plan and my ideas for supporting Miss E will allow her to be successful both in preparation for her holiday and for long term.

Works Cited
Burgess, F., 2011. The NLP Cookbook. 1st ed. Carmarthen: Crown House.
Chrysalis, 2014. Lecture notes from Module Six. s.l.:Chrysalis Not For Profit Ltd.
Geary, A., 2001. The Food and Mood Handbook. 1st ed. London: Thorsons.
Greenberger, D. & Padesky, C. A., 1995. Mind over Mood: Changing the way you feel by changing the way you think. 1st ed. New York: Guilford Press.
Hadley, J. & Staudacher, C., 1996. Hypnosis for Change. 3rd ed. Oakland: New Harbinger Publications.
Heap, M., 2012. Hypnotherapy: A Handbook. 2nd ed. Maidenhead: Open University Press.
Jaloba, A., 2014. Weight off the Mind. 1st ed. Sheffield: Wellthought .
Karle, H. W. A. & Boys, J. H., 2010. Hypno-therapy: A Practical Handbook. 2nd ed. London: Free Association Press.
Koenig, K. R., 2007. The Food & Feelings Workbook. 1st ed. Carlsbad: Gurze Books.
Murphy, J., 1963. The Power of Your Subconscious Mind. s.l.:Wildside Press LLC.
The National Hypnotheraphy Society, 2014. Code of Ethics. [Online]
Available at: http://www.nationalhypnotherapysociety.org/listening-to-clients/code-of-ethics/
Yapko, M. D., 2015. Essentials of Hypnosis. 2nd ed. New York: Routledge.

Bibliography
Burgess, F., 2011. The NLP Cookbook. 1st ed. Carmarthen: Crown House.
Chrysalis, 2014. Lecture notes from Module Six. s.l.:Chrysalis Not For Profit Ltd.
Geary, A., 2001. The Food and Mood Handbook. 1st ed. London: Thorsons.
Greenberger, D. & Padesky, C. A., 1995. Mind over Mood: Changing the way you feel by changing the way you think. 1st ed. New York: Guilford Press.
Hadley, J. & Staudacher, C., 1996. Hypnosis for Change. 3rd ed. Oakland: New Harbinger Publications.
Heap, M., 2012. Hypnotherapy: A Handbook. 2nd ed. Maidenhead: Open University Press.
Jaloba, A., 2014. Weight off the Mind. 1st ed. Sheffield: Wellthought .
Karle, H. W. A. & Boys, J. H., 2010. Hypno-therapy: A Practical Handbook. 2nd ed. London: Free Association Press.
Koenig, K. R., 2007. The Food & Feelings Workbook. 1st ed. Carlsbad: Gurze Books.
Murphy, J., 1963. The Power of Your Subconscious Mind. s.l.:Wildside Press LLC.
The National Hypnotheraphy Society, 2014. Code of Ethics. [Online]
Available at: http://www.nationalhypnotherapysociety.org/listening-to-clients/code-of-ethics/
Yapko, M. D., 2015. Essentials of Hypnosis. 2nd ed. New York: Routledge.

Bibliography: Burgess, F., 2011. The NLP Cookbook. 1st ed. Carmarthen: Crown House. Chrysalis, 2014. Lecture notes from Module Six. s.l.:Chrysalis Not For Profit Ltd. Geary, A., 2001. The Food and Mood Handbook. 1st ed. London: Thorsons. Greenberger, D. & Padesky, C. A., 1995. Mind over Mood: Changing the way you feel by changing the way you think. 1st ed. New York: Guilford Press. Hadley, J. & Staudacher, C., 1996. Hypnosis for Change. 3rd ed. Oakland: New Harbinger Publications. Heap, M., 2012. Hypnotherapy: A Handbook. 2nd ed. Maidenhead: Open University Press. Jaloba, A., 2014. Weight off the Mind. 1st ed. Sheffield: Wellthought . Karle, H. W. A. & Boys, J. H., 2010. Hypno-therapy: A Practical Handbook. 2nd ed. London: Free Association Press. Koenig, K. R., 2007. The Food & Feelings Workbook. 1st ed. Carlsbad: Gurze Books. Murphy, J., 1963. The Power of Your Subconscious Mind. s.l.:Wildside Press LLC. The National Hypnotheraphy Society, 2014. Code of Ethics. [Online] Available at: http://www.nationalhypnotherapysociety.org/listening-to-clients/code-of-ethics/ Yapko, M. D., 2015. Essentials of Hypnosis. 2nd ed. New York: Routledge.