ABSTRACT
Miss W M came to therapy for weight loss. She is a size 20 and would like to be a size 16. In August she is invited to a wedding where she will give a speech and she wants to look very good (she understands that quick weight loss is not healthy, so she is happy if she would not be a size 16 in August, but approaching her goal gradually.) She is 14 stone (approx 88 kg) and 1.48 cm tall, BMI 40.2. She is diabetic, and has to eat regularly.
She is a single mum with 2 teenage sons and often feels tired and stressed. She is a bit worried about the family’s finances. She works in a voluntary organisation too which she find very inspiring.
INTRODUCTION and INITIAL CONSULTATION
At the initial consultation I used my notation form and gathered as much relevant information as possible about Miss W. I examined her medical, family and life history, including her childhood and relationship history.
I already had a good relationship with the client because she is a fellow student at the psychology course. At the initial consultation I tried to deepen this good rapport by giving my full attention to her and practising active listening. I used positive sentences that were empowering to help Miss W to feel at ease.
We ascertained her goal: she would like to lose weight gradually and be a size 16 instead of being a size 20. I explained her that the the safe weekly rate of weight loss is between 0.5 kg and 1 kg. That’s between around 1 lb and 2 lb a week. We assessed that for a safe and healthy weight loss she will need at least 6 month (approx 20 kg).
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While exploring her childhood history I focused on her relationship with food and dieting. During her childhood the family had just 2 meals per day. They ate a proper breakfast and throughout the day they just drunk (mainly water) and they had another proper meal in the evening. They were eating from one plate so the children had to eat very fast if they wanted to have enough. She kept this habit and eats quite fast.
In her family (and also in the society in Zimbabwe) women who were slim were considered unhealthy: a woman has to be curvy to be fertile and being able to deliver babies. She said she was never very slim but looked healthy. When she became pregnant she gain weight and it stayed on, because she was busy and did not have time to exercise and take good care of her. The same weight gain happened with her second pregnancy. She had more weight on but still felt healthy, active and attractive. When she had to leave her country and her husband died, she started to gain more weight and not long after she came to the UK she was diagnosed with diabetes.
She eats twice a day quite big portions, and I explained that it is essential to have regular meals in moderate amounts during the day. We agreed that she would make some changes and try to eat 3 times a day, eating healthy snacks between two main meals. We discussed what she is eating now, and agreed that she has to eat a wider range of food to ensure that she’s getting a balanced diet and her body is receiving all the nutrients it needs.
I asked her how motivated she was, and she said that she feels highly motivated and ranks herself between 9 and 10 on a scale of 0 to 10.
She did not have hypnotherapy for weight loss, tried some diet but because of her hectic lifestyle she did not managed to follow them. I explained that the key to keeping weight off is to make changes to her diet and lifestyle that she can stick to, and hypnotherapy can help to make and maintain these changes.
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1. The behavior I would like to change is my poor eating habits. I do not eat three meals a day, and the foods I eat are not always healthy. My roadblock is; I have an extremely busy schedule, which does not allow me the time to eat full, healthy meals. The new behavior I'd like to begin is eating three healthy meals a day, regardless of the amount of time I have. 2. In an average day I do not eat ...
To find out the reasons why Miss W overeats we used the chart in the Hypnosis for Change book (pages 63-65) and examined when, why and where she was overeating. We also looked at new options and alternative activities instead of eating. She eats more in groups, at business lunches and at social events. Miss W treats herself to a meal whenever she needs a reward or to relax. We were able to see clearly that her “danger areas” – the situations when she is more likely to eat excessive amount of food – are the gatherings, hence she will monitor herself how much does she eat at the next occasion.
I also looked for any hidden agenda in her case. I asked a lot of open question and also used the chart mentioned above, but I was not able to identify any at the first consultation. I will keep an open eye on it and look for any veiled motive or intention, because sometimes the clients are not consciously aware of their hidden agendas and for an effective therapy these need to be discovered.
I also assessed her modality, learning style, individual needs to be able to write a personalised screed for her. Because she is also working for her hypnotherapy diploma she tried a lot of different types of induction and she asked for 2 (Elman and the one with muscle relaxation) which she found the most effective for her.
Before our meeting I researched and learned what the DIABETES UK’s website contain about weight loss and healthy lifestyle. I printed the important parts and gave them to Miss W. We talked through and discussed in detail all the topics. I also gave her advice where to look for if she needs extra support (dietitian, etc).
We talked about the benefits of her planned weight loss.
Because she is diabetic I needed to obtain GP permission for Miss W. I talked to my tutor who agreed to go on with this case study. I asked the client to talk to her GP and ask for permission to carry on with our therapy. At first she said that this is not necessary but I insisted and told her that I can’t continue to work with her if we don’t have her GP’s permission. Finally she agreed and got a verbal permission from her GP.
The client is a fellow student at the hypnotherapy course hence there was no need to talk about hypnotherapy and how it works. For the same reason we did not use trial induction, but started with the weight loss screed right away.
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Regarding the confidentiality policy I reassured her that I will treat her as a client and not as a fellow student and all her information are secured and protected from disclosure to others.
I have considered whether we have any ethical issues and concluded that this case study does not appear to have any ethical issues.
I suggested her to keep a food diary and take sometimes photos of her meal so we can discuss how healthy her choices were.
I encouraged her to eat regular meals, try eating slowly, chew every bite well and be more active (walk more and carefully start to exercise).
I told Miss W that she can support her weight loss and dieting efforts by making healthy lifestyle choices.
She seemed to be very motivated and keen to start the therapy.
DIAGNOSIS
Miss W is heavily overweight (BMI 40) and has Type 2 diabetes. She got her GP permission to go for weight loss with hypnotherapy. I investigated the reasons of her overeating: she treats with food as reward and as a way to relax. Miss W also eats too much at gatherings.
I also examined whether I can treat Miss W and have found that her problem is within my professional competence. Besides I discussed this case with my tutor and she agreed to carry it out and gave me advice (how to work on weight loss with a diabetic person).
TREATMENT PLAN
I’d initially suggest a course of 6 therapy sessions, agreeing to review at any time along the journey, increasing or decreasing the number of sessions if necessary. The scripts we will use must be tailored to Miss W’s needs, taking into account her background, the reasons why she overeats and all the relevant information gathered.
In the screeds I will use hypnotic suggestions to reprogram her subconscious into eating healthily, being more active and making positive changes in her lifestyle. I will also use self-esteem boosts, and positive images of her. I will stay flexible and adjust the screed to the client’s needs and progress.
I’ll suggest her to use positive affirmations and make healthy lifestyle changes.
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SESSION CONTENT
21/03 Initial consultation and the first hypnotherapy session. (I already prepared a screed for her which I modified (see in italic text) according to the information gathered during the initial consultation.)
When we worked on the “why, when and where” chart mentioned above regarding new options, she wanted to change the food she eats when taking her medication to juice. I told her that she has to talk to her GP and ask for permission if she`d like to make such changes.
Next time we will work with the weight loss script that I’ll revise and adjust as necessary.
28/03 At the beginning of the session we talked about how Miss W felt, what changes were made; what, how much and how she ate (when, how, etc.).
She hasn’t started the food diary and I explained why it was important and what we can learn from it. We used the revised weight loss script for the hypnotherapy session.
We discussed positive affirmations, how to make them and how to use them effectively. I gave a screed to her to record onto her mobile (she has no other suitable gadgets) and practise self-hypnosis because of the Easter holiday we couldn’t meet for another 2 weeks.
Although she ate less unhealthy food she started to drink more juice and more alcoholic drinks which are not healthy, especially when being diabetic. Next time I will include unhealthy drinks in the screed and talked through this problem with her. Because alcoholic drinks were involved I also talked to my tutor and we agreed to keep an eye on the problem and if the alcoholic drink consumption increases or doesn’t stop I will immediately contact her.
We planned a session on the 18th of April but Miss W did not turned up. (Later she called to excuse herself.)
23/04 We talked through what happened since we met. She felt fresh and happy. She managed to stop drinking sweet and alcoholic drinks. She doesn`t have a food diary, so we talked about her eating habits and what and how much she ate using what she remembered. I explained again the importance of a food diary or some pictures.
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Nowadays, there are more and more students work part-time job in their free time. Actually, a part-time job can provide money and working experience to them. But it partly disturbs their study as well. So the high school students should not be encouraged to have a part-time job because of the following reasons. Firstly, most high school students are too young to work. Specifically, they still lack ...
She eats 3 times a day, seated, and has smaller portions than before. She eats more vegetables, less meat, and no sweets. She said she tried to drink more water (she stopped drinking juices) but struggles. She started to walk more and does some exercise at home 2-3 times a week. I encouraged her to continue with this more active lifestyle.
She did not measure herself but feels as if she started to lose some weight. We used the same script we used last time. Next time I will include encouragement to drink more water in the screed. We worked with the same weight loss script we used last time.
30/04 She managed to continue eating healthily and she lost half a stone. We talked through how and what is she eating and I found that her eating habits have really improved.
Still she didn’t use food diary and didn’t record the self hypnosis screed I gave her last time. I talked to her about the importance of her motivation and explained that she has an active part in the therapy and she has to take it seriously.
She was stressed today, had problem with one of her kids at school and also had difficulties at work (her passport expired and until she gets a new one she is not able to work.) We used a longer, very relaxing, induction, which she liked very much and was able to relax and enjoy the session. She felt good and more confident afterwards.
We planned a session for 7th May but Miss W cancelled it. I asked for another session the following week but she did not answer my messages/emails.
END OF TREATMENT AND RESULTS
The therapy worked for Miss W (she successfully changed her eating habits, became more active and started to lose weight).
Although she seemed very determined at the beginning I now doubt whether she is really motivated. Even though the therapy started to work for her I believe we could have an even better result if she did follow my advice and came to therapy regularly. I felt that as a fellow student she didn’t act as a client but rather as a fellow therapist and decided for herself instead of following instructions and she didn’t take the therapy as seriously as she should for a successful treatment.
LIMITS AND FLAWS
I’d prefer not to work with a fellow student again. Miss W didn’t follow all my advice and it seemed that because she was studying the same subject she decided for herself what to do and what not which I cannot accept (I’m eager to have feedback and ready to change the therapy’s content if needed but would like to plan and lead the therapy.)
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Many people have busy lives, especially someone who has to juggle more than one task per day. The people in particular that I am talking about are college students. How some of us have jobs and need jobs that help keep us in school. The tough part is that we have to spend most of our time on school which leaves very little time for work, even thought we do have to work to make a decent amount of ...
Miss W didn’t take the therapy as seriously as she could have therefore it was not fully successful even if she made some progress.
Conclusion
Hypnotherapy is a fantastic tool for weight loss but the client has to be highly motivated to achieve her goal. The therapy worked for the client but I am not considering it as a success. I’d like to meet Miss W and discuss in detail the problems I mentioned in the END OF TREATMENT section. I’m willing to continue to help her with her weight loss if she can accept that she has to follow my instructions (we can change them if she does not like them or they don’t work for her) and we have to meet regularly.
Appendices:
* Notation form
* Pinpointing when, where and why you overeat chart (copy)
* 3 screeds for weight loss
Bibliography
* Josie-Staudacher Hypnosis for a Change
* Roger P Allen Scripts, Strategies in Hypnotherapy
* Handbook of Hypnotic Suggestions and Metaphors D. Corydon Hammond, Ph.D
* Chrysalis Course Notes
