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Case study, number 2 of 3.
Miss E weight loss
Miss E came to see me asking for help to lose weight. Miss E is 27 years old and other than her weight is a fit and healthy young lady. She works full time as a staff nurse in a busy city centre hospital. Miss E is currently single and sharing a flat with her older sister who is also a nurse at the same hospital. Initial consultation
Having filled in her initial consultation form and establishing that there were no ethical issues that would prevent me from working with Miss E. I began by asking her what she hoped I could help her with. Miss E didn’t appear to me to be obese. At 1.65m tall she was unhappy with her weight which was currently 77kg. I wanted to establish how much weight she realistically thought she should lose. Using her weight and height I calculated her Body Mass Index at 28.30 , this meant that her goal of a one and a half stone (9.53kg) weight loss was realistic and achievable. We chatted for the next thirty minutes, in which time I discovered that Miss E had always had a problem with her weight but her biggest problem was not the loosing of the excess pounds but keeping them off. She was a classic yoyo dieter. I asked her how old she was when she first felt unhappy with her weight. She replied by telling me she could not remember a time when she felt happy with the way she looked. The youngest of four sisters, she explained that her mother and sisters were constantly dieting when she was a child and she grew up thinking it was normal to constantly criticise the way you looked. Food was seen as the enemy but also the source of comfort. There were always cupboards full of biscuits and crisps, but these were forbidden and only there for their father, although in times of stress or reward they were all allowed them as a treat (which happened on an almost daily basis). Having established the source of Miss Es negative body image we talked about her current eating habits. It was easy to see where she was going wrong. Her daily routine was to skip breakfast and buy a sandwich from the canteen in her lunch break. Dinner was often eaten on her own as she and her sister never seem to be on the same shifts. They had no set routine when it came to food shopping, both of them stocking the fridge whenever they had time. I asked if they still had a cupboard with biscuits and crisps in, not always she replied, only if their parents were visiting. She also told me that the staffroom was always full of tempting chocolate and homemade cakes, presents from grateful relatives to the nurses on the ward. Those tempting treats were always going to be there we both agreed, but hopefully with my help she would be able to resist them, most of the time. We then went on to talk about a time when she had felt really happy and relaxed. She told me about a holiday her and her sister had taken three years ago just after she had qualified. It had been a last minute deal, two weeks in Portugal all inclusive. I asked her to describe the place to me and what it was about the holiday she found most relaxing. Miss E talked in great detail about the pool the sun the relative quiet having studied hard for three years it was nice to have nothing to worry about. It had all been so last minute that she had not even had time to go on a diet before hand, something everyone did before their holidays. I asked her how she felt about her body during the holiday. She told me she would have liked to have been a stone lighter than she was but that she was very good at keeping covered up, only dropping her towel at the pool side before jumping in. She agreed that that was what she was hoping for, although she felt that she had gained an extra half a stone since the holiday that she was also keen to lose. I explained that realistically she should hope to lose one to two pounds a week, and with a few changes and positive thinking that should not be a problem. The challenge would be to keep the weight off once she had lost it; something I felt fairly convinced I could help her with. . During our chat I closely observed Miss Es eye movements and listened to the way she described her holiday looking for the subtle clues as to her modality and weather she would respond best to an authoritarian or permissive screed. Whilst describing her holiday Miss E painted a picture of the resort describing vividly the colours of the sea sand and pool. I jotted down as much as I could whilst she was talking which helped me to recreate the holiday for her under hypnosis. I decided that Miss E had a visual modality as she used very descriptive language, I also judged her to be more receptive to an authoritarian approach. Diagnosis
Miss E only wants to lose about a stone and a half, and realistically doesn’t have a set time limit to achieve her goal. Her body image and eating habits need to be addressed, she needs help to realise that food is not the enemy and that there are other ways to reward or comfort herself other than binging on unhealthy snacks. Treatment Plan
I explained to her that I would like her to come and see me once a week for the next three weeks, after that time we could discuss weather this could be reduced to fortnightly sessions. The initial session will focus on her body image and healthy eating. During the second and third session attention will be paid to the future and the impotence of a healthy diet and good eating habits. I will use the happy memories of her holiday to help her relax and see her body in a positive light. If she is successfully losing weight we can then discuss how often she should come for therapy. Session Content
During her first session Miss E was very relaxed and her breathing was slow and steady. I noticed a slight smile on her face when I asked her to see herself in the mirror in six months time. At the end of our first session Miss E reported that she felt ‘wonderful’ she was very enthusiastic and told me that she could not only see herself in six months time but that she could actually feel how good it felt. I asked her to weigh herself as soon as she got home and make a note of it. I told her she did not have to reveal her weight to me but to let me know if it had changed when she came for her next session. Miss E was equally enthusiastic when she came for her second session. She informed me that she had lost three pounds, and was feeling great. Her only concern for the coming week was that she had to work four night shifts. These were always hard she told me because they disrupt you’re routine and that the other nurses always eat sugary snacks to keep them awake. I promised I would try and help her with that. Because she had easily gone into hypnosis the first time I decided to use the rapid eye induction followed by a deepener and then took her back to her special holiday place. This time I added in praise for how well she was doing and also included some positive suggestions to help her during her time working nights. At the end of our second session I asked her how she felt about the rapid induction, compeered to our first session. She told me she had liked it and that it had felt a bit weird that her eyes would not stay open. She also told me that this time when looking in the mirror she was wearing a bikini instead of the swimming costume she was wearing during our last session. Before leaving I chatted to her about some small changes she and her sister could make to help her stay on track. I suggested pinning a shopping list up in the kitchen with a rota that would fit in with their shifts. I asked if her sister was supportive of her new healthy routine. Very much so she replied, and said not to be suppressed if I gained a new client. Another two pounds had been lost when Miss E arrived for her third session. I asked her how she had coped with the four night shifts. She told me they hadn’t been a problem as she had planned in advance and taken healthy food with her to work. She has also taken to keeping fruit and yogurts in the fridge in the staff room to stop her being tempted by the goodies. This time I focused on the long term benefits of healthy eating and exercise. Empathising that she should always feel good and positive about herself and her body, and that this could be achieved with healthy eating and exercise. I also repeated the rapid eye induction and deepener as she had responded well to it the previous week. I asked how she felt about only coming every other week as she was doing so well. She seemed to panic slightly at the thought of this and said she would prefer to continue coming every week as she was still worried that she would slip back into old habits. End of Treatment and Results
At the end of our three sessions I was very happy with Miss Es weight loss as she had lost three pounds during her first week and a further two when she came for her third session, a total of five pounds in two weeks. I’m sure she will continue to be successful and reach her target weight. Although I will continue to see her once a week until she feels more confident. Limits and Flaws
I felt that I was too quick to suggest that Miss E limit her sessions to every other week. I felt very uncomfortable when I saw her visibly show signs of panic. At that point I backtracked very quickly apologising and stammering slightly. This probably looked very unprofessional, but I took a couple of deep breaths and calmly reassured her that it was not a problem. With hindsight I think I mistook her enthusiasm for confidence and will be more attentive to that in future. Conclusion
Overall I was pleased with the way the three sessions had gone. I was able to take Miss E into hypnosis relatively easily and once there was able to let her visualise herself how she wanted to be. I believe I will have to continue to see Miss E regularly over the coming weeks as her negative relationship with food is so deep-set. I am preparing a self hypnosis training script to go through with her at her next visit, so she can continue her good work at home. Miss E reached her target weight after nine weeks and so far has managed to maintain successfully.