EXAMPLE ANSWERS: Q12

Q12. Propose an ethically and therapeutically appropriate approach for working with an adult whose presenting problem is weight control who confides in you that they over use laxatives to control their weight condition.

Learning outcomes: 1.5

Student answer If I was approached by a client who was using laxatives in order to control their weight I would seek to establish more background information. I would find out whether this is an established pattern and if they have or are being treated by a medical professional. If there is no medical intervention I would consider referral or advise them to seek medical advice. It may be that I also direct them to information such as https://www.nationaleatingdisorders.org/laxative-abuse-some-basic-facts and ensure that they are aware of some of the dangers e.g. electrolyte or mineral imbalance which impacts on colon and heart functioning; severe dehydration and resultant symptoms; prevention of the usual function of the colon and internal organ damage or death. I would ensure that they are equipped with the knowledge that laxatives are not effective for weight loss as they work on the large intestine- by the time food gets there most of the calories have already been absorbed. Laxative abuse causes water loss which will return as the client drinks fluids. I would only consider therapy if I felt I had adequate competence and if this would not be in place of or contraindicate medical treatment. I would make sure that the client agrees to a follow up session as I would not feel that his should be a one off. If I did decide to progress I would use metaquestioning to establish detail and function. A surface observation of the individual’s body shape may influence a line of question – is the person under, average or overweight? What is their desired outcome of taking the laxatives? Is the underlying focus an issue about body confidence? What have they tried previously? What are the changes they would like to create – healthy eating, exercise- and how would they know that these have been achieved e.g. a certain item of clothing fitting in a certain way. From the responses I would select an intervention. As many issues of body image have an element of control within them and I might use a type of control panel. I would make sure that I was clear as to which way the scale needs to go e.g. your level of confidence is at a 3 and you wish to increase this to a 7. I would then commence with an induction with ideomotor responses combined with a deepener and convincer to ensure that the client is in the therapeutic state. A relaxing place would be established and then I would ask them to imagine themselves on a screen looking and feeling confident and in control. I would ask them to imagine a remote control which has a volume control on it. This volume control can be seen on the screen as they turn it up and down – just like it is on your television. But this volume control is labelled confidence and note where it is at this point (3). I would then ask them to decrease the scale slightly- to level 2 so that they experience the dip and then turn the volume up finding that it moves easily and with little effort. With each press it moves the confidence and they can see the changes that it makes upon the ‘them’ on the screen. Noticing the way in which they show confidence – what it looks like, what it feels like…. This would continue until they are at the point where they are at or as close as 7 as they can be. I would then ask them to remove the batteries on the remote control – making sure that the volume will stay at the level it has been set –a level they have chosen and one which is comfortable to experience. Then I would use future pace to visualise and experience the ‘them’ in the screen in scenarios in which they are confident and happy with their body and the control they have over it –in a positive way. I would then return to the client to full waking awareness and ask how they felt now that their sense of confidence and ease within their body had increased. I would ensure that they contact me with feedback and book the follow up session that has been agreed. (LO 1.5 An ability to determine an ethically and therapeutically appropriate approach for more complex cases where specific training may not be available)

Tutor feedback (DO NOT delete/edit feedback. Write amendments, additional information & thoughts underneath this table) Correct. A sensitive and considered approach to this challenging client scenario. Well thought out and put together, thank you.

(Further student work goes here if requested through feedback)

Further Student Example Answer:  I have no intention of working with Weight Control clients, however should I encounter a client who is using laxatives for weight control I would inform the client of the dangers of over using laxatives due to the damage they can cause to the bowel function becoming impaired and potential long term health issues which may develop.

I would advise them to contact their GP for help and also offer to refer them to an experienced hypnotist who does work with Weight Control clients if they wished once their doctor has agreed.

I would expect an ethical hypnotist would want to establish the underlying cause of the laxative use verses reduced calorific intake plus exercise routine and work on both aspects of the clients issues.

Stopping the use of the laxatives as soon as possible to allow the bowels to resume normal function, offering alternative forms of relieving constipation if required, then work on the causes of the client over eating with aversion therapy possibly a hypnotic gastric band intervention. Finally providing the client with positive motivation to lose weight and get fit and healthy which would ensure a long lasting change.