In this essay I shall be explaining the issues Mr X has expressed, as I have understood them, as expounding the presented issue with the client in such a manner is also crucial to gaining clarity and building rapport. I shall then cover any ethical considerations that need to be accounted for and then seek to devise a relevant course of treatment for him.
Mr X has stated that he has been employed as an estate agent in the same company for 18 years. He has not progressed in his work although he is fully capable as has been demonstrated by his success at covering for the manager when previously asked to. Despite this he is apprehensive to put himself forward as a candidate for the managerial position now that the role has been made available. This same strain of hesitation is evident in his belief that his colleagues must find him boring as he is unable to socialise with them, but is afraid to ask them to meet on another evening for fear of rejection. He is unable to socialise with them as they do so on Friday evenings which is when he visits his mother. She in turn is someone he does not feel able to speak up before, and therefore refrains from suggesting he meet her on another day. Again the same fear of rejection is apparent in his desire to propose to his current partner but resisting because he believes she would reject him.
In my evaluation he clearly appears to be presenting with self-confidence and self-esteem issues in addition to having a great fear of failure. Before pursuing any potential course of treatment I must, as an ethical and responsible therapist, ensure that hypnotherapy is truly suitable for his issues instead of other avenues. I would make certain at this stage that he is not suffering from depression, as it would be out of my remit to treat him were this the case, and I would also enquire from him about any medication he may be on that could cause changes in his mental state, thus interfering with the proposed therapy.
Having satisfied myself that he is not suffering from any psychosis, and neither is he on any psychotropic medication nor dependent on alcohol or drugs, would I proceed to devise a course of treatment for him.
Mr X is undoubtedly a capable man in his field at work. The manager has on occasion asked him to stand in for him, but he has clearly not valued this achievement. In addition his colleagues are also obviously eager to socialise with him, but again he has placed no value on their invitation, and still believes they view him as ‘a bit boring’. He also has a partner but again has given his role in that relationship little value and is consumed more with the prospect of rejection. All of these points indicate a deep lack of self-esteem. It is usually accepted, as pointed out by Hadley and Staudacher that ‘the major cause of poor self-esteem is past negative programming that is the product of judgemental parents.’
This is most certainly going to be true in Mr X’s case, as he has spoken of his mother’s critical nature towards him, and even now feels unable to ask her to adjust the day for his visits to her in order that he could facilitate the social night with his colleagues, for fear of her ‘picking on him even more than usual’. Self criticism forms as a disabling critical voice in the mind that in time can become self-defeating and cause the person to form beliefs about themselves that are at best inaccurate and at worse completely false. But it has to be accepted by the therapist that this is the client’s belief about themselves, therefore merely showering them with compliments would be inefficient, rather it would be more beneficial to reframe the client’s view of the problem. In this case it would be necessary to reframe the situation in a manner that allows Mr X to be more aware of his competencies, such that his self-esteem is nurtured and he is then encouraged to take the steps he so desires.
I believe that a course of 4 hypnosis sessions should help him to build his self-esteem and aid him to move forward. In the first session I would discuss with him what exactly hypnotherapy is, what it can achieve and how we shall be using it in order that he and I may both be clear on what the objective of the sessions are and what can and cannot be accomplished, so that we both may make informed decisions on whether or not we wish to continue. I would ask if he would consider having the self-esteem script that I use with him recorded in order that he may use it at home in between sessions, as listening to the script on a daily basis will facilitate a better result due to the message being repeatedly fed to the subconscious mind.
This is essential when realising that the Conscious Critical Faculty (CCF) is constantly monitoring our experiences of the world and aligning those experiences with our deeply embedded beliefs. In order to counter the negative adjustments made by the CCF, it is necessary to by pass it through hypnotic suggestions regularly, until the CCF has been altered. At the fourth session I would do a review with him to analyse how he is feeling; how he feels therapy has benefited him and whether or not he feels he may need further sessions. It is my opinion that composing a self-esteem script for him and coupling this with affirmations and some practical NLP steps to boost his motivation, will resolve many of his issues because, ‘Self-esteem is one of the fundamental influences on nearly everything you do. When your self-esteem is low, almost all areas of your life – working, socializing, loving – are made more difficult.’ (Hadley and Staudacher).
At this point I would also be looking out for any secondary gains or hidden agendas. I do suspect that he may have a secondary gain: he claims that he cannot propose to his girlfriend because ‘he does not have much to offer her at present’, and so I wonder if perhaps he is scared that if he is promoted to manager, he will also now have more to offer her as he would be better off financially and in a more stable, respectable position. May he be frightened of the prospect of marriage? Does he feel incapable of being a good husband, of building a family and becoming a father himself? Does remaining in his position at work allow him to excuse himself from a range of other experiences? At such an early stage of the process however, I would not confront him with any of these speculations as it may cause offence, anger or upset. Instead I would continue with the suggested self-esteem script (see Appendix), affirmations and triggers, and if by the fourth session little progress has been made, I would hope that enough rapport has been built in previous sessions to allow me to explore the possibility of hidden agendas and secondary gains with him openly and truthfully.
I would begin the self-esteem script in a manner that builds his self-esteem in general in the hope that building his self-esteem holistically would go on to affect his ability to approach his boss for the managerial position, to ask his colleagues to change timings for socialising, to confront his mother without fear of her responses and to propose to his girlfriend despite the possibility she may reject. I would also allow for some specific work on his confidence at work in the script.
Having assessed him as being visual in modality, I would tailor the script to appeal to this modality. This would begin with a PMR script to relax him physically and mentally and I would encourage him to engage with these techniques outside of the sessions to calm himself when he is feeling nervous or tense. The script will then go on to deepen this state of relaxation, as it is believed that a deeper state of relaxation should allow for greater suggestibility and more imaginative imagery (Class Notes, Module 4).
Suggestions would be utilised in the script to let go of past experiences of rejection and other inadequacies that have been identified in discussion with Mr X. This would be done by using the image of a blackboard before him, which has a list of all the negative beliefs he has about himself, in his own words. I would then have him erase each negative word, in so doing removing its association with him and thereby ridding him of this past negative programming. As he removes each negative word I would ask him to replace it with a positive word. Again, this would be a word that he aspires to which I would have gathered from him in discussion. This would hopefully teach him to begin to associate these words with himself instead. I would then narrow the attention of building self-esteem to his workplace by anchoring him to successes that he has had. I would hope that reminding him and reframing his experience of work as a successful and respectable one will undermine the ‘inner critical voice that produces an internal fear’ (Hadley and Staudacher) thus allowing him to grow in confidence and self-acceptance.
If at the review he feels happy with his progress and would like a specifically tailored script for the job interview or any other situation, then we could discuss the possibility of me writing a more specific one then, but for the time being I would hope that a general script will be sufficient.
I would encourage him to listen to the recording of the self-esteem script daily but I would also give him exercises to build up his motivation. For this I would use NLP techniques. NLP teaches that there are 4 steps to success: firstly, to know what you want. Secondly, to take action to achieve that goal. Thirdly, to notice the results of what you did. And fourthly, to be prepared to change your behaviour until you get the result you wanted (Alder, 2009). I would encourage Mr X to discuss his goals and what he hopes to achieve from these sessions, to perhaps write them down and to consciously commit to these objectives. This is important as ‘having clearly expressed outcomes gives you the maximum chance of fulfilling them’ (Alder, 2009).
I may even encourage him after a few sessions, if he sees his self-esteem rise, to set himself a smaller objective such as striking up a conversation at the coffee machine with a colleague at work whom he has not previously spoken to, or to ask his girlfriend out to somewhere he wouldn’t ordinarily have done. It need not be a lengthy conversation or a particularly exciting date, but just make him realise he can approach people without fear. This would aid him in becoming the change he requires, not just wanting and imagining it. I would encourage him to see the outcomes of these actions; the sense of pride he feels, the confidence, and the accomplishment. These are all rewards for his positive changes. I would hope that these NLP teachings would inspire in him the confidence to grow and accept that rejection is not failure, but an opportunity, an experience by which he learnt how not to do it next time, to adapt himself the next time he is met with the same opportunity and to continue to enjoy the successes he thereby reaps.
In addition to this I would recommend he use positive affirmations. I believe that for most clients, affirmations are an effective tool in the artillery against low self-esteem, as Waterfield notes, ‘Affirmations work by reframing. A bad self-image is self-fulfilling: it gives out bad vibes to others, making them dislike you, which increases your negative self-image and so on and so on.’ Affirmations in my opinion work as a hammer persistently knocking away at the negative self-beliefs a person has until they have been smashed away. I would give him a simple phrase such as “I am getting more confident each and every day” to repeat to himself and when possible to visualise himself with all that confidence because mental practise of confidence will improve confidence as well as taking physical steps to change. (Alder, 2009)
I would hope that at four weeks we would have seen good progress in his self-esteem, resulting in him taking the steps towards those objectives he had set himself at the beginning of this course of therapy. I would hope that he has been enabled through this confidence to apply for his job, to broaden his social circle at work, to feel more relaxed and confident in his relationship with his girlfriend whether or not he decides to propose and to feel able to express himself to his mother without fear of her cutting remarks. If I found that issues with his mother were still presenting problems, I would consider referring him to a counsellor who can help him work through his issues regarding his mother.
Alder, H., “NLP: The New Art and Science of Getting What You Want”
Hadley, J. and Staudacher, C, “Hypnosis for Change”
Waterfield, R., “Hidden Depths”