9 Body image, sexuality, weight loss and hypnotherapy
INTRODUCTION
Problems associated with people’s sense of their own body have increased over recent years and discussions about body image are much more commonly found in the media, alongside those within health and social care. Orbach (2009: 1) suggests that ‘millions struggle on a daily basis against troubled and shaming feelings about the way their bodies appear’. Societal obsession with the perfect body, which includes being beautiful, fit, and slim and remaining youthful; all exert unrealistic pressures on individuals. The images of perfection are everywhere and our bodies are being shaped by forces beyond our control (Orbach 2009). It is not hard to see therefore why society is beginning to acknowledge this as a growing problem.
Over recent years, an increasing amount of literature has emerged, with a number of authors attempting to define body image and develop models relating to practice. Grogan (1999) defined body image as a person’s perceptions, thoughts and feelings about his or her body, which incorporates appearance, body size, shape and attractiveness. Concern about our bodies is normal and allows us to have healthy body awareness. However, excessive bodily concern can lead on to an abnormal focus and can result in bodily obsession or body dysmorphic disorder (Webster’s Dictionary 2008).
Disfigurement is a particularly difficult body image problem relating to more than just the visual effect of the disfigurement, but linking with the patient’s thoughts and feelings about how it was acquired. Barraclough (1999) reminds us that people cope differently with disfigurement and suggests that some people can be very self-conscious to changes that are not immediately obvious to others. It is important therefore, to assess the patient’s perception of the problem, while suspending our own judgement. One way of doing this is to adopt an approach developed by Berne’s (1972) and ‘think Martian’. When asking the person to describe how they see the problem, we suspend our personal knowledge base and judgement, in an effort to see it through their eyes. This technique is very powerful because, in addition to being empathetic, the therapist also enters into the patient’s ‘frame of reference’ by listening to the language and metaphors they use to describe themselves.
Body image is closely aligned with a person’s sexuality and as such, the authors recommend a broader working definition in order that all aspects of the patient’s persona are acknowledged. White (2006) takes a holistic view in relation to this area of practice suggesting that:
Freud (1936) also recommended a similarly broad approach, reminding therapists that sex is something we do but sexuality is something we are and as such incorporates many facets of the individual. It is important therefore, that when assessing patients, prior to offering hypnotherapy techniques, we need to ascertain how their body image concerns relate to the broader view they have of themselves, and whether this affects their roles and relationships with others.
ASSESSMENT MODELS
DIRECT/NEGOTIATION MODEL
The DIRECT/Negotiation Model (Box 9.1) utilizes a staged approach to assessing body image and sexual concerns which allows the therapist and patient to proceed at a mutually agreed level. It is a 6-stage approach which is particularly useful when negotiating with the patient as to whether they wish to discuss and work with particularly sensitive areas. Negotiation is used to elicit what the patient is comfortable working with and is used throughout the assessment, enabling the therapist to proceed at the patient’s pace. This can relate to either the depth of communication they are comfortable with, or when negotiating which hypnotherapy approaches they are happy to engage in. (For further explanation of this model, see Chapter 5, and a full version, which also includes Annon’s (1976) P.LI.SS.IT (1976) Assessment Model, can be found at: www://learnzone.macmillan.org.uk.)
BODY IMAGE MODEL (PRICE)
Price (1990) developed a 3-stage model which enables the therapist or healthcare professional (HCP) to identify and explore different aspects of a patient’s body image:
BODY IMAGE MODEL (CASH & PRUZINSKY)
Cash & Pruzinsky (2002) have developed a useful framework for assessing body image concerns. Their book offers a variety of tools which patients can use individually or can be used to form part of their therapy. A body image diary is used as a way of reflecting on their body image concerns. Patients are encouraged to notice:
Applying hypnotherapy
The American Society for Clinical Hypnosis (2009) suggests three main ways of practicing hypnotherapy:
IMAGERY
Imagery is an important aspect of working with body image issues. Two modes of imagery, which are useful in facilitating this process, are: ‘diagnostic’ and ‘therapeutic’ (Cunningham 2000).
Therapeutic imagery
Therapeutic imagery entails working in a positive way with the images the patient presents, based on the principle that images affect body function. The therapist encourages the patient to imagine beneficial changes in the images they see. The patient gets in touch with both their conscious and unconscious, to consult with their ‘Inner Healer’ in the imagination, to bring about healing from within (Cunningham 2000). From practical experience, patients work well using this approach. They are usually very inventive and can fill up empty spaces with ‘magic healing fluid’, making it the colour and consistency which is just right for them. They can change parts of the body which look dark and diseased by flushing out all the dark colours and replacing them with bright healing colours. Often the healing comes about in the patient’s unconscious through seeing themselves whole again; even though the physical reality may be different.
CLEAN LANGUAGE MODEL
Finally, another useful framework worth consideration is that developed by Grove and Panzer (1991) to resolve traumatic memories. The basis of the model is the use of what they refer to as clean language (using the patient’s words). They assert that this ensures that the patient’s meaning and resonance remains wholly intact, and is uncontaminated by the therapist’s words. Working in this way opens the door to change through developing a much more naturalistic trance which avoids evoking resistance. The therapy begins by inviting the patient to tell their narrative, paying attention to the language they use. This is done by examining the auditory, visual and kinaesthetic channels used, in addition to noting how they use language in order to describe their experiences and inner realities.
Memories
Patients generally recall events from the past. However, Grove and Panzer suggest that memories can also be anticipatory and relate to future events. The memories disclosed can either be real or imagined. They suggest that when working in this dimension the focus should be on the memory, as the words patients use simply give information. It is the memory itself which is the most significant aspect in relation to the therapy which follows (see Case study 1, Box 9.2).
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