Using the Case Study Provided at the End of the Module Identify and Explain the Client’s Issues and Devise a Course of Treatment for Him, Taking Into Account Any Ethical Issues.

Presenting Issue and Background Mr X is a 45 year old man who has worked at the same Estate Agency for 18 years. He has presented to me with the issue that he would like to apply for the manager’s position at his branch but his lack of confidence is holding him back. Mr X has stood in for the current manager on many occasions so he knows that he is capable of doing the job but has reservations as he doesn’t want to cause any upset amongst the other staff or management if he is not successful.Further discussion with Mr X revealed that one of the reasons he would like the job as manager is so that his mother would be proud of him and show him a little more respect.

She is currently living in a home and he visits her regularly every Friday night although he says she tends to pick on him. Mr X isn’t clear how or why his mother picks on him, just that she does. It also transpires that Mr X’s colleagues tend to go out for drink after work on a Friday night on a fairly regular basis but because of his commitment to visiting his mother he feels he cannot join them.He believes that they find him boring and unsociable because of this. Mr X has considered changing the day he visits his mother on the odd occasion so he can join his colleagues but feels his mother wouldn’t understand this and would pick on him even more than usual. He has also thought about asking his colleagues to join him on a different night of the week for drinks but believes they would say no and fears their rejection.

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Mr X has a girlfriend he describes as a ‘sort of girlfriend. ‘ He says he would like to propose to her but, again, fears rejection.He also doesn’t feel as if he has much to offer her which is another reason the manager’s job is an attractive prospect. Mr X seems to be a man who is very aware of other people’s feelings and worries about how he comes across and what others think of him. I have assessed him as visual in modality. Assessment The first thing that jumps out about Mr X and his presenting issue is that he obviously has a serious lack of confidence.

He doesn’t believe in himself and his own abilities, either in his personal life and personal relationships, his relationships with his co-workers, or in his career.However, the first thing I would take into consideration in this case is something not actually mentioned in the initial information provided, but it’s something that would give me concern and something I feel would need to be addressed before any treatment was offered. Is Mr X suffering from depression? As a therapist it would be unethical for me to treat a patient who has not been diagnosed as being depressed but whom I feel may be suffering from depression.In this instance I would suggest to Mr X as politely and as tactfully as possible that he seek help or advice from his GP before seeking any further assistance from me. This is obviously assuming that as an ethical and professional therapist I have taken a medical history and have asked for information regarding any medication Mr X is taking and also any additional or alternative treatment he is receiving and have taken it all into account.

If Mr X has already had a diagnosis of depression then I would, again, have to consider my options before agreeing to treat him.As a novice therapist I am not allowed to treat a client who is suffering from depression and I would probably refer Mr X to a more experienced associate, explaining that he would receive a more fulfilling and successful treatment from Ms Y than from me. As there is no mention of depression or anti-depressants in the initial information provided I am going to assume Mr X is not suffering from depression, either diagnosed or undiagnosed and I am able, ethically and to the best of my ability, to treat him. The presenting problem seems to be a lack of confidence. Mr X wants the confidence to apply for the manager’s position.He also wants the confidence to be more interactive with his colleagues and to be comfortable in social situations with them.

The situation with his girlfriend also appears as if it could be fixed if Mr X had more confidence in himself. However, as the lack of confidence seems to be prevalent in many different parts of Mr X’s life, and having taken all of the information provided into account, I believe he is suffering from a lack of self-esteem as well as confidence. I would go as far as to suggest that his relationship with his mother probably has a lot to do with his current confidence and self-esteem issues.It seems as though she still has a lot of control over her son and he considers her thoughts and feelings above everything else. I believe he is always searching for her approval and respect and maybe this is another reason for not asking his girlfriend to marry him as his mother may not approve. I believe there is a secondary gain for Mr X in that if he increases his confidence enough to apply for the manager’s job and gets it he will then be in a position where he will feel as if he is a good enough prospect to propose to his girlfriend.

If she were to say yes then that opens up a whole new set of issues regarding his family and specifically his mother. Will his mother approve of his girlfriend and their impending marriage? Will his mother understand and accept that he will then have other family related responsibilities which may take priority over her? Or is Mr X really as keen to be in a position to propose to his girlfriend as he says? He calls her a ‘sort of girlfriend’ and to me this doesn’t suggest he’s very committed to her and certainly not committed enough to think of marriage.Is his lack of prospects just an excuse for not proposing and in fact he has been using his lack of confidence as a barrier to moving on with his life? I feel it is almost as if Mr X needs to ‘grow up’ and take responsibility for his own life and happiness instead of always searching for the approval of his mother. He is 45 years old and he should realise that he needs to be his own person now. He needs to learn to be firm with his mother but that it doesn’t mean he won’t still be treating her with kindness and respect.The fact that he has now asked for help suggests he is somewhat aware of these issues and maybe even accepts that he needs to address them, especially if he is going to change his future both in his career and in his personal life.

For the purposes of this study I will assume he is the one wanting the help and it isn’t his girlfriend or mother pushing him to move forward in his life and improve his career prospects. Treatment Mr X needs to learn to look at things differently and to react to them in a positive way. He needs to stop assuming people will always be looking for the negative in him and try to promote the positives.To do this we need to use Neuro Linguistic Programming, or NLP. NLP is the use of certain techniques to promote successful and positive behaviour.

By suggesting and promoting a specific way of thinking you can change a person’s self-perception and help them to change the way they behave, act and react in certain situations. Some of the techniques used in NLP are: Pacing: It is important to build a rapport with your client and a good way to start this process is by pacing yourself with them. A therapist will adjust the way they behave and the speed at which they speak to align with their client, hopefully inducing a level of trust.Leading: Once you have successfully ‘paced’ your client and shown that you understand them you can then ‘lead’ them towards a way of thinking and behaving that will benefit their situation. Matching: This technique assists with pacing and helps to further build a rapport with your client. Essentially you match your client’s behaviour, mirroring the way they are sitting and other body language.

People will generally feel more at ease with you, feel more comfortable with the process and learn to trust you more quickly.Metaphors: There are many different types of metaphor and their use helps get across messages in a simple and easy to understand way. They are very useful in NLP as they can be personalised and scripted to meet the client’s personality, their hobbies or anything else important to them, or they can be applied to many different issues a client may present with and used accordingly. Affirmations: The client can repeat positive phrases or statements to themselves or the therapist can use them during an induction to help encourage and reinforce positive behaviour or beliefs.During our therapy sessions I would initially try pacing and matching with Mr X to help put him at ease and encourage him to trust me.

He obviously has self-esteem issues and he may feel self-conscious so the matching should be especially useful in making him feel more comfortable and relaxed. The first technique I would suggest to Mr X would be the use of positive affirmations. Phrases such as: I am a good person and I deserve to be happy. If I believe in myself then so will others. I have a lot of great qualities.

I am a strong, capable person.Other people like me for who I am. I would encourage Mr X to repeat these phrases to himself whilst looking in a mirror. By doing this on a regular basis Mr X should begin to believe in them and his behaviour should slowly alter accordingly. It’s like introducing a self-fulfilling prophecy. An alternative for Mr X saying these affirmations in a mirror would be to write them down on cards and leave them in areas of his home he frequently goes to.

Good places to use could be the cupboard where he keeps the teabags, his bathroom cabinet or even the fridge.These affirmations will also be used in a personalised script for Mr X, see attached PMR and deepener, and used during our therapy sessions. Feedback from Mr X as his therapy progresses will be essential. The induction and script can be altered as the therapy sessions continue, changing what doesn’t work and expanding on the elements that do. I will also need to assess how hypnosis as a whole is working for Mr X so I can give him some idea of how many sessions he will need.

Again this could change depending on how Mr X responds to his treatment.