Kate is 21 years of age and has a very poor self image; in fact she hates the way she looks. As a result, Kate has such low self esteem that it prevents her from looking for work. Kate’s mother is concerned about her daughter’s feelings and subsequent unemployment and therefore has encouraged her to attend counselling.

A summary of the sessions is as follows. For ease of writing the Professional Counsellor is abbreviated to “C”.?In the first session C focused on building rapport with Kate and encouraged her to talk about her feelings. As Kate is an extremely shy and softly spoken person, C asked open questions and then validated her as she responded. From this session C was able to elicit useful background information and begin to build some rapport with Kate.

Essential Case Information

Kate is 21 years of age and has struggled with her weight all her life. She remembers back in primary school how the kids used to call her “fatty” and would not want to play with her. The taunting continued throughout high school however it was more subtle. Kate found it difficult to make friends and often found herself excluded from social events.

Although Kate’s mother is very supportive, the put downs continued at home. Kate’s father would say things like “why don’t you go on a diet” or “what are you eating that for it’s only going to make you fatter”. Her elder brother was embarrassed to be seen with her and to make things worse, he was quite athletic.

A few months back, things were starting to turn around for Kate. She began a relationship with a man (Mark), started exercising and lost about 10 kilograms. Slowly she started feeling better about herself, however the relationship didn’t last and consequently Kate’s self esteem is now at it’s lowest. She blames herself for the break-up and believes that her boyfriend ended the relationship because she’s fat. However, when questioned further about this Kate could not recall a time when Mark had ever criticised her appearance, in fact he seemed to be very supportive.

At the moment Kate has such low self esteem that she doesn’t even want to try to find a job, she thinks “who is ever going to hire me”. Kate also described how her friends have stopped calling her because they say she is constantly criticising them. Kate stays at home all day and every time she looks in the mirror she thinks how ugly she is. It is important to note that Kate is currently within the healthy weight range for her age and height.

It is obvious that the foundations for Kate’s low self esteem where laid down early in life, however as an adult it is important for Kate to now recognise that she is in control of her self image and hence has the power to change it. Therefore at the beginning of the second session C discussed the issues of personal control and how it would benefit Kate if she took responsibility for her self esteem regardless of the influence that others may have had. C established Kate’s commitment to improve her self image and stressed that it was not constructive to “blame” others.

C then discussed with Kate the importance of setting her own standards and not listening to those people who tell her what she “ought” to do or look like. Kate’s father was the most obvious culprit, however C stressed that social standards also have a big influence on young people, especially women today.

The ideal woman is portrayed in magazines and on television to be extremely thin and therefore the average person who compares themselves to these models is going to feel overweight. Kate revealed that she does read a lot of popular magazines in her spare time and often feels saddened afterwards, she agreed to stop this for a while.

Finally, C asked Kate exactly what aspects of herself she would like to change in order to enhance her self esteem. Kate’s response was to lose weight, get more confidence so she could find a job and hang out with her friends more.

In the next session C began to introduce the principles of Cognitive Behavioural Therapy in order to modify Kate’s negative thinking. C explained how constantly telling herself that she was ugly and overweight was only reinforcing her negative body image and low self esteem. Therefore, Kate needed to recognise and combat inappropriate negative thinking in order to enhance her self image.

C therefore suggested Kate use a strategy called Thought Stopping and explained to her how it works. C explained that, as an example, when Kate looks in the mirror and thinks how ugly and overweight she is she needs to identify this as a negative thought and get herself to stop. C described how even saying STOP out loud will help her become more aware of negative thinking.

C then explained to Kate how the use of positive affirmations would help her replace negative thoughts. For example, whenever a negative thought about her appearance did pop into her mind, Kate needed to replace it with affirmations such as “I’m a fit and healthy person” and/or ” I’m honest and friendly”. C explained further that it would help to get the focus off her physical appearance and affirm her personal qualities. Kate agreed with C that she would try and implement these techniques.

At the beginning of the next session Kate told C how she had tried to stop her negative thoughts, but was concerned about how frequent and automatic they were. C assured Kate that it is normal for someone beginning to use Thought Stopping to be amazed by the extent of their negative thoughts. C also assured Kate that recognising the extent of her negative thinking may help her realise the importance of the thought stopping exercise. C assured Kate that she had made some progress, however she should keep persevering as it will take some time.

As Kate had a lot of time on her hands to think, C thought it appropriate to recommend some sort of activity to keep her busy and her mind more occupied. Until now C hadn’t administered the PNTP as she felt that while Kate’s self esteem was so low that she may perceive the profile as a test and therefore something to “fail at”. C now felt that Kate had already begun to improve her self esteem and the profile would be of use to help with activity choice. C therefore administered the Personality Need Type Profile and the results indicated that Kate was a Personality Type B with a score of 2,10.

Kate was not surprised at the results as she longed for greater social involvement, however as she was hardly ever invited out she had not had the opportunity to develop appropriate social skills. This lead to a discussion about the effects of not meeting needs and how it might contribute to her lack of confidence and low self esteem. C discussed with Kate a range of issues including how having a boyfriend provided greater opportunity for socialising, and that since the break up she has also had little interaction with her friends

The discussion then moved to how Kate could actually gain more need gratification. C suggested to Kate that finding employment and going to work would meet a lot of her social needs, however in the mean time she could get involved in some type of team sport. Kate stated that she wouldn’t mind playing netball again and agreed that this would provide an opportunity to socialise, meet new people and also increase her fitness. Kate was excited about the idea and was going to ask her mum to help her find a netball club.

Next, C talked to Kate about her estranged friends and asked if their was truth to their claims that she was critical of them. Kate admitted that she had been negative towards them and after a big argument they told her that they didn’t want anything to do with her until she stops being so critical. C explained how it’s common for people with low self esteem to cut others down through constant fault finding and criticism, however the rejection Kate experienced as a result has only served to lower her self esteem even further. C explored the possibility of Kate talking with her friends and explaining how important their friendship is to her and that she is trying to be more positive.

In the following sessions Kate gradually became more confident as she continued to use positive self talk, as a result her attitude also became more positive. Kate also gained the acceptance of her friends again as they noticed this change. Kate started to go out more frequently and there was a noticeable change in her level of self esteem. Consequently it was time to address the issue of her unemployment.

Cause and effect relationships are difficult to establish with cases of poor self esteem as it is such a vicious cycle. Nevertheless, it will be easier for Kate to eliminate negative thoughts such as “Who is ever going to hire me” if she begins to focus on developing some new skills. In time she will begin to believe that she does have something to offer an employer.

C approached this issue by explaining to Kate that everyone has their own personal shortcomings and some we are powerless to change, like our body type and physical features. However, working on those things which are changeable, like skills and abilities are extremely rewarding and may give a huge boost to one’s self esteem. Kate explained how she has always wanted to be a legal secretary and would love to do a secretarial course. It was decided that Kate would research the availability of courses and immediately begin teaching herself to type.

By the next session Kate was really excited as she had enrolled in a course and was due to start the following term. She explained to C how she has been quite busy and was starting to feel a lot better about herself again. When C was truly confident that Kate had accepted herself for who she was and was no longer dwelling on those things she could not change but channelling her energy it into proactive thoughts and behaviours, there was no further need for counselling. Kate may still have a long road to travel in continuing to enhance her self esteem however now she has more skills to help her on her way.

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