This client asked me for bulimia hypnotherapy. I really wasn't sure what to do. Bulimia is known for being extraordinarily difficult to treat. I asked her about her history. She was very open and happy to talk about her condition. She said that at its height she would vomit three times a day. Pretty much after every meal. She ended up dangerously thin.
Her life has been dominated by bulimia. It started in her teenage years. She managed to stop on her own when she left university and had to get a new job. She felt that she would now be in control. And it worked. When she got her first job she realized that she couldn't keep doing this and keep a job. Then she changed jobs. She had a week in between. This allowed her mind to begin to ask "what if?" And she just fell apart. She left the new job after two days and had three months off.
Bulimia Hypnotherapy
Right now she is worried that she is going back into it and vomits twice a week. I couldn't really find any one thing that triggered it or that she was worried about. Her parents had always been helpful and supportive. She could not think of anything in her childhood that might have set it off. She said in it was all about anxiety.
This gave me the idea that I might be able to deal with the anxiety directly through metaphor replacement. I asked her to think about the anxiety and what it was like just before she feels she has to vomit. She said is a mixture of anxiety and fear. I told her to focus on the fear. I got her to concentrate on the fear to allow it to come out to be aware of it. Fortunately for me it was right at the surface and she was able to latch onto the fear immediately.
I asked her where the fear was in her body. She said it was in her chest and in her head. Previous experience has shown that I cannot do anything when the client says the feeling is in the head. So I focused on the feeling in her chest. I asked her what it was like. After a while she said, "it's like a square". I said, "is it a square or a cube?" "It's a cube."
I then got her to describe the cube in increasing levels of detail. She said it had sharp edges. When I asked "how big is it?", She said "it's about the size" and gestured with her hands indicating was about the same width as her body. It was hard, cold, solid, heavy, and grey. When I asked, "and what else to know about this cube?" She said, "I have to carry it about with me."
Metaphor Replacement for Bulimia
Having established the fear as an object, it was just the case then of getting her to change it. I asked "can you imagine making it a little bit bigger?" She immediately said "yes". I asked, "and can you make a little bit bigger still?" "Yes." "And even bigger?" "Yes." "And can you make it a little smaller?" "Yes." And she proceeded to demonstrate that she could make it a little smaller.
I encouraged her to make it smaller and smaller until at some point she said "it's in my hand I can hold it". I asked her, "and what is it look like now? How has that thing changed?" She said, "has rounded edges, like a die". I then asked her what she would like to have happen to this thing. She said, "I would like to throw it away". I asked, "And where would you throw it?". "Into the ocean." I needed to make sure that she got rid of the thing completely. So I asked, "and where would you throw it into the ocean?" She said "from a clifftop".
I then said "now imagine yourself on that hilltop. Imagine you have that die in your hand, and you are throwing it off the cliff". To my surprise, she picked up a hand and made a throwing motion. I said to her, "describe what is happening as that thing goes into the ocean." She said "it's gone into the water with a splash". I wanted to be sure that the object was totally destroyed. So I said to her "what happens to things that went to the ocean?". She said "they settle on the bottom".
I could not get her to give any more detail, so I prompted her to begin thinking of how to destroy the object. I suggested that saltwater might have an effect on it. She said "is beginning to rust the surface is now mottled". I then went on to suggest that the rust would continue, it would flake off, that thing would break up into small parts. I then got her to agree that the thing would get rolled around in the waves and broken up into tiny pieces like sand. They would just be dispersed out and gone forever.
Then I asked her to take three deep breaths and relax even more.
In that state, I asked her to become aware of her own body. I told her, "now check on around your body. Check your knees and your knuckles in your nose and everywhere. See if there's anything left of that old fear that needs to be dealt with. Or has it all gone?"
After a moment she said "it's all gone".
Her Experience of bulimia therapies
We then spent some time talking about bulimia and how it affected her life. It really is a devastating disease. She was a lovely young woman, and yet had never had a boyfriend. We talked about the various therapies that she had been involved with.
I asked her "what did you find most useful to you in those therapies?" She said "I found a form of group therapy very helpful. I met a lot of people, very ordinary looking people, who also had the same illness. That allowed me to believe that I actually was normal. There wasn't something weird about me. That I wasn't the only person in the world to do this. I also found some of the CBT exercises that I was given were useful in turning off the thoughts".
Then I asked her to check again about the fear that she had been talking about. I wanted to be sure that I had actually made a difference to her. She said, "no, it's really gone. I can feel it. I know that is just not there now."
How would you approach this case? Share your ideas below.
