M decided to give up smoking, as she didn’t feel comfortable with her habit out of control. She asked me for help as she had tried to give up smoking several times and she failed. As a result she decided to try hypnotherapy.
She was explained the ethical implications of working together as she is my close friend. She was also informed that because am a student she will not be charged for the session and she agreed for her treatment to be used for the purpose of this case study as long as her personal details were omitted. I also informed her that I was bound by a code of ethics and she received the details of it prior the treatment (Hunter 2000 ps146-148).
As we have already had a chance to talk about hypnotherapy in the past and I practiced PMR on her daughter, her expectations about hypnotherapy were realistic and she wasn’t afraid of being hypnotised. She agreed to undergo one session treatment where I would use a booklet containing information about smoking and its results in a pre-hypnotic setting before delivering personalised screed that would use her fears and ambitions to good effect.
The session went well and she enjoyed it. It has been two months since the treatment and she has not returned to the habit so far.

Initial Consultation

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M is 69 but looks much younger. She is light built and medium height. She is generally healthy and doesn’t take any medications. She is friendly and cheerful. She used to lead active life as used to work as a prison warden and hike in forest in her free time, however since she moved to large town to be closer to her grandchildren her only activity outside was occasional walking and taking care of her allotment where she plants flowers and vegetables. She complained that there was no forest anywhere around and that she didn’t have much to do in her new place. She is retired now.
M’s parents didn’t smoke at all. Her husband used to smoke a lot for many years but gave it up 4 years ago for health reasons. She started smoking when she was 20 but that was just an occasional social smoking in company of their friends. She quitted it completely when she got pregnant. She began smoking again shortly after she got retired. Initially it was an incidental smoking however she admitted that recently she reached more than 10 cigarettes a day and that increase worried her. When questioned “Why?” she explained that she realised that with age she became more fragile and she didn’t want to suffer unnecessary health problems. It was apparent that she was afraid of losing her physical fitness and becoming left out as a result of that. As she admitted that she smoked when she was feeling bored or useless I realised she might use smoking as a consolation and to pass the time.
She has two daughters and both of them visit her often together with their children. Both granddaughters are vivid and demand a lot M’s attention. Consequently she needs a lot of stamina to keep their pace and that might have attracted her attention to her diminishing capability.
She never smoked outside and the only place she smoked at home was on her balcony, as she didn’t want to smoke in her family presence in order not to expose them to passive smoking. Her health and health of her family are important to her.
She tried to give up three times during last two years. First time she tried to cut it down gradually using nicotine patches. Then she tried to quit at once. The third time she tried to give up with help of self help books. Each time she went back to smoking quickly however she wasn’t sure why. M was informed that I would not be able to help her to give the habit up unless she really wanted to stop smoking and that the final result of the session was dependant on the fact if I had her full cooperation. She agreed. She gladly completed the questionnaires given and promised to read the booklet I gave her.

Diagnosis

Having spoken with M I felt she had big chances to succeed. She was determined and had enough of good reasons to quit however to be successful she also needed to adjust her life pattern. By paying close attention to her personal situation it was apparent that she needed more challenge and activity in her present life as feeling useless and bored led her to the habit. Furthermore, the companionship of cigarettes lessened feelings of isolation and loneliness after she moved from her old house to the city (Hadley and Staudacher 1996 pg72). Additionally being aware of diminishing stamina and physical fitness made her anxious that she wouldn’t be able to take care of her grandchildren.
She really wanted to give up smoking for all the above reasons and she also had support of her family to do that, however because she unsuccessfully tried to cease smoking in past her confidence suffered. I thought it needed the booster in order for her to succeed in smoking cessation for good.

Treatment plan

During the initial consultation we agreed for one two hour-long session and M was advised that it was a complete abstinence programme. She agreed and we set the session date for the next day.
First stage of the session was aimed to investigate her habit in detail, present her facts and figures regarding smoking tobacco and talk her through the possible effects of smoking based on the info contained in the booklet she was given during the IC.
In my opinion the important factor contributing to her previous failures was the boredom and idleness she experienced after she moved home. Consequently the second part of the session was aimed to make her aware of that relation and decide how to change her life pattern in order to make it more attractive and physically involving to her.
Then I planned to explain her the hypnotherapy process and perform hypnotherapy session. As she uses a lot of visual and kinaesthetic expressions when she talks I decided to use compound modality for her screed and because she used to work as a prison warden I believe she reacts better for direct and authoritarian style (Chrysalis 2014 M2 p18). Therefore I decided to use authoritarian screed of compound modality beginning with PMR and a deepener relating to her interests (running in forest).
Because she failed to give up several times I decided that the screed needed to contain elements of ego strengthening (Chrysalis 2014 M6 p19) and as recently the amount of the cigarettes she smoked increased I have chosen the powerful screed based on imbedded and direct suggestions coupled with visualisations and elements of aversion therapy to help her to cease the habit effectively. When I created the screed I used few ideas from Diamond Smoking Screed by Roger P. Allen (Allen 1997 pg 253) and Nonsmoking Induction by Hadley and Staudacher (Hadley and Staudacher 1996 pg 79), as they seemed to fit perfectly to M’s needs.
The last stage of the session was planned as a feedback after the hypnotherapy and additional advices to follow after the session.

Session Content

M arrived to the appointment punctual and excited. She was very determined to give up smoking. On scale 1-10 she gave herself the highest mark (Chrysalis 2014 M6 p19). She even mentioned that she had got rid of all smoking paraphernalia and spare cigarettes from her house before she came to the session. I congratulated her on determination and reminded that achieving success in the matter would be her responsibility when I gave her the best help I could (Chrysalis 2014 M6 p31).
As we like each other as friends and her daughter told her about good results of the relaxation session I had with her it was very easy to establish good rapport. We started with talking trough the history of her habit. She mentioned that her husband also felt strongly that she shouldn’t smoke and he supported her in her attempts to cease smoking. Actually it looked she was the only person that smoked in her circle. That and the fact that her husband managed to give up smoking gave her additional reasons to quit. She felt guilty that she was the last person burdened with that habit among the people around her. I explained her the subconscious affecting the habit and assured that she had much bigger chances to free herself from smoking this time if she engages fully (Chrysalis 2014 M6 p20).
When asked what benefit she had from smoking she mentioned: “It is something to do with my hands” and “A cigarette is something to wait for.” However in “WWW questionnaire” she revealed that she usually smoked when she felt lonely. When asked if she thinks her husband also felt lonely at new place she said he was more outgoing person. It looked she had some difficulties to find her place in new surrounding and wasn’t confident enough to go out to meet new people. I have suggested to consider a counselling session about that problem and she agreed to think about it.
There was a moment I suspected her to treat smoking as a way of attracting attention to her however she never smoked in presence of her family and claimed that she received more than enough attention from her relatives. Further questions confirmed that statement. She was embarrassed that she still couldn’t give up smoking. She didn’t seem to suffer with stress nor with pressure, however more questions revealed that she found it difficult to find something engaging to do in her new environment.
We went through the “WWW Questionnaire” and I have explained her that it was necessary for her to find new constructive and realistic options for the left column records, as she needed to change her behaviour pattern if she wanted to succeed.
I asked if she considered the possibility of involving in any other kinds of additional physical activities than cross-country running. That would make her form better and reduce the boredom she suffered. She answered that she might try swimming as her husband was a good swimmer and went swimming twice a week. We agreed that walking with her granddaughters in the nearby parks might be a good idea as well; especially that it could reduce her feeling of being idle.
When we moved to facts and figures regarding smoking she seemed to be aware of all the dangers and it looked she thoroughly studied the booklet given the day before. Before we started the hypnotherapeutic session I assured M that she could withdraw at any time during the treatment if she wished.
She was advised that she would remain motionless during the session so it was a good idea to use the toilet if needed before we begin. After she returned I have asked if she had any questions regarding the therapy. She didn’t have any.
I have chosen the PMR based on the forest motif, as M likes forests. Apparently it was a good choice as she relaxed very fast and with help of the deepener she reached the necessary hypnotic state. Her breathing was shallow and regular and she was sitting motionless but comfortable on the chair with her hands close to her sides. After she relaxed in her special place (dream forest) I delivered the ego strengthening suggestions in order to build up her confidence. Then implicit suggestions were given that she was already able to give up smoking. I supported them with numerous positive suggestions to convince the subconscious that smoking cessation is positive process and not deprivation (Karle and Boys 1978 p91). The client remained calm and seemed to be hypnotised deeply as the unexpected noise of the dustcart outside didn’t create any visible reaction despite the fact that it was very loud.
At this stage I delivered the metaphorical suggestion of M giving up smoking (Hogan 1961 pg 319) and then I noticed vivid REM for the time of the metaphorical picture. When we returned to positive suggestions the eye movements slowed down. Then I delivered a visualisation that included elements of aversion therapy however as many therapist suggest limited effectiveness (Karle and Boys 1978 p 93) and high relapse rates in such method of treatment (Cherry 2018) I decided to focus more on positive suggestions in further part of therapy. I utilised the motifs of her family and health, as they were important for her during the IC.
No visible signs of discomfort during the whole screed were noticed and the only noticeable reaction from the client while hypnotised were rapid eye movements and unusually flushed cheeks. The client came out of hypnosis without any problems.

End of treatment and Results

After reorientation M was puzzled and sleepy so she was advised to remain sitting for a while which she did until regained the balance. Asked about her feelings she confirmed she enjoyed the treatment and that she is a non-smoker now. She was advised about the possible withdrawal symptoms and cravings and we have discussed the improvements in her lifestyle in terms of participating more vividly in her family life and sport centre activities. M promised to keep me updated on her non-smoking. The effects of the therapy still remain successful after two months from the treatment.

Limits and flaws

I found the screed very long and considering that English isn’t my native language I found it very energy draining as I had to focus constantly on appropriate pronunciation, voice tone right emphasis and pace of the delivery. I was concerned about the effects of the treatment, as I didn’t have a chance to deal sufficiently with client’s problems to find her space in new town during a single session. However that wasn’t the main purpose of the treatment and she was advised about it as mentioned above.

Conclusion

M’s attitude towards giving up smoking was outstanding. From the beginning till the end she was committed and determined to succeed. This, combined with personalised PMR and authoritarian compound screed worked well. She is happy about the outcome and hopefully will not smoke again. The therapy revealed some other fields she could be helped but it is up to her if she is going to work on them in future as she was advised.

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