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).

A broader view of body image would include more than just the issues relating to appearance but would involve the psychological perception by the individual of their body as being intact, whole and properly functioning. There are many life-threatening and life-limiting illnesses which can cause body image changes, or which impact on how the body functions; these include strokes, multiple sclerosis, rheumatoid arthritis, diabetes and cancer, to name but a few. In addition, the result of life-changing events such as accidents, surgery including amputations and colostomies, leave many people with body image issues. Some of these changes are temporary, while many remain permanent and require the person to adjust to them.

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

Assessment of body image and sexual concerns is dependent on the therapist’s attitude, knowledge base and skills in eliciting the patient’s perception of their problems. Three models which provide a framework to assist this process will be considered.