5. WARNING: Losing weight can damage your life!

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Susan is an attractive woman of 47 who wants to try Provocative Therapy to lose weight. She has been on and off various diets since she was 20. Recently she visited a gynaecologist for a well woman check-up and he routinely checked her bone density. He found that she was susceptible to osteoporosis (thinning of the bones) and advised her that it would a good idea for her to lose weight. Susan sits next to PT looking confident, even defiant. He realises immediately that she is a solid person who is likely to respond strongly to anything I say or suggest. Good! Provocative Therapy is essentially a no-holds-barred negotiation about what the patient should do about her life. It often works particularly well when patients have strong views about what they want in life.


Provocative Therapist: (smiling warmly) Okay Susan, what do you want to fix today?


Susan: I want to look at the issue of my weight, from the health point of view, my bones, my constant back problem.


Provocative Therapist: What do you want to lose? Ten pounds? Would that be a success?


Susan: Maybe if I lose 5lb or 10lb I’ll find that inner thing, I’ll think maybe I’m happy now, happy at that, then I can take a rest and try again and lose another 10lb.


Provocative Therapist: But you are happy now. If you hadn’t gone to that gynaecologist you wouldn’t even know you had a problem!


Susan: And that is not worrying me untowardly. I’m just looking at it from the point of view that you’re not getting any younger, you can’t have any more time to play with because you’ve got to address it now before it becomes a problem.


(Provocative Therapist acts non-plussed with an exaggerated quizzical look on his f ace and pretends to misunderstand what Susan means.)


Provocative Therapist: You don’t have any more time to play?


Susan: From the bone density point of view! You can’t build it back up. I’m thinking of my health Brian! (Susan laughs confidently.)


Provocative Therapist: Have you thought of taking up smoking?


Susan: (laughing, she has thought of this herself!) Everyone says that it apparently helps you and then I’ll just die of something else!


Provocative Therapist: Tell me, when you purchase furniture, do you have to buy industrial strength stuff from a special store?


Susan: No, what nonsense! I can sit on any chair, well most chairs anyway.


Provocative Therapist: Okay I’m just getting a sense of what your daily life is like. Does your refrigerator rear back in horror when it sees you coming?


Susan: (laughs) Okay I get the message.


Provocative Therapist: What message? I just need to understand your predicament. Tell me another thing: Have you considered emigrating to a country where fat people have the highest status? I can suggest several such countries - admittedly most of them are in the Third World...


Susan: (laughs)


Provocative Therapist: You’ve got lots of friends? A boyfriend?


Susan: Yes I have friends and I’ve got a boyfriend.


Provocative Therapist: Good! You know I see you as a happy confident person.


Susan: Do you?


Provocative Therapist: Indeed I do. So I must ask you: Why change at all? Are you prepared to be treated as a sex object? An object of envy? Other women will envy you if you lose weight, you know.


Susan: Well perhaps that’s good. It can be an inspiration, they’ll think, if she can lose the weight, then so can I.


Provocative Therapist: (raising my voice in strong disagreement) No, no, no, they won’t think that at all! That’s exactly what they won’t do!


Provocative Therapist: Now listen carefully to me and I will explain exactly what is going on here.


Provocative Therapist: Your girlfriends look at you and say ‘Here is this woman, she’s fun, she’s successful, she’s rich and she’s confident. And she has no problem attracting boyfriends! (Susan nods in agreement )


Provocative Therapist: Yes, they see all this and they envy it all, but they have one consolation.


Susan: What's that?


Provocative Therapist: They can say to themselves: ‘Well at least I’m thinner than she is!’ That’s a big consolation and if you take that consolation away from them, they could turn against you!


Susan: (indignantly) Well they’re just going to have to get used to me being thin!


Provocative Therapist: How can you be so heartless? And another thing, men are going to start looking at you salaciously, they will start treating you as a sex object! I mean if you have no problem attracting men as you are now, imagine what is going to happen when you slim down!


Susan: (laughing, she clearly likes the idea) That’s a problem? I don’t care if they do.


Provocative Therapist: That’s what all the girls say – until it happens to them!


Susan: I’ll cross that bridge when I come to it.


Provocative Therapist: Okay, but don’t say I didn’t warn you!


Provocative Therapist: (in a matter of fact voice) Do you ever go to a gym? You know, wear a leotard and work out?


Susan: No that’s something I wouldn’t ever do. I wouldn’t subject them to the flab.


Provocative Therapist: That’s very understanding of you; now you see why losing weight is not a good idea for so many reasons.



FOLLOW UP

Two weeks after this conversation, Susan actually joined a gym and started to work out regularly. A month after this conversation, she had lost 14lb.