Treatment 2: Psychology and skin disease

In this chapter we hope to provide an
understanding of the central issues involved in
counselling. We will outline our definition of wha
counselling is and the potential benefits of
counselling to dermatology patients. We also
discuss some of the most commonly used and
effective techniques in counselling people with
skin disease.

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Help your therapist help you

A common problem that arises when with counselling in medical settings is that your counsellormaymake assumptions about the nature of your condition and the way that it affects you, unless you are able to clearly express your feelings to him or her.In order to know how you understand the problem, the counsellormay ask for information about certain key areas regarding your illness experience. It’s often a good idea to think about this beforehand. For example, you may want to consider what the skin condition is, its course, duration and possible treatments that might be associated with it, Also how the condition affects you psychologically, coping with the condition, its effect on daily activities and on your perception of yourself? It is important to address these issues. Lack of understanding about your concerns by the counsellor can lead to problems in the therapeutic relationship and delay the benefits that you can reap from counselling.
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Do You Have Dry Skin?

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Why Does Skin Become Dry? The horny layer is water-resistant, but not waterproof. We are constantly losing water through our skin, as water from body cells slowly migrates to the surface and evaporates. On an average, we lose about a pint of water daily this way. (This is in addition to the water we lose through perspiration from sweat glands.) But certain factors can increase the rate at which your skin loses water. If you live in a dry climate, for example, you'll probably experience dry skin because arid air speeds up the evaporation process. Most of us get drier skin during the winter, too, regardless of where we live, because artificially heated air is dry. Another factor is age. As we get older, the horny layer loses some of its ability to hold water in. Not surprisingly, many of my older patients complain of dry skin. Pampering Dry Skin How can you counteract the drying process? Certainly, a mild cleanser and effective moisturizer are important. in a coming post we will tell...
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Treatment 1: The people (health professionals, skin camouflage and support groups)

Professionals involved in the treatment of skin disease The parents of a new-born baby with a congenital skin condition or a person who acquires a skin disease later in life may be confronted by a wide range of health professionals. In this section we list the professionals that a skin disease patient may meet at some point during their health consultation, and briefly describe the role they play. As will be seen, the problems associated with skin conditions can be many and varied and a wide range of health professionals can be involved in the treatment process. Dermatologists These are physicians who specialise in dealing with skin conditions which require medical treatment. The conditions that dermatologists work with include acne, psoriasis, eczema, vitiligo, urticaria and some skin cancers. They often prescribe conventional medical treatments such as steroid creams, tablets, lotions and sessions of ultraviolet light therapy and can give good advice to patients and parents of childre...
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Cognitive behavioural therapy

Cognitive behavioural therapy (CBT)was developed by Aaron Beck in the 1960s to help treat depression. Beck believed that the way people thought about their lives and the events around themwould affect the way they felt. If a person had positive or rational beliefs they would feel fine; if they had negative or irrational beliefs they would feel emotionally unhappy. The beliefs that you have about your condition can influence how you cope with it.Negative or irrational beliefs such as, ‘I have done something bad to deserve this illness’, or ‘Everything in my life is ruined now’, will inevitably make you feel low and upset. More positive beliefs on the other hand, such as, ‘The illness is only a small part of me and I will cope with it’, will make you feel more positive about your condition. Negative or irrational thoughts are often the result of ‘errors in processing’ wherebyexperiencesandinterpretationsaredistorted(Beck,1976).Such‘cognitive errors’ include: l Selective abstraction – atten...
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Distraction

Another technique that you can use to control anxiety due to negative thoughts is through the use of distraction. This technique is useful when you find yourself becoming anxious or distressed in a particular situation. If, for example, you begin to feel anxious while on a bus because you are worried that others can see your psoriasis lesions, then you may use distraction as a means to help divert your attention from the anxiety-provoking thought. There are several ways that this can be done.
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Skin-Care Basics 2

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The importance of skin care cannot be underestimated. Did you know, for example, that the skin is the largest organ of the human body? Mostly we take our skin very much for granted and don't spend much time thinking about the skin’s functions and their importance, until some problem occurs or we injure ourselves.The following article provides some insight into why good skin care is important and suggests a simple skin care regime anyone can follow to help your skin perform at its best. In addition, it discusses some lifestyle factors which will improve your skin if followed. It's not rocket science, really it is just common sense. HERE ARE SOME IMPORTANT TIPS FREE FOR YOU 1.Precious drops of olive or almond oil added to your bath water enhances a creamy, shiny and smooth skin. 2.To prepare a rich oil bath, blend together a quarter cup of olive oil, one tablespoon shampoo, one cup vegetable oil and one tablespoon lemon juice. Use one or two tablesp...
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Explaining skin disease to children

“Samantha was a happy, outgoing 6-year-old who had been born with a large port-wine stain on the left side of her face and neck. The mark did not seem to bother Samantha. She and her mother referred to it as her ‘strawberry stamp’, and joked about how it was proof that she loved strawberry ice-cream. When she was around other children, they would ask her questions about it and she seemed comfortable talking about it and consequently did not appear to have difficulties engaging with other children. As the time approached when she would be starting school, her mother, Janice, began to feel concerned about how other children in the class would react to her. She decided to speak to a teacher at the school who suggested that it might be a good idea if Samantha could talk to them about her birthmark. She suggested that through this any erroneous ideas that the other children had about Samantha could be dispelled and she could take control of the situation by offering explanations that she fel...
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Skin disease and the parent–child relationship

The relationship between the child and the parent may have implications for the way in which the child makes sense of and copes with his or her condition. Research suggests that one of the most significant factors in the development of behavioural problems of children with disfiguring skin conditions is the reaction of the parents to the illness or deformity.Over-protective parentswho shield their child from social problems, such as teasing, may prevent the development of childhood friendships and social skills, which are vital for later life. The birth of an infant of remarkable appearance can cause delay in how they bond with their mother and result in sadness, similar to that experienced by mothers of infants with other congenital disorders. Normal reactions of parents, which tend to occur with the birth of a child with a skin condition, are detailed below. Parents of children with skin disease should be aware of these. l Parental mourning, i.e. the denial, anger and sadness that the ...
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Challenging thinking errors

After you have learned to identify negative thoughts you will need to learn to change. If you are working with a therapist you will find that he or she uses questions to help you to challenge your beliefs. She will encourage you to think through alternatives to your beliefs or responses rather than holding on to your negative thoughts. For example, a therapistmight ask a patient who is worried about other people noticing her eczema: Counsellor: What is the worst thing that you could imagine if someone was to see the patches on your arms? Patient: That they would stare at me and wonder what was wrong with my skin. Counsellor: Well, let’s assume that that’s what would happen.Why would that be such a terrible thing? Patient: I don’t know, I guess I just hate the idea of people staring atme. Itmakes me feel uncomfortable, I never know what to do. Counsellor: Perhaps if we could work on some practical coping strategies together such asmaking eye contact with the person that is staring, or di...
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Remembering positive aspects about appearance

Another techniquewhich can be useful in copingwith changes in your appearance is thinking of, and listing, positive aspects of your appearance. So much emphasis may have been placed on your skin condition that it becomes all that you see when you look in the mirror. You may ignore the fact that prior to the onset of the condition you liked certain things about the way you looked. You may find yourself focusing only on the skin disease and minimising the importance of other bodily features, or indeed the importance of your body as something more than just an aesthetic object. If this is the case, you need to try and ‘look past the skin disease’ and identify what parts of your appearance you are happy with. Doing this can help remind you that you are more than your skin problem and that your appearance may be attractive in other ways. Graded exposure The fear and apprehension that a person feels about themselves and others may dominate all aspects of their life. In the same way that a pe...
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