Questions and Answers About The Skin Deep Method
Q: Why is there so little research on the application of psychological
techniques to skin problems?
A:Only a small percentage of dermatologists, allergists, or immunologists
specialize in the psychological side of skin disorders. Very few mental health
practitioners and researchers have turned their attention to skin problems.
Economics is also a factor. What influences the availability of research funding?
Psychological approaches can't be patented and bottled, so few drug companies
are handing out research grants. Almost none of these diseases will kill you,
which has a strong, negative impact on government research funding. The national
organizations that actively lobby for more research typically prioritize drug
development and basic medical research. I can't fault these decisions,everyone's
first choice would be a quick and definitive cure, but we are in an age of new
appreciation for the role of psychosocial factors in medicine, and more work is
beginning to explore the areas that the Skin Deep program uses.
Q: Should I stop using the cream or pills my doctor prescribed when I start
your approach?
A:Everyone using the program should have a medical workup first. Typically, by
the time people come to my door, they have seen several or more practitioners. A
drawer bulging with pills, creams, and lotions is commonplace. None of these
have been a cure-all, but what about the one or two that are somewhat helpful?
This is something each person must decide for himself or herself. If I feel a
treatment is clearly not appropriate or may be harmful, I will share my concerns,
remind the person that I'm not a dermatologist, allergist, or other relevant
physician, and strongly urge a second medical opinion.
Q: Can I use the approach for other problems, such as migraines, irritable
bowel, chronic pain, hypertension, asthma, or whatever?
A:Most of the techniques can easily be adapted to other problems. I've focused
on skin disorders partly because I've had more experience with them. It has also
been especially valuable for people to have a book that addresses their unique
problems and solutions, integrated with those issues that are more universal.
Please borrow, adapt, customize, and apply as much as you can to other areas. I've
certainly borrowed a great deal in the reverse direction.
Q: I'm already in ongoing psychotherapy. How do I integrate the Skin Deep program?
A:Having completed or being in ongoing psychotherapy is a plus. Don't despair if
the therapy is helping your life but your skin hasn't improved. Often
psychotherapy (or relaxation training or meditation) can make a major
contribution but doesn't produce results by itself. This is not to say that it
can't; more commonly, the approach hasn't been focused on skin issues, and that's
not where you see results. The Skin Deep program is designed to bridge
the gap and focus the potential of the other techniques on the skin.
I often see people who are in ongoing psychotherapy with someone else. Typically,
the primary therapist and I will have telephone conferences to coordinate both
sides of the work, and I will urge the therapist to read material that will help
him or her be more aware of possible links between life and skin issues.
Psychotherapists are almost always excited and receptive to this collaboration.
The whole is greater than the sum of the parts.
Q: How long does it really take?
A:Prediction is a tough business. The world record is held by two people who
told me that their warts went away after our initial phone contact to set up an
appointment! Warts do not disappear on their own, so it may be an artifact, but
I suspect not. Other practitioners have had the same experience.
Several years of psychotherapy may be necessary to set the stage for successful
skin work. For others, resolving a portion of the life issues opens the door to
resolve a portion of the skin symptoms. Then the next chapter of the emotional
growth sets the stage for more skin improvement.
Some skin problems vanish forever and that's that. For others, the war is
lifelong, and the techniques let you win more of the battles more of the time.
Ten to twelve weekly 45-minute visits is the "basic course" for people
who come in to the office. A thorough diagnostic workup, training in the
techniques, and at least beginning results are usually a realistic expectation
in that time frame.
Q: Why does all my turmoil come out through my skin rather than other organ
systems?
A:Heredity sets the stage for some problems, such as psoriasis. Some people are
born with one or another organ system more or less durable, more or less
reactive. Physical injury or deprivation may leave an organ system more
vulnerable. Too little, too much, rapidly fluctuating, anxious, or inappropriate
attention to an organ system may leave it more vulnerable. Some things in life
are just bad luck or good luck.
The "Why There?" chapter addresses why the problem may be on
your nose rather than your toes. Why your skin rather than your pancreas or knee
joints? This is a question worth asking, although expect to reach a point of
diminishing returns after a while. The above paragraph is a good starting point.
Q: Do you really think all skin problems (or medical problems) are
psychological?
A:This is really several questions in one. Can we imagine a skin or medical
problem that would not have emotional impact? With the exception of a condition
that was trivial or one that was totally hidden, I can't.
Q: Which of the diagnostic and treatment techniques work best?
A:"Listening to Your Skin" (see chapter 2) is the core of the
diagnostic program. Taking the key feelings out of your skin and into your mind,
heart, and actions is the essence of treatment for most people. Still, there is
a significant minority who have no use for all that "psychobabble" and
get good results with just the hypnosis and ideal imaginary environment . "Why
now?" is often very productive, but about one-quarter of the time it's hard
to make sense of the answer.
The Animal Test wins the award for the most answers for the fewest questions. I
use it in individual work, and it gets an especially good response in workshops.
Psychotherapy and holding on and letting go issues are universal. Depending on
the person, they may be discussed very directly or be there more "between
the lines."
Q: Do people keep doing the hypnosis after things improve?
A:Approaches range from A to Z. Some see improvement in their skin and often
life changes as well and then stop the self-hypnotic work?hopefully forever. (If
the problem were to recur, they could simply dust off the techniques.) "Positive
addiction" characterizes another group. These people have come to regard
their hypnosis breaks as essential as brushing their teeth or washing their
faces. It is its own reward quite independent of skin concerns. A middle group
gears up hypnotically when hard times are on the horizon then tapers down or
stops when their lives and skin are on track.
Q: Are tapes helpful?
A:I work more and more with tapes. There are some very good relaxation, imaging,
and healing tapes available at bookstores. I give everyone I see here in the
office the option of our doing an individualized tape. About one-third to one-half
take me up on it.
We usually record the part of the actual session in which we do the same
exercises described in this book. A library of different versions is a
possibility.
Q: Do you see specific male\female differences? Do more women come in? Do
women get better results?
A:Women come in about three times as often as men. This is about the same ratio
as nonskin psychotherapy and counseling. Most of the diseases and conditions are
not particularly more common in women than men. The usual explanation is that in
our society, it is easier for a woman to admit that she has needs and to talk
about them. Men are more often held back by the myth that a "real" man
should be like John Wayne out on the plains, "not needing nothing' from
nobody" except perhaps his horse.
Q: I'm totally fed up and despairing. I've tried everything from the
conventional medical to the alternate and holistic approaches, everything in
your book, and nothing works for more than a few days.
A:It is certainly possible that you have an "incurable" problem. You
may have to wait for some new medical advance or a shift in your personal
ecology or life circumstances to get relief.
Yet it is puzzling that anything works even briefly, if that's the case. It is
even more striking if a number of things have worked, but not for long.
Something is fishy. Take two chapters ("What If It Got Better?" and "Holding
On/Letting Go" ) and call me back.
Q: Do you use hypnosis for age regression and finding specific critical early
traumas?
A:I used to believe and suggest to people that the idea of a key trauma that
single-handedly created the emotional or physical problem was just too simple.
The related idea that going back in hypnotic age regression and reliving and
reintegrating that trauma could produce quick and dramatic results also seemed
simplistic. Instead, I believed that most skin and emotional problems were the
results of patterns of many individual instances built up over longer periods of
time.
Now I think that both scenarios are quite common. Posttraumatic stress disorder,
dissociation, multiple personality disorder, and vulnerability to physical
symptoms are now better understood. Devastating experiences, whether in wartime,
natural disasters, or individual accidents or assaults, can create problems in
otherwise healthy individuals.Physical and sexual abuse can go on for long
periods and be the culmination of a pervasive pattern of lack of love, respect,
or protection. Yet a single instance of either of these experiences can send an
otherwise healthy person into a tailspin. Hypnosis is a very useful tool for
tracking down and defusing these traumas.
Q: The self-hypnosis started out pretty well but now whenever I do it I fall
asleep. What's the story? What should I do?
A:If you fell asleep once in a while, it would probably just tell you to get
more sleep. Some people need to avoid the two hours after big meals because of
sleepiness. Doing the exercise at bedtime and then fading off into sleep rather
than doing the 5, 4, 3, 2, 1 is a good option. Your problem sounds like
something else entirely.
Q: What about exercise?
A:Vigorous, regular physical exercise is essential to good health. It is
physically and emotionally the closest thing that we have to the Fountain of
Youth. Depending on your problem, you may need to carefully plan the type or
amount of exercise you do.
Q: I've been meditating (been doing relaxation exercises, been in
psychotherapy) for years. As helpful as it's been, my skin hasn't improved a bit.
A:Have you been focusing the techniques on your skin? You'd be surprised how
many people have been working hard at approaches similar to those in this book
and hoping for skin as well as life results but have not really focused on skin
symptoms or built clear bridges between the life issues and their skin. Generic
relaxation, meditation, and psychotherapy sometimes result in skin improvement,
but more usually they do not. Don't take this as an indictment of the work you
have been doing. Go back through the book and see how you can use it to bring
the benefits of what you are already doing to your skin.
The hypnotic state gives you a door to thoughts, feelings, and memories that are
much more distant in ordinary consciousness.
This is the good news. This is also the bad news. You are probably on the verge
or tuning into something that feels like too much too soon. The sleep is a self-protective
mechanism. It may be a very necessary protection. Old fears can turn us
all into ultraconservatives despite our usual political inclinations.
Here's an approach. Do your usual exercise but repeat regularly the message, "Something
has me feeling edgy, uncomfortable, scared. I don't need to tune into anything
unless the time is right. Self-protection is legitimate and worthy. My inner
self may present things to me that shake me up but not anything I'm not ready
for. I can keep anything on 'hold'' for as long as I wish, but perhaps I'm more
worried about this than I need to be."
With the combination of support, "elbow room," and encouragement, you
may well be able to get back to the benefits you'd been reaping before. A next
step would be to identify intellectually what you are in flight from. Then when
the time is right, you may want to grapple with the emotions.
Q: What about groups?
A:I'm a great believer in the power of the group. Self help and mutual help
groups are discussed. Psychotherapy groups are very useful. I routinely send my
individual therapy patients (both those with and without skin problems) to these
groups as an adjunct.
Q: What problems do people present with most often?
A:The "big six" are eczema, warts, genital herpes, psoriasis, acne,
and hives. Then would come itching and scratching unrelated to any of the above,
recurrent infections, venereal warts, hyperhidrosis, and shingles.
Q: Is your whole practice skin problems?
A:About two-thirds of the people I see at this point have come in for a reason
directly or indirectly related to their skin. Some have come for treatment of
specific symptoms, others more to focus on life issues, but with some relevance
of past or present body, sexual, or skin concerns.
Q: Do you teach?
A:I don't do regular classroom teaching. I do lecture regularly to professional
and lay groups. I also do clinical supervision of therapists in training both at
Boston's Beth Israel Hospital Psychiatry Department and privately.
Q: Do you see people from out of town?
A:At first I didn't. It just seemed unrealistic to accomplish anything of value
in the short visit to Boston that was realistic for most people. I was wrong.
Now I have people send me the written answers to the diagnostic exercises before
they come. The people who are willing to hop on a plane to get the care they
need are usually both highly motivated and very action-oriented. They get an
enormous amount done in a brief time. Some continue parts of the work with
practitioners back home. Others may come several times over the years. Telephone
follow-up and tapes to take home help bridge the geographic gap. For a few, my
being a thousand miles from them has been a plus. Some people's sense of shame
at having the problem or seeing a psychologist is so great that if I lived in
the same city they would never have come in.
Q: How is this approach seen in the medical mainstream?
A:I find that physicians and nurses are more and more informed and excited about
the role of the psychosocial factors in medical treatment. The much more
difficult question is what can they do with this information in day-to-day
practice. To say "You seem to be under a lot of stress and that is probably
having a lot of impact on your skin" can feel pretty lame to both patient
and practitioner if that's the end of the conversation. Many skin patients are
reluctant to follow up on mental health referrals. Many areas do not have mental
health practitioners who are well informed about skin problems. At this point,
many more professionals are open to the role of emotions than have specific
resources, techniques, or referrals to offer to patients.
Q: How can I help my doctor get more tuned in to the psychological side of my
skin?
A: Ask if he or she would be willing to read key sections of this book or pass
on copies of a few of the most relevant articles from medical journals. Remember
that most professionals are swamped with reading. The more you can track down,
copy, focus, underline, or otherwise facilitate access to the material, the more
likely it will be read.
Before you begin the education process, really press yourself to define your
goals. What specific changes in your doctor's behavior are you looking to
produce. Could you produce this change more directly by asking for it? Is your
hope unrealistic? If your doctor were to read all the material and agree
enthusiastically with every syllable, then what? Are you trying to turn a high-tech
plumber into a poet? Some physicians and nurses are quite tuned in to the
emotional side and are very intuitive, supportive, and empathic, yet neither
their training nor the caseloads make the hope that they could do a sort of
informal psychotherapy realistic.
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