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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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