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Breaking The Itch/Scratch Cycle: 

One Young Woman's Story

Until recently, I'd never heard the word "excoriation," but now I know it was my primary symptom:  "scratching so severe as to tear the flesh." That's what I did every night, clawing until blood flowed. I was shocked to read that neurotic excoriation is caused by emotional difficulties 98 percent of the time. I was taken to doctor after doctor from 1957 to 1971, but this was never mentioned; no one acknowledged that I had emotional problems. Perhaps my parents thought the problems would go away if they pretended they weren't there. Maybe they were ashamed to admit their daughter might have such problems.

Nighttime was the hardest time. Without the day's distractions, it was just me and my itching, me and my skin. Kids with severe eczema have an early self-awareness that comes from confronting themselves in the dark every night. The nightmare is your own body; the monster is you. This is emotionally devastating to a child because it breeds self-hatred; when you feel so bad, you think you must be very bad, what did you do that you're being punished for? Parents' reassurances are dwarfed by the power of the itch, like an evil spirit. It was basically a solitary struggle.

At age eight I was fascinated by Houdini because he had been able to escape any physical confinement, handcuffs, straitjackets, chains. I myself was put into straitjackets, handcuffs, chains, and gloves to keep me from ripping my skin to shreds every night. I would spend my nights figuring ways out of confinement; I'd wriggle my skinned and bleeding wrists out of the cuffs and tear at my flesh with a sense of triumph.

Eventually, I learned to stop myself from scratching by concentration:  I tucked my hands under my butt and pretended they were paralyzed. But whether I struggled to free myself to scratch or to stop myself from scratching, I would only strive for a harsh physical control over my body. For three years, I was a wild animal with myself as prey.

I was a secretive child, always ashamed of my skin. Trying to hide, to pretend I was normal, to fool everyone by remaining mysterious, I lived in a fantasy world. I hated to explain my allergies:  I told all sorts of lies, believing no one would go near me if they knew the truth. I became cynical at a very young age, hardening myself after so many disappointments:  the doctors promising miracle cures, my parents promising miracles from God.

Looking back, I can see the sexual side of my eczema. I was able to touch and play with my body more openly than most children; strangers were always peering at and touching my naked body. I needed to have oils and lotions rubbed all over me, a task I particularly enjoyed when performed by my father. He gave me a good workout with his big, muscular hands.

Scratching was like ecstasy to me:  digging my nails in and running them up and down my body was orgasmic; I moaned and grunted as I scratched and clawed myself.

I can remember the advantages. Everyone gave me and my skin attention; it made me important, although in a negative way. I got sympathy and affection that other kids didn't get. It was a way to miss school, sleep late, be lazy and spoiled, feel special and unique, spend time alone and in fantasy, avoid social confrontations.

My situation was painful, but it was safe and familiar, keeping me dependent and afraid of risks. I always had an excuse to avoid an unwanted task?I was the exception to every rule.

Before age eleven, I believed a fierce vigilance the only defense against the all-powerful itch. The only relaxation I remember from those years was exhausted collapse after scratching myself into a frenzy, but then I learned to relax consciously.

This came about through my attempts to overcome my insomnia. Left to themselves, my hands would scratch automatically, and it was scratching that kept me awake. To keep my hands otherwise occupied, I held them up in front of me and touched the fingertips together one by one, watching them slowly move and lightly touch, thumb to thumb, forefinger to forefinger, down the row and back again. In this way, I hypnotized myself to sleep.

After a while, I realized that this not only helped me sleep, it lessened my desire to scratch. I wasn't forcing myself not to scratch; I just didn't need to. I was overjoyed with this new feeling:  for once, I would let go of my vigilance and still feel safe. I then observed that my slow, deep breathing during this little exercise was in itself enough to relax me; soon, whenever I sensed a wave of fitful scratching approach, I'd close my eyes and breathe deeply to break the chain reaction.

I learned to defuse triggering situations. For example, if I exercised or got nervous to the point of sweating, I'd start scratching wildly. I believed I was allergic to my own sweat, and I convinced the doctors that I should be excused from gym class for this reason.

Then I developed an alternative. When I started to sweat, I'd relax by deep breathing and tell myself:  "You don't feel any itch. Your skin is fine. Sweating is okay. You don't have to scratch when you sweat. Just relax, sit quietly until you stop sweating, and you'll be fine." With my relaxing and soothing self-talk, not only didn't I itch, but the redness, welts, and hives that often accompanied sweating no longer appeared.

I learned to ignore the itch and my ravaged skin, leaving it to heal in peace. After years of ripping scabs off partially healed gashes and clawing them open to bleed and deepen, I finally learned to enjoy watching wounds heal.

I became able to limit my scratching to circumscribed areas. I'd allow myself to scratch my legs, for example, as long as I left the rest of my body alone. Then I gradually reduced the permissible area until there was no place left to scratch, or I'd first let myself scratch my arms, narrow that down to the hands, then to one finger. For some time, I had my scratching narrowed down to my lower legs, which I continued to use as a battleground. Since last year, however, I've been totally free of rashes, wounds, and itching. I've let the hair grow on my legs to seal that "tomb" forever.

Before, my hands had been the enemy, inflicting rape and torture on my innocent body. I hated them. Once I learned to relax, I made peace with my hands, treating them with the same tenderness and respect I wanted them to show my body. I learned to use them for healing. Saying, "What do you really want, skin?" I'd stroke the damaged, itchy areas, kissing them and rocking as I hugged myself.

I learned to communicate with myself, talking out loud. At first, I told myself stories to distract myself from scratching. Then I learned how to tell myself what I needed to hear. I would pretend I was my mother telling me that she loved me; then I'd speak in my own voice, saying how afraid I was that I'd never get better. And on and on, taking turns with voices until I'd said all I needed to say and hear. As I hugged and stroked myself, I'd cry and assure myself, "Don't worry, I'll take care of you," creating my own support system for changing my life.

I began to tell myself?and believe?that I was doing my best at every moment:  if I couldn't control myself this time, I'd do better next time. "Can I stop scratching now?" I'd say. "If I can, that would be good. If not, that's okay too?I'll give myself five more minutes to scratch and then stop, but next time I won't have to scratch at all." I gave myself high praise when I didn't scratch. The praise, I knew, had to come from myself since I no longer believed anyone else. I congratulated myself for keeping clear what areas of skin I could.

When I decided that I, not my parents or my doctors, was my own savior, I stopped worrying about other people's infuriating questions, their warnings about scars, and their promises of miracles. I stopped worrying about looking ugly or causing a public scene by scratching when I needed to scratch. No longer ashamed of my uninhibited self, I started answering questions frankly and addressing people's fears of contagion matter-of-factly.

I saw that I had a right to handle my disease in my own way, whether or not it was offensive to others. I claimed my right to be treated with respect, not like a leper or an uncontrollable child. I developed the confidence to go out in public, whether or not my skin was beautiful. I finally realized that no one was scrutinizing every pore of my skin, and that even if they were, it was none of their business and I was not obligated to look good for them.

I learned not to fear my emotions, gradually understanding how to deal with them calmly instead of falling, in an overwhelmed panic, into a chain reaction of scratching. Listening to my deepest instincts, developing a relationship with myself based on love, respect, and communication, I experienced a rebirth.

My strongest memories are of crying myself to sleep every night. My mother would come in and rock me and reassure me that she loved me and that maybe tomorrow there would be a miracle and I would be all better. I prayed for that miracle and waited for that miracle for a long time. Then I just stopped believing in God.

Shelley went back to school and is now a licensed psychologist in private practice. She works with people who have skin problems in San Francisco.

By Dr. Shelley F. Diamond

This young woman's description of the itching that twisted and constricted her childhood sounds extreme, but anyone who has been caught in the itch-scratch cycle will recognize her torment.

It can have many causes. This woman's diagnosis was atopic dermatitis: eczema. Some medical illnesses produce itching:  diabetes, liver disease, kidney problems, or reactions to medications. So do simple insect bites. Itching can accompany eruptions of eczema, psoriasis, and hives or torment skin that looks perfectly healthy.

Is your itch medical or psychological? You and your doctors could pursue this fruitless question for years and you'll be itching all the while. So get the best medical work-up and treatment you can but remember:  All itching is ultimately psychological. However intense, regardless of origin, itching is not a disease but an experience; it has no physical reality that even the most diligent of scientists can find. Using negative hypnosis techniques, researchers have produced itching in a healthy arm that had been fully anesthetized, that was unable to physically feel anything.

This is certainly not to dismiss itching as "all in your head." It's every bit as real as pain; the most agonizing pain has no detectable physical form either, but no one argues that all pain is imaginary. Significantly, the sensation of itching is carried by the same nerve fibers that carry pain. Both pain and itching may have physical causes whose impact is aggravated by psychological factors.

The question uppermost in the mind of most itch sufferers is a simple one:  "How can I make it go away?" As with pain, while medical treatments often help, the big surprise is the effectiveness of psychological techniques. Hypnosis and similar pain-control methods have proved effective enough for some people to go through major surgery with no medication at all. The same power can be used to tame an itch.

The first step in treating any itch should be a good medical evaluation. Your dermatologist or allergist may discover "trigger factors" in your diet and environment and encourage you to minimize or eliminate them. He may suggest wearing different clothes or washing them in a different detergent and avoiding certain foods and chemicals. If there is an underlying disease, such as diabetes, he will refer you to a specialist for treatment.

Beyond that, medical care simply aims to reduce the itch itself. Anti-itch baths and tar ointments suppress inflammation and lubricate the skin; antihistamines such as Atarax relieve some itching by breaking the biochemical chain. Most frequently used nowadays are the corticosteroids, such as cortisone, which reduce the inflammation that intensifies itching. (Mild forms of these creams are now available over the counter.) For many people, these conventional approaches are not enough.

The psychological techniques in this book will relieve itching regardless of its cause, even when it's as medical as liver disease. In fact, it appears that itching with a clear and specific medical cause responds best to psychological intervention because there is less emotional reluctance to "let go."

The psychological and medical approaches work well together. Relaxation, for example, can help you to get more relief out of less cortisone, letting you avoid the feeling of dependence many people get as their steroid cream takes a central role in their lives.

Psychological itch control has four parts:  (1) breaking the skin code to understand and respond to the medical and/or psychological message that your body is screaming with its symptom; (2) relaxation to relieve the tensions that aggravate the itch; (3) life changes to alleviate situational stresses; and (4) breaking the itch-scratch cycle.

Itching can reflect any of the eleven tasks listed in chapter 2. The dictionary definition of itching, "a constant irritating desire or longing," is often right on target. I've often found that itchy skin is hard at work on the task of "looking for love and protection." A "maddening itch" is another accurate figure of speech that hints at anger beneath the surface. Is your skin taking a beating? Metaphorically, we are "feeling itchy" when we are no longer content but not yet ready to act. Many a literal itch strikes people caught in this life bind.

The basic emotional push behind itching and scratching is always a healthy one. The scratching, picking, or tearing is an attempt at self-help, directed at one of the tasks or at the skin itself. We scratch to reduce the itch. The intent is honorable but the technique is terrible. Similarly, the picking and tearing so typical of people with acne is an attempt to improve the skin. The intent is fine, the technique ineffective.

We also talk of sexual frustration as "feeling itchy." Itching?particularly in the genital and anal areas?frequently means the skin is working on the task of seeking love or dealing with more complicated sexual conflicts. The logic can be startlingly clear.

Tim, a thirty-five-year-old consultant, suffered a kind of ultra jock itch that took the form of a red, burning ring from his anus to the top of his penis. Looser underwear, a milder laundry soap, and cortisone cream helped, but no dermatologist had managed to find a medical cause and nothing had made it go away.

Through persistently listening to his skin and observing his Time Line, Tim finally gained insight into the symptom's hidden meaning. The itch appeared whenever a setback undermined his sense of potency.

For Donna, a forty-year-old mother of four teenagers, the problem seemed to be small, relentlessly itching bumps on her legs, buttocks, stomach, and arms. Twelve years of dermatology, creams, lotions, baths, and pills had occasionally helped but never resolved the problem. She was frustrated, angry, and disappointed with herself and her doctors, and she was still tearing at her skin. In therapy, we quickly identified a key source of irritation in Donna's life:  her husband. He was distant, withdrawn, and sexually demanding--a combination that left her feeling used. She was caught between her anger and her inability to confront him. After several sessions, Donna came to see how her skin had been waving a red flag to express the frustrated feelings she couldn't feel directly:  it was ceaselessly itching to change. Her "itchy" feelings started to move from her skin to a mix of anxiety, anger, and sexual excitement as she began to take a more direct, even combative approach with her husband.

Donna needed more immediate help, though. She learned to practice a relaxation exercise and spent less time scratching. She developed her ideal imaginary environment:  a cool, soothing swimming pool. Effective as these techniques were, she needed still more help. Any time she succumbed to the impulse to scratch, it started an avalanche. Her scratching became frenzied,and she became terrified she'd lost all her new gains. So Donna and I developed two other techniques that finally helped break her twelve-year habit. I'd like to teach them to you.

(A word of warning:  These advanced techniques won't give maximum relief if you haven't learned the diagnostic and treatment exercises of the earlier chapters. You still need to work through the emotional and life issues that fuel your problem; you need to enter the healing state regularly, luxuriating in your ideal imaginary environment.)

Unlinking The Chain 

Itches are like chains:  shake any link and every link rattles. Scratch your wrist and soon a cascade of itching will pour down your arm, over your shoulder, and across your chest. This sets up a black-and-white situation:  either your mastery is perfect or you slip irreversibly into total itching. You need the freedom to itch or scratch a bit without falling back to zero.

1.Do your usual sequence, relax, enter the healing state, and sample the soothing pleasure of the ideal imaginary environment.

2.Loosely focus on the image of a length of chain, but imagine that each link of this chain is totally separate from the others. No matter how vigorously you shake it, one link can't budge any other link.

This image helps your mind and body unlearn the expectation that the first itch or scratch unleashes the whole cycle.

Don't work or push at this image. Plant it like a seed each time you do the series of exercises. "Water" the seed a hundred times a day by letting yourself see the image of an unlinked chain for a fraction of a second. Take some of the energy that you throw into your typical inner monologue of doubt and fear and use it instead to fertilize the seed, the image.

You can put this image to work in many ways:

Unlink the itch on the side of your knee from the skin on the front and back of your knee and all over your body. Even if you were to scratch the side of your knee a bit, it wouldn't matter. The experience is totally separate from all other itches and scratches.

Unlink today's itch or scratch from all your yesterdays. Imagine that each itch means no more to you than the most incidental itch would mean to someone who had never heard of the itch-scratch cycle. Unlink it from the difficult time in your life when the problem started. Separate now from history.

Unlink the urge to scratch from the action:  let it simply remain an urge. If you can observe, "Ah yes, there's that old urge, ho hum," you have disconnected it from any action or emotion.

Unlink the rest of yourself from the itchy piece of skin. Imagine it floating across the room. It has nothing to do with you.

Step outside of yourself. See the person over there who is struggling with an itch. Observe that he or she looks exactly like you. Wish him or her good luck. Then move on to something else.

Most important of all:  unthink your skin from its assigned task. Let your head and heart do the longing; express the anger; feel the sexual feelings. Let your skin be skin.

Now stop. Let yourself benefit from the unlinked-chain techniques for at least a few days before going on.

Scratching Hand To Soothing Hand 

You've been trying to stop scratching with willpower? It simply won't work. Your itch keeps building, keeps calling out for help. Your hand finally reaches to relieve it, almost of its own accord. The hand is quicker than the will.

Why can't you just tell yourself to stop scratching? Very simple:  You never told yourself to start. Your conscious willpower self isn't running the show.

Then who is in charge here? Neither your conscious mind nor your unconscious mind. You don't direct the scratching but you're not unaware of it either. Your scratch control center is directly linked to the healing part of the mind that we've been exploring throughout this book,but as you well know by now, if you want help from this part of yourself, you have to speak its language. You can't push, work, or insist. You need to be subtle and wily.

For example, try to not think of a hippopotamus. Now try harder. Bulldozing yourself with willpower is not effective. Now have each hippopotamus turn into an elephant. Much easier?

Rather than struggling to restrain your scratching hand, you can convert it; you can turn the pesky hippopotamus into a loyal, powerful elephant of an ally.

At the very moment your hand reaches to scratch, it is transformed into a soothing embodiment of your ideal imaginary environment. You can learn to do this conversion as automatically as you once learned to catch a ball:  you don't do it, your hand itself does. You can use this technique as you would use steroid cream to gain control over your itch. Once you break the cycle, you may find that your skin heals itself.

It probably took you years to learn to catch a ball smoothly and without thinking, but you can learn to transform your scratching hand into a healing hand through daily practice sessions with the help of the healing state:

Using your own customized method, relax and induce the healing state.

Experience your ideal imaginary environment.

Unlink the chain.

Imagine your hand as a deep reservoir of whatever sensations are most healing and soothing for your skin. When your hand is full almost to the bursting point, move it to each of the areas that sometimes itch. Just rest the soothing hand lightly on your skin. you needn't rub or press. Feel the soothing sensations flow out your fingers, taking over so totally that there is no room at all for an itch. Give each area as much help as it needs. If you hand needs replenishing, just take it away from your skin and let it fill up again. You can repeat the procedure as often as needed.

Focus on the idea that your scratching hand will be automatically transformed into a soothing hand. In the middle of its flight, before hitting the target, your hand will become a healing instrument.

Go through the procedure at least daily, preferably twice a day. Be prepared for a discouraging period before you master this challenging but ultimately effortless mental magic. When it works?when your hand reaches for an itch and automatically soothes with a touch?you'll feel more like an amazed spectator than someone who's "broken a habit" by heroic willpower.

You can't work at these techniques any more than you can convince a flower to grow faster by cheering it on. Plant the seed of each technique, and feed it with relaxation and repetition. (If it starts to feel more like work than a personal gift to yourself, take a day off.) To add momentum to the learning process, take a fraction of a second a hundred times a day to remind yourself, "unlinked chain" and "scratching hand to soothing hand."

Nighttime itching is a particular torment.5 A good night's sleep becomes a distant memory, as  mind and body ache for rest. Why is scratching such a problem at night? I suspect it's the absence of daytime distractions. At night, we are back to basics, our wishes and fears, our bed partners, our body's aches and itches.

In the past, you've continued scratching all through the night, even though your conscious mind was asleep. In the same way, the soothing hand technique will keep on working now. The scratching hand used to awaken you but the soothing hand will protect your sleep and dreams. Because you're only a spectator, the conversion will go on whether you are asleep or awake.

What's true of most skin disorders is rarely clearer than with itching:  you're an active part of the problem and you must participate in the solution. There is real magic in these techniques, but even a master magician has to practice. That demands energy, but much less energy than you've been putting into itching and scratching.

Other New Psychodynamic/Behavioral Approaches 

The history of psychology is dominated by two great streams of thought and practice. Each proceeds, often oblivious or even hostile to the other. Each has its own vocabulary, publications, associations, and treatments.

The psychodynamic approach explores feelings, thoughts, relationships, and the role of personal history. These tools are used in psychotherapy to help resolve emotional conflicts, inhibitions, and other life issues. The behaviorists, concentrating on observable actions, developed techniques to help control behavior. (I don't think the rift came from the lack of enough people who needed help to go around. Human suffering has never respected the law of supply and demand.)

If you are battling a major skin problem, you have no patience for professional politics?you need all the help possible, and you need it now. Fortunately, more and more bridges between the approaches are now being built. Both groups have embraced relaxation and hypnotic imaging. More and more practitioners are becoming convinced of the folly of ignoring anything that may help.

Scratching is a behavioral problem. The itch-scratch cycle is both triggered by and triggers profound emotional issues. It is a true crossroads. Here are three new therapies combining psychodynamic and behavioral approaches.

New Therapies

Swedish clinical psychologists divided seventeen adults who had atopic dermatitis for at least three years into two groups.6 The experimental group used psychological techniques plus their usual cream. At the end of a month, they were scratching less and had clearer skin than the cream-only control group.

How did they do it? Their psychological techniques came from earlier work, which you can consult for more detail. Before starting, patients in both groups were given a golf counter to track the episodes of scratching. They were asked to identify the situation that produced the strongest urge to scratch and to determine the intensity of the urge and note if it was local or global.

Then the psychological treatment group went on to become more aware of how, when and where they would begin to move their hands toward the areas they scratched. They made a real study of situations in which they scratched more often or vigorously.

The heart of the treatment was a repertoire of behaviors that were incompatible with scratching. When a seemingly irresistible urge to scratch struck, they had a new weapon. At first, people were taught to put their hands firmly and motionlessly on the itching area for one minute, then to move them to their thighs or to grip some object. When they felt confident with this approach, they moved on to not touching the area before moving their hands to an object or gripping their thighs.

With this technique mastered, they practiced it again while visualizing themselves in a high-risk situation. The therapists helped with gentle reminders if the patients began scratching. Let's look at another different way of combining the two approaches.

Drs. Caroline and Peter Koblenzer make quite a team. Both are dermatologists and she is also a psychiatrist and psychoanalyst and the author of Psychocutaneous Disease, the definitive reference book in the field. They start from the psychodynamic side of the street but are also responsive to behavioral possibilities. This report is particularly interesting as the eight patients were between one and a half and eight years old with chronic atopic eczema. They had been through multiple unsuccessful treatments and had become quite miserable. They are described as whining, angry, clinging, and demanding. The descriptions are clear and grim, with both child and parents held enslaved night and day by incessant scratching (like the woman whose description starts this chapter). Yet after treatment and with one to four-year follow-up, the Koblenzers conclude, "Atopic eczema of infancy responds readily and predictably to treatment: only a small percentage remains intractable."

What worked? How do they get the kids to stop scratching? Their program has three components. "Aggressive conventional dermatologic therapy" is combined with weekly psychotherapy with the mother and child and specific behavioral instructions.

The psychotherapy focused on the parent's feelings toward the child and the quality of their relationship. Each mother-child relationship shared key difficulties that fueled the problem. The mothers (and some fathers) responded to their angry feelings toward the child with an overcompensating solicitousness and inability to set limits and make appropriate demands. This put the whole family into an impossible bind. The psychotherapy provided a path out:

We found that our acceptance and empathic understanding of their difficulties permitted the "unacceptable" negative side of their ambivalence gradually to reach consciousness. When put in the context of their life experience and current circumstances, these negative feelings became understandable to them, and could be "allowed" ; with this insight the parents could more realistically appraise their need to infantilize, overindulge, and overstimulate the child.

It's not hard to believe that this would be a great help, but how did they get the kid to  stop scratching? They strongly urged and supported the parents to permit scratching! "Scratching could be given up once the positive reinforcement provided by the wished for maternal response was denied." The child was also required to return to his or her own bed at night, a time when both scratching and the resultant family turmoil were especially intense. Since anxiety heightens both itching and scratching, the child also benefited from the better relationship with a mother who was more appropriate, consistent, and at peace with herself.

We see virtually the same pattern in adults. They are at once overprotective of themselves and very harsh and judgmental. Often spouses will slip all too comfortably into the role of an alternately harsh and oversolicitous parent who becomes the partner in an endless Stop Scratching dance. The approach works for "kids" of any age.

Let's look at a group treatment that rounds out the integrating of behavioral and dynamic techniques.

At the University of California in San Francisco, Cole and colleagues gathered ten adults with severe, chronic atopic eczema that had been particularly unresponsive to medical care. They all continued using creams but avoided systemic steroids. For the first twelve weeks, four dermatology residents rated each person's skin. This established a baseline. Then everyone learned the psychological techniques as the residents evaluated their progress through twelve weeks of treatment and a one-month follow-up.

The treatment package was multifaceted. Relaxation and hypnotic techniques were an important tool. Each of the weekly groups ended with them and each person was asked to spend an additional hour a day practicing. Each patient studied and recorded the times and rates of his or her own scratching using a hand counter. The observations then extended to physical sensations and then to the thoughts and emotions triggering scratching. A rating of the amount of pleasure experienced with scratching was an important addition.

Next came training in techniques to provide relief without damaging skin or initiating the itch-scratch cycle. Rubbing, slapping, and a cold slush mixture were suggested. Anticipating their high-risk periods let people do the relaxation and imaging exercise in advance.

As they became more sophisticated, people were urged to focus more on the emotions (such as anxiety, helplessness, anger, or resentment) that triggered bouts of scratching. They were also supported to look for secondary benefits from their problem and at the pitfalls of learned helplessness. Each person set up a system of self-rewards for scratching less.

The group became more and more cohesive as members shared personal experiences and supported one another's efforts. Itching and other sources of anxiety became reminders to use new coping skills rather than the start of a vicious itch-scratch cycle. The group showed improved skin, less scratching, and reduced use of steroid cream.

Note that none of these results were miracle cures but solid, hard-won improvements. It's hard to know exactly which were the "active ingredients in each of the three packages.

Here's my view of what helped:

When scratching is a major component of the problem, no amount of medication, support, or insight is going to do the job alone. You need a "something" to do in the heat of the moment. This is true for scratcher, parent, or spouse.

Honest, caring relationships heal. The group members' growing ability to be open and supportive to one another was key. The therapist's structure and support let out the parents' own feelings that they had been taught were unacceptable. They could then provide structure and support to their kids.

You have to own and embrace an action, feeling, or characteristic before you can get rid of it. Each patient had to become a "connoisseur" of scratching. They really studied the settings, relationships, thoughts, emotions, and gratifications that fueled the itch-scratch cycle.

Symptoms are not "bad." They are honorable, energetic attempts to fill honest needs. They have complete integrity but lousy technique. Find better techniques for soothing, getting needed attention, protesting, or whatever and the symptoms will be history.

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