The counselling process for skin pickers

Tasneem Abrahams
Mar 28th, 2017

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Therapy can help you handle emotions from problems or stressors, even if they aren't dramatically life-altering or traumatic. Therapy is well-known for its problem-solving techniques and reputation as a tool for overcoming anxiety, depression and addiction. This article summarizes the therapy process as it was formed and structured by Dr. Vinod, one of the first members of our counselling team when our online therapy program was first launched. 


In the process of decision making, two parts of us having opposite views surface in our conscious mind and get into a dialogue. Successful therapy requires a resolve of the conscious mind to fully engage in the counselling process.


Once the therapeutic relationship is initiated by the patient, it is important that expectations are set upfront and patiens are assessed to determine their readiness for the program. We do not work with clients. Those who choose brief Consultation - we try to send them questions right away to start our work. That saves time and helps client in maximum possible way to address what they have to share and work on.


The journey begins as first session. In online therapy, the therapist does not prescribe medicines, or advise any stress relief exercises rather the therapist reflects like a mirror and a sounding board. Whatever feelings and imagery she gets while reading clients' answers, she try to verbalize and write it to them. Their feedback/reactions is welcomed the therapist tries to understand the clients as a whole person. And does not look at them as specific parts of their bodies. Picking is one highlighted aspect of them. As the therapist understands that, picking is like road signals trying to alert client about something that is not seen by him/her in an obvious way. The therapist helps the client to help herself. Cients are encouraged to take an initiative to understand their own mind.


After the initial smooth (or rough) steps of the journey, we start with actual exploration phase in therapy. The therapist will send few sets of questions and compile the answers sent by clients. This will help clients revisit their past right from very early age till current life status. It takes first 4-5 sessions to gather all relevant information about the client's emotional world. A systemic compilation of answers helps the therapist look for missing links. Clients experience variety of emotions when they make this endeavor. They become aware of shame, guilt, rage, anger, jealousy, rivalry, need of attention and appreciation, sadness, loneliness, self-pity, shifts in moods, panic states, insecurity, fear of losing close ones, fear about death, fear about break in relationships, fear of losing jobs, fear of losing friends, and fear about what people will say.

During this process

  • Some clients become aware of thoughts and emotions during-before-after picking. They note them and write about them. They thus provide very useful information.
  • Few freak out at the exaggeration in picking. Yet, they somehow know that they are working on dark areas of their mind so that is obvious.


People develop multiple defenses to protect their sense of integrity and safety and security. In short, whatever they think and do as right, fails to satisfy them. They feel that their future is bleak. Some feel suicidal. Some feel afraid. Some feel overwhelmed. Some feel like quitting

We could be having all possible things that one may require to be happy, still, we miss something vital. This conflict creates internal dissatisfaction. It leads to picking. It is important to work on these internal conflicts.


The therapist chooses time to disclose this theme to the client, who could be tired of answering seemingly tough questions, who could be feeling desolate and, unhappy and could be desperately waiting to see some light, some hope, finding some cause behind all the agony.

Life is never a bed of roses in spite of having best of the outer conditions. It’s not always full of thorns, as well. The path of life has a mixed and unpredictable texture under our feet with unexpected twists and turns and weather.

In therapy, it is termed as game playing. We all play psychological games unknowingly. The motto of the game is to be in good books of all the people. We cry/plead/yell/argue/discuss/defend/manipulate/lie/gossip/distort/sulk to be influential and try to get what we want. All games end in inevitable frustration for all those who are involved in it. Nobody understands why this happens. We all continue to live in the same unhealthy way year after year. We don't know how to undo it. In therapy, we have a chance to be aware, accept and undo game playing.


Growing as an emotionally insightful adult is a long hard process in therapy, to be done under the supervision of a trained therapist.  Old habits die hard. Attainment of adulthood benefits clients to be strong-sure of themselves-calm-comfortable with them. Of course this does not happen overnight. It may take weeks/months sometimes years depending upon the speed of progress of the client in letting go of his wishes.

When the therapist feels it’s the right time, she will then disclose and explain at length, about the underlying unconsciously created, self-defeating theme to the clients. Almost all of them completely and readily and simply agree with that and feel a kind of relief. Now, they can link their pain and agony and confusion in a simple equation. They start looking at the mess with somewhat clear vision. They feel optimistic enough to work on their conflicts and move on with life, in real time.

The simplicity and openness in acceptance of their unrealistic conviction about self, gives clients a feeling of breakthrough. Now, they express their wish to clear off their pending emotional issues. Almost all clients feel that their mind is cluttered up and is occupied with issues from their past and they do not feel ready enough to work on their present issues. So, we generally keep their current problems bit aside, for the time being.


Online therapy provides the convenience and comfort of working from home/office at your pace. It keeps secrecy and privacy of your identity. We engage in therapy with a welcome note and later start working on a questionnaire. We work hard on your stories and aspirations. We try to do justice to the cause of understanding, what is there lying beneath your picking. You then try to apply our newly found knowledge in your day to day life.

Tasneem Abrahams

Tasneem is an Occupational Therapist, and a graduate of the TLC foundation for BFRBs professional training institute. Her experience in mental health includes working at Lentegeur Psychiatric hospital forensic unit (South Africa), Kingston Community Adult Learning Disability team (UK), Clinical Specialist for the Oasis Project Spelthorne Community Mental Health team (UK). Tasneem is a member of both the editorial team and the clinical staff on Skinpick, providing online therapy for people who suffer from excoriation (skin picking) disorder.

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