Annette Pasternak's "Success in skin picking freedom: 7 Attitudes and qualities you need"

Tasneem Abrahams
May 10th, 2016

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Annette Pasternak, Ph.D. is the author of the book “Skin Picking: The Freedom to Finally Stop”. She has honored us with a guest post around her personal experience helping others overcome skin picking and the attitudes and qualities one needs in order to do so. If you would like to contact Annette, you can contact her through her website

7 Attitudes and Qualities You Need - By Annette Pasternak

Originally, I learned from being in treatment myself and also from personal discoveries that helped me become free of the continually destructive cycle of skin picking. In my last four years as the “Stop Skin Picking Coach,” I have learned more and have especially developed a clarity about which attitudes and personal qualities will set you up for success in this endeavor. Have them or develop them; here they are:

1) Internal motivation and readiness:

The first thing I’ve learned definitively is that you must be internally motivated to change and be willing and ready to do the work that it takes. There is simply too much effort, over too long a time necessary for you to sustain, if you do not want to change your behavior badly.

When I say internal motivation, I also mean that you want it for yourself and that your desire is relatively uncomplicated by the desires of those close to you. Ideally you wouldn’t have, for example, a husband intimating that the fate of your marriage depends on you stopping your picking. Or a parent whom you want to please or just get off your back about it. That’s a lot of pressure and can be very de-motivating.

I hate to say this at the outset, but some people’s progress really is undermined by their home situation. If you are living with someone who blames you for the behavior you can’t control, or who is impatient, demanding or overly involved about your recovery, it makes it much more difficult to recover. To have such challenging close interpersonal issues at the same time you are are trying to change your behavior and re-balance your nervous system doesn’t allow you the space, support and acceptance that promotes recovery. So, you might need to address those relationship problems first, or together with your attempts to stop picking.

2) The ability to prioritize the work:

Doing what it takes to recover is making the work involved a priority. Some of the best successes I’ve seen have been people who were out of work and placed skin picking as the number one problem / priority in their lives. But I’ve also seen people with extremely busy lives do tremendously well too. The commonality is that they also make their recovery a priority and not a last priority after spouse, work and children. Not that it has to be prioritized above those things of course, but it does have to be alongside them. You can’t attend session after session without doing the recommended actions and expect much improvement.

Support, guidance and accountability are still needed to help a motivated person achieve success. Specific steps build new positive habits designed to interfere with and make the undesired behaviors unnecessary or impossible. Yet despite all the expert support, guidance and accountability, I have learned that there is one condition in which people find changes almost impossible to implement.

If you are depressed, that depression may have to be addressed first. I would say that is the biggest challenge in getting someone ready to be ready to stop picking. And while there are plenty of holistic recommendations that work, such as exercise and special breathing, or diet improvements and specific supplements, if you are very depressed, you may have a hard time implementing even simple changes, so the pace of the program is slower. During sessions though, learning a process of inquiry can be transformative - recognizing negative thoughts and learning to let them go, then choosing more positive thoughts instead.

3) Interest:

It is tempting to say that a positive attitude is needed to stop picking, but I have coached several clients in which a positive outlook has not at all been present at first and the person still has great success. In these clients, a feeling of total desperation mixed with just a sliver of hope at the beginning turns into a fantastic attitude as they shed negative emotions, take positive actions and see more and more evidence of personal success.

An attitude that does lead to success, along with being motivated and ready to do what it takes, is an interest in the process. An attitude of personal growth and throwing yourself into the work, an interest in and attention to your personal internal physical / emotional / mental state, really helps you to stay engaged as you enjoy the process.

4) Surrender:

Another helpful attitude is one I would call surrender. To come into coaching or therapy with the realization that you have tried and tried and finally come to the conclusion that you cannot stop picking on your own, you put your trust in this professional you hire. It helps to release control and be led. For example, when your therapist tells you to keep track of your picking, you do it and don’t question it. When you have decided that you can’t do this alone, you have to trust and try what they are telling you. (At least for a while. If you’ve given it a significant try and you don’t seem to be getting where you’d like to be, then by all means look elsewhere and come up with a better plan.)

I have one recent client who has done phenomenally well – no picking in months. She has done to the letter everything I have suggested and I’ve pushed her a lot with my recommendations because she is so good about taking them. When I praised the way she’s done even the most challenging things, she told me she just treats my recommendations like a prescription. “When your doctor tells you to take the whole course of antibiotics, you do it,” she said.

That’s an attitude of surrender which I could contrast with other clients I’ve had who consider my recommendations more as ideas – things that they could try if or when they feel like it. There’s no sense of urgency, and there’s no surrender – they leave it up to themselves and a decision whether to do it or not. Or a decision of when to do it, rather than treating it as unquestionable that they’ll do it now, no decision necessary.

5) You don’t need to be perfect:

Despite definite success when clients follow my recommendations to the letter, I have learned that many paths can lead to a similar destination, and that everyone is different. In staying flexible I have learned that many clients do succeed even when they don’t implement every recommendation I make. For example, I had a client who did not cover the mirror, a step I recommend that breaks the habitual face picking behavior of many, but she became amazingly adept in her own self-talk, allowing her to not lean into the mirror anymore.

6 & 7) Patience and persistence:

Because change can sometimes feel slow, it can be frustrating if you focus on how many times your hands still want to go to your skin, how you are still experiencing strong urges, or how much you are still picking. Stay focused on the process and recognize and appreciate the progress you have made so far. A continual focus on what you have not yet attained is discouraging. You’ll have more energy to learn from the picking you are still doing, and to apply that learning, when you feel good about your efforts and accomplishments so far.

Annette Pasternak, Ph.D. is the author of the book “Skin Picking: The Freedom to Finally Stop”. Contact her through her website

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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