Group Therapy for Skin Picking

Tasneem Abrahams
Oct 27th, 2014

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Dermatillomania Group Therapy

What is group therapy?

Group therapy is a shared therapeutic experience which can be engaged in on its own, or as a means of additional support to supplement primary therapy. Group therapy is usually offered to people challenged by similar issues, with the objective to increase self awareness, increase social comfort, provide support, develop skills and promote positive social interaction. Participants in group sessions find discussing their problems with those who can offer genuine empathy gives them a sense of belonging and encouragement. In contrast to individual therapy, group therapy fosters the development of multiple relationships to harness the healing power the sense of belonging has on an individual.

Group Therapy for Skin Pickers

People who struggle with skin picking disorder often feel extreme shame and loneliness, and are unable to talk to others about their experiences. Group therapy can therefore provide a valuable, safe environment where people with skin picking disorder share similar feelings and experiences. There are many different theoretical constructs that guide the group process, particularly in process-oriented groups. The most effective theoretical framework for the treatment of skin picking disorder and other body-focussed repetitive behaviours (BFRBs) is the cognitive-behavioural model. Cognitive-behavioural therapy (CBT) is a skills-based therapy, which teaches the individual to gain awareness of their thoughts and emotions and reflect on the impact of these on their behaviours and vice versa. The individual is then taught the skills to either challenge faulty thought patterns or embrace the existence of negative thoughts but responding with alternate, more acceptable behaviours. In this way, CBT groups tend to be structured, directive, collaborative and time-limited. Skin picking disorder yields very tangible behavioural consequences, so CBT groups can prove very effective as these groups are task-focussed and typically encourage participants to set clear goals and outcomes.

Advantages of Group Therapy

The clear advantage of group therapy over the traditional individual patient-therapist relationship is the leveraging of multiple relationships to assist individual growth and problem solving. Group therapy can be a powerful agent of change through some of the “curative factors” identified by psychiatrist Dr. Irvin D. Yalom.

  • Instillation of hope: Watching others cope with skin picking disorder and overcome similar problems successfully instils hope and inspiration.
  • Universality: Group therapy provides people struggling with skin picking with a feeling of being understood and being similar to others. Enormous relief often accompanies the recognition that you are not the only one struggling with the disorder.
  • Altruism: People with skin picking disorder often feel shame and guilt at not having control over the behaviours. The process of helping others is a powerful therapeutic tool that greatly enhances one’s self-esteem and feeling of self-worth.
  • Group cohesiveness: Belonging, acceptance, and approval are among the most important and universal of human needs. Group therapy can help someone struggling with skin picking disorder to feel truly accepted and valued for the first time. Another advantage of group therapy is that is a much less expensive option than individual therapy.

Disadvantages of Group Therapy

One of the biggest barriers to engaging in group therapy is that it is a social space by nature. Many skin pick sufferers also struggle with social anxiety or phobias, which will make speaking and sharing in a group very challenging. In addition, the bigger the group of people, the more likely the possibility of clashing personalities. This can negatively impact on the overall group experience. As previously indicated, the type of group therapy used for skin picking disorder and other BFRBs is usually CBT, which incorporates types of activities that some individuals may find very difficult to engage in within a group setting, such as role play and listening to or sharing intensely personal details of one’s experiences. For some this may even present a problem in a one-on-one relationship with a therapist. Another alternative to group and individual therapy in these cases is to engage in virtual therapy sessions such as the online course offered by Communication with therapist is text based, via secure worksheets – which particularly fits people who don't like the idea of opening up face-to-face. Group therapy is also not suitable for individuals who have suicidal ideation and must be able to effectively communicate on a basic, functional level. In any therapeutic relationship, trust has a huge influence on the effectiveness of therapy. In a group setting individuals need to have trust in not just the therapist, but all the members of the group. There is always the inherent risk that individuals in the group may break confidentiality as they are not bound by professional obligation the way therapists are. Awareness of this risk can impact negatively on the way members share information and therefore on the overall therapeutic process. Developing a strong, healthy therapeutic dynamic within a group is paramount to its success, but this can take time to develop. As such, while group therapy can be very effective and has powerful healing mechanisms, it is not suitable for everyone.

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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