Skin Picking Sexual Abuse

I saw this client previously and tried to help him with his skin picking psoriasis. He told me that there had not be much change. "I am still picking my skin." He does not see any change in the severity of his psoriasis.  He sleeps in a separate room from his wife because he doesn't want her to waken up with blood all over the sheets.

However, after seeing me, he decided he could do something about it, and has started seeing a counselor. "I feel the counseling is helping me."

In the first session he mentioned that he did not get on with his father. This time, he began speaking more openly about the behavior of his father. We spent some time talking about his family situation. He now talks to his father but does not talk about the childhood abuse. His brothers and sisters are still not talking to his father.

Therapy for Skin Picking

I decided that I had to focus on his abuse and to clear his feelings about that. I got him to think about the pain, the abuse, how he feels about it, everything to do with how his father treated him. He clearly didn't want to go there. But I kept at it until he obviously was feeling it. I began to see tears in his eyes.

I got him to focus on what the feeling was like. He was crying and withdrawing into himself, but he said it was "red, it was blood". I try to develop that. I asked him what it was like as an object. He said it was a box. Then he changed it to a cube. He said "it's made of clear glass, glass like a milk bottle. About one liter. It is soft and warm and smooth like skin". I asked him "and what happens to skin over time". He said "it gets old".

I developed the idea of changing the object so that the skin was "old and wrinkled and sagging" and the whole box thing was losing its definition.  Eventually I got it small enough that he wanted to hold it in his hand. It became clear that this represented his father. I asked "what do you want this thing to do?" He said "Say sorry". I try to get a dialogue going between him and the object but he just wouldn't do it. I asked him to ask the object why the behavior had happened. He said "I know why it happened. I was in the way".

Externalizing his emotional abuse

I got him to put the object into a chair. This got it out of his body and into something he could deal with. The thing started changing but he got very emotional about it all. I realised then that he was back to being that painful lonely little child. So I did inner child work with him. I got him to go back to the child, to hold the child, all the normal therapy progression. He did very well at this: he clearly was there, he was crying, he was holding the child, and he took that child away from there. I got him to tell the child "you did not do anything wrong. It was not your fault. You were born perfect. You are a beautiful deserving little boy."

I did more direct suggestion for strengthening his feelings about himself.

Outcome of Skin Picking therapy

By the end of our session he was crying freely and allowing his emotions out. I suspected this is the first time is ever done that. I asked him "when was the last time you cried in public?" He thought for a while and said "once, at a funeral".

He told me that this was the first time he had ever talked about his background to anyone else. "I thought that if I could keep it inside, I could avoid thinking about it, and avoid the pain". It is quite common for skin problems to be the result of unresolved emotional issues. His skin picking was a symptom of his inner turmoil. I told him that he had now started on a  journey that would end in catharsis, the release of his bottled up feelings, and a gradual end to his skin problems.