The main problems noticed by the therapists when examining people suffering psoriasis was that most of patients suffered stress (Knott) and low self-esteem (NCH) also as a result of the disease. Approximately one third of people with psoriasis experience depression and anxiety and 10 per cent of them admit to contemplating suicide (Pressat). Such figures suggest that it is worth to work on the mentioned problems especially that researches prove that when the subconscious issues were sorted many patients experienced meaningful remissions of psoriasis or at least felt much better as their perspective to the disease was changed (NCH).
A course of treatment I devised for D began from thorough initial consultation interview, during which he confirmed he suffered psoriasis for eleven years and that his grandfather suffered it too. Usually the plaque appears on his palms, elbows and knees. The flares come and go and he couldn’t tell what causes them to appear. According to D he doesn’t smoke and doesn’t exceed with alcohol. However, it was clear from what he was saying that he was overworked, suffered a lot of stress at work and didn’t have enough sleep and those might cause flare ups (Karle and Boys p 16). He used to treat his psoriasis with Epaderm ointment, Naprosyn and Indocin but gave it up two years ago as they improved the symptoms a bit but didn’t help to remove the plaques completely despite he used the for almost a year.
I have asked him how he felt about his condition and he answered that psoriasis made him feel lonely, unattractive upset and tired. He loves swimming and sunbathing but he is embarrassed when people are staring at patches on his skin and when he is asked about the plaque it makes him frustrated and helpless. That is why he avoids pubic beaches or swimming pools. I have not discovered any secret agenda during the consultation. He admitted also that it affected his social life as he was rejected because of the disease in the past and that he was tired explaining to people that it is not infectious. Screed Assessment tool confirmed D responds well to authoritarian style compounding all modalities with a predominance of visual modality so I resolved to use such PMR induction followed by a deepener and suggestion of D being on a beach in warm sunshine and feeling the sun healing his skin.
I also decided to anchor the expression “skin cleansing” to visualise the body without psoriasis. During the hypnotherapy sessions I chose to use active suggestions of improvement of the skin condition and general healing (Karle and Boys p112) and in consequence to make the client feel more self-confident. It was clear for me it was important for him to work on his self-image to make him feel better about himself and change his beliefs regarding the psoriasis. I wanted to make him believe it is possible not to think about psoriasis all the time. He needed to curb the feeling of shame and the constant anticipation of rejection rooted in the subconscious. In order to achieve the above he needed some ego strengthening and confidence building too.
In order to achieve that we agreed that in addition to our weekly sessions every evening before falling asleep D will listen the self-hypnosis CD I would prepare for him to facilitate healing process, reduce emotional stress and make him feel less anxious (Hadley and Staudacher p130). It was not very likely that just one session would resolve the issue so we agreed he would undergo four sessions and then we would evaluate the results and if necessary prolong the treatment or adjust it. On top of it I believed it would be necessary for him to adjust his life habits the way he wouldn’t be so fatigued. As a piece of advise after the first hypnosis session I aimed to advise D to make sure he had enough sleep, return to GP and resume medical treatment and also relax as often as possible (at least once a day) using the anchor expression and the CD induction.
Many therapists suggest hypnoanalysis as the best tool to use as a complementary treatment for psoriasis, however the symptoms of it may be very similar to the effects of grief and loss (Holbrook). Obviously grief as a stressful state may also trigger the real psoriasis (Wiessner). Whatever the scenario it is worth to deal with grief before we focus on fighting psoriasis. Different therapist name may name the grief stages a bit different however the characteristics of them are quite similar.
(Hadley and Staudacher p.242) Generally the first stage is shock and denial shortly after the loss. It is followed by the stage of separation and pain when the grieving starts to assimilate the loss. Then the suffering enters despair stage, the lowest of stages that may be accompanied by depression. Since then it usually gets better and they achieve acceptance stage when they begin to get used to life without the lost.
The last stage is resolution and reorganisation stage, when the sufferer has adjusted their life the way they can more or less normally lead normal life without the lost. Grief stages may appear in almost any order and it is also possible to get stuck on any of the grief stages, which is unhealthy for the stuck and difficult for the people that surround them. They can also reoccur in cyclical manner, which can be misleading to inexperienced therapist. (Hadley and Staudacher p.241) Because in most cases it is necessary to go through the same phases of the grief curve in order to prevent maladaptive and dysfunctional experiences in future it is important for the hypnotherapist to be experienced enough to help the client.
Otherwise it would be ethical to refer the client to the therapist with necessary skills and knowledge. The same applies to psoriasis. Some patients need experienced therapists to examine the background of the disease. In some cases it would be necessary to use the techniques as past regression in order to find sensitising event.
The therapist without necessary training could make more harm than benefit to the patient. As a result if the inexperienced therapist believes the flares of psoriasis originated from a happening in the past and stress resolution and self-worth strengthening are not sufficient to help the client it is important to refer them on under the guidance of the supervisor (Chrysalis p).
