This chapter examined the close and complex relationship between psychology and skin disease in an attempt to demonstrate the need for psychological interventions in the treatment of dermatological conditions. Indeed, it has been shown that there is a real need to address psychosocial issues surrounding disfiguring dermatological conditions. The impact skin disease has on the patients'well-being as well as his/her relationship to the outer world can be great and varied. Hence, a major aim of the present chapter was to conceptualise skin disorders as a biopsychosocial phenomenon, which have the ability to exert negative pressures on sufferers and therefore their management calls for a holistic approach.
Although evidence was provided that psychological treatments can be efficacious in addressing them, still much of the research in this area is methodologically flawed. Some studies often have small numbers of patients and some lack appropriate controlled groups. Additionally, as the majority of the research has employed quantitative designs, much of the depth of information regarding patients' beliefs about psychotherapeutic approaches, such as relevance, motivation and expectations is lost. Finally, studies have failed to examine variables, such as length of treatment and treatment at different stages of illness, which can provide more data on the benefits accrued from such approaches.
Therefore, there is a great need for systematic evaluation to determine the treatment efficacy of different approaches to counselling and the development of psychological treatments, which will focus on the unique issues pertaining to dermatology patients. Future research should seek to examine the utility of different modalities for various skin conditions by employing designs that will compare them. Thus, controlled studies should be devised to compare differences between the effectiveness of different psychological treatments as well as varying time and stage of illness. Moreover, future research should seek to address factors, such as motivation, adherence to treatment and treatment expectations. On the whole, it appears that the positive outcome of therapy is dependent on non-specific variables, such as motivation and expectations rather than on specific treatment variables per se (Van Moffaert, 1992). Hence, investigations with less motivated and committed samples need to be considered in order to establish precisely the types of individuals that are likely to benefit from therapeutic services.
In conclusion, the fact that psychological interventions can have important effects on the severity of chronic dermatological disorders offers an exciting prospect for the management of skin patients. Certainly, we have come a long way in our understanding of the relationship between psychological factors and dermatological conditions. More knowledge and education of the public around issues concerning counselling and its effectiveness in dermatological conditions is needed. Prejudicial beliefs about psychological services as well as patients' own psychological difficulties, particularly perceptions of stigmatisation, may impede them from attending such treatments. However, as health professionals we can begin to overcome these obstacles by providing patients with comprehensive information about psychological approaches and helping them to make more effective use of and derive benefits from the psychological interventions available to them. Ultimately, dermatological conditions, like other illnesses, need to be addressed not only in terms of the objective effects of the illness but also in terms of the subjective experience of the patient; it is only through well-researched, methodologically sound psychological techniques that we can ever hope to address that.
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