Andrew Thompson talks to DrB

Psychodermatology remains thin on the ground

Andrew Thompson is a Chartered Clinical and Health Psychologist and an accredited practitioner in Cognitive Analytic Therapy. He lives and works in Yorkshire, U.K., where he is a visiting Professor of Clinical Psychology at the University of Hull and a Reader in Clinical Psychology at the University of Sheffield. He has written numerous book chapters and several books on conditions that affect appearance  and he has published a number of studies on psychosocial issues associated with skin conditions. He is the Psychological Advisor to the UK All Party Parliamentary Group on Skin, and has provided advice on psychological issues to The British Association of Dermatologists, The British Dermatological Nursing Group, and several skin related charities.





DrB: How did you first become involved in the psychology of the skin?

AT: During my doctoral studies in the mid 1990’s I became interested in the type of self- consciousness called “appearance concern". The burden of having a long term skin disease isn’t simply to do with the severity of the condition. Finding out about which factors account for the differences in how we cope with conditions that affect appearance is important: important for giving appropriate support, and important for developing effective treatment. I have some personal experience too, having had hand eczema at varying points in my life,that has increased my awareness of the subtle ways in which skin conditions may affect quality of life.

DrB: Psychologists come in different shapes and sizes - can you give us an overview of how you call yourselves? What is the difference between Clinical, Counselling and Health Psychology, and is being Chartered important?

AT: You're correct - there are lots of different types of psychologists. In the UK an important distinction is made between Practitioner Psychologists, who provide a service to the public, and other types of Psychologist, who might work primarily in industry or academia. Practitioner psychologists include Clinical, Health, and Counselling Psychologists: their title reflects their particular training and expertise. All are required to have appropriate training before they can be registered with The UK Health & Care Professions Council. If they are also members of The British Psychological Society, they can also have their expertise recognised by applying to be Chartered.

DrB: You are a University Reader - this is an academic post. What do you get up to?

AT: The largest part of my work is training Clinical Psychologists, but my role involves teaching, research, public engagement, clinical practice and unfortunately, some administration! The majority of my research is focused on psychological aspects of skin conditions, although I have a wider interest in coping with all long-term conditions that affect appearance. On the clinical front, one day a week I run a clinic for people distressed by a range of health conditions, including those affecting the skin.

DrB: How can psychologists best get involved with teaching and training?

AT: I think there is a need for psychologists to share their expertise with colleagues in other disciplines on how to both assess and manage psychological distress associated with skin conditions. I have been fortunate to run workshops at conferences with nursing and medical colleagues, often arranged by both British Association of Dermatologists and British Dermatological Nursing Group, and what has struck me is that education and training works best when it is interdisciplinary and practically focused.

DrB: What research question are you most interested in at the moment?

AT: There remain many unanswered questions as to the types of psychological variable - such as coping styles, and other individual differences - that differentiate between those people that become distressed by their skin condition, and those that don't.  I’m also really interested at the moment in developing psychological interventions (particularly self-help) that might help reduce distress.

DrB: How much psychological help is available generally now in the UK for people with skin problems?

AT: Unfortunately, psychosocial services and support for people with skin conditions remain thin on the ground in the UK. This is really disappointing as we know from reports such as that of the UK All Party Parliamentary Group on Skin that there is a huge need for such services, and there is good evidence now for targeted behavioural interventions like habit reversal in the management of atopic eczema. In the wider mental health field there is excellent evidence for the effectiveness of psychological interventions and for focused self-help resources for dealing with some of the common forms of psychological distress that may face people with skin conditions.  .

DrB: Which part of your work do you find most satisfying?

AT: I find my clinical work the most rewarding part of my job.  I never cease to be humbled by the trust people choose to place in me when they share how they are feeling or what they have been through.  I see people who have often had many stressful or even traumatic experiences. I find it very rewarding when someone I’ve built a relationship with appears to feel understood and begins to see a connection between current feelings, thoughts, beliefs, and past experiences in such a way that their morale begins to rise and they start to see that there might be some solutions.  Often being heard and feeling understood has to come first, before changes can be made.  This isn't easy for people, and what is essential in any psychotherapeutic relationship is developing compassion. When people feel low, or socially anxious, they also struggle to be self-compassionate. Self-criticism comes more naturally at such times, and the therapist needs to help build self-compassion.