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Objectives: Problematic skin picking (SP) is a poorly understood experience characterised by a drive to pick the skin and related psychosocial impact. In the DSM-5, problematic SP is classified as ‘excoriation (skin picking) disorder’. The aim of this article is to present a rare qualitative perspective on the lived experience of problematic SP, prioritising participants' voices and sense-making. Design: An in-depth qualitative study of individuals who self-identified as picking their skin problematically and experienced related distress. Methods: Seventeen UK-based participants were recruited online and interviewed about their SP. Participants were given choice of interview modality, including instant messenger platforms, telephone, email and Skype, to maximise comfort and improve the accessibility of the study. Transcripts were analysed using thematic analysis. Results: Three themes offering novel insight into the phenomenology of participants' SP are highlighted and explored: (1) how cognitions and circumstances drove and permitted SP, (2) how participants ‘zoned out’ while SP and the escape or relief that this attentional experience offered and (3) participants' feelings of shame and distress in how they felt their SP may appear to others. Conclusions: This study contributes in-depth and novel ideas to the understanding of SP phenomenology and identifies how environmental factors, cognitions, contextual distress and shame may be considerations in therapeutic intervention. It presents the complexity of SP sense-making and demonstrates the need for individual formulation.

Objectives: This study utilises a ‘helpful factors’ approach (Elliot, 2010) to explore the therapeutic processes occurring within community-based adult reading and writing for well-being groups in a large city in England. The groups are facilitated by a practitioner with diplomas in psychodynamic counselling, creative writing, and creative writing for therapeutic purposes. The study aims to develop an understanding of the therapeutic and group factors which participants have experienced as being most important in supporting their well-being. Method: Twelve individual, semi-structured interviews were conducted for this study. Participants were recruited purposively from three reading and writing for well-being groups. By conducting qualitative interviews, the researcher worked to initiate an open dialogue in which participants could freely share their experiences and themes could be developed. The interviews were analysed using thematic analysis, following the guidelines of Braun & Clarke (2006). Results: Four overarching themes and thirteen sub-themes were developed. The overarching themes were named utilising participant quotes that effectively reflected the central organising concept of the theme. Overarching themes were: “Hey look, here I am, this is what I’ve done”, "A space in which you are not only allowed to talk, but also to listen”, "It's a helpful tool that's not invasive, that's not trying to be a cure", and "But I don't want to put him on a pedestal!”. Conclusions: The potential contribution of this work lies in the hope of expanding access to community-based sources of non-pathologizing support—both for adults who identify as well and those experiencing mild to moderate mental health problems. Reading and writing for well-being groups are a cost-effective intervention that may have the potential to address the socio-political problem that is the scarcity of low-cost mental health services in the United Kingdom. The findings of this research support the findings of prior qualitative research on therapeutic creative writing and bibliotherapy groups (Fair et al., 2012; Dowrick et al., 2012; Gray et al., 2016) whilst additionally making a unique contribution to the literature.

With a few exceptions, the subject of social class has rarely been addressed in counselling and psychotherapy research. This study seeks to contribute to redressing this omission by exploring therapists’ accounts of how social class operates within therapy, its impact on the therapeutic relationship, and the relationship between social class and mental health. Eighty-seven practicing psychologists, counsellors and psychotherapists, from trainees to experienced practitioners, completed an online qualitative survey about social class in therapy. Critical thematic analysis was used to analyse the data and explore the therapists’ sense-making around social class. One (smaller) group of therapists located individuals’ mental health difficulties within the wider socio-political context and positioned class differences in therapy as something that cannot be transcended by the therapeutic relationship. Another (larger) group of therapists framed psychological distress in individual and psychological terms and as separate from the wider socio-political context and constructed class differences as something that can be transcended in therapy. We take a political stance in interpreting this analysis and argue that the dominance of ‘oppression-blind’ sense-making arguably points to a need for a change in class-consciousness at the heart of counselling, psychotherapy and psychology, so that therapists are more cognisant of the relationship between mental health and clients’ socio-political context, and their own social power in the therapeutic relationship.