Why some practitioners fail with habit reversal for chronic atopic eczema



At a recent habit reversal training workshop with Peter Norén we reviewed together the good results we get using habit reversal in The Combined Approach for chronic atopic eczema.

We highlighted our top tips for success, and went on to consider our failures - why some of our patients have not done well.

Sometimes however failure seems due to the practitioner, rather than the patient.

Here are four important practitioner issues that we discussed:

1. The practitioner fails to understand the programme.

The approach requires more than the typical out-patient consultation, and crucially combines habit reversal with optimised topical treatment in a therapeutic programme that includes follow-up.

2. The practitioner has failed to engage with the patient.

The fundamental part played by the practitioner-patient relationship cannot be over-stated. Success is unlikely unless the right attitude is established from the start.

3. When the practitioner takes a short-cut.

The time constraints in clinical practice are such that it is tempting to give over-simplified habit reversal advice. Leaving out awareness training, or just telling the patient what to do, are common mistakes.

4. Starting with a difficult patient.

Success with all patients is not possible. What is certain in our experience is that most patients do very well, very quickly, and are delighted. Characteristically they easily accept and commit to the programme.




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