Emotional support and consent play an important role in consulting for surgical and non-surgical cosmetic treatments

Posted on the 11 July 2014 at 13:58

I feel very honoured to be a Member of The Expert Reference Group of Health Education England's NWL Non- Surgical Cosmetic Intervention Review. I am the only psychotherapist on the table. It might seem odd that a psychotherapist should be on the table of a non-surgical cosmetic intervention group but I am there to represent the emotional world of patients. What does that mean?

Well, it can be anything from pre-procedure anxiety right through to extreme emotions resulting from physical outcome. The most important part of a cosmetic surgery counselling session is the conversation about expectations. A realistic look in the mirror is not easy for anyone but when it comes to cosmetic interventions this is an unavoidable task. Many people think psychotherapists are there to help people with mental health problems and/or to spend countless weeks, months, years and decades going over the same old ground. Nothing could be further from the truth when it comes to cosmetic surgery counselling. Whether you call it psychotherapy, counselling or emotional support it all amounts to the same thing - the ability to help the patient explore what is going on for them emotionally with reference to a cosmetic intervention. This could be pre-op or post-op. Pre-op is interesting because information and support is of concern to anyone no matter how far away in the distance the possibility of a procedure may be.  Generally, though, it relates someone who is quite near to their procedure date.

However, awareness of emotional support assists with the cultural shift away from advertising. Cosmetic surgery brings up emotions in patients that they did not know they could feel. Some will take these emotions in their stride but others do not cope as well. The benefit of cosmetic surgery counselling is that patients do not have to go online to speak to strangers who may or may not have hidden commercial or referral agendas and no training in emotional support.

As a Member of the Expert Reference Group for the Health Education England/NWL Non-Surgical Cosmetic Intervention Group, I have contributed indicative content for my specialist area of emotional support for cosmetic patients. Unlike the distinction made between the HEE/NWL and The Royal College of Surgeons Interspeciality Committee on Cosmetic Surgery Group, I do not draw a psychoIogical line in the sand between surgical and non-surgical patients.  Experience shows that often the surgical patient is also the non-surgical patient and vice-versa. In other words someone who goes in for a face-lift may also be having an injectable treatment for best effect.

While a member of the RCSIC Patient Group has a seat on the HEE/NWL Expert Reference Group, no known patient group from the aesthetic/cosmetic world sits on the RCSIC. This is how communication problems start, which is a great pity as one of the central issues everyone is trying to remedy is communication. I have requested a place on the RCSIC group just so that surgical and non-surgical can have consistency in patient feedback. I received a reply to my request explaining the rather complicated procedures of the RCSIC together with their assurances that patient groups would be invited to comment after the meetings! 

I was invited to attend a Westminster Briefing Conference which was an opportunity for interested parties to present on their chosen subjects and bring the audience up to speed on Government progress post-Keogh. The distinction between surgical and non-surgical was evident but Westminster Briefing has an open door policy that did not discriminate between surgical and non-surgical attendees.This is the way of open communication.  I spent the day thoroughly absorbed in listening and learning as representatives from surgery, dentistry, nursing, government and industry outlined their aspirations and concerns for the  forthcoming safety measures that will be put in place by both surgical and non-surgical governing bodies. The surgical presentation made little reference to the RCSIC although they did display a lovely photo of the Royal College of Surgeons "in case any of the aesthetic professionals were unfamiliar with it".

Two main themes emerged from today's conference: Support and Consent.

It is music to my ears as it would be to most interested parties when speakers delicately touch on the winds of change that point towards a reality of more honest dialogue with patients on expectations and peer support among themselves in perhaps achieving this. They are referring to diluting the historically poison advertising. The desire was palpable but so was the recognition that without a radical shift in advertising this may not happen. There was genuine exhaustion from the relentless distortion by the media. There was an unspoken question of whether a group of ethical professionals could ever put the genie back in the bottle without some creative thought.  Without realising it, these professionals were talking about counselling/emotional support. The same subject cosmeticsupport.com has been talking about in blogs and websites for so long.  So have we finally met the professionals on the same page?

The feeling in the room was that with honest dialogue and some radical changes in advertising everything will return from distortion to normal again. I would love to believe that this would be true. Patients see practitioners as people who can ‘fix’ them through scalpel or the syringe and anything less is just plain withholding. Patients do not expect either scalpel or syringe from counsellors. It is that distinction that makes the difference in delivering the message.

Patients need to be well-informed. A consultation with the practitioner should focus on what is going to happen to them physically. This is what they are experts in. Counsellors focus on the mind. The need is there because life-changing alterations to the face or body are emotional. Practitioners attempting to hold a psychological conversation with a patient while also explaining the physical side of the procedure are just overwhelming patients in too many cases. Too much information!

From my perspective, the duality between surgical and non-surgical is less relevant for emotional support. This technical division is important to assist important technical practicalities. This division may lead us to the assumption that non-surgical is less dangerous from the emotional support perspective.  This is not necessarily the case. A patient looking for a quick injectable treatment may harbour more psychological problems than someone turning up for multiple procedure surgery.

Many surgeons have said to me: ‘we need someone on site who can be there when we need them to talk to the patient’. Counselling just does not work this way. This is why so many clinics hire ‘patient advisors’ who are to hand when needed but this is nothing like counselling. It is another distortion.

Patients gain no benefit in rushing from a detailed conversation about the physical to the emotional. Patients need time to digest thoughts and feelings. Most psychotherapists favour comfy surroundings rather than a clinical environment to practice in. Cosmeticsupport offers online help as well as phone help and various other options. The object is not to dilute the therapy but to make it as comfortable for the patient as it can be. Counselling is not supposed to give pain - it is supposed to take it away. What better way is there than in the comfort of your own home or in a therapists warm cozy environment to share your secrets? The recognition of the need for options is an important part of our service. The option to choose how you see a counsellor and when you see a counsellor as an integrative holistic part of an elective private cosmetic procedure must surely be gaining currency.

The second theme of the day was consent. I was itching to point out the close connection between support and consent at today’s conference but often feel that the industry is not yet open enough to understand counselling. The world of the practitioner is different to the world of the patient even though both patient and practitioner may often be one and the same.

They talked about patients being disappointed with results even though they sign a physical consent form. And there’s the rub. My previous blog was about emotional consent. Disappointment is not physical. It is emotional. Talking about happiness, sadness, disappointment or any one of a host of other emotions related to cosmetic procedures is a conversation about emotions. This is a conversation that should happen with a counsellor in a cool-off period with the request of a signature for emotional consent.

Surgeons, dentists and nurses are all concerned for patients when it comes to the reality of results. Too much advertising coupled with a lack of solid fact has led to distorted expectations from cosmetic interventions. Practitioners are aware of this but how many want to really challenge the source? In their enthusiasm for best practice they want to help patients understand disappointment but this is not the role of the practitioner. This is the role of the cosmetic surgery counsellor as cosmeticsupport repeatedly points out.

This is not the first time I have written about emotional consent. I wrote a blog for Consulting Room on this subject last year because it is of concern to me too. Aesthetic practitioners can be brilliant and some can create miracles with a scalpel or a syringe but that does not make them counsellors who are trained in the emotional welfare of a patient qua consumer.

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