Download the report - The Healing Foundation

a strong evidence base in other areas of psychological treatment, we can work with individuals
and groups to develop new, sustainable and positive appearance schemas which will facilitate
social interaction and inclusion and promote positive adjustment.
The high levels of individual variation that have been evident in earlier studies of appearance are
clear in this study too (studies 1-4, 5, 8, 10-12). Thus we have needed to develop a tool which
allows us to choose from a range of interventions and packages of support. Whilst one person
may benefit from a detailed psychological input, many others respond to less intensive
measures. Indeed there is evidence for brief solution focussed approaches which focus on
managing staring and comments from others (Clarke, 1999).
The intervention manual has therefore been designed both to provide an informative evidence
based background to the area, and to describe a range of methods and approaches to
managing appearance concerns. In common with the stepped approaches used in the delivery
of clinical care in other conditions, we have devised a stepped care model for the management
of appearance.
A stepped care approach to psychosocial intervention
Informed by the results of The Healing Foundation study, the manual provides the theoretical
basis on which to plan intervention, together with an outline of the approaches that have been
used so far in disfigurement and in associated problems of appearance anxiety and social
phobia. Clinical examples are used to illustrate the range of problems that people encounter.
Stepped care models, now routine practice in cancer care, provide an approach which facilitates
the psychosocial care of patients by providing a role for everyone in the care team. Level one
intervention refers to the provision of a sympathetic and caring environment in which people are
treated with dignity and respect, encouraged to ask questions and provided with relevant
information. Whilst all team members are involved at this level, more complex interventions
(level 4) would be delivered by specialists with additional training. A similar approach is
illustrated by the PLISSIT model in sexual health, used here because it offers the advantage of
an acronym which aids recall.
The PLISSIT model (Annon, 1974):
1. Permission
2. Limited Information
3. Specific Suggestions
4. Intensive Treatment
Level 1: Permission
The first level – permission – is a particularly important concept. Observers often worry about
whether it is appropriate or not to address issues relating to appearance. The model provides a
framework in which a direct approach is encouraged. Permission also applies to both sides of
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