Transcript:
Client and Helper:
H1: Hello my name is Tina and I’m interviewing you today for a class paper would you like to participate in my study?
The Skill You Used: Open question
Comments: I was trying to engage in getting the client into opening up and sharing while understanding that I am a student providing her counseling.
C1: Sure, I have a lot going on in my life and could really use someone to talk to because I am not doing particularly well right now.
Comments: Client seemed very relieved because she was really in the middle of her own crisis situation.
H2: What is the most pertinent stressor in your life right now that is causing you to feel like you are going to break down and lose it, is it the hair pulling, or your living situation?
The Skill I Used: Closed question
Comments: I was trying to get to the point of her immediate crisis, so we could start talking about the issue she was struggling with most at this time.
C2: She states she has a lot of stress in her life pertaining to her living situation and relationships amongst also having Trichotillomania and she felt like she was going to have a nervous breakdown because both her boyfriend and her twenty five year old daughter are using drugs and stealing from her while living with her, and they hated and blamed everything on each other and yell and scream at her all the time. Comments: Client immediately opened up to me about all her personal information; it was almost like she was a volcano ready to erupt. She has no one to talk to usually and completely unloaded.
H3: So, correct me if I’m wrong but you are saying that your daughter and your boyfriend are both using drugs, verbally and emotionally abusing you and stealing from you while you are allowing them to live in your house, and because of the stress of this situation you are pulling your hair out more than normal and it is causing you to feel like you are going to have a nervous breakdown?
The Skill I Used: Reflection of meaning
Comments: I wanted to make sure I had a firm grasp on the issue at hand so that she could feel like I understood what was going on in her life and situation.
C3: She Stated yes that is exactly it, “I want them both gone I just want to be alone, I want them both gone, but if my daughter is not as bad with drugs right now as she used to be and she told me that if I kicked her out she would be on the streets and used all the time and it would be all my fault. And even though he helps me with some stuff, he does more harm than help and I don’t want my daughter to think I chose a man over her.”
Comments: She was carrying a lot of guilt and while she loves her daughter, and this man helps some, the way she is feeling is not worth the amount he helps. She wants some time alone to figure things out and she even talked about once she took care of herself and did what she needed to if her daughter was clean, she could come back.

Trichotillomania is a type of compulsive behavior. This means that people with the condition feel an overwhelming urge to pull their hair. They also may have other compulsive habits, such as nail biting or skin picking. Some also have problems like depression, anxiety, or obsessive-compulsive disorder (OCD). Compulsive behaviors like trichotillomania involve brain chemistry and may be genetic (meaning they can sometimes run in families).
People with trichotillomania may feel embarrassment, frustration, shame, or depression about the condition. They may worry about what others will think or say. They may feel nagged by people who don't understand that they're not doing this on purpose. They usually try to hide the behavior from others — even their families. This can make it difficult to get help.
Having trichotillomania can affect how people feel about themselves. Some are self-conscious about how hair pulling affects their appearance. Because of this, they might feel less confident about making friends or dating. Others might feel powerless to control the urge to pull or blame themselves for not being able to stop. Feelings like these.
Trichotillomania (trik-o-til-o-MAY-ne-uh) is an irresistible urge to pull out hair from your scalp, eyebrows or other areas of your body. Hair pulling from the scalp often leaves patchy bald spots, which people with trichotillomania may go to great lengths to disguise.
For some people, trichotillomania may be mild and generally manageable. For others, the urge to pull hair is overwhelming and can be accompanied by considerable distress. Some treatment options have helped many people reduce their hair pulling or stop entirely.

What Is Trichotillomania?
Trichotillomania (pronounced: trik-oh-till-oh-may-nee-ah) is a type of psychological condition that involves strong urges to pull out one's own hair.
Doctors used to believe trichotillomania was rare. But that thinking is now changing as experts gain a better understanding of the condition and more people come forward for help. Trichotillomania affects more girls than guys. Most people who have it develop it during adolescence. But trichotillomania can start in kids as young as 1 year old.
What Happens With Trichotillomania?
People with trichotillomania pull hair out at the root from places like the scalp, eyebrows, eyelashes, or pubic area. Some people pull large handfuls of hair, which can leave bald patches on the scalp or eyebrows. Other people pull out their hair one strand at a time. Some inspect the strand after pulling it out or play with the hair after it's been pulled. About half of people with the condition put the hair in their mouths after pulling it. Some people are very aware of their pulling; others seem to do it without really noticing what they're doing.
It might be hard to understand why some people would pull their own hair or eyelashes out — or why they wouldn't just stop. But trichotillomania isn't just an ordinary habit that a person can easily stop.
My Client
So with this explanation of this serious disease I will talk about my client now. The client is a 47 year old female who suffers with Trichotillomania. She pulls out her hair and eats the follicle she says she enjoys it very much. She states is a stress reliever, the client lives with her family and states the family can get bossy at times she states that the hair pulling and eating is like hiding in a room all by herself and just pulling her hair out. Observation of the client is that she wears a bandana on her head and she states that she a 25 year old daughter who has a drug problem and is living with her. In her disease her daughter has never seen her head; she states she is practically bald at the beginning of the interview. She stated she would not take her bandana off for anybody.
Trichotillomania is a compulsion to repetitively pull or pluck one's hair, resulting in noticeable hair loss. Many people with trichotillomania feel ashamed and embarrassed by their hair pulling, attempt to hide it from friends, co-workers and family members, and do not seek help. Many who consult their personal physician or a dermatologist because of hair loss never reveal the true cause and doctors often fail to consider this diagnosis (http://www.diagnose-me.com/cond/C609743.html). Some researchers have found that nearly 20% of hair pullers eat their hair or chew off and swallow the root ends. Called trichophagy, it can lead to hair being lodged between the teeth and more seriously to large accumulations of retained hairs in the stomach and digestive tract called trichobezoars (hair balls) (http://www.diagnose-me.com/cond/C609743.html). Hair pulling very rarely causes irreversible baldness. However, when the behavior stops, hair occasionally grows back gray or white and it may be finer, coarser or curlier. These changes may normalize over time.
Some researchers have described early onset (childhood) and later onset (adolescent) types of trichotillomania. There is no clear evidence that children with this form of the disorder are at increased risk for developing future psychiatric problems. However, children who are four, five or six and are still pulling their hair may begin to overlap with the later onset type trichotillomania which has a less favorable prognosis.
The trauma of hair pulling also increases the risk for scalp infection. Sometimes repetitive hair pulling can cause problems such as carpal tunnel syndrome, tendonitis, and neck/back strain. Perhaps the most common serious medical complication of trichotillomania is avoiding medical care for other illnesses because of the shame associated with hair pulling and the fear of its discovery (http://www.diagnose-me.com/cond/C609743.html).
More about my client
My client lives with her boyfriend and twenty-five year old daughter, and has a stressor on top of her hair pulling. Her boyfriend is an alcoholic and a drug addict and states he party’s every night and consumes at least two three drinks during the week if it’s not every day it’s every other day. The client states that the boyfriend is a major stressor but she loves him, and states that he helps her with the bills. Client states her first sign of this disease started in childhood though when she started picking the skin around her nails and leave the skin bare or as they say “mother-in-law” if you are familiar with the term, it’s the skin around the cuticle. Well she would go beyond the cuticle sometimes. But as we were speaking the client’s boyfriend and daughter was a great stressor to her not only did they give her stress but I would personally classify this relationship of client and boyfriend as unhealthy and abusive. The client wasn’t really getting into her boyfriend’s alcohol problem she was to just on the hair and the pulling; and the satisfaction she got when she even thought about this and how she desired to just go in a room by herself and just start pulling and eating her hair. She stated she was having some stressors at home too. She states she would be bossed around by her daughter and her boyfriend and that they would yell at her and scold her for simple things.
She stated as far back as she remembers she would pick the skin around her nail when she was a child, she doesn’t remember what age exactly. She says she would also brush her hair very hard and a lot of hair would come on the brush or even when she was taking a shower and she didn’t go to the doctor to get this checked. She states that she would pull out her white hairs but she doesn’t remember if the pulling of the hair started before the white hairs started to grow on her head or after. We were talking for a while she told me what she had to tell me we even went to the park and she sat on the swing and was just really depressed about the whole situation, I could see it in her face. I asked her many open and closed ended questions we shared moments of sadness as well as joy. She stated she would try to get help and that therapy was an option for her. She finally took off her bandana and showed me her head, I’m sorry to say she looked like a cancer patient which I would never dare to tell her but the showing of her head traumatized me in a way that I felt the woman’s’ pain. I just questioned myself, “Why a woman so beautiful would put up with so much from people who treated her in a way that she didn’t deserve to be treated. She was very sweet and the people she took care of and were supposed to love her physically and emotionally and verbally abused her.
Trichotillomania, which is classified as an impulse control disorder by DSM-IV, is the compulsive urge to pull out one's own hair leading to noticeable hair loss, distress, and social or functional impairment. It is often chronic and difficult to treat.
Trichotillomania may be present in infants, but the peak age of onset is 9 to 13. It may be triggered by depression or stress. Due to social implications the disorder is often unreported and it is difficult to accurately predict its prevalence; the lifetime prevalence is estimated to be between 0.6% (overall) and may be as high as 1.5% (in males) to 3.4% (in females).

The name, coined by French dermatologist François Henri Hallopeau, derives from the Greek: trich- (hair), till(en) (to pull), and mania ("an abnormal love for a specific object, place, or action") (http://www.squidoo.com/Trichotillomania-Treatment).
Identifying the Treatment for Trichotillomania Obsessive Compulsive Disorder
Psychological analysis of Trichotillomania sufferers has revealed the reason for pulling out of the hair. to be a condition called "secondary gain". People with Trichotillomania receive a secondary gain or satisfaction from pulling their hair out. The gain received often derives from a self-sabotage to avoid being hurt by other people. Women often use these tactics to make themselves less attractive for abusive men.
The solution to stopping the self-abuse is to reverse the brains thought structure which tells Trichotillomania sufferers that abusing themselves by pulling out hair is equivalent to avoiding pain from others. It may sound complicated, but the brain is automatically set up to avoid pain at all cost, so inflicting self-pain is seen as a defense from pain to people with Trichotillomania.
The beginning of stopping the hair pulling obsessive disorder has to begin with the control of the subconscious mind. With the right treatments for Trichotillomania, the brain can begin the cure of the hair pulling obsession by not associating the pulling of hair as pleasure.
5 Steps to Stop Pulling Out Hair in the Trichotillomania Treatment, one is Medicinal - Reuptake inhibitor drugs, two is acceptance, three is cognitive therapy, four is emotional triggers and five is relaxation (http://ezinearticles.com/?5-Steps-to-Stop-Pulling-Out-Hair---Trichotillomania-Treatment&id=2525238).