Let us take a moment to consider the luxury of having our worst fears about ourselves safely out of sight from the critical scrutiny of the outside world.

Now consider how you would be affected if you believed that your appearance exposed all that is most deplorable about you?  You look strange, all of your grotesqueries betrayed in your face.  Your appearance is shocking: “I am shocking!”

I grew up believing the way I looked revealed my abnormalities.  My face elicited distress, mistrust and even hatred.  For this reason, I grew up with a sense that people where really angry with me.  I caused offence and revolt.  The way I looked was not only a disappointment, but I considered my visage unnatural and uncanny; believing that my actual existence was hurtful to others and harmful to those I came into contact with.  This was mirrored in the expressions and behaviour of people I encountered.   As a child, growing up in the UK, I spent long days thinking there was something terribly wrong with me, thinking: “I am ugly and repulsive.  I look absurd...”  Often wondering what it would be like if I didn’t have a face.

I was born with a (“hare”) cleft lip and a cleft palate.  This affected the appearance of my nose, which was flat or “squashed” until my mid teens, when a thin slice of my rib cartilage was used to ‘repair it’; to give it more length and shape.  The cleft in the roof of my mouth was ‘restored’ using bone chiselled from my hip and chin.  I have had in the region of fifteen operations to look the way I do today.  As you might expect, my changing appearance has had a considerable effect on my life; much of this experience, especially when growing up, has been physically and psychologically painful. 

My article is concerned with counselling people who are visibly different.  Needless to say, not all clients who have negative attitudes towards the way they look will be (or will have ever been) ‘disfigured’ in any way.  Their distress and anxiety is no less potent and destructive to their fragile sense of self and, whilst writing, I am mindful of all people who perceive their appearance as damaging.

Henry, S. (2011). Disfigurement and visible difference: The impact upon personal and personality development and the implications for therapy. Person-Centered & Experiential Psychotherapies, 10(4), 274-285.

Davies, D., & Aykroyd, M. (2002). Sexual orientation and psychological contact. In G. Wyatt & R. Sanders R (Eds.), Rogers' Therapeutic Conditions: Evolution, Theory and Practice. Contact and Perception. (pp. 221-233). PCCS Books.

Davies, D. (1998). The six necessary and sufficient conditions applied to working with lesbian, gay and bisexual clients. The Person-Centered Journal, 5(2), 111-120.

“When I think about all the marks I have against me in this society, I am amazed that I haven’t turned into some worthless lump of shit. Fatkikecripplecuntqueer. In a nutshell. But then I have to take into account the fact that I’m articulate, white, middle class college kid, and that provides me with a hell of a lot of privilege and opportunity for dealing with my oppression that may not be available to other oppressed people. And since my personality/ being isn’t divided up into a privileged part and an oppressed part, I have to deal with the ways that these things interact, counterbalance and sometimes overshadow each other. For example, I was born with one leg. I guess it’s a big deal, but it’s never worked into my body image in the same way that being fat has. And what does it mean to be a white woman as opposed to a woman of colour? A middle-class fat girl as opposed to a poor fat girl? What does it mean to be fat, physically disabled and bisexual? (Or fat, disabled and sexual at all?)”

Lamm (1995)

“Of course it is important as therapists to develop an awareness of how race, gender, sexuality, or ability levels might impact upon one’s experience, and we can develop these understandings through reading and by immersing ourselves in the struggles of oppressed people. However, in the therapy room, we should let clients lead us to understand their social locations and how various forces have come to shape their lived experiences in unique ways. This is not to assume that clients have access to knowledge about how all the discourses and forces that have shaped their being. Rather this analysis prepares us to come with an openness to take part in a journey of discovering how unique individuals make sense of their social realities and being in the world!

Shaindli Lin Diamond & Joseph Roy Gillis (2006)

“Social significance is attached to our genitalia, skin colour, sexuality, physical impairments, age, income, job, religion and whether we have a permanent home, and this profoundly affects almost all aspects of our lives.” 

Rose Cameron (2017)