Find a Trichotillomania Therapist

Understanding trichotillomania and how it can affect you

Trichotillomania, often called hair-pulling disorder, is a repetitive behaviour that leads to noticeable hair loss and can affect your daily life, mood and self-image. For some people the pulling is episodic and connected to specific triggers, while for others it can become an automatic response linked to stress, boredom or strong emotions. The impact is rarely only physical - many people describe feelings of shame, embarrassment and a wish to hide the behaviour from family, colleagues or friends. Because the habit can be so private and habitual, recognising it as something that can be worked on is an important first step.

Signs that indicate therapy might help

You might consider looking for specialist support if hair-pulling is causing distress, if efforts to stop have previously been unsuccessful, or if the behaviour interferes with work, relationships or social activities. Other signs include persistent urges to pull despite wanting to stop, skin damage or infections from repeated pulling and a cycle of relief followed by regret. You do not need to wait until the behaviour becomes severe to seek help - early intervention can make it easier to learn alternative responses and to address any underlying anxiety or low mood that may be contributing to the behaviour.

What to expect in therapy for trichotillomania

When you begin therapy, the first sessions will usually involve an assessment where the therapist asks about the history of the pulling behaviour, current triggers, past attempts at change and the things you hope to achieve. This helps the therapist tailor treatment to your needs and to set realistic goals. Most therapists will work collaboratively with you to map patterns - where, when and how pulling happens - and to identify emotional and situational triggers. You can expect a mixture of practical strategies to reduce pulling, alongside work on thoughts and feelings that maintain the habit.

Structure and pace

Therapy sessions are typically weekly at the start, lasting around 50 to 60 minutes, although some practitioners offer shorter or longer sessions depending on your needs. Progress is often gradual - you will work on awareness, build new responses to urges and practise strategies between sessions. Your therapist may suggest keeping a diary or using simple tracking tools so you can see patterns and measure change over time. If you are seeing a therapist who is also a clinician registered with the HCPC, or a counsellor accredited by the BACP or trained through NCPS programmes, they will explain assessment and outcome processes clearly.

Common therapeutic approaches used

There are several evidence-informed approaches that therapists use to help with trichotillomania. Habit reversal training is a widely used behavioural technique that helps you recognise the urge to pull and replace it with a less damaging response. Cognitive behavioural therapy, or CBT, helps you examine and shift unhelpful thoughts and beliefs that might perpetuate pulling, such as harsh self-judgement. Acceptance-based approaches and mindfulness can teach you to observe urges without acting on them and to relate differently to uncomfortable feelings. For some people, addressing co-occurring anxiety or depression is an important part of treatment. Therapists often combine elements from different models to create a programme that fits your situation.

Specialist training and accreditation

Look for therapists who state they specialise in body-focused repetitive behaviours or who have undertaken training specific to trichotillomania and habit reversal. Accreditation with BACP or registration with HCPC for clinical professionals indicates recognised standards of practice, and practitioners who reference NCPS training show a focus on evidence-based approaches for this condition. Specialised experience is particularly helpful if you are seeking support for a child or adolescent, or if the pulling is part of a broader set of concerns that include anxiety, trauma responses or neurodivergence.

How online therapy works for trichotillomania

Online therapy offers practical flexibility - you can attend sessions from home or another comfortable environment, which may make it easier to maintain regular appointments. Video sessions generally mirror face-to-face sessions with assessment, collaborative goal-setting and skills practice. Many therapists will use screen-sharing to go through worksheets, habit-tracking tools and step-by-step programmes. You may also receive exercises or audio practices to use between sessions, and some practitioners offer messaging between appointments for brief updates or check-ins, depending on their practice policies.

Remote work can be especially helpful if you live outside major urban centres, have mobility constraints or need evening appointments. It is useful to prepare a quiet space and ensure a reliable internet connection. Your therapist will discuss how to handle moments of intense urges during or between sessions and will agree a plan for managing risk and urgent concerns should they arise.

Choosing the right therapist for you

Finding the right therapist is a personal process. Start by checking qualifications and whether the therapist mentions experience with trichotillomania or body-focused repetitive behaviours. Read profiles to understand their therapeutic approaches - if you prefer a practical behavioural plan, look for habit reversal and CBT experience; if you want to explore feelings and history more deeply, psychodynamic or acceptance-based approaches may be offered. Consider whether you want someone who has worked with adults, adolescents or both, and whether they have experience with neurodivergent clients if that is relevant to you.

Practical considerations matter too - ask about fees, session length, cancellation policies and how they handle between-session contact. Many therapists offer a brief introductory call or message so you can get a sense of rapport and discuss expectations before committing. You might ask how they measure progress and what a typical treatment timeline looks like for someone with similar needs. It is reasonable to enquire about registration - many therapists will list BACP, HCPC or other accredited bodies on their profile.

Preparing for your first session

Before your first appointment you may find it helpful to note when pulling episodes tend to happen, any triggers you can identify and what you have already tried. Think about what you want to change and what a successful outcome would look like for you. Bringing this information to the assessment helps your therapist create a focused plan and makes early sessions more efficient. If you are seeking support for a young person, a parent or guardian may be invited to provide background information while the therapist explains how they will involve the young person in decisions about treatment.

Moving forward

Working with a counsellor or therapist can give you tools to reduce hair-pulling and to address the thoughts and feelings that sustain it. Progress often involves setbacks as well as gains, so patience and regular practice are important. If a particular therapist or approach does not feel like the right fit, it is fine to explore other options until you find someone who aligns with your needs. The directory listings below are designed to help you compare qualifications, approaches and availability so you can take the next step towards support with confidence.