physical contact in therapy

i see so many people talk about touch or contact, our dear Soli wanting to be held as a parent holds a child, others wanting a hug, and some who recoil from the idea. It seems to be a hot topic all round. And of course, i am talking about nonerotic touch, we all know that sexual contact would be a bad idea no matter how much some may want that.

These were just twobooks i found right away... but in one of them there's an author who basically says that outside of an individual T's own intuitions there really isn't any answer within the profession... no guidelines based on research. i DON'T KNOW if that is true, it's just what she said. i'd be happy to see stuff that says the opposite.

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Often the hands will solve a mystery that the intellect has struggled with in vain. - Carl Jung

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Book:
http://Touch in Psychotherapy: Theor..., and Practice
Edward W. L. Smith
, Pauline Rose Clance
, Suzanne Imes

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As a therapist, do you ever shake hands with a client? Do you ever lightly touch a client's hand or shoulder as a conversational marker? What happens if you inadvertently touch a client? Nonerotic touch is a powerful form of communication, and research and clinical experience indicate that it can contribute to positive therapeutic change when used appropriately. This thoughtful book brings together experienced clinicians to review the research and to offer ethical, theoretical, and practical guidelines for using nonerotic touch in therapy settings. Featuring extensive clinical commentary and case examples, chapters address such topics as evaluating a client's desire to be touched, working with survivors of sexual abuse, the role of touch in regression and reparenting approaches, communicating with clients about the use of touch, and managing "touch errors."

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Book:
The Ethical Use of Touch in Psychotherapy

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Is ethical touch an oxymoron? Is the bias against touch in psychotherapy justified? Can the recovery process be complete without healing touch? Mental health professionals are entrusted with the awesome responsibility of providing appropriate treatment for clients in a safe environment that nurtures trust, a necessary ingredient for optimum movement through the therapeutic process. Though treatment approaches vary, most modalities are verbally based and, in theory, exclude physical contact. Fearing that any form of touch would likely lead to sexual feelings or interaction, clinicians tend to shy away from the topic. In The Ethical Use of Touch in Psychotherapy, however, authors Mic Hunter and Jim Struve skillfully demonstrate that touch--a most basic human need--is intrinsic to the healing process along with talk-therapy, regardless of the practitioner's theoretical orientation. While the use of touch is a given in other health care settings, it remains a benefit denied as taboo in psychotherapeutic relationships, due to transgressors whose unscrupulous use of a valuable technique have marred its reputation. This book encourages readers to conduct a meaningful self-reflection and explore possible misconceptions related to touch in order to rejuvenate its acceptance. Based on years of sound research and clinical experience, The Ethical Use of Touch in Psychotherapy promises to enrich clinical discussion and stimulate further empirical research. This insightful and progressive presentation is a must read for clinicians, interns, and advanced students, as well as lay readers interested in the dynamics and innovations in psychotherapy.

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my bend is that limited touch done in either casual, normal ways, like hand shaking, etc is good for some, and that other more meaningful touch can be helpful too if done constructively. But that's just me.

what do you all think? Anyone got books or papers that talk about the opposite?

Wow. Well, you made me read a bit

Personally, i think the issues and benefits of physical contact with therapists are the following:
the issue - if there is the possibility of sexual urges towards the T, it should be excluded, such as different gender, or whether you're homosexual etc.. as it could become confusing, and leave the T unable to help due to mixed emotions.

Whereas, the benefit of a handshake, hug or a hand on shoulder is that it can feel comforting, especially to those who feel inadequate to others..

It all depends on the circumstances.
anyone agree?

Kelly. xx

I certainly think that nonerotic touch can play a powerful role in the therapy process but must be used with a certain amount of caution on the part of the therapist. Before introducing touch into the therapy relationship I think the therapist should have sound grounds to do so in the best interest of the client and not himself. Clients who have strong erotic transference issues might confuse touch that is nonerotic and assigne erotice meaning to it. These boundries must be clearly spelled out before any touch should occur. I know that my therapist and I touch frequently in the process of our therapy relationship but I understand the nature of the touch as we discussed it and I feel comfortable with it and so does my therapist. At the end of each session we "hug" good bye and this feels so normal and natual and human that it has had a very healing effect on my relationship with therapist.

I think some therapists are uncomfortable with physical contact due to fears of allegations of inappropriate behavior. They probably were told to stay away from it during their training, in part due to the potential for lawsuits. Also, I think the different flavors of psychotherapy have different views on it, so again, the T's training probably influcences them a lot. I think for some clients and therapists it is right, and can be very healing. And for others, it would not be therapeutic. I think the T and the client need to get to know each other well before knowing if it is right for them. My T does hug me occasionally and it is very healing. He gives me the sort of hugs two close friends might share, that two humans might share. (I do not have erotic feelings for him or a desire for him to be my parent, so there is no confusion for me.)

Someone, I believe it was Mouse, posted a link here once, to a longish treatise on the borderline patient. I read through it all and one thing it mentioned was the use of touch. I remember especially it saying that if the T applies pressure with his hand to the inner thigh of the patient, this can be very therapeutic! I was kind of floored by that. I do not think I would like my T touching my inner thigh. But yet it's very therapeutic? I would like to read more about that sort of therapy, as it is beyond what I know. (This was only a very small part of the article and the use of touch was not a main point.)

My therapist always shakes my hand hello and goodbye. He will also touch my shoulder or elbow or back. It's good for me. I appreciate it. It makes me feel less disgusting and dirty.

I can understand both sides of the "argument", from both the practicionners perspective, as well as the client.

For me personally... I've had 3 counsellors. First one was fairly touchy feely, but I'm that type of person. The second woman, I only remember her holding my hands once when I was in a bad spot emotionally. My current therapist... he's given me a hug (at the end of his term when I thought we'd never see each other again) but beyond that... nothing.

I like physical contact myself... but I could see it could get out of hand if I got it every time I wanted a hug or anything like that.

Interesting reading! I don't remember reading any literature on this (but I may have, although I am a lowly undergraduate psych student, I do a lot of extracurricular reading) but I'll see if anything comes to mind!

I found the article on BPD. Here is the link:
Borderline Personality Disorder: Profile and Process of Therapy

And here is the part on touch I was referring to in my other post:
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The heavily abused borderline splits the mind off from the body and feelings. She may be very analytical, further cutting off from feelings. Automatically going to the head reinforces the non-feeling self. Bodywork can be very effective with people who have difficulty hooking up to their emotions (Lowen, 1985).

Clients with weak emotional discharge and poor emotional maintenance benefit greatly from the full presence of a therapist who applies strong pressure to vital, armored physical areas. The inside of the upper thigh is an area of great release when pressed carefully. The close physical proximity of the therapist provides the much needed emotional security for the deep expression of long repressed feelings.

For some very repressed borderlines, bodywork utilizing pressure-release points may have to continue over a long period of time in order to get the client used to being in touch with the real self. But the effort can be worth the reward of seeing the client happily smiling after his or her long, dark journey into a psychic hell.

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Has anyone here ever done bodywork?

I think, like anything else in therapy, it will depend on that therapist and that client. If a therapist doesn't initiate touch and it doesn't come up in conversation I don't see how it can happen. I've mentioned touch and had therapists adjust to what we discussed and I'm sure therapists have "reached out" to me and then adjusted to my reaction/response without conversation, too. I know I've had conversation where a T has said it wasn't her "syle" and that has been fine with me. The relationship and that "happens" as a result of the interactions within therapy are what have been most important to me so I have tried to use whatever happens for healing.

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I don't see how it can happen

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Well, we could jump in their laps.

just kidding. I agree Perna. It's a very individual thing no right or wrong answer except for the obvious taboos.

omg sunny... yeah, ahem, the inside of the thigh pressed carefully !!! hahahahahahaha... holy bat crap... almost spit out my drink. But i would imagine that body work would be done the same way accupressure and such are done... not like you'd be talking away and T would reach over and grab your thigh! Although that is a much funnier scenario. Hey T, i gotta few other um, release points i wantcha to check out... hahahahaha

gee i hope it's not an "argument" not here anyway... just interested in opinions... and i'd be really interested in any other sort of articles or books about this. i'm wondering if anyone knows of good sources of info discussing both sides.

of course if it's used at all it has to be on a per case basis. i just think about the more strict T's that wouldn't dare shake hands to those who hold clients while they cry. i'm sure some do worry about lawsuits, i wonder about that. i never really hear of medical lawsuits here much. i wonder why it seems, from what i read, then that training says no, but everyone seems to see a "per case" benefit possibility.

i'm also not just talking about serious deliberate touch either *necessarily* although thats cool too.. practice hugs? My T shook my hand when we first met... and he did touch my hand when i asked him to (i have a collagen disorder that makes my skin feel kind of velvety, among other issues). He took my hand and felt it as i had asked.. nothing was made of it and i didn't find it made any impression. But if you all remember Pink's post about her hand being touched, very different experience, and very valid and important IMO. Different T's, different clients, diffferent orientations... different everything. Now T doesn't shake my hand and there have been moments when i am sure he was considering it and decided not to... those puzzle me, i think he thinks he would scare me away.

i wonder, if there doesn't seem to be a way to have a hard and fast rule... why don't they just teach that?

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MzJelloFluff said:
i wonder, if there doesn't seem to be a way to have a hard and fast rule... why don't they just teach that?

</div></font></blockquote><font class="post">Well, maybe they do. It probably depends on what kind of therapist you are studying to be. I think some orientations are more open to touch than others.

I was just thinking of how the dynamics of touch between me and T changed when my husband entered the therapy picture. When T and I have individual therapy, we usually don't touch. He does not shake my hand. At the end of sessions, we sometimes hug, especially if it has been a really hard and emotional session, with a lot of hard work. Or just if it seems I really need it. But when I have done couples therapy with T and my husband, T has never hugged me (maybe husbands might perceive physical contact between their wives and a therapist as a threatening move, you know, like "get your hands offa my woman!"). But yet my T shakes my husband's hand at the end of every session. And since he shakes my H's hand, I guess he feels like he has to shake mine, so he does, but I always get a two-handed shake, whereas H only gets a regular one-handed shake. Fascinating! I always think the two-handed shake is a way of saying, "hey, sunny, you're the original client, you're special to me" or some such garbage. It seems more of an emotional connection to give someone a two-handed shake than a one-handed shake. I'm reaching, aren't I? Oh, Lord, I sure am glad T doesn't know that I think about these things.

I know too that, for me, touch has a lot to do with my attitude. That's I think what is important with Pink. I concentrated, when I gave my weekly payment to T on her hand and my hand and handing it to her "personally" :-) and even now when I'm receiving change from a clerk I try to get my hand in there in personal space rather than donning gloves and mask and telling the clerk to just "drop it" down to my hands waiting 6" underneath.

In my field touch can be a very powerful healing tool both physically and psychologically. However, in psychotherapy I can certainly see what there is great harm vs. benefit debate.

My T has never touched me, and I'm OK with that.

My T has never touched me, he has come close and at times I thought he was going to put his arm around me or touch me and I felt my body tense, as much as I trust him and care for him, I cannot go there, I think it would make me panic. I think I would probably think he wanted more, only because of where my mind is, and I don't want to have to have that internal battle. I know that there isn't any kind of sexual behavior on his part, he truly cares about me, but it would put me in a bad place.

I often wish my female therapist would give me a simple hug or something when Im really upset and crying but there is no contact at all between us .I feel crap after therapy going home crying.

have you talked about this desire with her mazer?

I'm with you, Mazer. My male therapist only shakes my hand, at the end of the session when I'm walking out. When I feel really %#@&#! and am having a hard time crying et al, sometimes I feel like I want a hug from him--or at least a squeeze around the shoulder, or even a two-handed hand shake as someone else mentioned. I'm sure there are very good and valid reasons not to touch clients--but sometimes it just seems like it would be the nice thing to do for him to do that. Then I just feel like crap driving home.

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mazer said:
I often wish my female therapist would give me a simple hug or something when Im really upset and crying but there is no contact at all between us .I feel crap after therapy going home crying.

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I've often wondered about this. How do they end a session if you get upset and cry? I wouldn't want to be told..'Oh, hey its great that I finally got you to cry, but times up you have to leave now?' I wouldn't want to be out paying my bill with red eyes and tissues. This is awful! I'd feel like crap too..Your T just made me angry!

You just described my session today with my t. Today was my 1st appt. since the holiday's. My eyes were almost too swollen to drive home. It was lovely

tulips

My T, pdoc, and addictions doc are all in the anti-touch school of therapy and that's fine with me. I think I've only shaken my T's hand once and that was when I first met her 10 years ago. My pdoc did touch my shoulder once, when we were kind of joking around about the possibility of my having a brain tumour (long story don't ask) but she immediately apologized. I really prefer the no touch approach, and would view anything else as a violation of my boundaries.

---splitimage

I've had two therapists and they both allow physical touch. My first therapist held me whenever I wanted it. She "reparented" me. It was very powerful and healing. My current T will hold my hand or hug me if I ask. I believe it has been an important part of my recovery.

my T hugs me at the end of every session now, and if that ritual ever stopped, it would cause way more harm than good.

((Tulips)) sorry to hear things went like that for you. Hope your feeling better.

I had a student in my office a few months ago who had lost her mother a few months before. The stress of school was starting to pile up and she just needed to vent. Now mind you, I am not the faculty member most students come to when they are feeling down and needing support. I'm more of the one who give the kick in the @$$ when they need it. I'm a bit out of my element in this situation-but holding my own. So she is in my office talking and I am listening and paraphrasing intermittently. The all of the sudden I said something back to her, and the flood comes. I have never seen so much grief in my life. Honestly, at one point I'm thinking..I'm going to need the wet vac. Her emotions were so intense that I could even feel them somewhat..I know it sounds stupid, but it was a very profound experience for me to see that intensity. I think I did a good job of hiding my shock, I stayed there with her and just waited it out. I think in the end she felt a lot better and she left looking drained but better somehow. My only regret in thinking about that experience is that at one point I just wanted to reach out and hug her, but didn't. It was just a barrier that I wouldn't cross. I think I did touch her shoulder at one point.. but I probably should have given the hug when the impulse occurred.