Touch In Therapy

This is an issue that has been stirring around within me for a while now, and I think its time to put words to it. First however, I would like to define touch as a hug, or hand on a knee, or hand on a shoulder while leaving the room – or anything along similar lines. I have very mixed views on this subject, and when it comes down to it, touch in therapy is very situation and individually dependent. There are certainly situations where touch would be inappropriate; however, given alternate circumstances, touch could be very beneficial.

Issues along similar lines can be taken back right to the birth of the client – or any individual for that matter. Touch deprivation has been linked back to an infant’s failure to thrive. Massage therapy has been linked with positive outcomes for depression, immune system functioning, and state anxiety. Clearly there is research that indicates touch can be a positive contributor to healing of some sort. There is however; a very fine line that separates the prior information, and how this relates to therapy. There is also research that indicates touch is not beneficial, especially for clients with a history of abuse, clients who struggle with personal boundaries, and individuals who are sexually charged.

So what about those clients who believe they are unloveable? Would it not be beneficial (after a therapeutic and trusting relationship has been established), for the therapist to show them that they are not horrible? Would this simple nonverbal act of a comforting hug (obtained with permission), not be a gesture that could not be summed up with words? When is it appropriate to display affection in a therapeutic relationship? Where should the line be drawn?

I would like to examine how a simple (though, nothing ever is), hug in therapy might be beneficial, as well as detrimental to the client.

This gesture may provide the client with some physical form of comfort, that given by the therapist, is a way to show their support. In other words, this gesture might be able to demonstrate in a non-verbal way, that the therapist cares, and is doing his or her best to provide comfort. Perhaps this comfort is something that the client feels they are not able to obtain in real life, and thus, by receiving one in therapy, it is a way to feel better – even if just for a brief second. Perhaps it gives them something to “hold onto” in between sessions, or it allows them to trust in their therapist more, and as a result, be able to share further information. There are many different reasons why a hug might be beneficial. The problem however, arises when the client begins to look forward to these events. When the client feels the need for this to occur every session, or when the client feels an increasing need to see the therapist and/or receive a hug from them. To the outside viewer this may seem a little far-fetched, but if you can imagine yourself feeling completely alone and misunderstood, and you have a therapist who cares and understands you… its only natural that you would want to be around them more, as they show you that you do matter. This however can lead to transference – a process whereby someone unconsciously redirects emotional attachment from another figure in their life (or absence of a figure in their life) onto the therapist. This can be an either positive or negative experience, however, it is not uncommon and is especially problematic involving issues surrounding love and/or abandonment.

Transference is a common occurrence that develops in therapy, and has many benefits and costs in and of itself. With a skilled therapist however, this can be overcome and processed in therapy itself. Transference that goes unacknowledged, and doesn’t resolve… well that can lead to real problems when it comes to termination. A therapist who offers a hug (or accepts a hug from a client), can be unknowingly feeding this need for affection of the client. At a surface view, this may not seem all bad. The problem however arises when continuing support in this way. A simple hug might then turn into a road for dependence, might contribute to the irrational magnification of the therapist, and is essentially setting the client up for further heartache, as this therapeutic relationship ultimately must come to an end. This angle supports the one view of mine that suggests there is no room for friendship in therapy. Friendship only muddles the reason why the client initiated therapy in the first place – to have an objective point of view on the struggles in one’s life. Dual relationships are simply not beneficial, and unfortunately, with the wrong interpretation of the situation, a simple hug might be a stepping stone to this sort of dependence in therapy.

So the question remains, when is touch appropriate in therapy?

I’ve gathered many opinions on this subject, and I still do not have a definite answer, however, I have narrowed down my views quite a bit. I believe touch can be beneficial under specific circumstances:
• The client must have a sense of being in control (i.e., either requesting permission themselves, or having the therapist ask permission before being touched).
• The hug was a result of the client’s need for affection, rather then the therapist. Using the technique of physical touch has a lot more to do with how the client is feeling, as oppose to filling some need of the therapist. Intention is the key to touch.
• There is already an established, trusting, therapeutic relationship, and the hug (or display of touch) is congruent with the emotional intimacy of the relationship.

This all being said, I certainly believe there is a time and place for a hug (or touch) in therapy; however, this technique must be used with caution. The age of the client also has an impact on the level of touch in therapy. For example, when working with children, there is a general behaviour of using touch more frequently then with adolescents or adults.

Anyway, here I will end my rant on this subject… hopefully I didn’t bore you all!

Thoughts?

Personally, I think touch is very scary - I can't deal with it with anyone. Having said, today, T was very affectionate. She sat on the floor with me and I could really tell that she was there. On the way out the door she touched my back. She knows how I feel about touch and normally I would have freaked out - this time it was fine though.

I think it's ok when there's an important connection and it serves a purpose. If it's not excessive and doesn't last a long time then it's ok. Hugs are a bit much in my opinion - but a simple "I'm here" touch is fine in moderation.

mawl

Sorry I didn't read the whole original post word for word because I just cant' at the moment...but it is something I am experiencing at the moment...the need for touch...as I sat bent over in emotional pain in my last session, images kept flashing in my mind of what it is I am wanting to do, what do I want, what will stop this pain, this ache...I got an image of T standing and coming to sit next to me and me turning to her and us hugging...but in the moment I thought that I felt repulsed and uncomfortable with the idea...when I sat up and faced T again and said what do I do? I hate it when you sit silent watching me begging and pleading for something...T than said, you cannot wait for the breast? you need it you want it, you do not want to wait for it to be presented? ...I than got scared that even a hug would not surfice because my yearning and wanting is going on in fantasy...and what if T were to move to me and sit with me and hug me and the pain didnt go away???? because I know now this loss of touch has already happened and its the mourning off its loss that must be done...T's hug at the moment would be a stop-gap, an illusion of everything being ok...I'm begining to think now that a hug in the here and now would be just that and would not really be enought to heal the past...T sitting and bearing my pain over the loss of touch is the only real "touch" that will heal...and than perhaps if the day comes when T is ready to end..than one hugs and says, Thank you...knowing where the hug is coming from and what its exactly for...anything less then this would be more about the T not able to bear their clients mourning over the loss of touch ...and wanting to hug to "fix" anf fix isnt heal...I hope I've made sense and perhaps kept with the sprit of the original post...as I say, my mind is rather eractic at the moment...its waiting for a breast that never presented...

I think that touch can be appropriate for certain clients at certain times, but I think it should be discussed first. Both parties should be okay with it. My therapist gave me a hug goodbye when I first left therapy. I had strong feelings for him, but neither of us were really aware of that at the time of the hug. I think it was quite beneficial. It felt like I was able to communicate a thank you to him this way. It is something I will always remember. Even though I did later develop romantic feelings for him, what I felt during the hug was a warm goodbye. There were times during difficult talks that I wished I could hold his hand, but this was the only time we actually touched during therapy. During these other times I felt as if he were holding me emotionally with his caring and his acceptance. In most cases it is probably best kept to a minimum, but I think it would depend on the client and the situation.

from a client perspective, there have been times when i have wanted to be touched by my pdoc or (even) my crazy-ex-T. just a hug, or maybe a brief touch on the hand, or something. i didn't ask for it though, because i knew my T didn't do touch, and because with my pdoc - i thought the mechanics of it all would be too awkward. he wears a suit, and they are funny things to hug people in .

from a psych perspective - what i have read suggests that if a client wants touch, then maybe it would be more appropriate to get it in the form of massage or something. a touch from T - whilst it provide immediate relief - it doesn't really solve any problems, only gives an illusion of something being slightly better for the moment, so has no inherent value, and probably a lot of risks.

if i were to become a T, i would have a no touch policy, too.

Hi Jacq,

I'm not sure you can have a universal set of rules that apply across the board. I do think Mouse put it quite well. .

I do not believe that transference is a bad thing but as you said can be a positive experience. In fact, I believe that is is through the transference that a lot of healing takes place. I am going to disagree here--I think that those issues--when presented through the transference--can resolve through the feelings presented.

Touch is a normal human need. I would think that it would take a lot of preparation between therapist and client before touch is used in therapy, but I also would imagine it can be very very healing as well.

I have touch in therapy it heals me more deeply then words.

I have heard that touch with patient's that have been abused is not advised. However, I was abused sexually as a child and after having been with my T for 2 1/2 months she finally asked me if I like hugs and if I wanted a hug as I was walking out the door. She then said she has lots to give.
I was not opposed to the hug at all. I actually liked getting the hug, it was not a trigger, it hasn't made me want to contact her more. In fact, in the following session she asked me how I felt about the hug from the previous session and I said it was fine, so as I was leaving she asked if she could give me another hug. This time it was a bigger hug, again I was perfectly fine with it.

For those who don't like being hugged, I actually think through time and work on the relationship that small steps could get you to the point of enjoying a hug, after all touch can be very therapeutic. I consider it a type of desensitization. I think most, if not all people, even if they don't like touch, actually deep down crave it but perhaps feel unworthy or unlovely to accept it.

I honeslty don't think that research itself can answer these questions appropriately. We are all so different, even if we suffered similar abuse the way we respond may be different due to all the other factors presented growing up. I am all for "appropriate" touch.

Hangingon

My t was initially reluctant to use touch since I was a victim of childhood SA. But after many years, I've begun to develop a truly safe attachment with her and have repeatedly told her I believe I really need nurturing touch in order to heal. We are taking it very slow and so far, she has only hugged me twice and patted my back once when I was really in pain. I haven't found it to be triggering at all; it doesn't bring back flashbacks to my SA or anything. (We are both female; my abuser was a male).

Also, after receiving touch, I do not find myself wanting more and more. I don't need a hug at every session. In fact, after getting a hug or a pat on the back, I find that I'm able to "hang on" to the relationship better between sessions and don't need to have email or phone contact as much. So it helps me hold the relationship inside and actually I feel less needy.

I think touch is a good thing for me. But we are taking it S-L-O-W. Any kind of closeness scares the crap out of me, and it's hard to let anybody comfort me, especially when I'm feeling vulnerable and small. Yet I'm finding that, in little bits occasionally, it feels warm and healing.

I don't see touch as a way to hide or smooth over the pain I have inside that needs to come out. I don't see it as a substitute for grieving for what I didn't have as a child. I see touch as something necessary for me TO BE ABLE TO face and work through my traumas. In other words, I need to be able to feel comforted at times when talking about and grieving my losses becomes too painful to bear. It makes it less scary to face and work through things. I was left on my own as a child to face all kinds of fearful things, and I don't want to face those things alone again now. Sometimes when I get pulled into the bad memories from my childhood, I feel alone and it is hard to remember that my t is there with me to help me cope with the pain. A touch reminds me of her presence and keeps me in the moment.

As far as dependency, I already know I'm dependent on my t. But I don't think touch is increasing that. If it helps me to "hold onto" the relationship for longer and longer periods of time, touch might actually help me take steps toward independence.

I'm sure touch can be a bad thing for some people, but for me, I've always felt that it needs to be a part of my healing work. I actually see it as something that, as we take it slowly, will enable to me to increase my trust of my t and learn that touch can be safe and not abusive like it was during my SA.

As a clinican who is skilled in the use of therapeutic touch in treating physical conditions... I see touch as a very powerful healing tool.

However, as with any healing tool, its effectives relies in the skill of the clinican using it.

At this point I do not think touch would be helpful in my therapy...at least not coming from my T. However, I hope that at some point, touch could be used or could occur in therapy and not cause problems. This to me would demonstrate that I have truly healed.

I have safe, appropriate touch in my therapy, and it is very healing and grounding. We talked about it and processed it A LOT before it ever happened, and with some new topics we are getting into, the touch doesn't always feel as safe and so there isn't touch then. I am in charge.

this is all very interesting to me.

I don't particularly want T to hug me, and on the two occasions when she has patted me on the arm on my way out, she seems to do it when she is moved. Once with happiness, and once with sadness, from what I could sense; or maybe I am just oblivious (again- something I excel at ).

jacq10 wrote: I believe touch can be beneficial under specific circumstances:
• The client must have a sense of being in control (i.e., either requesting permission themselves, or having the therapist ask permission before being touched).
My T has usually asked me if I wanted a hug, with these words, "share a hug?" I would not request a hug if he required that I ask him for one. Especially the first ones we shared. How would you even know if a hug was permitted? I definitely wouldn't have asked if the potential for rejection was there.

• The hug was a result of the client’s need for affection, rather then the therapist. Using the technique of physical touch has a lot more to do with how the client is feeling, as oppose to filling some need of the therapist. Intention is the key to touch.
I don't want a hug because I feel a "need for affection." I can see that might motivate some people but not me. A hug is just the physical fruition/manifestation of our strong connection, attunement, and intimacy in therapy. It just feels "right" that we share a hug, very natural given our closeness. Also, I wouldn't want the hug if my T was just doing it to be therapeutic. Yuck. I believe our hugs have some degree of reciprocity. He hugs me because of how close he feels to me and I hug him because I feel so close to him. If he was just doing it out of therapeutic obligation or clinical technique, I would sense that and not participate. I need the hug to be "real".

• There is already an established, trusting, therapeutic relationship, and the hug (or display of touch) is congruent with the emotional intimacy of the relationship.
This is the case for me. When I first began therapy, we did not hug. It was quite some time. We needed to develop the emotional intimacy and attunement before we hugged.

Quote:

Dual relationships are simply not beneficial

The guidelines for therapists and psychologists are actually a bit squishy on this point. (I've looked at the guidelines of 3 different professional associations.) In some cases dual relationships are considered beneficial. Read up on the relevant guidelines--they're interesting! This is one area in which the trend is to allow some duality rather than requiring boundaries to be increasingly stringent. For example, some guidelines now leave it up to the T to judge whether attending a client's wedding, graduation, etc. would be beneficial or harmful to the client rather than having a strict "thou shalt not do this" rule. (Of course, the absolute boundaries on sexual relationships remain in effect.)

Is touch essential for my healing? I don't think so. I get plenty of emotional holding and empathy and caring in session with my T. The hugs are a bonus we sometimes do at the end of a session. We don't do them every time, just when the session warrants it. It's a very natural flow from the talk and feeling of the session to the hug. When I don't get a hug I don't feel bad about that. Hugs haven't increased my dependency on my T.

I'm not sure what this means. Is a hug supposed to be a display of affection? I don't see it as that. I see it as an expression of closeness. As for displays of affection, some involve touch and some don't (e.g. verbal, facial expression, body language)--I wouldn't want absolute boundaries on these displays as well as hugs. So no, I don't think affectionate displays should be banished from the therapy room.

I don't see the hug as the only part of therapy that does this. When you have a close and connected relationship with the T, it is going to be very painful to part ways, no matter if there are hugs involved or not. That is just part of therapy--the extreme closeness while knowing it will all end. Can we learn to accept the intimacy and closeness and not hold ourselves back from healing because we know it will all end one day? That is a difficult task of therapy, but if undertaken successfully, it can bear riches beyond one's expectations.

I think in some cases a lot of preparation would be very helpful, even essential for some people, but isn't necesary in all cases. My T and I didn't discuss at all whether we would hug beyond his question "share a hug?", and it worked out well. But we knew each really well, and were quite attuned, before we first hugged. I think if we had discussed it a lot, it wouldn't have been quite the same experience. It would have made it into this momentous, big event, with all sorts of implications that are just not part of our hugs.

Interesting post, jacq10--thank you!

Sunrise,
I would not have asked my T for a hug because of the fear of rejection. I saw my last T for a year and she never offered one, she did rub my arm once as I was walking out. It's not that I would not have wanted to hug, I just didn't have the nerve to ask.

With the T I have now, she asked me if I liked hugs; this was at the end of very hard session, and almost 3 months into the process. My response to her was I would never ask for one. She said can I give you one. I am glad she asked because I do like hugs. I don't get them very often outside of therapy but in therapy, they are safe.

hangingon

hangingon, I'm glad you have a therapist who was able to do the asking. How nice you now get hugs.

I actually don't think it would have occurred to me to ask my therapist for a hug. I would never have done that not only for fear of rejection but because I am very respectful of boundaries and it might have been perceived as invading his and also putting him into the awkward situation of perhaps having to reject me and say "no." So it was much better that he do the asking so he could communicate to me that hugging is not against his boundaries.

With my first therapist we never hugged and it wouldn't have been appropriate because we were not close.

I think these things have a way of working themselves out....

I brought up this topic with my T, though it wasn't personally referring to me, and she told me that she doesn't really do touch. She said that there are certainly times where she has put a hand on a back, or something along similar lines, but believes that the more important thing is the reasoning behind the desire for a hug.
Now I just want a hug more then ever.
I feel like she knows that that was what I was getting at, though the way I brought it up made it easier for me to ask. I would never be able to just directly ask for a hug.
Now I don't think I'll ever be able to get one

I liked the way my T knew that I really wanted to hug him goodbye even though I only asked for a handshake. I also had the fear of pushing the boundaries so I never would have asked outright for a hug even if I really wanted one. He was just in tune with me and knew.

Maybe the time will be right for you to get that hug one day, jacq10.

Maybe I should ask for a handshake and she will get the hint! lol

When I did once ask T what she would do if I wanted a hug, though I quickly added that I didnt' want one, but what would she do? would she?? T sat quite for a while and than said, "yes, but we would also have to talk about it".

I think I asked that question perhaps 2yrs ago and sometimes when its time to go and I stand up on a monday and she stands up and I dig in my jeans pocket for her money I feel her kindness looking at me and I never turn toward her I always stand at an angle unable to meet her eye to eye, though I am about a foot taller than her LOL!, but still, I wonder sometimes what would she do if I suddenly grabbed her and hung on to her. I don't know why but lately I have the feeling that she is wanting me to ask again, because she keeps saying "you don't know what you can have because you never ask, you feel rejection so much", and I think, what does she mean?? Does she want me to ask again? has she grown to know me more now and realises that perhaps a hug would do a great deal for me now? I don't know, perhaps the best thing is to ask again, but I dont know if I can.

"hi my name is stumpy and i'm touch challenged.""hi stumpy" (i said it for all of you)there now that we got that out of the way...my parents never touched in anything close to a good way...affection was never postitive. i'm not good with touch. i've got a "peep" who handles the touch thingie for me when i'm stuck and have to but if i can get away with not doing it then thats just fine.my t will hug me upon occasion. but she always asks first. same th she wants to come sit next to us or touch us. always asks. sometimes we would like a hug but we don't ask. if we are in the midst of a really horrific memory she knows it grounds us and will use it to get us back.we know she is safe so we don't mind that she does touch us. our old t was NOT safe and that sacred us big time.now as far as us hugging our t...thanks to our parents from hell we never got hugged as a kid so we never learned to hug (yerah i know sounds weird and pathetic) so we are scared and don't know how to hug. t says she will teach us. otherwise we tend to stand there like a giant lumpy blob (okay a short lumpy blob really). she made a comment the other day that "maybe someday you will hug me back" and we told her that we don't know how too...she said she realized that we didn't know stuff but didn't realize how much it affected us...but that she would teach us and not to worry.

Aw... mouse,
Perhaps one of these days you can say, I know what I want but I am afraid to ask for it. Then wait for her response, then mention the hug.

Like she said, sometimes you just don't know until you ask. If that is a desire of yours and she's already told you she does give hugs. I would say try it out and see.

Hangingon

I think if my T said "share a hug?" I would have a heart attack and be totally weirded out. So I guess I am one of those who would need ton of preparation for touch. I would NOT want him to hug me. Aside from my personal touch issues (I'm not a touchy feely person) he is at least a foot taller than me so it would be hugely awkward.

On the other hand I would LOVE for him to touch my hand, in a kind way or pat my shoulder as I leave. Hmmm, will I ask for that? I don't know....certainly not yet, but I am not ruling it out for the future because I think it's important for us to express our longings and desires, even if it makes us uncomfortable and sad.

On second thought as I read this I know that I would probably jump if he patted my shoulder so forget that. What a tightarse I am! LOL

T and I had a LOT of preparation for any kind of touch. Now it feels very comfortable. But like you, Miss C, if T had just offered me a hug out of nowhere without all of the prep we did, I would have freaked! In fact, I spent a lot of early therapy, being really, really careful to never let him touch me - like when I handed him a check, I held it by the TIPS of my fingers, and I practically backed out of the room when I left LOL.

When I was seeing Teacher T for meditation stuff, she put her hand gently on my back as I was walking out one day and I nearly jumped out of my skin. No T's touching me without a ridiculous amount of preparation, please!!

In real life, I'm actually really huggy - I always hug my kids' friends, and I hug some of my friends a lot too. I think it's partly because I'm in AA (talk about hugs - sheesh!) and partly because the only memories I have when I was young of good touch are of my best friend's mom giving me these big, warm hugs. I want to be that mom for my kids' friends (although my oldest is 12 and nearly all of his friends are the same size as me or bigger now, so they are all very amused and thrilled about how giant they are when I hug them these days )

I have a good relationship with my T ...but we have had no physical contact. I don't know if she is like that with all of her other patients. As I think back to the 1st day of therapy...I didn't even shake her hand in greeting or leaving. From the very start my T seems to have let me set a lot of the ground rules. Now that she specifically knows touch bothers me...I'm pretty confident she won't be initiating any contact. If she did, it would cause problems for me. I have no idea how she would respond if I asked for a hug. She would probaby crack up laughing-just because it would be so uncharacteristic of me. I'm sure she would find a polite way to say no, if she doesn't do that.Frankly, unless one of those ego state totally took over...I would never put myself in a position to be rejected.

Very well Put, Very well....My relationship with my pdoc is, in the beginning, my very first visit with her, I was a Freaking Mess! I had never had pdoc relationship like this one (been w/her now 4-2-1/2 yrs...Touching is allowable at this point, when she first hugged me, i was scared, I was apprehensive & wanted 2 pull away but I felt her warmth & Sincerity in her work & in her Heart..... I have serious issues with my mother (had, she's dead now) she never touched me throughout my entire life...I struggled my whole living life 2 want her 2 want/love me...Acknowledge me!!?....but never even an, "I love You".......so when my pdoc initiated the first hug, she asked me first if it would b ok? I was crying & screaming in this poor womans office, she pulled her chair up 2me 2face me, 2 get close & she held my hands ever so lightly(and she still does)...I will never forget that moment, and that was just my first day!...... we have been 2gether now 4-some time & the best damned doctor I have ever had! TG!
all I wanted was 2die, well she changed that! she has changed everything in my life...she uses a Method like no other doctors even have knowledge of! I told her about this Method myself & she was familar w/his work....It has had such a powerful affect on me, people cant believe the difference in me..... I struggled since i was very young, now i just turned 51...lol. Usually i would dwell on the age thing, but my doc has trained my mind, my body, in a whole different way....I have been doctoring since i was 34, and was never satisfied with any doc i had....God has sent me an Angel & I am so Grateful....she has sat on the floor w/me many gillions of times, holding me, i have thrown myself at her feet & cried w/my head on her lap....I dont feel any transference on my side the least bit, whether she does , she has not ever discussed it w/me....Docs r people 2 & just as Vulnerable....every doc is different & I've been thru many over many, (2many!)years....(i was diagnosed w/many things), Past Docs had no affect on me, nothing ever resolved, there R allot of Bad! Docs out there folks, Dont waste your time on one That is worthless & Unaffective, a few times w/them U should b able 2figure out if your a Good Fit....Well my search is Over, THIS ONES A KEEPER....and she give the best HUGS EVER!