Touch and Therapy
February 20th, 2012 adminThought I’d post some of my comments and also excerpts from an article that I shared with the IEDTA (International Experiential Dynamic Therapy Association) list serve in a discussion on touch between therapist and patient. A colleague had been told she should not have allowed her patient to give her a hug before the session.
Years ago, I had the good fortune to be in a supervision group led by Dr. James Grotstein, the esteemed and brilliant analyst. This very subject came up after I presented a case in which I mentioned touch during a session in which the patient was in the throes of enormous grief and wanted me to touch her hand. Dr. Grotstein felt at that time that no touch should occur ever between therapist and patient (gratifying the longing) but rather that the need to be touched should be interpreted. I remember feeling quite alone in my point of view that there were in fact instances in which touch proved helpful and normalizing and healing. Dr. Grotstein asked that I stay after the group to continue the discussion and he gathered a number of articles on the subject to help me to see the error in my thinking. Although we continued to disagree on that particular case (there would be others in with I would avoid touch), I found him to be caring and devoted in that way.
I came upon an excellent article on the touch question, Zur, O. and Nordmarken,N. (2011). To Touch Or Not To Touch: Exploring the Myth of Prohibition On Touch In Psychotherapy And Counseling. Here are excerpts:
“Therapists can deliberately employ many forms of a touch as part of verbal psychotherapy.These forms of touch are intentionally and strategically used to enhance a sense of connection with the client and/or to sooth, greet, relax, quiet down or reassure the client. These forms of touch can also reduce anxiety, slow down heartbeat, physically and emotionally calm the client, and assist the client in moving out of a dissociative state.”
“Recent research done by the Touch Research Institute has demonstrated that touch triggers a cascade of chemical responses, including a decrease in urinary stress hormones (cortisol, catecholamines, norepinephrine,epinephrine), and increased serotonin and dopamine levels. The shift in these bio-chemicals has been proven to decrease depression (Field, 1998, 2003). Hence, touch is good medicine. It also enhances the immune system by increasing natural killer cells and killer cell activity, balancing the ratio of cd4 cells and cd4/cd8 cells. The immune system’s cytotoxic capacity increases with touch, thus helping the body maintain its defense against pathogens (Field, 1998).”
“The traditional psychoanalytic emphasis on the analyst’s neutrality and distance and the focus on clear, rigid, inflexible boundaries omit touch as a therapeutic possibility. (For an excellent historical review of attitudes toward touch in therapy, see Bonitz, 2008).”
“The fear-based paranoid notion, promoted by the slippery slope idea, that non-sexual touch on the part of the therapist inevitably leads to sexual relationships and exploitation, discourages therapists from utilizing touch.”
“The meaning of touch can only be understood within the context of who the client is, the therapeutic relationship, and the therapeutic setting. Accordingly, before employing touch, it is essential that the clinician consider unique treatment elements for each client including factors, such as culture, history, presenting problem, diagnosis, gender, history, etc. One must also consider the therapists’ education, training, theoretical orientations and comfort with non-sexual touch. Systematic touch should be employed in therapy only when it is well thought out and is likely to have positive clinical effects. Touch must be approached with caution with borderline or acutely paranoid clients. Special sensitivity is also required when working with people who tend to sexualize relationships and/or have been abused, molested or raped. There is also a growing body of
knowledge that shows the damage done by the systematic and rigid avoidance of all forms of touch in therapy.”
From Dr.Kai MacDonald came a highly cautionary message for male therapists: “An important statistic that comes to mind on this topic comes from a course I run for health care professionals—mostly MDs–who have been referred for boundary violations. Our study of this group (as well as past literature) indicates that 90 + % of participants are male.”
