Physical touch has long been a controversial issue in psychotherapy. While some professionals consider touch one type of nonverbal communication that can have therapeutic value, it is also widely believed that touch in therapy can be too easily abused and that any value may be outweighed by the risk of harm to people in treatment.
The creation of an artificial mind-body split in psychotherapy began around the 1970s with the advent of cognitive-based therapies which, I believe, helped contribute to the divorcing of our emotions from their very real physical base—without our bodies there would be no emotions! Around the same time, controversy and publicity surrounding some approaches to sex therapy practices and an increase in risk management practices led to an emphasis on protecting people receiving therapy from abuse through inappropriate touch. Concerns continue today with the use of body-based therapies internationally, though in America, the level of concern about the use of touch in therapy appears to be much higher, as Courtenay Young points out in the article “About the Ethics of Professional Touch.”
Certainly anyone experiencing posttraumatic stress as a result of having been physically or sexually abused may be hyper-sensitive to any type of touch and/or issues of established personal space, with good reason. The impact of abuse, and the process of healing, is likely to have an impact on interpersonal relations throughout life. Therapists who work with people experiencing these and related symptoms need to be particularly sensitive, as it is possible for people healing from abuse to easily be re-traumatized by a careless touch or embrace.
Touch and Talk Therapy: The Rosen Method
Techniques involving touch have been used as approaches to healing for many years. Some techniques, such as the Rubenfeld Synergy Method and the Rosen Method, combine touch with talk therapy. The Rosen Method, a combination of gentle touch and verbal feedback that reflects what the person in therapy is experiencing, was developed by Marion Rosen, a physical therapist who worked with individuals undergoing psychoanalysis in Germany in the 1930s. She drew on touch therapy as a way to help some individuals access unconscious memories and past events they had forgotten or suppressed.
At the heart of the Rosen Method is a belief that chronic muscular tension is a way of “holding against” feeling something we’d rather avoid, a belief that is in line with current thinking about trauma. Many individuals who have participated in the Rosen Method treatment report feelings of safety and support, along with deep relaxation.
The Use of Touch in Therapy Today
Many recently developed conventional therapy modalities fall under the umbrella of cognitive therapy. As this name implies, these approaches rely heavily on the thoughts of the person seeking treatment. In general these therapies would never involve the sensation of touch, as healing is considered to occur through cognitions: thoughts, observations, and verbal affirmations.
However, some older therapy practices do support the use of touch. Body-based psychotherapy, for example, which is taught by the Hartford Family Institute, has its roots in Gestalt therapy and Bioenergetic Analysis. Gestalt therapy, developed in the 1940s and 50s, emphasizes what is being done and felt in the present moment. Bioenergetic Analysis, developed in the 1950s by Alexander Lowen, is grounded in the idea that chronic muscle tensions in the body can serve as (often unconscious) blocks to emotional expression. Both of these therapies emphasize the experience occurring in the present moment, which includes both physical and emotional sensations.
The Institute provides for a therapist’s touch as a means of healing while still emphasizing the need to maintain appropriate professional boundaries, respect for the person in treatment, and a keen awareness of any individual’s personal history that might sensitize them to touch. According to Dr. Lubin-Alpert, one of the founders of the Institute, “Not to touch any clients at any time can be experienced as abusive as the original neglect to the … infant inside the adult client.” Touch might occur in the form of hands on the shoulders in support of a person imagining a confrontation with a childhood abuser or gently holding hands with someone grieving a personal loss.
In all cases permission is sought before the gesture is made, in order to maintain the empowerment and safety of the person in treatment. “Would it be okay to move a little closer?” and “Would you like to take my hand?” are typical questions a therapist might ask. In no case would a therapist proceed without a clear indication from the person being treated that it is acceptable for touch to be used.
The Ethics of Touch for Professionals
The question of appropriate professional standards is addressed by all professional organizations representing people who provide psychotherapy. The National Association of Social Workers, which represents most of the professionals providing behavioral health services in the U.S., explicitly addresses the issue of physical contact between therapist and person in treatment, mentioning “cradling and caressing” techniques. Such activities are prohibited when there is a chance of psychological harm to the client.
The American Psychological Association addresses the issue more narrowly in the context of sexual harassment, mentioning physical advances sufficiently severe or intense as to be considered abusive but not the broader issue of touch. The American Counseling Association has similar guidelines in its code of ethics.
In general, most therapists are very reluctant to use touch for both ethical and potential legal reasons. If you are comfortable with your therapist and feel that something like this might benefit you, you may wish to bring this up in session, as your therapist may be willing to discuss their feelings and concerns openly.
There are sufficient arguments both for and against the use of ethical touch in therapy. While the potential ramifications of the abuse of therapeutic touch must be considered, it’s also worth considering that most of us, from time to time, could use a hug or even just a pat on the back.
- Alexander, B. (2009, March 26). ‘Sex surrogates’ put personal touch on therapy. NBCNEWS.com. Retrieved from http://www.nbcnews.com/id/29881206/ns/health-sexual_health/t/sex-surrogates-put-personal-touch-therapy/#.WVLjCGjyuCg
- Code of ethics. (2008). The National Association of Social Workers. Retrieved from https://www.socialworkers.org/pubs/code/code.asp
- Lubin-Alpert, N. (2015). The ethics of caring and touch from a mind, body, spirit perspective. The Door Opener. Jun-Aug, 222.
- History of the Rosen Method. (n.d.) The Rosen Institute. Retrieved from http://roseninstitute.net/about/about-rosen-method/history
- Kertay, L., & Reviere, S. L. (1993). The use of touch in psychotherapy: Theoretical and ethical considerations. Psychotherapy: Theory, Research, Practice, Training, 30(1), 32-40.
- Young, C. (2005). About the ethics of professional touch. European Association for Body Psychotherapy. Retrieved from http://www.eabp.org/pdf/TheEthicsofTouch.pdf
- Zur, O. (2017). Touch in therapy and the standard of care in psychotherapy and counseling: Bringing clarity to illusive relationships. United States Association of Body Psychotherapists Journal, 6(2), 61-93. Retrieved from http://www.zurinstitute.com/touch_standardofcare.pdf
- Zur, O., & Nordmarken, N. (2017). To touch or not to touch: Exploring the myth of prohibition on touch in psychotherapy and counseling. Retrieved from http://www.zurinstitute.com/touchintherapy.html
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