Boundaries and Types of Touch In Psychotherapy

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therapeutic touch

(Photo from the Mother Love Bone’s album ‘Apple’)

By Jason Briggs, MA, LMFT

“Art…We are flesh and blood and full of faults. But we are also full of warmth. The world is full of confusion, but there is compassion in its midst. Communication via simple touch can transmit so much of us in just one minute. Like a painting or a piece of music. I want to touch your soul. I only wish I could be sure it was the right thing to do.”
– Jay Woodman, SPAN

In this piece we will explore ways to be boundaried when integrating touch in psychotherapy. Therapeutic touch is defined as any physical contact between a client and her therapist while participating in psychotherapy, which is non-sexual in nature. In this missive, we will address how therapists can use touch to help heal their clients.

Touch is often highly avoided by psychotherapists, partly because it’s rarely discussed in schools and training programs, and because of an over-arching lack of interest and understanding by gatekeepers in the field of psychotherapy, both historically and present. I will discuss how not using touch can be neglectful when a client needs exactly this type of support. Touch is an important and equally healing form of communication, possibly on par with words (i.e., Fridlund, 1994; Young, 2005). Given that touch, so often confused with sexual touch by therapists and clients alike, is so healing, we as therapists must no longer abandon considerations when using touch in psychotherapy and instead explore what using touch can do for our clients to facilitate a greater healing in the therapist-client relationship.

When using touch, one must always consider her rationale for why this adjunct type of support is being used, considering both client and therapist and the boundaries they share and are surrounded by. Touch enacted in therapy by the therapist in traditionally more rigid ways may stem less from an awareness of healthy boundaries and excellent standards of practice and instead from a lack of awareness or interest in the various standards of practice regarding touch and the benefits of the use of touch in psychotherapy. Maybe a therapist considering using touch hasn’t thought of what is barring their interest and ability to use touch as a viable form of communication in psychotherapy. Myths, as unchecked assumptions, are perhaps the most pervasive reason therapists don’t suss out how to use touch in their practice. Here is one such myth:

“There is a myth of the slippery slope that non-sexual touch inevitably leads to sexual touch, which is unfounded, scientifically unsupported and basically is paranoid. It’s pretty crazy actually if we just look at it. The assumption that soothing touch leads to sexual touch is nonsensical. In spite of numerous therapeutic approaches, theories and practices that systematically and effectively use touch in therapy, it has been marginalized, forbidden, called a taboo, often sexualized and at times criminalized by many schools and ethicists, licensing boards as well.” – Ofer Zur

What is the cost of a therapist’s lack of interest and awareness of touch in psychotherapy? Here is one possible outcome: “Indeed, touch deprivation has been consistently linked to aggression, delinquency, social isolation and depression in children and adults (Field, 2003).” Given this knowledge and the standards of practice in the field of psychotherapy, standards rooted in a larger philosophic service-based assumption known as the Hippocratic Oath (to always do no harm), it bears to reason that touch in psychotherapy cannot be ignored as a matter of the wellbeing of the clients we serve.

Boundaries that bar touch are likely to be too rigid and may prevent necessary information from being received by the client, possibly to sooth or calm, and prevent ongoing dissociation, etc. Touch that communicates harmful information to the client by her therapist needs to be withheld by the therapist, as this places her below the standard of care and practice and is illegal.

This harmlessness of using touch and assessing the potency of touch includes the therapist learning the client’s preferences, background, history, ability to stay in the present, power differentials and much more. Consent allows sharing of information, verbal or non-verbal (touch), to be given and received in ways that are experienced as healthy by client and therapist alike. It goes to say that negotiating boundaries around touch must be learned by therapists to raise touch into the realm of healing and that healing must be raised to unequivocal predominance. Boundaries allowing information to be shared in a defenseless way allows bonds to be felt between client and therapist. This sharing is like a cell whose nutrients are present and released, even when toxins exist. Toxins are contained for the time being and released when shame and fear can be let go of by the relational field found in the client-therapist relationship.

There are three types of touch in the literature on touch. The first is those adjunct forms of touch shared by psychotherapists, which complements verbal therapy and can take many forms. The second type of touch is therapeutic touch by body psychotherapists whom use their training in somatic psychotherapies to dictate what type of interventions may be used when considering touch for their client’s needs. The third type of touch is inappropriate or hostile touch and these are sexual, hostile or punishing touches and are illegal and unethical in the field of psychotherapy. With sexual touch the initiator intends to sexually arouse the therapist, client or both. In the first type of touch there are many forms and purposes for using touch with our clients.

Therapists who learn more about their clients and their own relationship to touch and how to use it effectively have advantages over those therapists who don’t have touch at their disposal as an important healing intervention. Raising our voice and awareness regarding touch, as therapists, means embracing the simplicity of touch, its complex applications, and preparations on how to use it in therapy. Doing this means raising touch to its rightful and helpful place in psychotherapy, not only as a valid form of communication but one that embodies a combination of silence, caring and connection, which words simply fail to communicate.


References

O. Zur , Nordmarken, Nola (2015) Touch and Boundaries in Psychotherapy: To Touch Or Not To Touch, Exploring the Myth of Prohibition On Touch In Psychotherapy And Counseling, Clinical, Ethical & Legal Considerations, Online Education.

O. Zur (2007). Touch In Therapy and The Standard of Care in Psychotherapy and Counseling: Bringing Clarity to Illusive Relationships. United States Association of Body Psychotherapists Journal (USABPJ), 6/2. 61-93. Copyright USABP www.usabp.org

Mozilla Firefox, Google search, (2018, July 15, 9:10 pm). https://www.goodreads.com/quotes/tag/touch

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