Touch in the therapy room

[Cherrypie]

There was a thread before on physical contact in the therapy room however it focused mainly on hugging. It feels to me to be minefield of concern for both parties but maybe thats just in my head?

I wonder what are peoples views/experiences are of any kind of touch in the room.. I imagine it could bring about a vast scope of feelings for counsellor and client.

In your experience as a client or a counsellor I wonder has it been helpful or harmful? Maybe you feel it should it be banned from the start or is it a natural humane response to hold a distressed persons hand, touch, hug etc? I wonder how it feels to deny or be denied of touch if it is banned.

Does it depend on the relationship? Level of trust? Or maybe you feel its never a good idea..

Cherrypie

[IndieSoul]

My therapist and I were doing an exercise one day that involved her kind of pushing down on my arm. To me, it was a good thing. It made me feel closer to her, because I desired her affection so much. Hugging, though, kind of freaks me out for whatever reason :dead: I don't know, it just seems weird right now. Maybe once I get to know her better and become more comfortable in our relationship, then I'd be ok with it.

[TDM]

I don't know... I've given this a fair amount of thought, because I've been to both sides of this before... and I still dont know.

TDM

[Jenny]

My ex therapist hugged me once and she'd often touch my arm when i was upset.. in fact she even used to rub my back some times when i was really upset. It was magical at the time.. i could really feel and believe her caring for me.

But then it also left me wanting more. Which in the end resulted in our therapeutic relationship coming to a (horrible) end.

So yes, while i think it can be nurturing, it does open up a can of worms. For me i had always thought touch was a big no no in counselling so i never expected it.. but when it happened i was shocked and wanted more.

But i guess you'd have to also be careful because touch may not be soothing for all.

[andyhp]

I don't know... I've given this a fair amount of thought, because I've been to both sides of this before... and I still dont know.

TDM

A great thread!

I don't know either! I've touched clients as 'part' of therapy. Trust has been a factor, the relationship at the time has been a factor, cultural issues have been a factor, why the client is there has been a factor, whether the client is male or female has been a factor, where I've touched them has been a factor and why comes into it too!

What is 'acceptable' touch for one client e.g a white middle aged male, may not be acceptable for another e.g. a young British Asian female client.

There are two famous, or probably infamous, cases of 'touch' in the therapy world that spring to mind. (Both are published and are already in the public domain so no confidentiality issues).

The first involved Brian thorne a well known person-centred therapist. He and his female client 'got naked' lay on the floor and embraced. He was .......(put your own word there) enough to present the work as a case study at a conference. He received very mixed reactions! BTW the client claimed 'it' was a major turning point for her and a huge factor in her 'recovery'.

The second involved Patrick Casement a psychodynamic practitioner. At one session he promised to hold the hand of a female client in the next session while she re-experienced a traumatic event from her childhood. In between sessions he 'reconsidered' as he felt he had made the offer due to countertransference. It's not crystal as far as I can recall what exactly the client thought of this. Anyway he was pretty well condemned in an edition of a famous psychodynamic magazine (name escapes me, something like Journal of Psychiatry).

I'm not judging either of these people, plenty of others have done that already. My personal opinion is that both were acting in the best interests of their clients as they saw them. I would definitely not hold someone's hand while they were re-experiencing a trauma, albeit for different theoretical reasons than Casement and I cannot see myself doing what Thorne did. Only my 'way' though.

Anyhoo, I know therapists who definitely 'won't' under any circumstances (outside of say administering CPR I presume!), some who 'will' and some who might or might not (me I suppose).

[Cherrypie]

Thankyou for sharing your thoughts with me..

In my therapy touch seemed to be banned...it wasn't a spoken rule but I just knew it would not occur or be welcomed. Well I thought I knew it anyway! I assumed! Tsk tsk..

There was a comfort in this unspoken boundary to some degree but I must admit that in times of great distress however I felt the oddness of this physical isolation and it seemed unnatural that another human being sitting so close would not even touch my arm or hold my hand..

I see the reasons behind some therapists having a no touch rule. I see the danger of the slippery slope and I have read the pain that some hugs have even caused but I just wonder how on earth you apply this denial of touch in practice..I don't know how I could refuse someone and I know I would personally have felt quite devestated had I asked for a hug and been refused..

I also had an expectation..actually even a fear.. that there may be some kind of symbolic hug at the last session marking the end of our long therapy together. I know that in the last minutes I avoided eye contact because I was so concerned about this happening or not even happening. I made sure my hands were full with keys and bag. We did not hug. I was relieved and dissapointed if you can be both and on reflection I just feel a bit sad about it.

I can not help but wonder whether I was not touched at all in all that time because of a therapy thing or because of a me thing..a bit silly I know..but it is there in my mind. It did cross my mind too that a therapist may feel its safer or nicer ? to hug/touch one client and not another..

xCherrypie

[Cherrypie]

Oh my goodness!! Well..thats quite a bit of touch isn't it.. When I said hugs etc I did think there is surely never any etc!

We were writing at the same time Andy so my reply was not knowing you were there! How have I missed the Brian Thorne story!!

I must go and investigate this story immediately... Hehe.. and I shall return with my thoughts on that one!

:scooter:
xCherrypie

[Cherrypie]

Well I am really frustrated now because I can't find the full story just lots of people referring to the story!! If anyone else finds a link do let me know..

[andyhp]

I'm afraid I can't help you with a source for the whole story as I can't remember it! It was in a book but something seems to ring a bell that he wasn't the author as such. One of those books with contributors and an editor, he being one of the contributors (there's surely a better way to describe those books than this!!). Not a lot of help that was it!?

[mel]

I think whatever happens in the therapy room needs to be talked about and worked with. In other words, the therapist needs to find out (however long this may take - and it can take years for some clients to talk about it) how the touch or the situation where the touch was experienced made the client feel etc.

It must not be ignored. Hence some therapists will not be afraid of touch as they are able and willing to work with what that evokes in the client. They are not scared to 'go there'. Some might touch and not even think about how huge that is for the client. And that can become dangerous (life thhreatening) for the client.

I have had a few years person centered therapy where my therapist had touched me, rubbed my back, held my hands and hugged me. It was an awesome experience on some level unfortunately this therapist, although she KNEW about transfernece and counter transference, she did not know how to work with it and it was left festering in the room. She left me 'alone' with what that did to me, didnt want to know. And when something isnt talked about, huge fantasies can be created.

I have also been in psychoanalytical therapy three times a week for 2 years now and the work is so differnet. It is still very early days, too early to talk or even think about touch (because of the unresolved hurt the ex therapist had caused) but I know that this therapist is not afraid of emotional and physical closeness (there has been an incident or two) but it would be worked with.

Also, I hope that each therapist who experiences touch with their client or the strong need not to touch their client, brings that to supervision and perosnal therapy, it is vital, so their own transfernece or counter transfernece is not acted out on the client. And it really is... just for the good of the client.

[Katmandu40]

My therapist has touched me at different times or held my hand (to keep me from hurting myself). It doesn't happen often....even less in recent years. I was like Jenny...it left me wanting more and I even found myself getting more and more upset in session to try to get more of that touching. I'm not really sure how it worked itself out. My guess is my therapist recognized this was happening and withheld touch. This is actually hard for me to admit to!! I can't remember the last time she touched me to be honest. I think that for a time it really was important for her to do this...for trust and for me to feel I could depend on her...just as it was important for her to then withdraw touch to teach me to rely on myself more. Does that make any sense?

[Cherrypie]

I really, really want to thank posters for contributing to this thread with some of their very personal experiences.

It certainly can be hard to talk about and I know that as I felt it when sharing my own experience here. I think for me, I sometimes feel embarrssed about the level of dependancy I had on someone I paid. I felt that, as with everything in the room, the touch or indeed no touch issue had a heightened importance than it would were it to happen to me in the 'outside' world.

I do hope though, that in our sharing here, we realise that we are not alone with sometimes difficult feelings and it may help others too that read these posts but do not feel that they can or want to contribute.

Thankyou Lots & Lots

:grouphug:

xCherrypie

[Fluffy Flowers]

My first counsellor used to hug me and it was for her benefit, not mine because I didn't like the touch.

My second therapist held my hand in one session once because I was dissociated and it brought me back to myself and was SO helpful and completely rightly placed. We talked about it a bit after.

My current therapist will also use touch, although we have not used it yet. We discussed how it helped with my last therapist when I dissociated and so we decided if I get that way in the session then she will use it to help ground me. She asked me the other day 'do you need to me to touch you' which to me sounded like an odd question but I knew that she was checking it was ok and she wasn't crossing boundaries. At that time, I actually didn't, but I was surprised she asked, I think because I was presuming she would work on instinct.

[andyhp]

Some really interesting experiences of touch and the part it can play in therapy.

On one hand there is an instance of a therapist touching a client in a way that clearly (for the client) 'helped'...grounding with dissociation which, is one of the situations where I have touched clients. On the other there are 'back rubbings' and unwelcome hugs. For some touch was 'banned' in therapy for others it seemed fairly regular.

I have hugged clients but this has been rare and always initiated by the client (male and female clients)
I have touched clients in very similar circumstance to Fluffy Flowers and this has always been talked about and the reasons clarified beforehand (male and female clients but see below)
Gender matters for me in that there are areas of the body where I would feel comfortable touching a male client but not a female client.
Culture matters. I work with a diverse group of clients from many cultures and this has had a major impact on touch. There have been many clients where culture (and gender) has meant any touch is 'taboo'.
I talk about touch beforehand when possible and always after if it wasn't possible before. There have been some occasions when talking about it was not possible at all.
My approach is not relevant as far as touch goes...as far as I'm aware.

So, briefly there's me. Now what about other therapists? I want to ask some questions of you...

Have you touched clients...if so why?

If you don't touch at all, why not?

What part does gender play in touch for you?

What part does culture play in touch for you?

What part does your approach play...if any?

[Jenny]

I do think you've touched on something there Andy.. well for me anyway lol. I remember a time in my counselling when my counsellor put her hand on my chest.. well, i can't quite explain it but let me say i would never have let her do it if she had been a he! She did ask me several times whether i was ok with it and said we could stop any time i wanted.

But yes, i think gender does also play a part in it.. male to male, female to male, etc etc. And i also think it's important, as my ex counsellor did, to ask whether it's ok etc.

Would be interesting to hear what counsellors think/do.

What would you do if you had a policy not to touch clients but a client actually asked you for a hug??

[Katmandu40]

I asked my psychiatrist for a hug (she is also my therapist) and she gently refused. I was totally crushed and it took me a long while to get over the rejection. It was very hard for me to even ask for a hug so when I was rejected it hurt all the more. For the life of me, I can't remember how we dealt with the rejection I was feeling. I know we talked about it and I got over it finally. That was really hard though!!

[Old Wolf]

Quote: "What would you do if you had a policy not to touch clients but a client actually asked you for a hug??"
In general my policy is no touching. There is no one simple answer to this. It would depend on so many different factors that could be in play at the time. e.g. was there an ulterior motive at work - was it part of the clients need to control? - was there a strong sexual presence at the time etc.etc. Any final judgement would need to be made at the actual time of the request. I would find it hard to refuse someone in real distress but even then it might be a more beneficial way forward for the client not to agree. Every situation is as unique as the individuals concerned and there are two people involved - therapist and client.
OW

[andyhp]

I do think you've touched on something there Andy.. well for me anyway lol. I remember a time in my counselling when my counsellor put her hand on my chest.. well, i can't quite explain it but let me say i would never have let her do it if she had been a he! She did ask me several times whether i was ok with it and said we could stop any time i wanted.

But yes, i think gender does also play a part in it.. male to male, female to male, etc etc. And i also think it's important, as my ex counsellor did, to ask whether it's ok etc.

Would be interesting to hear what counsellors think/do.

What would you do if you had a policy not to touch clients but a client actually asked you for a hug??

It matters doesn't it!! I have touched male clients on the 'chest' but not female clients.

I'd be interested to know if there is a specific form of psychotherapy/counselling that does not allow touch. As far as I'm aware there are none...could be wrong. I am aware that if using CBT with a person who is experiencing PTSD, and as part of the work they are going to 're-live' the original trauma, then it is strongly recommended not to touch the client while they do this as it would be tantamount to giving the client another safety behaviour and hence could make the re-living pointless.

[Cherrypie]

The A-Z of counselling by William Stewart says that psychoanalytical approach has a 'no touch' rule.

He says 'it offers no escape for the client and frees the counsellor from possible collusion or self gratification. On the other hand full expression of thoughts feelings and fantasies is encourged.'

[andyhp]

The A-Z of counselling by William Stewart says that psychoanalytical approach has a 'no touch' rule.

He says 'it offers no escape for the client and frees the counsellor from possible collusion or self gratification. On the other hand full expression of thoughts feelings and fantasies is encourged.'

I am aware that touch can be an 'issue' in psychoanalyitc therapy due to it possibly 'contaminating' the, as yet, undeveloped transference but as far as I was aware touch is not taboo as a 'rule'. I'm also aware that in many case studies I have read psychoanalytic practitioners have 'touched' with seemingly little regard for the affect on the transference.

It does seem there is a potential dilemma here...touch is theoretically 'shaky' and yet in practice done so often. I am not a psychoanalytic therapist so perhaps this dilemma would be best answered by one who is...anybody?

Does Stewart differentiate between the different 'schools' that make up the psychoanalyitc approach? (e.g. Kleinian). They can have very different views on many things including touch and transference. One practitioner of the 'art', a follower of Bowlby I believe, recently referred to one the most 'sacred' of psychoanalytic concepts, the unconscious, as 'a handy metaphor'. In some psychoanalytic circles this would possibly result in a good whipping, if not a long and painful death!!

[Cherrypie]

Does Stewart differentiate.. No he doesn't in this book as far as I am aware. Its quite limited on info actually, just gives snippets on many different counselling concepts so maybe not a great book to quote from but I read the term 'no touch' rule and remembered this thread..

It seemed to go along though with the little I thought I knew about Freud but now I have just googled the topic of the 'psychoanalytic rule of abstinence' and it seems there is indeed a vast topic of debate about what Feud actualy originally intended and as you say there are examples of cases where this 'rule' or prescription as I also heard it called somewhere has plainly been ignored. It makes me think of one bible and a thousand translations..

I was interested to read one article that said Freud never used the term 'rule of neutrality' which my college taught us he had but the article said that this term developed over time.. The problem with finding stuff on the internet of course is that it could be al b*ll*cks and written by Larry the Lamb.. I am still yet to learn how to find reliable sources.. After all, any old pie can waffle any old rubbish... as I seem to be doing now..

xCherrypie

[andyhp]

You ain't speaking rubbish Cherrypie, you're spot on. It's (touch) a big issue for any approach to therapy and it seems to me even bigger, and also totally confused, in regard to some of the psychoanalytic 'ways'. A lot of the 'differences' between the psychoanalytic schools stem back to when Freud and his followers evacuated to London and 'clashed' with The 'British Independents' who were mainly influenced by Melanie Klein (object relations). By all accounts these were not clashes over 'minor' issues.

There was a leading Kleinian guy by the name of Fairburn who defined the goal of psychoanalytic therapy as, 'to effect breaches of the closed system which constitutes the patient's inner world, and thus to make this world accessible to the influence of outer reality'. To all intents and puposes this is a pretty good way to state the goal and rationale of CBT!! He also said that transference cannot occur when there is 'genuine contact' between two people...pretty much what Carl Rogers said. Neither of these widely accepted Kleinian 'stances' would have pleased Sigmund Freud I think or would 'cut much mustard' with some psychoanalytic practitioners today.

Andy x

[IntuitiveCounselor]

Anything that is beneficial and does not hurt the patient in anyway, long term or short term is good.

[Cherrypie]

Hi Intuitive Counselor and welcome to the board.. :welcome:

Could you be more specific about what you might consider beneficial touch? I wonder where your boundaries lie as regards touch or indeed if you have any? Afterall a client may well feel that sex would be beneficial..

Difficult to judge long term effects as well isn't it as I don't suppose we often get many long term updates from clients..

Hmmm.. lots to think about.. I'd love to hear your view..

Cherrypie

[ScottishLass]

My counsellor of 2 years hugs me. She didn't use any physical touch at all until we had been seeing each other for a year. She now hugs me if I am upset and I usually give her a hug before I leave ( only because she had signalled that it would be ok. I wouldn't have hugged her if she hadn't of initiated it ) for me it helps to feel physically held in a safe place as I have experienced abuse in the past. It helps to feel physically accepted by a safe person who doesn't make ant demands on me. I guess it has to be right for the situation though. For example, she is the same age as my
Mother so it's more of a nurturing feeling. If she had been a male counsellor though I most certainly would not have found it a "safe" hug so I would say that caution does need to be used and the situation needs to be considered carefully.