Touch in psychotherapy is a controversial topic. Freud used touch in his early work but later denounced it–citing the dangers of touch where intense transference exists.
Since then, psychoanalysts, lawyers, risk managers and ethicists have advised psychotherapists to rule out touch as part of talk therapy with the main reason being that touch is a “slippery slope.”
The slippery slope argument that has dominated current practice results from the lack of theoretical distinction in the psychoanalytic literature between nurturing touch and sexual touch. But, it is precisely that distinction that matters in a thoughtful discussion on the use of touch by a psychotherapist.
In the early to mid 20th century, Object Relations theorists such as Rank, Klein, Fairburn and Winnicott, shifted the focus to pre-oedipal development and opened a door to differentiating between sexual touch and early developmental needs for soothing touch.
Harlow and his famous research using wire and cloth monkey mother surrogates (Harlow, 1971), followed by a long line of infant-child and attachment research furthered our understanding of attachment and the need for physical touch to provide comfort and affect regulation in infants and babies.
Attachment research, not to mention intuition, validates that touch is paramount to healthy development especially in infancy and childhood.
Currently, body psychotherapies like the Alexander Technique unabashedly use touch. As Zur et.al. (2011) note, other body psychotherapies such as Reichian (Reich, 1972) and Bioenergetics (Lowen, 1958, 1976) use touch as their primary tool in psychotherapy, see its value, and endorse it as a therapeutic tool wholeheatedly.
Additionally, experiential psychotherapists routinely touch patients as when they are tapping on a patient’s knees during EMDR processing, pressing on a patient’s stomach to “take over” physical tension as practiced in Hakomi (Kurtz, 1990), or having the patient push against the therapist’s hands to experience the physicality of setting boundaries as in Somatic Experiencing (Ogden et al., 2006).
Furthermore, some talk psychotherapists will touch their patients when the patient initiates so as not to insult or embarrass them.
Examples of this type of casual touch include a spontaneous hug, a handshake, a kiss on the cheek or a “high five” as a show of support.
Most psychoanalysts are highly opposed to any form of touch in therapy (Menninger, 1958; Wolberg, 1967; Smith et al., 1988). However, many other orientations support the clinically appropriate use of touch (Williams, 1997; Young, 2005; Zur, 2007a, 2007b).
The literature is replete with pros, cons, guidelines and advicc on touch. A literature search and review offers a wealth of articles on touch in psychotherapy. Zur and Nordmarken (2011) have written an exhaustive paper on the clinical, ethical and legal considerations of touch in psychotherapy.
Harm or Healing
Touch, like all psychotherapeutic interventions, has the capacity both for harm and for healing. Rothschild (2000) believes that, in some cases, judicious touch is useful as long as client and therapist agree.
It is crucial to think before acting; to understand the counter-transference and transference implications; to collaborate with our patients about potential benefit and harm, all of which will result in making wise clinical choices.
Surveys of clients who have experienced touch in psychotherapy indicate that touch reinforced their sense of the therapist’s caring and involvement. The findings also “support the judicious use of touch with clients who manifest a need to be touched, or who ask for comforting or supportive contact” (Horton et al., 1995, p.455).
Years ago, during my analytic training, before I ever thought about actually using touch with a patient, I remember reviewing the NASW’s and APA’s guidelines on touch—mostly out of curiosity. I was surprised at the time, since the taboo felt so strong in my mind, that neither of them expressly prohibits touch.
They do expressly prohibit sexual boundary crossings and imply the essential message for all caregivers and health professionals: Above all, do no harm!
Being held is a profound developmental need. If a patient has been deprived of this basic need, it makes intuitive sense that a therapist’s skillful use of touch could foster healing.
There is also an argument that not using touch when needed might hamper healing or even cause harm. For patients who were denied adequate physical affection or were outright neglected, not tending to these developmental and basic needs for physical comfort and soothing, when needed and/or requested, could be construed as an enactment of the original trauma.
Instead of a blanket rule against touch, I think a better way to think about touch is whether it could move someone toward transformance (Fosha, 2007) and healing, versus re-traumatization.
I consider touch the way Ron Kurtz (1990) of Hakomi Therapy does, that it is a form of nourishment. He believes, and my observations concur, that if a therapist provides the right nourishment that the patient truly needs, the patient will accept only what is needed and when replete with nourishment will move from dependency to exploration of the world at large.
In other words, supplying what is truly needed will lead natural development to continue.
*Note: Touch is a powerful tool. Any therapist who uses therapeutic touch must be highly trained to ensure a therapeutic experience.
Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. Routledge: London.
Fosha, D. (2000). The transforming power of affect: A model of accelerated change. New York: Basic Books.
Fosha, D. (2007). Transformance, recognition of self by self, and effective action. In K. J. Schneider, (Ed.), Existential-integrative psychotherapy: Guideposts to the core of practice. New York: Routledge.
Harlow, H. F., Harlow, M. K., & Suomi, S. J. (1971). From thought to therapy: Lessons from a primate laboratory. American Scientist, 59, 538-549.
Horton, J., Clance, P.R., Sterl-Elifson, C., & Emshoff, J., (1995). Touch in psychotherapy: A survey of patients’ experiences. Psychotherapy, 32, 443-457.
Kurtz, R. (1990). Body- centered psychotherapy: The Hakomi method. Mendocino, CA: LifeRhythm Books.
Lowen, A. (1976). Bioenergetics. New York: Penguin.
Menninger, K. (1958). Theory of psychoanalytic technique. New York: Basic Books.
Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach. New York: Norton.
Reick, W. (1972). Character analysis. New York: Simon and Schuster.
Rothschild, B. (2000). The body remembers. New York/London: Norton.
Smith, E., Clance, P .R. & Imes, S. (Eds.) (1998). Touch in psychotherapy: Theory, research and practice. New York: Guilford Press.
Williams, M. H. (1997). Boundary violation: Do some contended standards of care fail to encompass commonplace procedures of humanistic, behavioral, and eclectic psychotherapies? Psychotherapy, 34 (3), 238-249.
Wolberg, L. (1967). The technique of psychotherapy (2nd ed.). New York: Grune & Stratton.
Young, C. (2005). About the ethics of professional touch. http://www.eabp.org/pdf/TheEthicsofTouch.pdf.
Zur, O. (2007a). Boundaries in psychotherapy: Ethical and clinical explorations. Washington, DC: APA Books.
Zur, O. (2007b). Touch in therapy and the standard of care in psychotherapy and counseling: Bringing clarity to illusive relationships. U.S. Association of Body Psychotherapy Journal, 6 (2), 61-93.
Zur, O. & Nordmarken, N. (2011). To touch or not to touch: Exploring the myth of prohibition on touch in psychotherapy and counseling. http://wwwzurinstitute.com/touchintherapy.html.
Therapy session photo available from Shutterstock