Types Of Touch In PsychoTherapy

Touch is extremely important for health, healthy development and healing. The medicinal aspect of touch has been known and used since earliest recorded medical history, 25 centuries ago. Touch triggers a cascade of healing chemical responses including a decrease in stress hormones and an increase in seratonin and dopamine levels. Additionally, touch has been shown to increase the immune system's cytotoxic capacity, thereby helping our body maintain its defenses and decreasing anxiety, depression, hyperactivity, inattention, stress hormones and cortisol levels.

Psychoanalytic Prohibition Of Touch In Therapy

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Massage therapy has been shown to reduce aversion to touch and to decrease anxiety, depression and cortisol levels in women who have been sexually or physically abused (Field, et. al., 1997). It decreases diastolic blood pressure, anxiety and cortisol (stress hormone) levels (Hernandez-Reif, et. al., 2000). One study examined the effects of massage therapy on anxiety and depression levels and on immune function. The subjects received a 45-minute massage five times weekly for a 1-month period. The findings were that: 1) anxiety, stress and cortisol levels were significantly reduced; 2) natural killer cells and natural killer cell activity increased, suggesting positive effects on the immune system (Ironson, et. al., 1996). Bulimic adolescent girls received massage therapy 2 times a week for 5 weeks. Effects included an improved body image, decreased depression and anxiety symptoms, decreased cortisol levels and increased dopamine and serotonin levels. In a study of children with ADHD, touch sensitivity, attention to sounds and off-task classroom behavior decreased and relatedness to teachers increased after massage therapy (Field, et. al., 1997). Following five 30-minute massages, children/adolescents had better sleep patterns, lower level of depression and anxiety and lower stress hormone levels (Field, et. al., 1992). Massage therapy also decreased the anxiety, depression and stress hormone levels of children diagnosed with PTSD, who survived Hurricane Andrew. In addition, their drawings reflected less depression (Field, et. al., 1996).


Recent research on pregnancy and infant massage documents benefits of touch that might allow us to consider this form of touch to be labeled as psychotherapy at the earliest stages of human development. Massaged babies show improved emotionality, sociability, soothability, temperament dimensions, and better face-to-face interaction behaviors (Field, et al., 1996). Many hospitals are now implementing Tender Touch parent education programs that promote the philosophy of developmental care in order to individualize infant care to maximize each baby's developmental potential. Other similar programs teach Tender Touch volunteers how to work with drug-exposed newborns. These programs were developed for at-risk infants and can be conceptualized as infant psychotherapy.

Eiden, B., (1998) The Use of touch in Psychotherapy. Self and Society 26/2, 3-8.
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There are many different approaches to touch in therapy. One approach, often referred to as body psychotherapy, or somatic psychotherapy, sometimes uses touch as one of its primary tools while also employing verbal communication. It is a commonly misheld belief that all somatic or body psychotherapists utilize physical touch in psychotherapy. While many do, there are others who advise against touch. The concept that we are embodied beings, and the respect for the unity between psychological and bodily aspects of being, is common to all forms of somatic body psychotherapy. These schools of thought recognize the body as a vehicle of communication and healing. Another approach, and the focus of this paper, employs touch as an adjunct to verbal psychotherapy or counseling. Body psychotherapies include schools, such as Reichain (Reich, 1972) and its numerous branches, Bioenergetics (Lowen, 1976), Somatic (Caldwell, 1997) or Hakomi (Kurtz, 1990). These approaches focus on harnessing the healing power of touch. There are numerous other psychotherapeutic orientations that have embraced touch. These orientations formalized the use of touch in therapy as an adjunct to verbal therapy. They include Gestalt therapy (Perls, 1973), several variations of humanistic psychology (Rogers, 1970) and group therapy (Edwards, 1984). They also include some parts of feminist, child, family therapy and dance and movement therapy (Smith, et. al, 1998; Satir, 1972). In spite of the numerous therapeutic approaches, theories and practices that systematically and effectively use touch in therapy, touch has nevertheless been marginalized, forbidden, called a taboo, often sexualized and at times, even criminalized by many schools of psychotherapy and ethicists (Young, 2005; Zur, 2007a).

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The term 'slippery slope' refers to the idea that failure to adhere to hands off, rigid standards, most commonly based on analytic and risk-management approaches, will undeniably harm clients, nullify therapeutic effectiveness and often leads to therapist-client sexual relationships. This fear-based view has been most dominant in the discussion of employing or incorporating touch in psychotherapy. It underlines most arguments against the use of physical touch by therapists. It asserts that a handshake, non-sexual hug or a re-assuring pat, are all just the first downhill steps towards inevitable deterioration, towards full- fledged sexual relationships.

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Also in agreement is Simon (1991), who decrees that: "The boundary violation precursors of therapist-client sex can be as psychologically damaging as the actual sexual involvement itself" (p. 614). This poignant statement summarizes the opinion that the chance for exploitation and harm is reduced or nullified only by refraining from engaging in physical touch or any other boundary crossing. Many writers describe a long list of therapists' behaviors (e. g. self-disclosure, hugs, home visits, socializing, longer sessions, lunching, exchanging gifts, walks, playing in recreational leagues) that they believe to be precursors to sexual dual relationships (Borys & Pope, 1989; Craig, 1991; Lakin, 1991; Pope, 1990; Pope & Vasquez, 1998; Rutter, 1989; St. Germaine, 1996). Without doubt, touch tops this list.