Five arguments in favor of the use of touch in therapy

There is a widespread belief in the psychological community that the use of touch in psychotherapy is illegal. The “taboo” against the use of touch was established long ago. This prohibition, which still persists today, prevents touch from being accepted as a valuable psychotherapeutic approach.

Here, I evaluate five common questions I have encountered in my years of teaching the therapeutic use of touch:
1. Does touch unduly foster dependent infantile wishes and gratify Oedipal fantasies?
2. Does touch gratify a client’s manipulative needs?
3. Can touch lead to transference and countertransference problems?
4. Is touching clients a slippery slope to sexual transgression?
5. Shouldn’t touch be reserved for family and social interactions?

Does Touching Clients Serve Or Hinder The Goals of Psychotherapy?

Current developmental research validates the use of touch as an important, if not essential, therapeutic intervention. There is now solid research indicating that critical levels of attuned touch are important for normal brain maturation and for socioemotional and cognitive development. Given that the primary importance of attachment is widely accepted, and that neuroscience provides evidence of the body’s critical role in development, the time is ripe to examine the vital contributions of touch and bodywork in the repair of relational and emotional trauma.

Argument #1

Does touch unduly foster dependent infantile wishes and gratify Oedipal fantasies?

Psychoanalytic tradition asserts that using touch to satisfy a patient’s desire for the missing comfort of the mother fosters a clinging infantile dependency, and serves as a stimulant for Oedipal fantasies.

Counter-Argument

Touch is a fundamental mode of human connection in the infant–mother relationship. In order for mother and child to relax into breastfeeding and reciprocal gazing, a baby must be securely supported in its mother’s arms. Secure holding underlies a baby’s feeding and gazing connection.

Adults who seek psychotherapy have generally experienced some form of abandonment, abuse, or neglect in early life, and often report never having had the experience of being securely held in a way that allowed them to yield into trusting support. I am reminded of a client who insisted on lying down during his sessions, yet kept lifting his head to look around. His neck soon tired, and he could barely continue to lift it. Finally, he uttered the words: “Is anybody coming?” and burst into tears. He remembered lying in his crib for hours, waiting for his mother, who never came. He finally had given up hope that she would ever come, and had fallen into a collapse that became his basic stance in life: “No use trying; it won’t happen.” For this client, being touched was an immense relief. The experience of having someone hold his weary neck and tend to his preverbal needs was transformative. He was able to release the long-held pattern of hopelessness, and open to the gratifying sensations of supportive presence. As our somatic work progressed, he reclaimed his desire to live.

On an analyst’s couch, patients face away from the analyst, away from relational contact. This helps patients focus on their inner process, and leads to insight and growing maturity. But in cases of early relational trauma, the lack of contact can exacerbate the isolation of clients who yearn for connection, or who have not experienced satisfying nurturing relationships. Abused and neglected individuals have never had the experience British pediatrician and psychoanalyst Donald Winnicott called "going on being" — the secure holding within which a baby can be fully absorbed in the intense work of its development.

Avoiding touch contact can repeat the physical neglect or rejection undergone by a client as a child. The touch taboo can rob patients of effective, perhaps critical, ways to fulfill primary needs that were never met. Early traumatized clients need neurological repatterning experiences in addition to reworking the cognitive and emotional aspects of their relational traumas. A physically close, but nonsexual, nonviolent, non-abusive, nurturing, comforting, and affect-regulating touch experience can help clients (and their nervous systems) move through the painful early deficits that often continue to bring suffering in their adult relationships.

Avoiding safe, nurturing touch
is a cruel re-creation of the original relational trauma,
a repeat of the experience of physical neglect or rejection
undergone by an individual as a child.

Argument #2

Does touch gratify a client’s manipulative needs?

It is argued that while some patients are genuinely in need of the reparative contact denied in childhood, others will use contact to avoid self-awareness, and sidestep facing painful feelings.

Counter-Argument

Psychotherapists are trained to address manipulations and enactments, and a client’s manipulative strategies are not reserved to the arena of touch alone. The fear that gratification leads to avoidance or entitlement is a residue of childrearing techniques handed down from past generations, which were mostly concerned with shaming children into becoming compliant, obedient citizens.

If the findings of Harry Harlow on the innate need for touch in baby monkeys can be extended to human beings, it should be expected that the need to be touched would arise in the therapy of clients with attachment trauma who were touch deprived. It is detrimental to the nervous system and unfulfilled early need for connection to have clients relive painful memories of “wire-mesh mothers” or “cloth mothers” without offering somatic repair. Client manipulations are a sign that basic needs have been denied, and withholding touch may repeat the original missing experience. In order to avoid painful feelings of misattunement and neglect in their therapy, there is a high likelihood that traumatized clients may depersonalize their therapist and the therapeutic relationship.

It can therefore be argued that avoiding contact is a cruel re-creation of the original relational trauma — a repeat of the experience of physical neglect or rejection undergone in infancy. Caring touch that offers gentle support may, in fact, lay the foundation that helps patients deepen their capacity for self-exploration.

The psychotherapeutic use of touch encourages the preverbal self to be cognized, and brings about a strengthening of the body ego. Far from creating dependency, touch sets the separation-individuation process in motion:

Holding and rocking allows unconscious, preverbal healing to occur. Bodily feelings arising during touching can be profoundly self-communicative, self-informing. They bridge preverbal gulfs, integrating and resolving old emotional-bodily confusions and conflicts. It is as if, in the containing hands of the manual practitioner, the body-self understands itself a little more and can relax and grow in such understanding. (Bevis, 1999)

Argument #3

Can touch lead to transference and countertransference problems and block the expression of hostile feelings?

Psychoanalysis and traditional psychodynamic models maintain that touching patients violates the therapist’s neutrality and negatively intrudes on the therapeutic process. It is argued that, when working with primitive mental states, touch can hinder and contaminate the transference by: a) blocking the expression of hostile feelings, b) triggering the need to protect personal boundaries, and c) foreclosing free association. Additionally, in cases where transference involves the enactment of an abusive past, touch can rekindle a patient’s powerlessness in the face of violation, and trigger unaddressed issues of power differentials and microaggressions. Touch, it is therefore argued, is more than likely to lead to transference and countertransference problems.

Counter-Argument

Although these concerns are valid and important, they are also one-sided arguments that reveal a lack of knowledge about the psychotherapeutic use of touch. Why would the avoidance of touch not be equally contaminating to the transference?

A somatically-trained psychotherapist is aware of situations when touch is contraindicated. In cases where the transference involves the enactment of an abusive past, touch is used with great care, if at all. If the body has been violated, it is acknowledged so that if, and when touch interventions are chosen by therapist and client, they offer a reparative experience that does not rekindle the powerlessness of the original violation. Some types of touch and movement, such as grasping or pushing away, are intended to help clients externalize hostile aggression and assertively express re-owning their integrity.

Supportive touch that elicits trust and safety can give deprived clients a caring, comforting, affect-regulating, yet nonsexual, nonviolent, and non-abusive experience that helps the body, brain, and nervous system learn to receive nurturing. Touch encourages the nonverbal self to become known, and bodily memories that arise during a touch session are profoundly self-informing. Being held and nurtured allows healing to access unconscious preverbal experience that would not otherwise be reached. In the containing hands of the somatic psychotherapist, the body-self understands itself a little more and learns to overcome the debilitating effects of overwhelming traumatic triggers.

Argument #4

Is touching clients a slippery slope to sexual transgressions?

It is a major concern to those who mistrust the use of touch that it may be interpreted by a client as an invitation to intimate contact, and lead to sexual acting out. When exploring physical, sexual, and emotional abuse, some patients might experience the therapeutic use of touch that is meant to be empathic and compassionate as an invasion of personal space, or an expression of covert aggression.

It is also argued that since abusive, violating touch is used to enforce power, establish dominance, and maintain control, therapists could fall into the trap of using touch to dominate or manipulate clients — especially in situations where male therapists are working with female clients.

Counter-Argument

Psychotherapists are trained to sustain boundaried emotional intimacy in the therapeutic relationship. One may therefore wonder why the profession has such a fear that touch, more than any other intervention, would easily sweep away the professionalism of a trained psychotherapist. Because abused individuals often do not have access to their capacity to set boundaries, the issue of boundary breach is a serious therapeutic concern to the somatic therapist. It is not, however a reason to foreclose on using touch interventions.

Therapists who use touch interventions learn to track the subtleties of biological communication. The therapeutic use of touch, like any modality, requires professional training and emphasizes the development of personal somatic self-awareness on the part of the therapist. Those who see touch as dangerous do not understand the profound respect for the intelligence of the body that somatic training inspires in its practitioners. It is the therapist who is not trained in somatic techniques and body psychotherapy who is at higher risk of transgressions.

When exploring issues of physical, sexual, and emotional abuse, a somatically-trained therapist is aware that touch can trigger experiences of personal boundary breach that could shut down a client’s capacity to trust the therapeutic process. The touch taboo speaks to the violation of boundaries, and untold suffering caused by sexual and physical abuse. These tragic touch dysfunctions bring mistrust to the use of touch as a therapeutic intervention. Unfortunately, they also foreclose on the deep yearning and disappointment that neglect and the lack of loving touch leave in client lives.

Few of us have been touched in aware and attuned ways.
Our fears about touch reveal the pervasive dysfunctions of touch
that bring therapists to mistrust it as a therapeutic intervention.

Most body-centered disciplines, such as medicine, surgery, chiropractic, nursing, bodywork, and physical therapy, use some form of touch for which practitioners are professionally trained. Each of these disciplines has a code of ethics to safeguard the patient and ensure the practitioner’s professionalism. The ethical criteria for the use of touch in psychotherapy follow similar guidelines to those in other health professions:

  • Professional training in the modality employed
  • Proficiency in using the chosen techniques
  • Obtaining client-informed consent
  • Attunement to the client's therapeutic issues and needs, and maintaining open communication
  • Confidence in the choice of the therapeutic intervention

 

Argument #5

Should touch be reserved for family and social interactions?

This argument holds that touching is a natural expression of emotional connection, and should therefore be reserved for family and social interactions such as handshakes to express friendship, a touch on the shoulder for empathy, or a congratulatory hug to express joy.

Counter-Argument

Avoiding touch can have the effect of perpetuating the belief that psychological issues do not concern the body, thereby reinforcing the split between psychological and somatic dimensions. Avoiding touch maintains the impression that psychological issues are more important than bodily experience.

The therapeutic use of touch and bodywork connects the cognitive self with its biological intelligence to help clients understand how thoughts, emotions, and sensations work as a unified whole. The therapeutic use of touch is an implicit language that directly addresses and integrates nonverbal physiological needs with psychodynamic awareness. Like attachment parenting, it puts a premium on giving individuals what they need to grow their capacity to be strong, independent, and loving.

In Conclusion

The following words by Bessel van der Kolk encapsulate the healing needs of the early traumatized self:

"How do you quiet down the frightened animal inside of you? The answer to that is probably in the same way that you quiet down babies. You quiet them by holding and touching them, by being very much in tune with them, by feeding and rocking them, and by very gradual exposure to trying new things."

References available on request: aline@neuroaffectivetouch.com

Dr. Aline LaPierre, PsyD, MFT, SEP is the founder and director of The NeuroAffective Touch® Institute which offers trainings in the therapeutic use of touch. She is past faculty in the Somatic Doctoral Program, Santa Barbara Graduate Institute (2000-2010). Aline is the coauthor of Healing Developmental Trauma: How Trauma Affects Self-Regulation, Self-Image, and the Capacity for Relationship now available in ten languages. She is currently Vice-President of the United States Association for Body Psychotherapy (USABP) and Deputy Editor of the International Body Psychotherapy Journal (IBPJ). For more information about her work, visit the What is NeuroAffective Touch®? page. For more information about touch trainings, visit the NeuroAffective Touch® Training page.