Reach Out And Touch A Patient
by Garry Cooper, LCSW
John, I hope you’re not one of those people who seem to have begun confusing morality with legality. These turkeys think that if if it’s legal, it’s moral, and if it’s moral, it’s legal. That represents a watering down of morality. If you don’t obey the laws and rules, the newthink goes, you’re wrong, a criminal, a bad person.
Two areas where this particularly manifests itself is in the lunacy of school administrators who, under zero tolerance drug policies, suspend students for bringing Midol to class, and, I’m afraid with therapists, who are so concerned with covering their ass against board hearings and malpractice suits that they leave their humanity outside their office. Therapy is, after all, a human endeavor, and therapists have a responsibility to step outside—and to help their clients step outside—the increasingly narrow confines of self-expression and freedom that our society seems to be imposing upon everyone. Everyone’s afraid of litigation; do we want to stroke that fear and do our share to help create a more fearful and constricted society?
We see this particularly with the issue of touch in therapy. There’s a vast body of research, much of it informed by neuroscience, showing that touch opens all kinds of emotional connections and doors. Therapists who do bodywork know how quickly they can help clients move to deeper insights, emotional release, and new behaviors and emotional formulations. It makes sense that even therapists who exclusively use talk should make strategic, carefully considered use of touch. For an excellent discussion of this, see Ofer Zur and Nola Nordmarken’s article on touch in therapy at http://www.drzur.com/touchintherapy.html .
And yet, many therapists refuse to touch a client, though a fair number of them will occasionally shake a client’s hand, which I suppose is something. Why the proscription against touching? Some of it’s historical—the legacy of the blank screen, the impassive analyst who gives nothing away—not a hint of emotion, cognition, humanity. Even today you hear therapists talk about the necessity of keeping the therapeutic frame. “My clients can get touch elsewhere,” one says, which of course is true, but irrelevant.
Such therapists fear that touching a client—giving a hug, a reassuring hand on a shoulder, a patting of the hand—will set off all kinds of wild transference notions in the client and throw the analytical process of therapy into chaos. It’s probably true that touch often means something extra and loaded to clients, but this paternalistic notion that the client can’t handle it or that the therapist and client can’t discuss it as part of therapy seems to me to assume that the therapist is much wiser and stronger than the client and needs to be in control of everything that happens in therapy. I don’t buy it.
But I think the main place where this idea of forbidding touch comes from is the fear of lawsuits and of complaints to boards. The idea’s out there, and it comes not just from Freud but from grad schools, codes of ethics and supervisors, that touch is verboten, outside the therapeutic frame and outside the therapist’s field of competence.
I suppose if we accept the notion that therapists are bloodless, super-rational, unemotional professionals, that’s true: touch is outside our field of competence. But if therapy is about a connection between human beings, touch can be a potent, vital part of the process. As Zur and Nordmarken point out, if we know that touch speeds up and deepens therapy, if we know it can be incredibly healing, then isn’t it more unethical to withhold it out of fear we might get sued? After all, who are we here for, if not the client?
People often say that rules are made to be broken, but I think it’s more accurate to say that rules are made to keep the least ethical and the least competent in line. One survey estimates that 4.4 % of therapists have had sexual contact with their clients (7% of male therapists and 1.5 % of female therapists.). Those people not only shouldn’t be touching, they shouldn’t be therapists, and codes of ethics won’t save clients from them.
Because touch is so powerful, therapists should use it wisely, with careful consideration what the touch will mean and what it’s intended to accomplish. The way to cover themselves is not to refrain from touching every client but to document every touch in their notes, along with their rationale for having used it, to discuss with the client what the touch means--and what it doesn’t mean—and to document that conversation as well. As Zur and Nordmarken point out, therapists have to keep the distinction clear—for themselves and for their clients—between boundary crossings and boundary violations. Only the most timid and rigid and the least thoughtful therapists fail to see the distinction between the two.
Some therapists, because of their analytic training, don’t believe in ever touching clients, and I really do respect them. They have a consistent perspective and consistent rationale that fits their way of doing therapy. But the majority of therapists aren’t psychoanalytic, and they refrain from touching because they’ve been told not to, under threat of sanctions and lawsuits. What exactly is it that they are modeling for their clients?
Garry Cooper, LCSW is a therapist and writing coach in private practice. His “Clinician’s Digest” column for the national magazine Psychotherapy Networker, covers the latest news and research in mental health and psychotherapy. Visit his website Psychology Trends. He can be contacted at garry@psychjourney.com
