CAN THE PROFESSION OF PSYCHOTHERAPY AFFORD TO BE UNTOUCHED ANY LONGER?

The Use of Touch in Psychotherapy

A summary of a presentation, given by Bernd Eiden at the 8th UKCP Conference 'Creating Chaos: the lifelong impact of the unheard child'

on 13 September 2002

General Introductory Observations and Questions

- We live in a culture in which touch is easily sexualised and has sexual connotations and is therefore avoided. Do we, as therapists, contribute and collude with the clients' apprehension about touch? Do we fear that touch invites sexual contact? Do we refrain from it out of fear, and not because we believe that it is bad for the client?

- It does not make sense to withhold touch when it is agreed that physical contact is essential for the formation of self, that it provides nurturance and stimulates the ability to bond and to relate to another.

Three fundamentally different positions/ methods in relation to the use of touch

A. The analytical position applies a 'no touch' rule and touch is explored in the client's fantasy only.

B. Body psychotherapy, as a humanistic approach, postulates that the self is embodied and experienced through and within the body.

C. The field of various body therapies have their own rationale for the use of touch. They attempt to change client's physical and emotional well-being.

A. The theoretical foundation for the 'no touch' rule in the analytical approach

The psychoanalytical approach holds the 'no touch' taboo to ensure the rule of abstinence and neutrality. The main reasons for this are:

1. The fear of the therapeutic relationship being sexualised by touch

Freud believed that any physical touch in therapy could stimulate a sexual desire, while the object relations therapists gave much more attention to the infant's needs and drives. They also formulated a position that the physical holding does not necessarily lead to sexual feelings and that physical contact does not simply gratify an instinct, but can facilitate a bodily experience for the client. Winnicott says that through touch the infant learns to accept the body as part of the self. Nevertheless, object relations therapists are also inclined not to use physical touch.

2. The fear that the development of transference is disrupted

Psychoanalysts believe that touch undermines the neutral relationship and that the projection of early oedipal feelings will be interrupted. Touch provides gratification and could therefore trap the client in a positive transference.

3. The belief that the process of developing the symbolic level gets inhibited

The symbolic level is achieved through the process of internalisation which happens through the absence of physical touch so that the internal image of being held can eventually replace the concrete holding. The analytic psychotherapist believes that touch gets in the way of enabling this process of internalising and symbolising.

4. The fear of transgression of professional boundaries

Due to the increase of complaints, the element of fear of being sued, may have grown in the current climate.

B. The purpose of the use of touch in body psychotherapy

Four methodological applications for the use of touch can be put forward:

1. To reduce body armour and lower the resistance

According to Reich the ego controls the impulses and emotions and the character is seen as a defence against strong emotions. The body blocks are defensive responses to conflict in earlier stages and are held in the form of muscle tension. This work is based on research of the relationship between energetic charge in the body and the autonomic nervous system functions, and the connection with respiration, e.g. the startle reflex causes contraction of the muscle and holding of the breathing.

2. To facilitate a sense of containment and safety

For clients who may have received inadequate or invasive touch in childhood, touch may offer an experience of nurturance and support the development of a core self. The intention here is to support and contain the client, so that the client feels safe enough and feelings can be released. We could say that here touch provides gratification and this might be beneficial for those clients who have been very deprived. It allows the underlying affect to come forward.

It is also acknowledged that touch can be soothing and calming in the state of the client being overwhelmed and aroused. It becomes a 'corrective emotional experience', which helps to strengthen body-ego boundaries when there is insufficient integration. Physical holding can help the client contain the fear of uncontrolled emotional expression and losing control. The emotional charge can be directed to other parts of the body such as the legs or the arms. Instead of discharge the client is invited to explore the internal swings of the emotions and contain them. Good physical holding provides emotional care. The 'metaphorical holding' (Winnicott) is not enough for some clients, they might need skin to skin contact. This form of touch helps the client to build a physical self, which is an important part of the formation of the self.

3. To bridge the gap between the kinaesthetic awareness and verbal expression.

Physical touch can give meaning to physiological experiences and sensations, e.g. sensations of coldness could lead to feelings of anxiety. All emotional experiences are bodily based and are first recognised by sensations. Preverbal information can come forward through sensing. It can also be crucial to give space for non-verbal communication before it is named.

This physical exploration can be seen as the equivalent to 'the free association technique' and can lead into an unknown, unconscious territory. The brain gets stimulated by tactile stimuli which can lead to heightened mindfulness and open new connections.

4. To elicit body memories

Memories can be literally touched upon, whether they are pleasurable or painful. The body stores memories which are suppressed through dissociation. Touch can be valuable in retrieving memories of abuse. The survivor is not able to feel the body from the inside and there is no sense of embodiment. Trauma has psychological and physiological characteristics. Feelings and sensations are experienced as events in the head and the affect is neutralised. Touch can bring aliveness in parts of the body that have been numbed. It can help to reinforce a physical sense of self and restore a sense of embodiment. Touch can communicate non-verbally respect and validation.

Counterproductive use of touch: Ongoing use of touch can keep the client in an early stage of development and inhibit appropriate development towards separation, expression of anger or asserting sexuality.

C. The purpose of using touch in various forms of body therapies

Alternative practitioners, e.g. craniosacral osteopaths, use touch for healing, calming, changing posture, relaxing muscle, influencing tissue, reducing pain, diminishing fatigue, decreasing the autonomic arousal state and thus helping to diminish stress, etc.

The difference between body therapies and body psychotherapy is the shift to working with the therapeutic relationship guided by and grounded in transference dynamics. The body psychotherapist is actively addressing defences and works with the underlying unconscious dynamics, while body therapists tend to apply a treatment and stay within the medical model or in the role of the supportive facilitator.

How does a body psychotherapist work with touch?

The work can be done standing, sitting or lying, lying either on a mattress or on a massage table. Touch can be applied in all these positions, by placing a supportive hand on a particular part of the body, when applying an exercise, when working with the breathing, when working with vegetotherapy methods to help the client connect with the body in order to activate the autonomic nervous system responses; by pressing into a muscle or holding the connective tissue; by providing physical holding in moments of distress, etc.

The Link to Neuroscience

The fundamental premise in body psychotherapy that our experience of the body is vital for a robust sense of self is now underpinned by new developments in neuroscience. It is confirmed that the emotional connection is central and that the thinking and feeling can not be separated. Spontaneity, authenticity and embodiment are fundamental and cognitive insight is not enough. A process of integration, involving the emotions, needs to happen and touch can facilitate this. The right brain receives information from the autonomic nervous system (ANS) about this experience. The body sensations and feelings will eventually be verbally communicated and put into a meaningful context which activates the left brain. Putting into words what is experienced in the body through touch integrates the two hemispheres. Change is more likely to occur by having added the organic component, as all aspects must be engaged for change to be meaningful, deep and long lasting.