Exploring Prohibition On Touch In Psychotherapy And Counseling and the Ethical Considerations of Touch, by Ofer Zur, Ph. D.  Introduction. Touch is one of the most essential elements of human development, a profound method of communication, a critical component of the health and growth of infants, and a powerful healing force Bowlby, 1. Harlow, 1. 97. 1, 1. Barnett, 2. 00. 5. Introduction. Touch is one of the most essential elements of human development, a profound method of communication, a critical component of the health and growth of. Brad Calder, Ju Wang, Aaron Ogus, Niranjan Nilakantan, Arild Skjolsvold, Sam McKelvie, Yikang Xu, Shashwat Srivastav, Jiesheng Wu, Huseyin Simitci, Jaidev. Ample research has demonstrated that tactile stimulation is extremely important for development and maintenance of physiological and psychological regulation in infants, children and adults Field, 1. Jean, Stack, Arnold, 2. Montagu, 1. 97. 1, 1. Siegel, 2. 01. 0 OBrien Lynch, 2. Touch has been an essential part of ancient healing practices. Touch has roots in shamanic and religious practices, and is reported to have been an integral part of health care practices and medicine since their emergence from the realms of religion and magic Levitan Johnson, 1. Smith, Clance Imes, 1. In his seminal work, Touching The Human Significance of the Skin, Ashley Montagu 1. He goes on to illuminate how the sensory system, the skin, is the most important organ system of the body, because unlike other senses, a human being cannot survive without the physical and behavioral functions performed by the skin. Among all the senses, Montagu states, touch stands paramount 1. Before Montague published his classic book in 1. Harlow 1. 95. 8 set the stage for our understanding of the importance of touch for emotional, physiological and interpersonal development in human and non human infants. In line with Harlow, Montagu concludes When the need for touch remains unsatisfied, abnormal behavior will result 1. Primarily Euro American cultures in general, particularly that of North American white Anglos, have developed a set of unspoken taboos in regard to touch. Based on Cohen 1. Hunter and Struves, 1. Dont touch the opposite gender This taboo is based on the belief or worldview that sexualizes all or most forms of touch. Dont touch same gender friends This boundary is primarily based in the homophobic fears prevalent in our culture. Dont touch yourself This injunction stems, in part, from some religious and puritanical doctrines and phobias around self pleasure and masturbation. Dont touch strangers This command is based on a cultural fear of the other, a paranoid attitude towards unfamiliar persons and those who are outsiders of ones own group. Do not touch the elderly, the sick and the dying This reflects a negative attitude in American culture towards the elderly, the sick, and the dying that manifests itself by segregating them from the rest of the population. The sick and the elderly are often housed away in specialized board and care facilities, where much of time hospital staff do not value touch as an essential part of care. Do not touch those who are of higher status This unspoken rule is prevalent in our culture, where it has been documented that people of higher status or power touch those of lesser status significantly more frequently than the converse. Touch, in this article, refers to any physical contact occurring between a psychotherapist and a client or a patient in the context of psychotherapy. Touch is one of many non verbal modes of communications i. Fridlund, 1. 99. 4 Young, 2. This paper looks at touch as an adjunct to verbal psychotherapy. However, it also reviews the literature on body psychotherapies where touch is a key therapeutic tool. This paper explores the rich duet of talk and touch and articulates how such a duet can significantly increase a sense of empathy, sympathy, safety, calm, and comfort, as well as enhancing a clients sense of being heard, seen, understood and acknowledged by their therapist Hunter Struve, 1. Touch is also likely to increase the sense of connection and trust between a therapist and a client Phalan, 2. Smith et. al., 1. The enhancement of the therapeutic alliance is of utmost importance, and as has been extensively documented, the quality of the relationship between therapist and client is the best predictor of therapeutic outcome Lambert, 1. Touch, in this paper, refers primarily to touch initiated by the therapist. However, when a client initiates or requests touch, the therapists must use his or her clinical judgment to ascertain whether providing or withholding touch is ethical and clinically advantageous in each therapeutic situation. Regardless of the vast scientific knowledge and data on the importance of touch for human development, communication, and its effectiveness in healing, the field of psychotherapy has generally shunned its use Bonitz, 2. Hunter Struve, 1. Smith et. al., 1. Young, 2. 00. 5 Zur, 2. Starting with Freud, traditional psychoanalysis looks at touch as an obstacle to analysis and cure of neurosis Fosshage, 2. For a variety of reasons, the field at large has embraced the analytic hands off stance. More recently, risk management guidelines, attorneys advice columns and ethical and legal experts have joined the psychoanalysts to warn us about the perils of touch. Touch in therapy has joined the list of modern risk management inspired taboos do not leave the office, minimize self disclosure and avoid dual relationships Williams, 1. Even those who endorse risk management reluctantly agree that a courteous handshake may be unavoidable. Viewing any non erotic touch as the first step on the slippery slope towards sexual relationships is one of the major erroneous beliefs and obstacles to understanding the importance of touch in therapy. Such sexualization of all forms of touch is embedded in the culture at large and manifested in faulty beliefs prevalent in the field of psychotherapy Lazarus Zur, 2. Some of the negative and frightening messages we have been inundated with come from prominent therapists, many of whom are psychoanalytically oriented. One example is Menninger, who asserts that physical contact with a patient is evidence of incompetence or criminal ruthlessness of the analysts cited in Horton, et. Simon, in a similar vein, instructs therapists to Foster psychological separateness of the patient. Wolberg 1. 97. 2, agrees Physical contact with the patient is absolutely a taboo since it may mobilize sexual feelings in the patient and the therapist, or bring forth violent outburst of anger 1. Similarly Karbelnig 2. Fourth, any type touch by psychotherapists may be construed as incestuous p. He summarizes his list of nine arguments against physical touch by stating Most likely, physical contact at the very least risks adversely affecting the psychotherapeutic relationship in any number of ways. 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.