What are your beliefs about physical contact with clients? What questions should you ask yourself before engaging in physical contact? How do you know when it is not a good idea? What are some of the potential negative outcomes? How do these risks and benefits weigh out?
My beliefs regarding physical contact with clients are “mixed.” Although I can certainly see benefits in some situations (increased sense of empathy), I see some serious risks as well (misinterpretation of the action, dependency). I am not a “touchy feely” person by nature, so this isn’t something I anticipate having huge issues with. I am innately more likely not to touch someone “non-erotically.” I would probably err on the side of caution for no other reason than “that’s the way I am.” Although I do have a desire to convey caring and compassion, I honestly don’t feel like I need to touch someone to convey that.
There are a number of questions I would need to ask myself before I would ever consider touching someone. Gender… if I wouldn’t touch someone of the opposite sex of the client in that situation, I probably wouldn’t do it at all. Age… honestly, I would be more comfortable hugging someone who was elderly than I would someone who was younger than me. I would consider the current diagnosis of the client, especially any history of sexual or physical abuse. If any history of abuse is present, including being raped, molested, sexual addictions or intimacy issues… it’s probably a safe bet not to touch them. I would also be very careful with paranoid or borderline personalities as it has real potential to evoke a negative response.
Also, I would consider the context of the therapeutic relationship… if it is individual therapy in a private practice setting I would be much more cautious than if it were in a group setting. I would also need to consider the length and the level of trust that has been established with a client. I would be much more inclined to touch someone if we had discussed the issue previously, or if we had a long standing therapeutic relationship/alliance. In any case, I would probably ask the client if it is ok with them if I touch their hand, etc.
I would consider the potential benefits of such an action, weighing my personal motivations and potential interpretations on the part of the client. All touch is reciprocal – one cannot touch without being touched… and I’m just not comfortable with touching. I agree with the text that if touching occurs, it should be a “spontaneous and honest expression of the therapist’s feelings and always done for the client’s benefit.” (Corey, Schneider-Corey, & Callanan, 2007, p. 316)
In any event, documentation of the type and frequency of touch, along with my personal rationale for employing it, is critical. This is increasingly important if touching is subsequently misinterpreted and a malpractice lawsuit is levied. Perception is reality for clients, and what is considered “appropriate” to me may not be “appropriate” to the client. Another potential negative outcome could be pre-mature termination. If the client is no longer comfortable with the clinician as a result of non-erotic touching, more harm has been done than good.
In conclusion, I think the risks outweigh the benefits in most situations. It’s not that I consider it taboo or anything, I just don’t think I need to touch someone in order to convey caring, sensitivity, or understanding. I can convey warmth and empathy with my voice. My aversion to touching clients has less to do with the potential negative outcomes than it does with my belief that other methods are as effective or more effective. If we drill down to a point where a client is crying and in obvious distress, I am of the belief that a certain degree of distress is healthy. Touching a client provides a false sense of security in my opinion, premature resolution, and a certain sense of dependence. In as much as I am there to help a client, I am there to promote independence, not dependence on the clinician. In more ways than one it has the potential to be counterproductive for the client, and for that reason, I am going to use touch very judiciously.
Corey, G., Schneider-Corey, M., & Callanan, P. (2007). Issues and ethics in the helping professions (8th ed.). Belmont, CA: Brooks/Cole.