[It’s important to note that in this post I am not talking about ‘body psychotherapy’, which is its own branch of psychotherapy in which therapists are specially trained to work with the body and with experiences and memories stored and held within it, in order to enable emotional release and healing. Instead I am talking only about ‘ordinary touch’ in other branches of psychotherapy, by which I mean a touching of hands or of fingers, a hand upon a knee, an arm around a shoulder, a hug, or other similar instances. I am also assuming, by and large, that the touching is not necessarily of a prolonged duration or a very regular occurrence.

To avoid writing a very long post, I have skimmed over the surface of what is becoming a more frequently written about subject, and I have not commented at all on the one very well-known and discussed case of Patrick Casement (1982) who refused to hold his patient’s hand when requested, in order to facilitate reworking a childhood trauma. Descriptions and discussions of this case can be found in a number of places including in two papers I have found particularly helpful, ‘The Meanings of Touch in Psychoanalysis: A Time for Reassessment’ by James Fosshage and ‘Physical Touch in Psychoanalysis: A Closet Phenomenon?’ by Kati Breckenridge]

I remember a painful therapy session from more than a year ago, in which my therapist made it very clear that hugs lay outside the boundaries of therapy. Up to that point I think I had still held on to a hope that it might be possible, if I waited long enough. If I’m completely honest, I think a part of me still hopes that perhaps she will ‘declare therapy over’ five minutes before the very end of the very last session, and will hug me before I leave. Hope can be very hard to stamp out – even if it turns on a technicality.

Since then, and until a few weeks ago, I’ve spent less time hoping for a hug or thinking actively about the subject of touch in therapy. And yet it’s been a subject that’s often been there in the background and I have felt a great need and desire for touch, on a number of occasions. Sometimes the need for touch feels simply like a desire to sit close to her, perhaps shoulder to shoulder, and sense her next to me. Sometimes it feels like wanting to have my hand held for reassurance or comfort; and at other times when I am very distressed I just want a hug and long to be held close for a little while. Most of the time I sit through those moments and we muddle, fight, wade or cry through them with silence or with words, or both. Occasionally, though, the need for physical contact feels so powerful it feels undeniable – as though it should not be denied. As though it’s absolutely vital in order to help repair a past or present experience, and cannot be replaced by words. I can feel that way both in and outside of session, but until a few weeks ago it wouldn’t really have occurred to me to talk about it – because since that time more than a year ago, it has felt as though there would be no point, because I know there is no chance of the undeniable becoming permissible.

Which is ironic, really, because so much of therapy consists of talking about needs that cannot be met – so why should this be any different? I am very grateful to ‘How to be an analyst‘ who raised the subject of touch in therapy in a comment on another one of my blog posts, and who happened to do it at a time when it was very pertinent for me and I was feeling a great need for touch. Since then, I have read a number of articles and papers (forwarded, with many thanks, by the author of ‘How to be an analyst’); and posts and comments by other bloggers and readers have continued to keep this very much a ‘live’ issue for me, even when, if I’m completely honest, I sometimes want to try and ignore it.

The difficulty is this – I don’t want this to be an issue for my therapy. I want to protect my therapy relationship at all costs, and I don’t want there to be matters about which my therapist and I are in complete disagreement. I don’t want to resent my therapist, or blame her. And so I have a natural tendency to try and talk myself into accepting her position on touch, and to convince myself that she is right. It would feel so much easier if I could tell myself I may not like it, but I think her way is best. But I’m not convinced, and the most I seem to be able to do is to sit on the fence, which is not a particularly comfortable place to be.

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Touch in therapy in complicated – there’s no doubt about that. It’s risky, for both patient and therapist; there is great potential for misuse and damage to be done; there are serious ethical questions to consider. But just because it’s difficult, doesn’t mean it should be discounted. How often should touch occur, who should initiate it, how is it possible to know whether it will be helpful or counter-productive in a particular situation? All good questions, but again, just because they are hard to answer and require careful judgement, doesn’t mean that avoidance is best. Touch is most definitely not part of ‘traditional’ psychotherapy; it has been pretty much taboo since Freud decided patients in session should be in a state of ‘abstinence’ and ‘non-gratification’ and that touch, amongst a whole host of other things, muddied the waters of analysis and departed from the model of the analyst as a neutral ‘blank screen’.

But if there’s one thing I’m convinced of, particularly after reading a number of articles on this subject, is that touch communicates, and lack of touch communicates. Lack of touch is not neutrality – it says something. Not touching is an action of the therapist just as much as touching is. Both therapist and patient are together involved in creating the environment of the session and everything that they do or don’t do is part of that creation and conveys a message and carries an impact. Is lack of touch an avoidance of touch? Is it a painful holding back or a hesitant relief at not needing to get any closer? Is it done for the patient’s benefit or the therapist’s comfort? A lack of touch has many possible meanings – but meaning ‘nothing’ is certainly not one of them.

My therapist may not use touch as part of her practice, but she doesn’t think it is wrong or ‘prohibited’. In that sense, I feel fortunate that this creates an environment in which it feels possible to discuss the subject more openly and more comfortably. I don’t think she will ever touch me; but neither do I think that she will show me the door if I touch her. Or at least, she has implied that she won’t. She has implied that if the desire for touch is there or if touch happens, it is something to talk about, in the moment, and to try and figure out and understand.

There are those who think that refusing to touch simply re-traumatises patients – that it reinforces the negative experiences of touch that they may have received as children, and that it doesn’t provide the positive healing experience they need instead. There are others who say that refusing touch allows the patient to fully experience the negative emotions from childhood in a way that enables them to be verbalised, thought about, talked about and worked through. This seems to be one of the key aspects of the debate over the use of touch in therapy and for me, it is intimately related to another key question (which I won’t go into here as it is a subject for another post!), namely: to what extent can therapy replace or re-provide what was missing in the past; and if it can’t, why is that? In what way is the process of learning or healing in therapy, different to processes or experiences that would have taken place in childhood?

But although these are key questions, they also make the assumption (made by Freud) that these desires, including for touch, are linked to infantile wishes. My therapist has said that although the child part of me may want a hug in session, it is made complicated by the fact that I am actually an adult. However, profoundly important though touch is in infant development, I’m not convinced that the desire for touch in therapy is always an ‘infantile desire’, and to describe it in that way can feel invalidating for the adult; as if the adult doesn’t have a right to feel the same need for affection. Touch in therapy isn’t there only in order to help heal experiences from childhood. It is also there to foster a sense of connection, a closer bond, and increased trust and openness, and there is evidence that it can communicate acceptance and enhance self-esteem. I don’t believe that all instances of my desire for touch come from a child-like place – and I wonder whether that makes the possibility of touch more difficult or more uncomfortable for my therapist to consider.

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Even if nothing changes in my therapy with regard to touch – and I don’t believe it will – being able to talk about it has been a positive experience. It is good to know that my therapist doesn’t see it as a ‘prohibition’ or as something ‘morally wrong’, and it is ultimately bonding (even if it doesn’t feel so at the time) to be able to discuss this subject in a way that makes it (and me) feel acceptable. In addition, reading and thinking about this, and trying to get underneath the skin of how I feel about touch and how it makes me feel about myself, has led to an important realisation, which I will talk about in Part 2, on ‘Feeling untouchable’.

For now, I can think of no better way to end than by quoting from one of the papers I have found most helpful, ‘The Meanings of Touch in Psychoanalysis: A Time for Reassessment’, by James Fosshage: “Touch is a powerful form of communication. We cannot afford to eliminate a profoundly important mode of communication from our healing profession. As with any form of communication, verbal and nonverbal, we can use it advantageously or not for facilitating understanding, communication, and the analysis.”