To Touch or Not to Touch: Transference and Countertransference in Touch

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To Touch or Not to Touch: Transference and Countertransference in Touch

Words: 2591

Subject: Psychiatry

Table of Contents Introduction The Importance of Touch Touch in context The relationship with the psychotherapist Case Study presentation Conclusion Use of touch in References Introduction The essay will be on “To touch or not to touch transference and countertransference in touch”. This topic has been chosen due to the controversies that have risen in the past years whereby both clients and therapists have argued on whether to touch or not to touch during therapy. This has been further strengthened by happenings such as misinterpreting touch in therapy and at the end of it all, the therapist and client end up in unwanted relationship and or ending of the therapy process abruptly. Transference as used in body psychotherapy basically means the redirection of a client’s feelings, thoughts and expressions from a significant source or person to a therapist. Transference is normally manifested as an erotic appeal towards a therapist that can be seen in many other forms such as fury, abhorrence, distrust, parentification, great dependence, or even placing the therapist in a god-like or guru status (Paul, 2003). Counter-transference according to Norcross (2001), is the “redirection of a therapist’s feelings toward a client, or more in general as a therapist’s emotional entanglement with a client”. A therapist’s attunement to his own countertransference is nearly as important as his perception of the transference. This not only helps the therapists to control their feelings in the therapeutic relationship but also allows them to foresee what the client is attempting to bring out in them. For example, if a therapist feels an extremely strong sexual appeal to a patient of the opposite sex, the therapist must realize this as countertransference and look at how the client will attempt to express this reaction in him. Once this has been identified, the therapist can therefore enquire from the client what her feelings are toward the therapist and look at the feelings the client has and how they relate to unconscious motivations, desires, or fears (Norcross, 2001).

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Therapeutic relationship in psychotherapy basically means the main agent of revolution in fulfilling the aims of personal development. The therapist must be genuine, harmonious, compassionate, open, sincere, non-judgmental and accepting of the client. The relationship and close association between the inner self of the client and inner self of the therapist forms the basis of healing and growth for both parties. The therapeutic relationship is “genuine” but this does not prevent the placement of appropriate challenges, guided exploration, skilled interventions or the reality of the contractual arrangements and maintenance of boundaries. Therapeutic relationship does not prohibit acknowledgment of transference and resistance by the client or counter-transference issues on the part of the therapist (Messer, 2006). Touch, in this article, is defined as any physical contact between a psychotherapist and a client during a process of psychotherapy (Fridlund, 1994 & Young, 2005). Research has shown that touch, in most cases, improves the sense of connection and trust between a psychotherapist and a client (Smith et. al., 1998). In this essay, touch refers basically to touch initiated by the psychotherapist. On the contrary, when a client requests touch, the psychotherapist should make a clear clinical judgment on whether the provision of that touch is ethical and of clinical importance in the therapeutic process. The use of touch in psychotherapy has joined the long list of modern risk management-inspired taboos (Williams, 1997). Even those who are in support of risk management do agree that a polite handshake is unavoidable. The seeing of any non-erotic touch as the initial stage on the steep slopes towards sexual relationships is one of the key mistaken viewpoints and hindrance to conceptualizing the usefulness of touch in therapy. This type of sexualization of all types of touch is attached to culture and expressed in false beliefs that are common in the field of psychotherapy (Lazarus & Zur, 2002). Some prominent therapists have been giving negative and terrifying messages, one example is Menninger, who emphasizes that physical contact is “evidence of incompetence or criminal ruthlessness of the analysts” (cited in Horton, et al., 1995, p. 444). Simon in a similar vein, directs the therapist to “Foster psychological separateness of the patient… interact only verbally with clients… minimize physical contact”. The Importance of Touch Touch, in itself has the ability to cause harm as well as healing. It is due to this that touch in psychotherapy has been viewed as lethal and to some extent legally risky or an obstacle to the process of psychotherapy. The dangers associated with touch in psychotherapy must not be a viable reason to avoid an important therapeutic modality. It should also be very clear that the decision or act of not touching too has powerful consequences that are ignored by mainstream psychotherapy research studies. Not to touch just as to touch has risks involved as Wilson (1986), puts it “Absence of any physical contact is likely to cause transference distortions (i.e. the client may view the therapist as a cold, withholding parent figure)” (Wilison & Masson, 1986, p.498). Wilson (1982) argues that, “To disregard all physical contact between therapist and client may deter psychological growth”. Touch in context Touch can only be understood in the context of the client, therapeutic relationship and the psychotherapeutic setting. (Zur, 2007a, 2007b). consequently, the use of touch must be seriously considered in its context as it can have varied meanings depending on different clients, therapists, and settings. (Hilton, 1997; Horton, et al, 1988, Koocher & Keith-Spiegel, 1998; Smith et al., 1998). It is worth noting that what may be considered with high esteem by another client may not be the same for the other client. For example, during the process of grieving, consoling a grieving mother through holding her hands and letting her cry out may not have the intended positive results if the same is applied in initial stages of psychotherapy with a female survivor of a rape. The relationship with the psychotherapist The interaction and association between a client and a psychotherapist are normally more important and central than any other methods for any healing to occur. The body physically responds by finding out its own appropriate answers and properly controlling itself, but for this to really take place over a long period of time, one should have a sense of feeling safe, accepted and understood. The psychotherapist is also more likely to be warm in manner towards a client. The argument about touch in the recent history has become more polarized with the growth and development of Body Therapies. Touch is an integral part of body psychotherapy its historical development in relation to what is described as the body/mind split. Body Psychotherapy has a tradition dating back to more than 60 years, beginning with W. Reich who started by including the body in psychoanalysis in the 1930’s. Reich (and other analysts like Ferenczi) have carried out researches and field studies on the use and application of touch initially from within an analytic framework. Reich projected that all scholarly insight into the genesis and etiology of neurosis would only displace and chase the symptoms in circles, unless it was rooted ‘dynamically’, i.e. energetically, physically, and emotionally. In modern-day body psychotherapy, this perspective is known as ‘holistic’ (Messer, 2006). The body/mind polarities which Reich had very much integrated were explained differently later on by a group of his students and followers. The split between body and mind can either be from a medical perspective or rational perspective. Reich said that, “…although it is misleading, it may be possible to allocate the different therapeutic approaches to positions along with a body-mind gamut. It is not just the therapeutic basis of any approach but how a therapist applies his knowledge and skills in a therapeutic relationship, i.e. the emotional and symbolic significance which the therapist’s approach acquires in the relationship”. Our personal responses to touch are rooted in the early experiences of touch in our lives and therefore are part of our biopsychosocial nature. Our approach to touch unavoidably taps into primitive and basic aspects of who we each are as individuals. These perspectives are also portrayed in diverse ways of conceptualizing the body in terms of healing theory, particularly in relation to the development of the self and to therapeutic change and consequently provide different rationales for touch within the therapeutic relationship. According to a study carried by Steven M. Herman in 1998 on relationship between therapist-client modality similarly and psychotherapy outcome that majored on the therapeutic relationship with regard to the use of touch (Baron & Baron, 1990), found out that countertransference should be differentiated from the psychotherapist’s in the moment feelings about the psychotherapeutic situation as these feelings can be of great importance clinically. A good demonstration of this situation is in a circumstance whereby the psychotherapist begins to feel uninterested, this can be an indication that he/she is unconsciously avoiding an important subject. (Mendelson, 2007). In the findings of his study, Herman found out that transference reaction feelings in touch are not different from the common “love” or hate. Love in this context is a belief in another; that is, it is a strong belief that the other person has some skills and techniques that you do not have. On the other hand, hate can be assumed to be the loss of trust in the other person. From this we can agree that extreme client’s belief in the psychotherapist can culminate into some serious problems that must be sorted out within the psychotherapeutic work. These problems, if not recognized early then the therapeutic relationship is usually compromised hence interferes with the outcome of the therapy. This can be further complicated by misinterpretation of role of touch in the therapy. He therefore came up role of touch in therapy. He concluded that touch when used effectively can influence one’s health and mental status. The main reason behind the use of touch is to reduce pain, to facilitate biochemical changes such as decreasing the autonomic arousal states which help to alleviate depression and panic and to increase the client’s capacity for feeling well and sense of being soothed and nurtured well (Dormaar, 1999). The utilization of touch is currently related to muscle tension, energetic charge, and its relation to the nervous system. Touch in itself can give one a form of safety and assurance that is conveyed none verbally. Some clients may experience a stronger contact with themselves through touch which can allow inner sensations and internal motions as a result of tangible stimulations (Lambert, 2006). Transference and countertransference can also create a lot of fears that lead to terminating psychotherapy prematurely, rather than working through the feelings. Touch is very important in the process of psychotherapy and forms a major part of therapeutic relationships as it has primary connection to human nervous system and it can serve indirect controller of inner sensations processes. Research has also shown that all emotional reactions can turn into therapeutic defenses. These defenses make the therapy process unsuccessful in that the defenses can create prejudgment of the indications of the therapy; this therefore blocks the free will that is needed in initiation of the psychotherapeutic process. Examples of these defenses include silence, denial, avoidance, taking distance, clinging to professional roles and protocols. For instance, one may feel powerless influencing the therapist’s action though he or she may invent a defensive mechanism through silence. These reactions can be represented in a diagram with hierarchy, distance and nearness. A therapist’s subordinate role is conceivable on lack of power and feelings of guilt basics. Dimension of distance and nearness in the touching processes are categorized into two illuminating basic types: type 1 and type 2 reactions. Type 1 entails keeping distance in which patterns are distinguished and client’s experiences and feelings are minimized while type 2 involves too much nearness thus becoming dependant on the client. These two types of reactions determine the type of therapeutic relationship that the therapist and client will have. This also affects transference and countertransference in touch in that they create a situation of pre-judgment that may lead to misinterpretation of touch. (Lazarus & Zur, 2002) Case Study presentation Mrs. Ellie a 26-year-old woman requested body psychotherapy on the recommendation of the local Cardiac Rehabilitation Service following her husband’s heart attack. She hoped that with time, she will come to terms with the death of her husband and find ways of coping with stress. After three months of body psychotherapy, she became more enlightened on the process and art of relaxing. Other positive clinical effects that she reported are maintenance of her blood pressure to normal levels, relief in arthritic aches and pains and comfort from her sinuses. She responded well to her therapy until a year later after her first consultation when she was diagnosed with a breast tumor that was malignant and invasive. During the two sessions prior to the biopsy, the sessions basically involved talking about her feelings, fear factors, and her future life. Body psychotherapy followed these sessions and involved light touch, touching her chest, abdomen and lower back and gentle massaging of the neck and head. Mrs. Ellie had a mastectomy and two weeks later resumed her therapy sessions. She was happier, and confessed that she could now afford time for herself. The transformations in her body were immense. She had her psychotherapy sessions weekly prior to chemotherapy as a preparation for it. Mrs. Ellie realized that the touch process was very helpful as it released the heavy ache in her new breast. With time, Ellie became stronger with the therapy process becoming more robust and deeper. Due to the positive improvements that were shown by Mrs. Ellie, the therapy sessions were gradually reduced over a period of two years with last stages being weekly, fortnightly and monthly until she finished her sessions. From this case study, we can therefore see the importance of body psychotherapy and particularly the use of touch in therapy. Touch helped Mrs. Ellie to appreciate the therapy process. Their interpretation of touch as being only for therapeutic relationships helped in creating a context in which the goals of the therapy were fully maximized and met. It is also evident that healing in psychotherapy is a gradual process and a lot of patience is needed in order for the healing process to be complete. From this case study, it is therefore evident that the decision to touch or not to touch entirely depends on both the client and the therapist. They should both evaluate the importance and the significant role that touch will play in the therapeutic process.

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Conclusion Use of touch in Body psychotherapy is still embroiled with a lot of controversies that need a lot of research showing how touch can be used mainly for purposes of therapy. It will therefore be important that fundamental studies for postgraduates and professionals, whether they are already involved in this field, or wish to learn more about incorporating touch into their own therapeutic practice (Hunt, 1999). The concept of touch is directly connected with ethical, theoretical and developmental issues discussed in the paper. Psychotherapy still contributes to thorough study of touch roles and functions ineffective therapy process. The application of touch in body psychotherapy is very vital and its effective and efficient use therefore needs to be studied further so that it can be utilized in a more professional way. It is important to underline the fact that modern psychotherapy is merely concentrated on the development of separate methodological touch applications for the purpose of outlining the concept significance and role in psychological process. As it was shown in the research paper, touch concept is considered to be one of the principal parts of psychotherapy investigations. References Paul, G. L., 2003. Strategy of outcome research in psychotherapy. Journal of Consulting Psychology. 31:109–118. Norcross, J. C., 2001. All in the famil: On therapeutic commonalities. Am Psychol. 36:1544–1545 Lambert, M. J., 2006. Implications of psychotherapy outcome research for eclectic psychotherapy. New York, Brunner/Mazel, pp 436–462 Smith, M. L., & Glass, G. V., 2000. The Benefits of Psychotherapy. Baltimore, MD, Johns Hopkins University Press. Hunt, D. D., 1999. Cognitive match as a predictor of psychotherapy outcome. Jon Psychotherapy 22:718–721 Foon, A. E., 1995. Locus of control and clients’ expectations of psychotherapeutic outcome. Br J Clin Psychol 25:161–171

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Dormaar, M., 1999. Consensus in patient–therapist interactions. Psychother Psychosom 51:69–76. Mendelson, G.A., 2007. Similarity, missed sessions, and early termination. Journal of Counseling Psychology, 14:210–215. Baron, J., & Baron, J.H., 1990. Rational thinking as a goal of therapy. Journal of Cognitive Psychotherapy: An International Quarterly, 4:293–302. Messer, S., 2006. Behavioral and psychoanalytic perspectives at therapeutic choice points. Am Psychol, 41:1261–1272. Fridlund, A., 1994. Human Facial Expression: An Evolutionary View. San Diego, CA: Academic Press. Hilton, R., 1997. Touching in therapy. In L. E. Hedges, R. Hilton, V. W. Hilton, O. B. Caudill, Jr. Therapists at risk: Perils of the intimacy of the therapeutic relationships. New Jersey: Jason Aronson, Inc. Horton, J., Clance P.R., Sterk-Elifson C. & Emshoff J., 1995. Touch In Psychotherapy: A Survey of Patients’ Experiences. Journal of Psychotherapy, 32, 443-457.

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Keith-Spiegel, P., & Koocher, G. P., 1985. Ethics in psychology: Professional standards and cases. New York: Random House. Lazarus, A. A. and Zur, O. (Eds.) (2002). Dual relationships and psychotherapy. New York: Springer. Smith, E., Clance, P.R. & Imes, S. (Eds.) 1998, Touch in Psychotherapy: Theory, Research and Practice, New York: Guilford Press. Wilison, B.G., & Masson, R.L., 1986. The role of touch in psychotherapy: An adjunct to communication. Journal of counseling and Development, 64, 497-500. Williams, M. H., 1997. Boundary violations: Do some contended standards of care fail to encompass commonplace procedures of Humanistic, Behavioral, and Eclectic Psychotherapies. Psychotherapy, 34 /3, 238-249. Wilson, J.M., 1982. The value of touch in psychotherapy. American journal of Orthopsychiatry, 52/1, 65-72. Zur, O., 2007a. Bounderies in Psychotherapy: Ethical and Clinical Explorations. Washington, DC: APA Books. Zur, O., 2007b. Touch in therapy and the standard of care in psychotherapy and counseling: bringing clarity to illusive relationships. U.S. Association of Body Psychotherapy Journal, 6/2, 61-93.

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