I had a recent experience with a patient who I’d been seeing individually for some months for psychological therapy where we said our goodbyes and she gave me a hug and a kiss on the cheek. I was really touched by this relatively simple gesture and it seemed to be particularly significant as we had spent almost a year of therapy sessions sat across from each other with a gulf of space between us. With my therapeutic work with adults (over the past year this has mainly been older adults and people with physical health issues who have sought therapy), I see a big part of my role as a therapist as creating a space were a person can experience healthy vulnerability – where they can safely be themselves without judgement and share thoughts and feelings that are troubling them or that they might elsewhere feel unable to reveal. As therapists working with adults, we use non-verbal communication such as the tone of our voice, pauses, silences, eye gaze and facial expression during therapy in a myriad of ways to facilitate this – to show that we are listening, that we understand, that we empathise.
However, I started thinking after the experience I described above, about how most psychologists working therapeutically with adults often avoid physical contact with patients. Throughout the majority of my training as a clinical psychologist, I got the impression that we should avoid physical contact with our patients, as this was deemed too close, too personal. I can see this point of view to an extent, as some people do not like physical contact and it makes them feel uncomfortable and of course unsolicited touch even in the most innocent sense can feel invasive to our personal space. It can give an impression of dominance and power (Gallace, 2010) and of course, touch can be inappropriate or perceived as so. I find it is sad that due to very real risks that it is obviously important to acknowledge and manage, all forms of touch have now become oversexualised. I suspect it is for this former reason in our increasingly litigious society that psychologists, as well as other professionals in caring roles such as teachers, simply refrain from touch or physical contact as they see it as a minefield best avoided.
Nevertheless, physical touch is one of our first senses that we develop as infants, allowing connection with others and the outside world. Most of us begin to experience love and security through the medium of touch as babies and tactile stimulation has been recognised as crucial to the development and maintenance of regulation of both physiological and psychological processes, including pain and emotion (Field, 2010). Although we generally perceive ‘touch’ as one unitary sense, it is thought to constitute information blended from a number of different kinds of somatosensory receptors in the skin and the rest of the body (Gallace, 2010). Interpersonal touch is recognised as having an important role in wellbeing (Field, 2001) and even the briefest touch from another can elicit a strong emotional response (Gallace, 2010). Indeed, Tiffany Field, a prominent researcher in this area, believes that many people today suffer from ‘touch hunger’ – a dearth of tactile stimulation. Interestingly, there are cultural variations in interpersonal touching behaviour, with research indicating that people from the UK and certain areas of northern Europe and Asia touch each other much less than their counterparts in France, Italy and South America (Jourard, 1966). Furthermore, touching behaviour is influenced by the gender, age and other characteristics of both parties (Gallace, 2010).
This brings me on to my next observation. I have spent the past four years working with children with intellectual disabilities and developmental disabilities and their families and I have noticed that I use touch very differently in this area of my work. In my own experience, children are more likely to touch others, both peers the same age and adults around them. Perhaps this is because the societal norms in the UK mean that it is generally more acceptable and often encouraged or elicited by adults, or because children are still developing socially and learning the social nuances of what you ‘can’ and ‘can’t’ do when with others. Most children seem to find touch comforting and reassuring and as a psychologist, I believe this is developmentally appropriate. However, I’m not necessarily sure touch becomes inappopriate or any less needed when we reach adulthood.
Touch can be especially important for people with an intellectual disability or developmental disorder (e.g. autism), as there is considerable evidence that the processing of sensory information is disrupted in these individuals (e.g. Tomchek & Dunn, 2007). This can result in ‘oversensitivity’ (hypersensitivity) and ‘undersensitivity’ (hyposensitivity) to different sensory stimuli and as a result of this, the avoidance or seeking of certain sensory experiences. Due to the explicit recognition of the importance of thinking about sensory processing when working with people with a intellectual or developmental disabilities, the power and importance of touch seems more readily recognised in my work as a psychologist with this population. Consequently, I feel that touch is less ‘taboo’ in this type of work than it can be in the settings where I undertake therapeutic work with adults with mental health issues.
Indeed, touch is used as both an augment to communication and as a therapeutic intervention in itself for children with developmental and intellectual disabilities. For example, intensive interaction is an intervention for those with autism and/or severe or profound intellectual disability that aims to facilitate communication and encourage positive interactions. I have found the use of intensive interaction with children with profound and multiple disabilities (a particular group of interest to me) an incredibly moving and rewarding experience, it really is something to enter the world of another who cannot readily enter yours as they do not have the communicative abilities. I have also found it incredibly liberating to communicate with another person at the fundamental level of touch, basic sounds and expressions and it really gets you thinking about the purpose of why we communicate at all.
Therefore, it seems somewhat bizarre to me when I think about it that we do not use touch more as therapists and psychologists, beyond its use with young children or those with developmental or intellectual disabilities. The issue is clearly a complex one, but surely we should be thinking about how touch might be used carefully and effectively where appropriate, rather than avoiding it all together?
If you’re interested, this article discusses issues specific to the dilemma of touch in therapy.