This article was accepted for publication in the Psychotherapist on 2nd July 2010.
Touch is the foundation of all senses (Montagu, 1971/1986) and it is no surprise that physical contact is at the heart of building and developing the relationship between the mother or father, and their infant.
Touch is the first important area of communication between a mother and her new infant. Mothers respond to upset babies by containing them, shutting down on their disturbing motor activity by touching or holding them. By contrast, fathers are more likely to jiggle or rock babies in a playful, rhythmic fashion (Dixon et al). Touch is a message system between the caregiver and the infant – both for quietening and for alerting and arousing.
(Brazelton and Cramer, 1991, p 61-62)
The Sterns have described the exquisite touching that the mother does as she gets to know her new born on the outside for the first time. And, when the baby is feeding at the breast the mother (or perhaps the baby) orchestrates a shifting back and forth between them to maintain the right level of arousal for the feeding to continue “at a reasonable clip”. Touching, gazing, and listening are integral to the dance between them. And the “highest point of feeling secure, where one experiences a safe haven” comes from a chest to chest embrace. “A baby held in that way faces the world without fear.” (Stern and Stern, 1998, p.162)
Touch remains a major part of adult communications. Indeed, at times touch says more than words can convey. Giving a warm embrace conveys love and companionship to the bereaved. It says “I am with you” when that is all that can be offered. And in intimate relationships touch speaks to the other of our deepest feelings.
However, many adults have difficulties expressing themselves through touch, although they may not seek psychotherapy. The robust looking person with the limp, clammy handshake is a clichéd example. Deficits, invasions and traumas in early life can impact on the capacity to express emotions through touch and to receive tactile communications.
Touch in psychotherapy
Prior to the development of psychiatry and psychoanalysis touch and massage were part of the cures offered to the insane and those suffering from “nerves” (Shorter, 1997) The forefathers of body psychotherapy such as Janet, Ferenczi, and Reich used touch in therapy. And it is well known that Freud in his cathartic phase used touch to elicit memories. Reich spent time in Norway and whilst he was there the training psychoanalyst, Braatöy (1954) attended Reich’s seminars. Braatöy collaborated with the reknown physiotherapist, Aadel Bülow-Hansen and, although he recognised the benefits of abstinence with certain hysterical patients, he also wrote on instances where he hid behind the abstinence rule out of his own fears and was aware of the message this conveyed to the patient. Indirectly, Braatöy has influenced all of the Body Psychotherapy Organisational Members within UKCP.
Touch is integral to body psychotherapy
Body psychotherapy has retained touch as part of psychotherapy and accordingly has developed considerable expertise in this area. Communicating through touch is a core competency learned during training by body psychotherapists, particularly if they have trained at the London School of Biodynamic Psychotherapy, the Chiron Centre for Body Psychotherapy, and Cambridge Body Psychotherapy Centre. This training is experiential and sits alongside theoretical and ethical considerations. The main vehicles for the exploration of touch are biodynamic massage and vegetotherapy, a “free association of the body,” developed by Reich in the 1920s. This form of touching is more than transferring social modes of touching such as hugs and handshakes to the consulting room. Trainee body psychotherapists also experience touch in their individual psychotherapy. This gives them an in-depth knowledge of their own issues relating to touching and being touched. It also provides confidence in relating through touch and provides the foundations for thinking about and exploring touch in clinical work. Supervisory relationships support this and deepen understanding.
Clients seeking out body psychotherapy
Many individuals seek out body psychotherapy specifically because it may include touch. These clients know that they have impairments around touch that they want to explore literally and not symbolically. Intuitively, they know that verbal language alone will not resolve the issues encoded bodily. The later clinical vignettes in this article are composites to illustrate touch in body psychotherapy.
In the contractual phase of body psychotherapy touch is discussed explicitly and agreements made about its use (or not). Touch is multilayered and complex in its meanings and the psychotherapist keeps these in mind, even if they are not always discussed. This way of beginning a psychotherapy relationship is different from other modalities of psychotherapy, where touch is for exceptional circumstances, or might be used cautiously and “sparingly”. This understanding of touch opens up a range of therapeutic possibilities not available, or indeed hard to imagine in other psychotherapeutic modalities (Westland, 2009b, Westland, 2010, Westland, forthcoming).
Touch as contact
Therapeutic touch is a learned skill, which becomes embedded over time in the being of the psychotherapist, and a major mode of communication. Body psychotherapists consider touch as “contact” and are taught to use “contactful touch” (Westland, 2009a).
Jenny’s psychotherapist, Elaine held her hand as she described her painful feelings. They had agreed this to help Jenny to stay present to her experience. However, Jenny felt the “absence” of Elaine in her touch and knew that she, too, was terrified, and had “gone”.
This snippet of interaction invites further exploration and is the stuff of body psychotherapy. Was Jenny misreading the touch? Was Elaine out of contact? Did she know it? Could they talk about it? Could Elaine find her way back and become present in her touch? Could Jenny express her feelings? Was Elaine becoming merged with the Jenny’s experiences? What happened next?
Contactful touch is a complex intersubjective interaction. It involves moment by moment, here and now awareness (mindfulness of sensations, thoughts, images, feelings) accompanied by curiosity to be brought to what is happening in the relationship between client and psychotherapist. The relationship flows back and forth, co-arises in a joint endeavour, and as it unfolds depends on the presence and intention of the psychotherapist. Contactful touch requires technical skills, expertise in timing, assessing the ambience around the transferences, and having some idea of what might be forthcoming on touching or being touched by a client. It is always exploratory and unpredictable, although a skilled therapist may have some inkling of what might arise. The psychotherapist should know how to explore what arises either non-verbally or perhaps using a combination of words, touch and perhaps gaze.
Touch is a direct communication
Touch is a direct communication between the client and the psychotherapist. It goes both ways – the client knows the psychotherapist, and the psychotherapist knows the client. This direct communication is not always possible to translate into words: touch and verbal language are different forms of communication. Indeed, words cannot express the subtleties of experience, including emotion, and moving to verbal communication can prematurely cut off further exploration of experience. Touch shows the defence system of both client and therapist and the availability for intimacy and contact. It is potent and reveals the relationship in stark concreteness. For this reason touch, as a form of communication is threatening to some as it fails to leave enough privacy for client and psychotherapist alike.
I felt safe with my psychotherapist as she was holding me, and told her something that I had not mentioned before. Her words suggested that she was receptive, but I felt her hand startle almost imperceptibly with my revelation.
Body psychotherapy tends to relate more from a “bottom-up” sensorimotor, emotional, experiencing process than from a more “top-down” cognitive process. However, in practice both modes of access to experience occur. Similarly, contemporary body psychotherapy shifts between more intrapsychic focus to more interpersonal relating and attention to emergent intersubjectivities. Sometimes the “conversation” in body psychotherapy will be directly via touch with little verbal back up.
Relating through touch
Touch is the choice of interaction with some clients as it creates space from the intensity of the interpersonal relationship. It can give a way of being in contact with another without the pressure to fend off a supposedly hostile world, which has to be defended against.
As Martha (psychotherapist) speaks, Susan (client) reacts by speaking more rapidly and justifying herself in well-trodden explanations. Susan is hyper-aroused, has quickened chest breathing, and a heightened awareness of every nuance of Martha’s being. Martha could sit silently and hold the client energetically and listen until the “emergency” passes. However, touch is possible with Susan and Martha decides on this way of going on. The predictable structures of biodynamic massage enable Susan to have brief moments of being with Martha and feeling the human to human contact in a low key way. Her system calms, her breathing deepens, and gentle tears spill and trickle down her cheeks. There is no need for either to say anything.
Susan’s mother had apparently been inconsistent, sometimes invasive, sometimes distant, and not able to “be” with her infant. Intellectual understandings had substituted for authentic emotional meetings between them. Sometimes Martha felt compelled to talk and to comment on the process, but it only interfered and took Susan back to the cognitive level. What was needed was just to be in the immediacy of the moment tracking feelings, thoughts, images and somatic responses.
Touch can also connect emotion and inner sensation to language.
Alex speaks in a monotone about her son. She says something about his dark, unreachable despair. She continues to speak of not cleaning the house, a problem at work, a visit from a friend. Life is a list of problems to deal with. Her sentences seem coherent, but are unintelligible, despite her considerable vocabulary. There are also no changes in tone or intensity or emphasis as she speaks. Conveying her inner life with its body sensations, emotions or images is a mystery to her and questions or comments about it produce blankness. Alex continues in the same tone of voice. Paul (psychotherapist) instinctively reaches out and takes her hand. It is icy cold and in that moment he recognises Alex’s almost frozen terror. Alex takes a breath, and Paul says “You are terrified about what your son might do to himself. You think that he might take his own life”. Alex silently nods. This is another small step towards recognising internal sensations and feelings and translating them into word language.
Sometimes touch opens up to spiritual experience.
“All artistic and spiritual experience – perhaps everything truly important – can be implicit only: language, in making things explicit, reduces everything to the same worn coinage, and as Nietzsche said, makes the uncommon common” (Gilchrist, 2009).
Jane recounts her experience after receiving biodynamic massage:
I was vaguely aware of you, but more with myself. I became suffused with feelings of utter peace and joy – I was me, and I knew that you were you – and we were all one with everything – I was in the world – and the world pulsed in all my cells.
Touch is such a central part of communication at all stages of life that the possibility of its inclusion in psychotherapy is vital. However, touch is powerful and should not be undertaken lightly in the therapeutic endeavour. Caution should be exercised with including touch with borderline, traumatised and potentially psychotic clients. Nevertheless, each psychotherapy relationship has its own unique potential and for a trained psychotherapist who is adequately supervised it may be possible to include touch. For some clients it is the main way to relate.
Please contact the author for a full list of references.
Gill Westland is director of Cambridge Body Psychotherapy Centre, which offers a full training in body psychotherapy. She offers individual body psychotherapy, training, supervision, and consultancy. She is co-editor of the international journal Body, Movement and Dance in Psychotherapy, published by Taylor and Francis.