Ethical considerations in the use of nonerotic touch in psychotherapy with children

Although touch frequently occurs in psychotherapy with children, there is little written on the ethical considerations of therapeutic touch. Because physical contact does occur, therapists must consider if, how, and when it is used, for both their clients' safety and their own. In this review, I further develop the issues suggested by Aquino and Lee (2000) in the use of nurturing touch in therapy by considering many types of touch that occur in psychotherapy with children; the possible positive role of touch; clients' perception of touch in therapy; considerations related to the therapist, the child's safety, and any history of abuse in the child's and family's background; and other practical considerations. I list guidelines.     

Cultural Differences in Physical Contact Between Hispanic and Anglo Mother–Infant Dyads Living in the United States

This is a study of differences in physical contact and tactile interpersonal behaviours between Hispanic and Anglo mothers and infants living in the United States. Infants were 9 months old and 52 mother–infant dyads, 26 Hispanic and 26 Anglo, were videotaped during free play without toys in a university laboratory playroom. Coders judged the interpersonal distance, physical contact and affectionate touch from the videotapes and mothers responded to a questionnaire about the importance of physical contact and affectionate touch in their relationship with their infant. From questionnaire data we found that Hispanic and Anglo mothers both touch their infants on a daily basis, although Hispanic mothers report touching more frequently, being more affectionate with their infants and having more skin-to-skin contact. From videotaped observations we found that there were no overall differences in mother–infant touch between the two cultures; however, the Hispanic mothers showed more close touch and more close and affectionate touch compared to Anglo mothers, who showed more distal touch. The results are discussed in terms of the role of touch in infant development and cultural differences in the evaluation of close physical contact and touch.     

The Male-to-Male Embrace: Breaking the Touch Taboo in a Men's Therapy Group

Because traditional male gender-role socialization prohibits male-to-male touching except in specific situations, many men in North American culture rarely have the chance to use physical contact to convey caring or closeness in male relationships. The author describes a men's therapy group in which touch seems to facilitate self-disclosure and interpersonal communication.     

Mothers’ and fathers’ early tactile contact behaviors during triadic and dyadic parent-infant interactions immediately after birth and at 3-months postpartum: Implications for early care behaviors and intervention

Mothers’ and fathers’ touch were investigated during their first naturalistic interaction with their newborns, and maternal touch was predicted from newborn to 3-months postpartum during the Still-Face (SF) procedure. Both parents displayed more nurturing types of touch when interacting with their infants for the first time. Maternal touch at newborn predicted maternal touch after, but not before, the SF 3-months later; more touch after birth was associated with more soothing, regulating, types of maternal touch following the SF, suggesting that the nature of these interactive contexts (post-birth, post-SF) may be parallel. To our knowledge, this is the first study to investigate the full range of maternal and paternal touching behaviors during the first hour after birth. It is also one of the only investigations that considers how mothers’ very first touch and physical contact relate to their later touch at 3-months. Our results uniquely contribute by revealing the nurturing and predictive quality of parents’ touch, and underscore touch as a primary means of early contact and communication.     

Haptic cues for orientation and postural control

Haptic cues from fingertip contact with a stable surface attenuate body sway in subjects even when the contact forces are too small to provide physical support of the body. We investigated how haptic cues derived from contact of a cane with a stationary surface at low force levels aids postural control in sighted and congenitally blind individuals. Five sighted (eyes closed) and five congenitally blind subjects maintained a tandem Romberg stance in five conditions: (1) no cane; (2, 3) touch contact (<2 N of applied force) while holding the cane in a vertical or slanted orientation; and (4, 5) force contact (as much force as desired) in the vertical and slanted orientations. Touch contact of a cane at force levels below those necessary to provide significant physical stabilization was as effective as force contact in reducing postural sway in all subjects, compared to the no-cane condition. A slanted cane was far more effective in reducing postural sway than was a perpendicular cane. Cane use also decreased head displacement of sighted subjects far more than that of blind subjects. These results suggest that head movement control is linked to postural control through gaze stabilization reflexes in sighted subjects; such reflexes are absent in congenitally blind individuals and may account for their higher levels of head displacement.     

Co-sleeping as a proximal context for infant development: The importance of physical touch

Co-sleeping is a complex familial phenomenon that has yet to be well understood by Western scientists. This paper provides an interdisciplinary review of research from anthropology, nursing, pediatrics, sociology, social work, public health, family studies, and psychology to focus on the role of physical touch in the context of co-sleeping, and how close physical contact in this context affects infants and their caregivers. Including an anthropological, evolutionary view of co-sleeping with other perspectives highlights it as an experience-expectant proximal context for infant growth and development. From this view, the importance of physical contact and touch in the nighttime caretaking microenvironment of co-sleeping becomes a central question, rather than an artifactual byproduct of “unhealthy” sleep arrangements. Rather than trying to eliminate co-sleeping, public health messages for parents would likely benefit from a more culturally-sensitive approach that focuses on advising how to co-sleep safely for families choosing it. For families trying to retain physical closeness between parent(s) and infants in the context of modern (especially Western) infant care practices that have reduced this physical contact, co-sleeping can be an important developmental context for encouraging and engaging in sensitive and responsive caregiving and providing a context for maternal-infant physiological synchrony and regulation.     

Mastery or mystery? Therapeutic writing: A review of the literature

Recent developments in online support and counselling suggest that the users of chat rooms, for example, or the Samaritans' e-mail 'listening' service, have already discovered the power of writing as a self-help vehicle. Developments in computer-mediated counselling and therapy are essentially text-based and client-driven. The therapeutic use of expressive and reflective writing is not widely recognised in British counselling and therapy circles. The empirical foundations for the therapeutic uses of the literary arts are, however, well established. This review aims to map the use of 'writing therapy' by drawing together cross-disciplinary research and practitioner reports which might support the place of writing as a creative therapy in its own right, whether as an adjunct to face-to-face counselling or as a self-help tool.     

The use of leisure counselling as a therapeutic technique

If leisure is defined as free or unobligated time, then leisure is clearly the category of time expenditure that has the greatest potential for making people healthy and happy but it also has the greatest potential for creating problems. Therefore, educating and counselling people on how to make best use of their free time can have a great impact on the physical and mental health of individuals. The intent of this paper is to explain how leisure counselling can be implemented as a therapeutic technique for the benefit of many different types of people. It is also the intent of this paper to provide those who work as counsellors with information about leisure and leisure counselling so that they can help their clients to improve their lives through leisure. Therefore, this paper examines the contributions that both leisure counselling and leisure education can make in promoting maximal physical and psychological well-being, although the main focus is on leisure counselling. The overall conclusion is that effective leisure counselling services can significantly help to improve the physical and mental well-being of individuals and society in general.     

Discourse analysis: Rich pickings for counsellors and therapists

Aim: It is only relatively recently that discourse analysis has begun to rise to prominence in the fields of counselling and psychotherapy. This paper briefly explains ways of understanding discourse analysis, discussing what the approach can offer counselling research and practice. Approach: An initial categorisation of recent discourse analysis studies is offered, to demonstrate diverse ways in which this type of research can address issues relevant to counselling practice. The five categories proposed range from the examination of language use in therapy to analyses that focus on the social structures, meanings and power relations related to therapy. Implications: The paper demonstrates that through the critical analysis of counselling sessions, research interviews, written texts and other materials, discourse analysis can provide insight into ways in which counselling operates as a social practice, and so help counsellors to contextualise their work within broader social structures and processes.     

Virginia Satir: An Integrated, Humanistic Approach

This article traces professional and personal influences that helped Virginia Satir to shape her worldview. She was an integrative humanist who included body, mind, emotional, and spiritual processes to transform systems ranging from the molecular to the cosmic. Her theories and techniques offered a wellspring of hope and possibility to individuals as well as large assemblies. The presentation of a case with young, abused children demonstrates her use of self (through physical touch) by sensitively reframing the cycle of violence as an opportunity for safe, cooperative contact.     

Attribution of personal characteristics as a function of the degree of touch on initial contact and sex

The current study was designed to measure the effects of degree of touch on initial contact on interpersonal judgment. Subjects (60 male and 60 female) reporting for an experiment on interpersonal judgment were met by the experimenter and another subject. The second subject was in fact a confederate. As the subjects were introduced, the confederate responded in one of three ways: a nod of the head (no touch); a firm handshake; or a firm handshake accompanied by a squeeze on the subject's right upper arm by the confederate's left hand. Half of the subjects met a male and half met a female confederate. Subjects were then placed in separate cubicles and asked to complete the Byrne interpersonal judgment questionnaire about the person they had just briefly met. This scale has six items (intelligence, knowledge of current events, morality, personal feelings, participation in experiments, and adjustment) for same-sex pairs and four additional items for opposite-sex pairs (dating, marriage, physical and sexual attraction). The results indicated that the variations in the type of initial contact between subject and confederate resulted in several significantly different interpersonal judgments. Of particular interest was the finding that a male confederate greeting a female subject was viewed as a more acceptable marriage partner the more touch was invoved in the initial contact. A female confederate greeting a male subject was viewed as a less acceptable marriage partner the more touch that was involved. The degree of touch also affected judgments of knowledge of current events, adjustment, dating, and physical attraction. Typically, the more touch, the higher the rating for the male confederate, whereas the female confederate was typically rated highest on the nod or handshake plus the additional touch to the arm, and least when she simply shook hands. The relevance of these findings to first impressions and role stereotyping are discussed.An earlier version of this paper was presented at the Western Psychological Convention, Sacramento, 1975.This study was supported in part by a faculty research grant from the University of San Francisco.     

Discomfort and avoidance of touch: new insights on the emotional deficits of social anxiety

Physical touch is central to the emotional intimacy that separates romantic relationships from other social contexts. In this study of 256 adults (128 heterosexual couples, mean relationship length?=?20.5 months), we examined whether individual differences in social anxiety influenced comfort with and avoidance of physical touch. Because of prior work on sex difference in touch use, touch comfort, and social anxiety symptoms and impairment, we explored sex-specific findings. We found evidence that women with greater social anxiety were less comfortable with touch and more avoidant of touch in same-sex friendships. Additionally, a woman’s social anxiety had a bigger effect on a man’s comfort with touch and avoidance of touch in the romantic relationship than a man’s social anxiety had on the woman’s endorsement of touch-related problems. These effects were uninfluenced by the length of romantic relationships. Touch is a neglected emotional experience that offers new insights into the difficulties of individuals suffering from social anxiety problems, and their romantic partners.     

Healing Touch Controversies

Healing touch is one of the gifts of our humanity. It has been used since antiquity in many cultures around the world. Healing touch has frequently been the source of controversy, however. The controversies explored are related to the historical use and abuse of healing touch in the church, the controversy surrounding the notion of energy fields, and that surrounding therapeutic touch as a modern healing-touch therapy.chair of the department     

Family therapy ‘lite’? How family counsellors conceptualise their primary care family work

A number of current developments in the field potentially provide opportunities for preventative relationship and family interventions to be integrated into primary care. In this context, it is important to understand what family counselling is and how it might differ from family therapy. Thus, this paper investigates how the service of one low-intensity family counselling provider, Relate, is conceptualised and practised by counsellors on the ground. Questions about practice were posed to five focus groups of family counsellors and these were analysed using thematic analysis. The findings suggest that Relate family counselling is seen as ‘family therapy lite’, with a flexible, eclectic and integrative use of concepts and techniques within a systemic framework. Implications of this conceptualisation of family counselling for training, practice and research are discussed.     

Responding to unemployment and inequalities in income and health

This paper discusses the social and economic context in which counselling and psychotherapy are practised. The use of ‘outplacement counselling’ and personal skills training programmes for dealing with unemployment and redundancy is criticized. It is argued that they involve a form of psychological reductionism which fails to acknowledge socio-economic realities. Research showing a strong link between inequalities of income and physical and mental health is reviewed. It is suggested that counsellors and psychotherapists have a professional obligation to acknowledge the social and economic circumstances likely to contribute to clients' mental distress and avoid the dangers of reductionism.     

Counselling in a Hospital setting: An introduction to the care project

Various research projects have investigated the efficacy of counselling in medical settings. To date, there is no conclusive proof that counselling is an effective form of therapy. But previous research projects have often been limited in scope and design, and have not represented an appropriate means of making an accurate assessment. The study introduced here seeks to establish whether or not group counselling is a therapy for patients suffering from rheumatoid arthritis. The research aims to use the most effective elements of both scientific and new-paradigm methodologies to determine whether atherapeutic relationship exists. The paper outlines the background to the research and describes its development so far.     

Audiographic communication for distance counselling: a feasibility study

To explore the feasibility of conducting counselling or therapy that involves image making via the Internet, and simultaneously to identify new issues to consider when implementing online counselling services, 10 people selected for their relevant expertise were invited to use an audiographic telecommunication system and to comment on it. Content analysis of focus group discussions and interviews yielded the following significant issues: (a) concerns about technical failure, (b) relevance for people with disabilities, (c) the need for clinical procedures and communication guidelines, and (d) lack of shared physical presence. The co-researchers considered this form of distance delivery to be viable, and identified parameters that would ensure safe and ethical delivery. Implications for practice and future development are discussed.     

Physical framework for a counselling environment in India: Thematic analysis of counsellors' perceptions

The influence of the physical environment on the counselling process is an inevitable part of a counselling session. However, there is little insight in Indian research into the desirable elements of the physical environment of the counselling room that helps facilitate a counselling session. Interviews were conducted with 10 professional counsellors in India. Thematic analysis of the data brought out various Basic and Organising themes under the following three Global themes: (a) Elements of the physical framework; (b) Counsellor's perspectives about the physical framework in counselling; and (c) Motivation to build a framework. The findings show how counsellors can systematise the physical framework to help construct the counselling session effectively.     

The effectiveness of counselling with older people: Results of a systematic review

In 2003 the British Association for Counselling and Psychotherapy (BACP) commissioned a systematic review of the research evidence relating to counselling older people. This paper reports on some of the findings of this review, particularly those which address the effectiveness of counselling with this population. Electronic searches of the research literature spanned six databases and were supplemented by hand‐searches of reference lists and key journals, along with an extensive search of the “grey” literature. The location of papers testing interventions which fall within a definition of counselling set out by the BACP, with samples aged 50 years of age or above resulted in the inclusion of 47 relevant studies. Studies investigated a variety of mental health problems in older people, particularly depression, anxiety, dementia and the psychological impact of physical conditions such as chronic obstructive pulmonary disease. Of the 47 studies, eight tested counselling as a generic treatment, 15 tested cognitive behavioural therapy, 13 tested reminiscence therapy, and 11 tested various other specific approaches. The review concluded that counselling is efficacious with older people, particularly in the treatment of anxiety and depression and outcomes are consistent with those found in younger populations. Evidence as to the efficacy of counselling interventions in the treatment of dementia is weak.     

Cognitive therapy and social power

This paper addresses the capacity of cognitive therapy to engage with issues of social power. Some indicators of ‘power‐sensitised counselling’ are proposed and these are discussed with reference to cognitive therapy. ‘Power‐sensitised counselling’ for the purposes of this paper is described as counselling that takes account of power differentials, both across society and within the counselling room. The paper opens a discussion about the potential developments of cognitive therapy that could facilitate an engagement with issues of social power. The significance of these issues for research into cognitive therapy is discussed.