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While preventing a client from hurting him or herself or others may require some physical intervention, physical punishment by a therapist is never appropriate in the context of psychotherapy. It often manifests as a light touch on the arm, hand, back or shoulder. However, it also reviews the literature on body psychotherapies where touch is a key therapeutic tool. These professionals generally view any deviation from these rigid boundaries as a threat to the therapeutic process. Massage has been practiced for thousands of years. In an interesting twist of logic, while professional literature, ethics classes and risk management principles advocate avoiding touch as much as possible, many surveys report that most therapists touch their clients in a non-sexual manner.

By Ofer Zur, Ph. To cite this page: Zur, O. To Touch Or Not To Touch: Exploring the Myth of Prohibition On Touch In Psychotherapy And Counseling. Advanced online course: Touch in Psychotherapy for CE Credit CEUs. Article: Touch in Ethical and Legal Aspects of Touch in Psychotherapy.

Article: Touch sexual massage points the Standard of Care in Psychotherapy. The Importance Of Touch. Medical And Psychological Effects Of Massage. Touch, Culture And Bonding. Touch And Ethnicity, Region, Class And Sexual Identity.

Types Of Touch In PsychoTherapy. The Prohibition Of Touch In PsychoTherapy. Touch And The Therapeutic Alliance. Surveys on Touch In Therapy Clinical Orientations on Touch. Sexual And Non-Sexual Touch In Therapy.

Body-centered Therapies: History, Reichian, Bioenergetics, Radix, Somatic Experiencing. Touch with Special Population. Psychoanalytic Prohibition Of Touch In Therapy. On Power And Touch In Therapy.

Touch As A Boundary Issue. Guidelines For The Ethical Use Of touch In PsychoTherapy. Touch has been an essential part of ancient healing practices. He goes on to illuminate how the sensory system, the skin, is the most important organ system of the body, because unlike other senses, a human being cannot survive without the physical and behavioral functions performed by the skin.

Primarily Euro-American cultures in general, particularly that of North American white-Anglos, have developed a set of unspoken taboos in regard to touch.

The sick and the elderly are often housed away in specialized board and care facilities, where much of time hospital staff do not value touch as an essential part of care. Touch, in this article, refers sexual massage points any physical contact occurring between a psychotherapist and a client or a patient in the context of psychotherapy. Touch is one of many non-verbal modes of communications i. This paper looks at touch as an adjunct to verbal psychotherapy.

However, it also reviews the literature on body psychotherapies where touch is a key therapeutic tool. Touch, in this paper, refers primarily to touch initiated by the therapist.

However, when a client initiates or requests touch, the therapists must use his or her clinical judgment to ascertain whether providing or withholding touch is ethical and clinically advantageous in each therapeutic situation. For a variety of reasons, the field at large has embraced the analytic hands-off stance, sexual massage points. Even those who endorse risk management reluctantly agree that a courteous handshake may be unavoidable.

Viewing any non-erotic touch as the first step on the slippery slope towards sexual relationships is one of the major erroneous beliefs and obstacles to understanding the importance of touch in therapy. Some of the negative and frightening messages we have been inundated with come from prominent therapists, many of whom are psychoanalytically oriented.

One example is Menninger, who asserts that sexual massage points contact with a patient is "evidence of incompetence or criminal ruthlessness of the analysts" cited in Horton, et. Simon, in a similar vein, instructs therapists to "Foster psychological separateness of the patient.

He summarizes his list of nine arguments against physical touch by stating "Most likely, physical contact at the very least risks adversely effecting the psychotherapeutic relationship in any number of ways. There are many different approaches to touch in therapy. One approach, often referred to as body psychotherapy, or somatic psychotherapy, sometimes uses touch as one of its primary tools while also employing verbal communication.

It is a commonly misheld belief that all somatic or body psychotherapists utilize physical touch in psychotherapy. While many do, sexual massage points, there are others who advise against touch, sexual massage points. The concept that we are embodied beings, and the respect for the unity between psychological and bodily aspects of being, is common to all forms of somatic body psychotherapy.

These schools of thought recognize the body as a vehicle of communication and healing. Another approach, and the focus of this paper, employs touch as an adjunct to verbal psychotherapy or counseling. These approaches focus on harnessing the healing power of touch. There are numerous other psychotherapeutic orientations that have embraced touch. These orientations formalized the use of touch in therapy as an adjunct to verbal therapy.

They also include some parts of feminist, child, family therapy and dance and movement therapy Smith, et. This article reviews the general importance of touch for human development, secure attachment, communication, the development and maintenance of physiological and psychological regulation, and the formation of therapeutic alliance.

Types of touch employed in psychotherapy are discussed, as well as the main professional sources for the prohibition of touch in therapy.

The western cultural context and its relationship to touch are also discussed as an additional source of the prohibition on touch. It then discusses the psychotherapeutic benefits of touch, and finally provides a summary and a set of guidelines for the use of touch in therapy. Within three weeks of conception, we have developed a primitive nervous system which links skin cells to our rudimentary brain.

Touch is our first language. Long before we can see an image, smell an odor, taste a flavor, or hear a sound, we experience others and ourselves through touch, our only reciprocal sense. We cannot touch another without being touched ourselves, and it is in this sense that there is great positive potential in forming a strong therapeutic bond and a vehicle for healing injuries created by early touch violations or lack of necessary touch.

Of course, the potency of touch holds the potential for harm as well as healing. Because of this, touch in psychotherapy has long been held to be dangerous and taboo or at the very least, legally risky, or a threat to the integrity of the therapeutic process. Risk, however, is not a valid reason to avoid an important therapeutic modality. Not touching has powerful effects as well and this aspect of treatment is ignored by mainstream psychotherapy literature.

However, not touching is also risky. Shamans, in many cultures, used touch as one of the healing practices used to heal mind, body and spirit. Healing practices began to evolve into the science of medicine in the middle ages. Touch sexual massage points who had long been honored by their communities gradually lost clout. Touch has become almost irrelevant.

Recent research done by the Touch Research Institute has demonstrated that touch triggers a cascade of chemical responses, sexual massage points, including a decrease in urinary stress hormones cortisol, catecholamines, norepinephrine, epinephrineand increased serotonin and dopamine levels.

Hence, touch is good medicine. Massage therapy has been shown to reduce aversion to touch and to decrease anxiety, depression and cortisol levels in women who have been sexually or physically abused Field, et. It decreases diastolic blood pressure, anxiety and cortisol stress hormone levels Hernandez-Reif, et.

One study examined the effects of massage therapy on anxiety and depression levels and on immune function. Effects included an improved body image, decreased depression and anxiety symptoms, decreased cortisol levels and increased dopamine and serotonin levels.

In a study of children with ADHD, touch sensitivity, attention to sounds and off-task classroom behavior decreased and relatedness to teachers increased after massage therapy Field, et. Massage therapy also decreased the anxiety, depression and stress hormone levels of children diagnosed with PTSD, who survived Hurricane Andrew.

In addition, their drawings reflected erotic asian massage parlors depression Field, et.

Recent research on pregnancy and infant massage documents benefits of touch that might allow us to consider this form of touch to be labeled as psychotherapy at the earliest stages of human development. Massaged babies show improved emotionality, sociability, soothability, temperament dimensions, and better face-to-face interaction behaviors Field, et al. Other similar programs teach Tender Touch volunteers how to work with drug-exposed newborns. These programs were developed for at-risk infants and can be conceptualized as infant psychotherapy.

Instruction begins by teaching a kind of attunement, training the caregiver to be observant of cues that indicate if the baby is being soothed or stressed by the type of touch. Caregivers are taught simple stroking techniques involving the amount of pressure, pace and consistency. Touch is adjusted as the caretaker responds to communication from the baby.

Touch attunement training is also beneficial for psychotherapists. Trial programs, which teach parents infant massage in an effort to reduce the incident of child abuse, show promising preliminary results. The opposite is true of abusive touch or lack of touch. In fact, the absence of loving touch has been documented to have profound impact on the will to live. They agree, as well, that deficits in the satisfaction of basic needs results in the development of defense structures that complicate and inhibit relationship to self and others.

For more than a million years mothers have held their infants close, responding to their basic needs with natural attunement and life affirming touch. We can also look to the practices of parenting in higher touch cultures to appreciate the positive benefits of healthy psychological and emotional development. And yet, with the onset of the industrial revolution and related changes in childrearing practices, the way in which modern westerners cared for and connected with their babies was altered radically.

Extended families were split up, depriving babies and mothers of the multi-generational, extended familial support system that had been the ground of childrearing in traditional communities for centuries. Never let them sit on your lap. If you must, kiss them on the head when they say goodnight. Shake erotic massage victoria with them in the morning. He chose rhesus macaque monkeys as subjects for his analysis, as they share ninety-four percent of their genetic heritage with humans.

The monkeys were offered access to two surrogate mothers: a "soft" terrycloth mother that was warmed by a light bulb that provided a positive tactile experience, and a wire mother with a bottle attached to it for feeding. The infants spent only the amount of time necessary for feeding with the wire mother and when left alone with her would cower in a corner.

When given the choice of both mothers, they would cling to the "soft" mother for up to twenty-two hours a day and, in contrast, when left alone with her, would give her a few hugs and then felt secure enough to explore a strange object on their own.

His observations of infant monkeys separated from their mothers at birth fundamentally changed our views. He discovered two very important things about development. Firstly, "comfort contact proved to sexual massage points a more significant parenting quality than feeding.

The second finding was that even those monkeys that were reared on the soft mother, as adults, were neurotic, asocial, autistically self stimulating, self mutilating, and sexually inept.

Subsequent studies involved providing the infants with a rocking surrogate. The infants in this study showed fewer abnormal developmental indicators. Normal functioning occurred, however, only in infants who were given contact with another live monkey for just one half hour a day.

They needed interactive sexual massage points to support normal development. That feeling of ownership requires touch by sensitive, attuned parents. Through sensitive parental responding, infants receive accurate feedback about the effects of their behavior and they learn that, when they signal a need, they can expect a prompt, predictable, and soothing response.

This makes it unnecessary to develop dysfunctional emotional defense systems. Infants who signal a need and are responded to by a sensitive, attuned parent feel a sense of control over their lives.

The importance of this cannot be overemphasized. Feeling in control, one feels greater assurance of psychological survival. Feeling less need to control, one can more easily form closer relationships and benefit from the emotional satisfaction of bonding needs. The converse is true as well, just as sensitive, attuned touch gets etched in our developing neural pathways enabling us to sexual massage points out and touch in that same way throughout our lifetime, touch that is absent when necessary, inappropriately sexualized, cold or abusive, gets recorded in ways that cause us to draw inward or to strike out.

Most abused children do not grow up to abuse their own children but those who do abuse their own children have almost always been abused in their own childhood: Violence begets violence. Department of Health, Education, and welfare, reviewed forty-nine societies and concluded that a lack of bodily pleasure derived from touching and stroking during the formative periods of life was the primary cause of violent behavior in adults.

Americans are considered by many other cultures to be independent to a fault, to be self centered, materialistic, lacking in reasonable social boundaries and somewhat abrasive. Perhaps because we are a culture with a high population of insecurely attached persons.

Ambivalent or insecure attachment may or may not be the cause of our poor reputation but research indicates that the largest percentage of insecure infants are found in cultures that value and require the earliest self reliance, while those that value interdependence have the highest percentage of securely attached infants Lamb, et. Anthropological data reveal mainstream American mothers as being less affectionate toward their children, more likely to touch their children in public mainly as a means of control, and to expect children to entertain themselves.

American children rate high in insecure coercive, negative behavior. Similar words could be used to describe adults in American culture. The bond between mother and infant is so intense that the Japanese literally call it "skinship. She gave the control group plastic infant carriers. Abused, neglected or touch deprived children learn not to trust touch.

They tend to have great difficulty feeling of value, feeling truly powerful, or of forming reciprocally supportive relationships as adults. The above discussion of touch, culture and bonding has direct implications for psychotherapy and counseling. The cultural taboo against touch in psychotherapy encourages therapists to perpetuate the neglect that originally caused the injury. Therapists tend to avoid touch, to neglect consideration of touch in a well thought out treatment plan and to avoid talking about this with clients.

Touching clients sexual massage points hurt them if done in the wrong way but touch can also heal old touch injuries. Not touching can cause injury to certain clients in certain situations. The silence about this in our sexual massage points and training programs of therapists, in supervision, or in actual therapy with clients often results in less effective therapy.

A dialogue regarding touch should be expanded amongst therapists and between clients and therapists in general. The touch needs of a securely attached client will be different than the needs of a client who was attached in an insecure or avoidant way as an infant.

Programs in attunement training, for parents and babies with attachment problems, have proven to be effective. Since babies lack language and conceptual skills, these parents are trained to "listen" to the body and to respond through appropriate touch. Although this is slowly changing, traditional training of therapists focuses very little on the body and hardly at all on touch. Touch attunement is a relatively neglected aspect of training and education for most therapists. Touch has a high degree of cultural relativity.

Among other things, Montagu observed cultural attitudes towards touch by developing a continuum of tactility. People of Germanic and Anglo-Saxon origin were placed on the low end of the continuum. Americans ranked only slightly higher than their English ancestors, sexual massage points, while Scandinavians occupied the middle position.

People of Latin, Mediterranean, and Third World ancestry were placed at the high end. He counted the number of times they touched during a one-hour period. America in general is a low touch culture. Within the American culture there are differences regarding touch between different regions, ethnic or minority groups.

Midwesterners who are strongly rooted in German and Scandinavian cultures are relatively restrained in their touch behaviors. In contrast, Americans of Latino heritage, a population found most often in southern regions of the country, touch easily and often. Americans of Indian heritage are more likely to be sensitive to class distinction with regard to touch. Unspoken social taboos are reflected in touch behaviors. Persons of a higher class may touch persons of a lower class, but not vice versa.

It is believed that the unspoken rules regarding touch between different classes is related to the history of the master-slave relationship in the U.

The relationship between ethnicity and touch has direct implications for touch in psychotherapy. How personal space is defined within a culture affects the interpretation of therapeutic touch. Cultural and sub-cultural power differentials, of both gender and class must be considered. Sexualization of innocent touch has a long history. Diaries from the time show poignant entries by mothers who guiltily sexual massage points and kissed their babies in secret, many of them feeling guilty for being unable to follow the dictates of the experts.

One must wonder if this includes a handshake or reassuring pat on the back. Most public displays of affection are held suspect, sexual massage points, especially males touching males. While most boys learn that affectionate touch between males is taboo, they are granted acceptable touch in competitive sports and in military action.

Many would find it embarrassing to kiss their fathers in public, but it is widely accepted for them to pat the buttocks of a male team member after a good play during a sporting event. These experiences are in direct contrast to the exaggerated, eroticized forms of nudity our children see on billboards, in the media, in unsolicited emails and on the Web, sexual massage points.

Madison Avenue knows, that which is taboo can be titillating and in this consumerist culture, eroticized nudity sells.

Unfortunately, in addition to selling products, it sells young girls unrealistic physical images to which they compare themselves. It sells the notion of a superficial relationship to sexuality and acceptability of irresponsible choices.

It sells the notion of bodies as objects rather than expressions of consciousness. This helps them to also develop a part of the cultural role for themselves and a relaxed attitude about the naked body.

The uneasiness about child development related to healthy sexuality, nudity and touch is likely to escalate. The uncovering of institutional abuse of children, such as the church and the foster care system, has fueled our vigilance.

We do need to protect our children. We also need to address the backlash. Innocent acts by parents, day care staff, and teachers are often falsely misinterpreted as sexual abuse. Clearly, touch is not inherently dangerous to our children and it holds enormous positive potential for development and growth. It is the small minority of childcare workers who act out of their own pathology who are dangerous, sexual massage points, just as it is the small minority of therapists who use touch to violate the boundaries of psychotherapy clients who are dangerous.

As a culture and in the profession of psychotherapy it is important to reevaluate sexual massage points protective interventions, not ban touch. Therapists, as this article articulates, also struggle with issues of touch in an increasingly adversarial legal and cultural environment, sexual massage points.

Touch, in the context of this article, refers to any physical contact occurring between therapists and clients. This section outlines several types of touch that are initiated by the therapist as an adjunct to verbal therapy. It generally refers to touch initiated sexual massage points the therapist, rather than client. This might include a handshake, greeting or departing embrace, a peck on the cheek, tap on the back, and other socially and culturally accepted gestures.

These gestures vary from culture to culture and from sub-culture to sub-culture. It often manifests as a light touch on the arm, hand, back or shoulder. When a therapist and client are in sitting positions, as they mostly are in psychotherapy, the touch may be on a knee. Consolation touch: Holding of the hands or shoulders of a client, or providing a comforting hug usually constitutes this kind of supportive or soothing touch.

It is most often done in response to grief, sorrow, distress, anguish, agony, sadness or upset. This is one of the most important forms of touch and is likely to enhance therapeutic alliance.

Reassuring touch: This form of touch is geared to encourage and reassure clients and usually involves a pat on the back or shoulders. Playful touch: This form of touch may involve play sexual massage points with a child in therapy or in family therapy involving children.

It might also take place in non-traditional types of therapy, such as when a therapist plays basketball with an adolescent who has not been responding to traditional verbal only-in-the-office therapy. Grounding or reorienting touch: This form of touch is intended to help clients reduce anxiety or dissociation. It usually involves helping a client be aware of his or her physical body by employing touch to the hand or arm. It can also be done by helping a client touch the fabric of the chair or sofa they are sitting on or by leading them to sexual massage points their own hands or head.

Corrective experience: This form of touch may involve the holding or rocking of a client by a therapist who practices forms of therapy that emphasize the importance of corrective experiences. This can take place with both adults and children. Erotic massage palors near me can take place in individual, group or family therapy. Therapists may model or demonstrate how to give a firm handshake to a shy client or how to hold a child who throws a tantrum.

It may also be used to teach clients how to respond to unwanted touch. Celebratory or congratulatory touch: This form of complimentary or approval touch can be manifested in a "high-five," a pat on the back or a congratulatory hug with a shy client who finally spoke out in group therapy, a historically passive client who asserts himself or herself in couple or family therapy or a child who has succeeded with a goal or good effort toward a goal.

Experiential Touch: This form of touch usually takes place when the therapist conducts an experiential exercise, such as in family sculpturing or in teaching gestures during assertive training.

Referential touch: This is often done in group or family therapy. The therapist can lightly tap the arm or shoulder of a client, indicating it is time for that client to speak or take his or her turn. It is also applied when a therapist attempts to indicate to the client that it is good for him or her to take a moment of silence.

Inadvertent touch: This is an accidental form of touch, such as an inadvertent brush against a client by the therapist. It refers sexual massage points touch that is unintentional, involuntary, chance or unpremeditated. It also includes the appropriate restraint of an out-of-control young child.

Touch intended to prevent someone from hurting another: This form of touch is intended to stop or restrain someone from hurting another person, as sometimes happens in family, couple or group therapy or when working with extremely volatile, antisocial or chronically mentally ill clients. This includes situations in which the therapists must physically intervene by restraining, holding or escorting the client away so he or she will not hurt someone else.

Staff of mental institutions and inpatient hospitals typically utilizes this kind of touch more frequently than most practitioners in private practice. Sexual massage points This form of touch is used by a therapist to physically defend him or herself from the assault of a violent client. Many therapists, especially in institutions, are specially trained in self-defense techniques that restrain clients with minimum force and minimum physical injury to clients. Therapeutic Intervention: Some somatic and body psychotherapies regularly utilize touch as part of their theoretically prescribed clinical intervention.

This would include Reichian, Bioenergetics, Gestalt and hypnotherapy among others. Massage, Rolfing or other hands-on techniques incorporated or implemented consecutively with psychotherapy also fit into this category, sexual massage points. Sexual Touch: The initiator of this form of touch intends to sexually arouse the therapist, the client or both. This form of touch between therapists and current clients is always unethical, counter-clinical and also illegal in many states.

Hostile-Violent touch: This form of touch involves a therapist being physically hostile or violent with a client. Physical assault is always highly inappropriate, unethical and, depending on the state, may be illegal, sexual massage points.

Punishing touch: This is another inappropriate form of touch where a therapist punitively punishes a client for "undesired behavior. While preventing a client from hurting him or herself or others may require some physical intervention, physical punishment by a therapist is never appropriate in the context of psychotherapy.

The above categories are all constructed around the intent of the therapist as the initiator of the touch. In reality, the intent of the therapist-initiator may vary from the impact on, or the experience of, the client. As we are all aware, therapists may intend to sooth a client by holding their hand but clients may experience such a gesture as controlling, violating, restricting or as a sexual overture. The experience of the initiator and the recipient are not always a match.

This paper discusses this potential discrepancy, suggests ways to minimize its occurrence and provides guidelines for therapeutic interventions. In summary, this article focuses on the forms of touch described in the first category, therapeutic touch. Numerous cultural, political, religious and professional forces affect our attitudes toward touch in general and in psychotherapy in particular. These forces co-contribute to the general sense that touch in therapy is an inappropriate, even dangerous behavior that should be avoided or at the least, when sexual massage points, held to a minimum.

The general western culture and its emphasis on autonomy, independence, separateness and privacy results in restricting interpersonal physical touch to a minimum. The cultural tendency in the US to sexualize most forms of touch facilitates confusion differentiating between medical, sensual and erotic or sexual types of touch.

The lack of differentiation between sensual and sexual touch is more pronounced for men in this culture than for women, as boys are homophobically socialized to avoid gentle sexual massage points sensual forms of touch. American men are socialized to be more familiar with violent, aggressive, drunken, reckless or sexual forms of touch. Acceptable forms of touch for men also include contact involved in sports and military action.

Attention to sexual abuse of children in general, heightened by the recent exposure of sexual exploitation of children by clergy, has given teachers, counselors, caregivers, ministers and other authority figures a new level of fear concerning touching.

The traditional dualistic Western mind-body or mental-physical split manifests itself in Western sexual massage points, including psychotherapy.

Typifying this split, are questions that are common in the field of therapy, such as "Is it organic or functional? Several feminist scholars have asserted that due to patriarchal values and inherent differences in power between men and women, most, if not all touch by male therapists of female clients has a disempowering effect on the woman.

The fear-based paranoid notion, sexual massage points by the slippery slope idea, that non-sexual touch on the part of the therapist inevitably leads to sexual relationships and exploitation, discourages therapists from utilizing touch.

Risk management, or defensive medicine, focuses on avoiding any therapist conduct that may appear questionable in court or in front of boards or ethics committees, regardless of clinical appropriateness and effectiveness. Most psychotherapists are wedded to the spoken word and often rigidly focus on and adhere to verbal communication. Using our penis tease video, humans consciously or unconsciously employ many non-verbal forms of communication, primarily visual, tactical and intuitive.

Still, graduate and professional education pays almost no attention to non-verbal communication. Most psychotherapists are wedded to the spoken word and often rigidly focus on and adhere to verbal discovernewyork.infochers have intensely studied non-verbal communication with children, sexual massage points, adults and in courting behaviors.

Very little of the resulting knowledge, however, has been incorporated into traditional psychotherapy training or practice. Since that time, thousands of research projects in a variety of fields, such as archaeology, biology, cultural and physical anthropology, linguistics, primatology, psychology, psychiatry, and zoology have been conducted.

The results of this research have established a generally recognized body of knowledge of sexual massage points cues and communication.

Recent discoveries in neuroscience provide us with an even clearer picture of the importance of non-verbal communication. Erotic massage key west paleocircuits in the spinal cord, brain stem, basal ganglia, and limbic system, cues are produced and received below the level of conscious awareness.

Many cultural influences involve an unspoken rule that people should ignore non-verbal elements of communication, so the task of incorporating conscious sensitivity and awareness to non-verbal communication is often limited. Generally speaking, women are superior to men in decoding non-verbal cues, most likely for biological evolutionary reasons.

Categories of Non-verbal Communication. Categories of non-verbal communication include internal cues and physiological responses. The elements of these categories are often not practiced voluntarily. Somatic and body psychotherapists assist their clients in becoming more aware of these subtle signs of emotion. Clinicians can learn to be aware of these reactions in themselves and educate their clients in "body voice" awareness. This can lead to rich discussion and gained insights regarding the meaning of what these emotional communications could mean.

Following are several categories and their elements. Personal Sexual massage points Personal space is also a form of non-verbal communication. Many factors affect the distance in which individuals experience comfort in approaching or being approached by others.

Power structures, role relations, gender, cultural factors, social relationships, location e. Eye Contact: Eye contact modifies the meaning of other non-verbal behaviors. Paralanguage: "Non-lexical" vocal communications suggest emotional nuances.

These include, but are not limited to, sexual massage points, inflection, intensity, tone, pitch or pauses. Facial Expressions: Transient facial expressions may communicate emotions that are not intended or conscious. The face is an extremely developed organ of expression. Gestures: Gestures are also often unconscious or unintended modes of non-verbal communication.

Adornment: Semiontics is the science of the emotional and psychological impact of signs and appearances. These elements might include: clothing, makeup, pickup artist online dating, pipes, belts, pillows, etc. Therapeutic sexual massage points can be served when therapists increase their awareness of these forms of non-verbal communication and educate their clients about them as well.

This self-knowledge is empowering to clients. People vary in regard to the mode they primarily rely on, whether it is auditory, visual, olfactory or tactile. It is essential to pay careful attention to the type of communication that is most effective which each client. A therapist who is sensitive to this issue might sit with a family and ask the father "Did you hear what was just said?

Then ask the son "Did you notice what just took place? Accordingly, the employment of touch must be carefully considered in its context. What is highly appropriate and effective with one client in a certain situation may be inappropriate and even damaging with another. Reaching out gently and respectfully to hold the hand of a grieving mother may not have the intended positive effect if the same is done in early stages of therapy with a female survivor of sexual abuse.

Following, is an example of the importance of context. Of course in a "standard" therapeutic situation, such a scene is likely to evoke associations of an unethical, sexual massage points, unprofessional, most likely illegal and inappropriate sexual mode. Now, imagine that this exchange takes place in a hospital room, the patient has cystic fibrosis, severe lung disease, and struggles mightily to breathe and speak despite the oxygen pressure mask she wears.

Gender issues are extremely important in understanding the context of touch. As noted above, men in general are more likely to sexualize touch unless it is hostile or aggressive Smith et al. They include presenting problem, diagnosis, personality, history, and in particular, history of abuse, sexual massage points, culture and gender.

Timing is as important. While a handshake may be appropriate at the beginning of treatment, other forms of touch, such as a hug or a kiss on the cheek may not be.

It is essential for the therapist to have explored his or her own relationship to touch issues as well. For example, a light touch on the arm by a therapist meaning to be supportive and affirming may be experienced by a client either, as intended, supportive, warm, encouraging and affirming, or it may be perceived as hostile, intrusive, controlling and disrespectful.

A study done by Horton et. Several researchers report how touch enhances therapeutic alliance. As such, appropriate touch is likely to increase the sense of connection and trust between a therapist and a client. In an interesting twist of logic, while professional literature, ethics classes and risk management principles advocate avoiding touch as much as possible, many surveys report that most therapists touch their clients in a non-sexual manner. About half viewed this practice as unethical.

Very few found the behavior to be ethically questionable p. The study of attitudes towards touch in therapy primarily involves issues related to sexual feelings, sexual touch and sexual boundary violations. Most of these surveys present several methodological concerns either because they seem sexual massage points lack clear differentiations between sexual and non-sexual touch or assume that, in most cases, non-sexual touch inevitably leads to sexual touch.

The bias against boundary crossing in general and touch in particular, combined with sampling limitations have also been a concern with the validity of the surveys. In their conclusion, citing several of their colleagues, they state, "The focus on erotic contact in therapy has raised questions about the legitimacy and effects sexual massage points ostensibly nonerotic physical contact" p. Like so many others in the field, they associate or link non-sexual touch with sexual touch.

Their study relates to the differential treatment of female and male clients with regard to non-erotic touch, which was systematically related to therapist-client erotic involvement. The same study did not find any correlations between non-sexual touch and sexual touch when therapists touched men and women equally. A more balanced view of touch and its potential benefits and risks is found in surveys of therapists and clients, presented in a series of chapters found in Smith et. Positive functions ertic videos touch, as expressed by clients who have experienced touch in psychotherapy, include providing a link to external reality, increasing self-esteem, and inviting the experience of new modes of relating.

The findings sexual massage points "support the judicious use of touch with clients who manifest a need to be touched, or who ask for comforting or supportive contact" Horton et. They see the value of touch and endorse it as a therapeutic tool whole-heartedly. Gestalt practitioners place a special importance on non-verbal communication and non-verbal intervention. Feminist therapists seem to have two camps when it comes to issues of boundaries, including touch. The more vocal, politically and professionally active faction focuses on issues of power, male dominance, sexuality, and oppressive patriarchal values.

Predictably, they take a strong stance against most boundary crossings and dual relationships and advocate for the protection of, what they see as, vulnerable female clients sexually exploited by powerful male therapists.

In this context any touch, sexual massage points non-sexual touch by male therapists of women clients is seen as disempowering and therefore harmful to women.

The much less vocal faction of feminist therapy focuses on essential issues of inclusion, connection, mutuality, self-disclosure, and equality. Along these lines, appropriate touch, which is congruent with the therapist-client relationship, is seen as potentially healing.

While most psychodynamic therapists thought touch could be easily misunderstood, humanistic therapists did not share this view. The following are some of his sexual massage points Therapists who touch are likely to subscribe to a humanistic theoretical orientation, while therapists who do not touch usually subscribe to a psychodynamic orientation.

Therapists who touch, obviously value touch in therapy and believe that gratifying the need to be touched is important. Therapists who do not touch believe that gratifying the need to be touch is detrimental to therapy and the client.

Unlike therapists who do not touch, therapists who touch were more likely to be touched by their own therapists and had supervisors and professors who believe in the legitimacy of touch as a therapeutic tool. Therapists who touch were more likely to experience body psychotherapies than therapists who do not touch.

Unlike therapists who do not touch, therapists who touch are obviously more supportive of models that use touch and employ body psychotherapy techniques. Female therapists tend to touch their clients more often than do male therapists. However, many writers have struggled with mapping the boundaries between sexual and non-sexual touch in therapy. Some focus on the areas touched i. Others focus on whether the intent is to sexually arouse the client, oneself, or not.

Yet others attempt to differentiate between overt vs. Part of the problem with differentiating sexual and non-sexual touch in therapy stems from the lack of differentiation between sexual feeling and sexual activity. Such lack of education undoubtedly exacerbates the problem, resulting in untrained therapists who tend to deny difficult or unacceptable feelings in a process, which is likely to increase their vulnerability to violate their clients.

Historically, there has been a centuries-long profound split between body and mind in Western thought and in psychotherapy in general. It has just been in the last twenty-five years that the correspondence between physiological and psychological processes has found form in somatically-based psychotherapies.

Body psychotherapy assists people in healing and developing not only through the use of verbal interventions, but also through guiding them to a deeper awareness of their bodily sensations, images, behavior and feelings.

There are many approaches to body psychotherapy just as there are multiple approaches in psychotherapy and a variety of techniques are employed.

Techniques common to most body-centered psychotherapies include attention to somatic awareness, breath, movement, imagery, and touch which can vary from deep manipulation used to release body blocks to supportive hugs or holding.

Humanistic, Existential and Gestalt psychology, as well as dance and movement therapy, family therapy, systems theory, biology, and Far Eastern philosophy have all contributed to body psychotherapy approaches. He described the ego as being first and foremost a body ego, and he taught that the physical blocking or discharge of energy is essential in the formation of psychological disorders.

He subsequently became fascinated with verbal analysis and the only aspect of his somatic perspective that remained a part of his focus was his technique of working with his clients as they lay on a couch. He felt this position relaxed tense musculature and regressed clients to earlier states of development by lowering their defenses. Ferenczi, originally trained in the psychoanalytic model, at one point spoke out as a proponent of hugging, holding, kissing and non-erotic fondling of clients, believing that the use of such therapeutic touch would provide corrective parenting to clients with early injuries.

Initially, Sexual massage points was supportive of his experiential experiments but withdrew his support when he became aware that Ferenczi had become sexually and romantically involved with more than one of his clients. Wilhelm Reich, a student of Freud, is often referred to as the grandfather of body-oriented psychotherapy, however, a long history of body-oriented approaches to healing, predate his work.

His development of character analysis correlated psychological and physical patterns. In this context, "character" is seen as a defense against strong emotions and has the function to bind anxiety in the form of muscular tension, e. Reichians work with the hypothesis that there is one, fundamental energy in the human body whether it manifests itself in psychic phenomena or in somatic motion. Both Reich and Lowen believed that organistic potency was a criterion for cure, but Lowen included the ability to express all emotion fully.

To this end, he developed exercises to help the client magnify and release tensions in the body, freeing blocked emotions. He works with breath, movement and sound as he examines the vibratory processes of the body down to the cellular level, sexual massage points. He believes that the quality of this pulsation shapes our physical form. He seeks to reestablish charge, formation, and discharge in a process that develops healthy tissue and holistically healthy individuals.

Charles Kelley, the founder of the Radix institute, describes "Radix" as the source from which energy, feeling, and movement are created and his work is less analytical and verbally oriented than Reichian therapy or Bioenergetics. There sexual massage points more focus on how a person blocks fear, anger or painful emotions rather than on content. He uses visual techniques to open the ability to access deep, spontaneous emotion and to choose appropriate goals, increasing self-direction, control and significance in the life of his students.

For Kelley, the focus is on education and growth. Somatic Experiencing SE is a naturalistic approach to the resolution and healing of trauma developed by Dr. The SE modality is based on the observation that wild prey animals, though threatened routinely, are rarely traumatized. Animals in the wild, according to SE theory, utilize innate mechanisms to regulate and discharge the high levels of energy arousal associated with defensive survival behaviors.

These mechanisms provide animals with a built-in, natural or innate immunity to trauma that enables them to return to normal in the aftermath of highly "charged" life-threatening experiences. According to the Foundation for Human Enrichment Somatic Experiencing is not considered as a form of psychotherapy, it stands on its own as an approach to healing trauma.

The Foundation is clear that SE is neither a psychotherapy sexual massage points a bodywork technique, but lends itself well to being integrated into these and other treatment modalities. The term focusing was popularized by Dr. Focusing refers to the simple matter of holding an open, non-judging attention something which is directly experienced but is not yet in words.

Focusing pay attention to the methods of inner awareness called "felt sense", a quality of engaged accepting attention, and a philosophy of what facilitates change. Stanley Keleman, Formative Psychology, sexual massage points. Formative psychology, was developed by Dr.

He describes as follows: Formative psychology, is based in the evolutionary process in which life continually forms the next series of shapes, from birth through maturity to old age. At conception each person is given a biological and emotional inheritance, but it is through voluntary effort that a human fulfills the potential for forming a personal life. Form gives rise to feeling. When individual identity is grounded in somatic reality, we can say: I know who I am by how I experience myself.

Formative psychology gives a philosophy and method of how to work with our life, sexual massage points. We learn to regenerate our emotional and instinctual vitality, to inhabit our body, and to incorporate our excitement and emotional aliveness. The goal of formative practice is to use daily life to practice being present and to create an adult self and reality.

I proceed from the premise that we are each conceived as an adult and that we grow the adults we are meant to be. Additional approaches to body psychotherapy. Other pioneers in the field have blended disciplines to form their work. New forms of body-centered psychotherapy are evolving which apply softer techniques and less analytical methodology.

These forms use less exploitive, stressful postures, invasive touching, or breathing to extreme states. There is less of a focus on analysis as the client takes more responsibility for finding meaning in the communication from their body voice.

Somatic sexual massage points refer to "energy" and associate it with the release of emotion and the restoration of health. This is a foreign concept to most Western traditionally trained practitioners but ancient and alternative healing methods refer to a force of energy that animates the entire organism. Chiropractors refer to it as "innate intelligence", Hindus call it Prana, Chinese, chi, Freud, libido, Reich, sexual massage points, orgone energy.

The limbic system, often referred to as the part of the brain that controls emotions, has forty times more neuropeptide receptors than other parts of the brain. Blood flow is closely regulated by emotional peptides, which signal receptors on blood vessel walls to constrict or dilate, and so influence the amount and velocity of blood flowing through them from moment to moment.

The brain requires a plentiful source of glucose in order for the neurons and glial cells to perform their function.

When emotions are blocked due to denial, repression, or trauma, blood flow can become chronically constricted, depriving the frontal cortex, as well as other organs, of vital nourishment. This can cause one to feel foggy and less alert, limited in awareness, with diminished ability to facilitate the body-mind conversation in order to make conscious decisions that alter physiology or behavior.

Hence, one becomes stuck repeating old patterns of emotion and behavior. The nervous system learns from pleasure, as well as pain. Each time we make sense of new information, the brain rewards us by releasing endorphins and other pleasure-producing petrochemicals.

We are familiar with these concepts as they relate to behavioral classical conditioning, and we are familiar with the common "aha" experience in psychotherapy. Touch is a very sophisticated language that is communicated through our skin, both receiving and giving information. We could say that CRF is the peptide of negative expectations, since it may have been stimulated by negative experiences in childhood.

Animal studies show that monkey babies deprived of maternal nurturing, neglected or abused have high levels of CRF. Feeling is healed through somatic experience because our minds and sexual massage points feelings reside in our bodies.

She asserts that we are literally able to consciously and intentionally intervene at the level of our molecules, making significant changes in our physiology, releasing certain biochemicals into our systems. The well-known tools of traditional psychotherapeutic trade, such as dreams and the symbolic meaning of words, as well as touch do, in fact, access the psychosomatic network. There is no doubt that these traditional tools have their place and their effectiveness but it is necessary to acknowledge other sexual massage points points of entry as well: the skin, spinal cord, and organs are all nodal points of entry into the system.

The deepest oldest messages are stored and must be accessed through the body. Multiple factors effect the decision making process in forming a treatment plan that includes touch, sexual massage points. It is crucial to address the specific touch experiences of special populations.

Survivors of Childhood Trauma. The use of touch with survivors of childhood trauma has been much debated. Due to the nature of their original injuries, many sexual massage points these clients are likely to feel intense vulnerability at the suggestion of touch in the intimate setting of psychotherapy.

There is the possibility that touch used with clients who are survivors of childhood trauma may recreate, or evoke, previous client-experienced dynamics of submission and victimization, entrapment, anger, fear, vulnerability and feelings of worthlessness. The concept of memory and trauma is highly controversial. Many studies document that traumatic memories are encoded in our sensorimotor system as kinesthetic sensations and images.

This results in the client having great difficulty reconstructing a narrative of their traumatic memories as they experience them instead as emotional and sensory sexual massage points Van der Kolk et.

Most authors agree that a client must want to touch or be touched and understand the concepts of empowerment before it is clinically or ethically appropriate to begin the use of touch in session Hunter et.

To this end, clients should be encouraged to express their preferences, to practice boundary-setting exercises, and to participate in creating a treatment plan. Many abuse survivors respond to anxiety by having difficulty in protecting their boundaries. Therefore, it is helpful for the therapist to state clearly that he or she accepts full responsibility for ensuring that there will be no sexual contact with the client, and to be clear about the process and type of touch that will be involved.

Hunter and Struve suggest that it is helpful to draft written ground rules as many survivors are highly dissociative and have difficulty retaining verbal information in stressful situations. Since most survivors of abuse have learned to mistrust touch, he begins by helping the client get in touch with his or her five senses that may have been undeveloped, sexual massage points, underdeveloped, or overdeveloped.

These exercises explore the distinction between good touch and bad touch and help the client to enjoy the benefits of soothing supportive touch. The therapists may then guide the client in nurturing, supportive self-touch such as self-massage or self-stroking. Another approach is to direct the client in the use of imagery to reconnect with his body, to recognize bodily sensations and to name them. It can also be less threatening for a client to experience safe, nurturing, non-erotic touch through the use of imagery.

Clients might further be instructed to deliberately engage in various types of touching activities, sexual massage points, such as touching trusted sexual massage points or animals, massage, or contact sports.

Any touching in therapy should be solely for the benefit of the client and great caution must be taken if the client is dissociated. The hypocampus, amygdala, hypothalamus and thalamus function by laying down memory traces that are subsequently regulated by stress hormones. Flashbacks can occur when a current stressor activates traumatic memory traces and the client dissociates and loses full contact with essential details in the current environment.

Positive therapeutic results have been demonstrated in the cognitive-behavioral treatment of psychological trauma survivors. It is essential that the therapist be familiar with the dynamics of dissociation before working with a trauma survivor. Many therapists consider touch of any kind to be inappropriate with clients who have been abused through violations of the body.

Many therapists and all somatic therapists believe that a client will have great difficulty in fully recovering from such trauma if only verbal or cognitive approaches to therapy are used. In a study done sexual massage points Horton et. Clinicians who do use touch in session, tend to do so in ways that reflect biases inherent in the larger culture. Adolescents may be particularly sensitive to dimensions of control with regard to touch and may react negatively to touch that could be interpreted as patronizing or unduly familiar Smith, et.

In one study, the staff of an adolescent treatment program modeled sexual massage points, nonviolent touch to incorporate physical contact as an acceptable aspect of the milieu. This is in contrast to high touch cultures in which elders are generally cared for at home in the company of extended family.

The Report of the Task Force on Sex Bias and Sex-role Stereotyping in Psychotherapeutic Practice. Rigid application of touch along gender lines fits the definition of sexism and is clinically inappropriate. From birth, American women receive more affectionate touch from males and females and are given greater permission to touch either gender and be touched by either full release massages. They are more likely to have and expect a broader repertoire of touch.

Psychoanalysis traditionally has placed an almost total interdiction on physical touch between client and analyst within the analytic arena. Yet touch, based on our largest sensory organ, the skin, provides a fundamental and elaborate form of communication. Psychoanalysis, from the days of its inception, has been highly concerned with the effect of physical touch in analysis.

Freud wrote to Ferenczi:. Clearly Freud felt that physical contact would almost certainly lead to sexual enactments. By his own admission, he was equally concerned with the reputation of psychoanalysis and forced the issue of touch to go underground. As psychoanalysis emerged, an entire analytic ideology was created around the prohibition of touch. It is based on the conviction that any touch is likely to gratify sexual and instinctual infantile longings or drives, subsequently contaminating the analytic container and nullifying the possibilities for analysis to help the clients work through their issues.

The effects of touch, like any boundary crossing, such as self-disclosure, gift giving or home visits, is a major concern in therapy, for almost all psychoanalysts and psychoanalytically oriented therapists.

Psychoanalytic theory emphasizes the importance of boundaries and the neutral stance of the analyst. Adhering to traditional analytic principles, his main guidelines state: "Maintain therapist discovernewyork.info psychological separateness of the patient. Refusal to touch and refusing to provide gratification, forces infantile sexual wishes into awareness that ultimately facilitates their renunciation. Touch is viewed as "muddying the transferrencial waters," and is likely to nullified analytic effectiveness.

The argument is that the power differential enables and, sexual massage points, some argue, encourages therapists to sexually exploit their clients. Instead, it views them as weak and defenseless in the hands of their powerful, dominant male therapists.

Therapists are generally hired for their expertise and this, in most cases, gives them at least some measure of being an expert, with knowledge and information that increases the power advantage over their clients. Power is, in itself, neither positive nor negative; it is neutral. Few, if any, marriage, business, friendship, or therapy relationships are truly equal. The problem of abusive or exploitative power in therapy is not going to be resolved by avoiding all touch and other boundary crossing in therapy.

The problem with the argument of power differential is that all patients are portrayed as malleable, weak, and defenseless in the hands of their powerful, dominant, compelling therapists. The disparity in power is regarded as extreme, sexual massage points is disempowering to the client.

Many therapists work with sexual massage points who are much more powerful than they. Often, these clients do not regard their therapists as particularly powerful or persuasive, and their therapists experience them as more powerful and successful than they. Such cases are a prime example of when therapists have to work hard at cultivating an aura of power so as to appear credible.

In summary, therapists must be very careful not to abuse the trust and power they often have in the therapeutic relationships. At the same time it is important that therapists humbly accept that some clients are more powerful than they are and acknowledge the limitation of how much power and influence they really have.

We must all remember that power by itself does not corrupt, but lack of personal integrity does. The first one is the distinct boundary of the physical body and the second one is the more illusive concern with psychotherapeutic boundaries. The boundary of the body is clear and well defined by the skin. It is, at once, the demarcation of physical, separate identity as well as the reciprocal experience of connection. While the skin is physically, distinctively defined, the numerous physiological and emotional regulatory systems affected when the skin is touched, are extremely complex and mysterious.

Boundaries in therapy sexual massage points, at least as complex as the body boundary. This section will focus on the boundary issue aspect of touch in psychotherapy. Boundaries in psychotherapy have been a topic of growing debate in the last two decades, with touch being a central element of the issue. Therapists who touch their clients, have often been viewed as problematic and their actions judged as a boundary problem that is often linked to, sexual massage points, or equated with, sexuality and harm.

They illuminate that there is a lack of differentiation between boundary crossing and boundary violation. As a result, confusion, false accusations and fear run rampant. In the field of psychotherapy, there is neither agreement nor a single definition of what constitute clinically and ethically appropriate boundaries between therapists and clients. Boundary crossing has been confused and equated with boundary violations. While boundary violations by therapists are harmful to their clients, boundary crossings are not and can prove to be extremely helpful.

In contrast to boundary violations, boundary crossings can be an integral part of well-formulated treatment plans. Examples are, a Reichian or Bioenergetics therapist who used hand-on techniques. Handshake, an appropriate pat on the back, handholding or a non-sexual hug are all also legitimate and often helpful boundary crossings. Boundary crossing may be simply seen as a departure from the traditional, rigid psychoanalytic approach or sexual massage points risk management proceedings.

At the heart of the opposition to touch in therapy is the argument that places immense importance on separation and clear and inflexible boundaries in therapy. Most of the support for this sexual massage points comes sexual massage points ethicists, attorneys, licensing boards, psychoanalysts, and rigid proponents of clinically restrictive risk management practices.

These professionals generally view any deviation from these rigid boundaries as a threat to the therapeutic process. As noted throughout this paper, the concern with boundaries has been intricately integrated as a primary focus of psychoanalytic theory and practice.

They have advocated an adherence to rigid therapeutic boundaries and oppose most boundaries crossing. In fact, many analysts have viewed even appropriate and helpful boundary crossing, such as a comforting hug or hand holding as poor boundary management. The concern with boundaries is not limited to analytically oriented therapists. Even though cognitive behavioral, family systems and group therapy are currently the most practiced orientations, they are ignored and marginalized when it comes to ethical discussion of boundaries.

They, therefore, judge the appropriateness of touch differently. Cultures, such Latino, African American or Native American, are more likely to integrate touch into the communication between therapists and clients. A rigid attitude towards boundary crossings in general and particularly towards touch in therapy stems in part from, what has been called "sexualizing boundaries. Touch and many other boundary crossings with certain clients, such as those with borderline personality disorders or other severe disorders must be approached with caution.

Effective therapy with borderline clients, for example, often requires a clearly structured and well-defined therapeutic environment. It is recommended that the rationale for boundary crossings be clearly articulated and, when appropriate, included in the treatment plan.

Rigid boundaries and rigid avoidance of all forms of touch can conflict with acting in a manner that is clinically helpful to clients, sexual massage points. Inflexible boundaries, distance and coldness are incompatible with healing. Boundary crossings, including touch are likely to increase trust and connection and hence increase the likelihood of success for sexual massage points clinical work. In summary, the exclusive reliance on analytic theory and adherence to risk management practices, which results in the eschewal of sexual massage points all forms of touch and boundary crossings, has been detrimental to the overall impact of psychotherapy.

Behavioral, cognitive-behavioral, humanistic, sexual massage points, group, family and existential therapeutic orientations are the most practiced orientations today. Risk management has become one of the most influential forces in medicine in general including psychotherapy.

Risk management is the process whereby therapists avoid certain behaviors and clinical interventions-not because they are clinically ill advised, unethical, harmful or wrong, but because they may appear improper in front of judges, juries, licensing boards or ethic committees.

No more hugs for a sobbing client. Like male preschool teachers who no longer hug young children, or camp counselor who would no longer hold a child in their lap for fear of being accused of inappropriate sexual behavior, many therapists, for similar reasons based on fear, have generally abandoned the practice of touching their clients.

Defensive medicine, fueled by fear, is the defining forces behind risk management practices. The teaching of risk management principles seems to dominate ethics classes in graduate school and legal-ethical continuing education workshops.

In all these formats, we are told never to hug, pat or hold our clients. Basically, we are told not to touch beyond a handshake and when possible even to avoid a handshake too. When we listen closely to the risk management dogma, it is clear that no one really disputes the scientific fact, and the common knowledge, that touch sexual massage points one of the most elementary human ways to relate and can be a powerful method for healing.

Nevertheless, we have been frightened out of employing touch sexual massage points most other forms of boundary crossings, such as self-disclosure, home visits, accepting gifts, bartering and many other behaviors frowned upon by the so-called "risk management" experts. Ironically, these are also the orientations most practiced by psychotherapists.

Misleadingly, many of these attorneys, ethicists and so called risk management experts have mislead the therapeutic community, clients and licensing boards and courts to believe that non-sexual touch is unethical and below the standard of care.

Unlike most commonly held beliefs, boundary crossings, such as touch are neither unethical nor below the standard of care. Ethics codes of all major psychotherapy professional associations e. All psychotherapy professional codes of ethics view sexual or violent touch with a current client as unethical. The obvious question then becomes, "Why are behaviors and interventions, such as touch, that are known to be clinically helpful, as well as very natural elements of human interaction, banned from our practices or, at best, driven underground?

In principle, nothing is wrong with managing risk if it is done thoughtfully by applying sensible clinical judgment and employing critical thinking munich erotic massage by train station than paranoid thinking. There must also be a sound knowledge of the professional codes of ethics and laws of states.

All actions and clinical interventions involve some risk. For that matter, we often forget that inaction can be risky and even damaging to clients, as well. In an emergency appointment with a psychiatrist right after the death of her son, as she sobbed uncontrollably, she begged him to hold her.

He refused, citing something about professional boundaries. Instead, he prescribed Valium. Eight years later, addicted to Valium and alcohol, she began therapy with me. It was the first time she had visited the grave. While the psychiatrist followed risk management guidelines to perfection, he also may have inflicted immense harm.

Did he sacrifice his humanity and the core of his professional being, to heartless protocol? All therapists may, of course, with due consideration, attempt to reduce their own risks and the risks to their clients when employing touch in therapy. This is especially important when working with cases involved borderline or dissociative proclivities. This attempt to reduce risk goes side by side with clinical integrity, relevant training, and sound employment of treatment plans.

Appropriate, risk-benefit analysis, requires that therapists ask themselves basic questions, such as "What is to be gained by employing touch and what is there to lose? What do I risk if I do not touch and what do I risk if I do? Complete guidelines for the use of touch in therapy will be found at the end of this article. Malpractice insurance carriers represent the primary force behind risk management, sexual massage points, or what some attorneys call "healthy defensiveness".

The rare, but nevertheless outrageously costly, judgments drive the malpractice insurance companies to advocate strict risk management practices and the avoidance of any behavior that may give a jury reason to suspect inappropriate behavior and levy an expensive penalty. Ironically, this strategy, as will be discussed later, is more likely to backfire on the insurance companies. Aiding and abetting the insurance companies and attorneys has also fueled the risk management fire, inspiring paranoia and widespread instruction in risk avoidance behavior.

Scheduled sessions with legal professionals abound at our professional conferences. Often, without any clinical training whatsoever, they sternly give us long lists of what we should avoid.

At the top of the list is, of course, "Do not touch! They tell us never to leave the office even though going to an open space with an agoraphobic client, as part of a systematic desensitization is the appropriate, sexual massage points, if not mandated, clinical intervention. They tell us never to socialize with clients even though it is often impossible to avoid doing so in rural areas and in small communities.

They tell us never to share sexual massage points meal with a client even though an "anorexic lunch" can be part of a perfectly sexual massage points family system-based treatment plan. Risk management and the fear it induces effects not only mental health, but also our entire society.

It is part of a bigger and more complex phenomenon: the American litigation explosion and the rights movement. Even though, as has been stated, sexual massage points, litigation is rare in our profession, the mere possibility of such a consequence is daunting and affects us strongly.

Ministers, teachers, sexual massage points, and youth counselors avoid touching - especially children or women. Litigation gone wild, indeed. The rationale is that the physician will not be accused of not having done everything in his power to rule out even the most unlikely diagnosis.

While attorneys laugh all the way to the bank, our risk management-intoxicated, phobic culture ends up settling for inferior care of every kind; children are deprived of touch and opportunities for play; and spiraling medical costs continue to bankrupt the country.

The standard of care is not anything that can be found in a textbook; it evolves as more and more professionals adopt certain practices, which then achieve acceptance as the "standard" in the community. A prime example of how risk management affects the standard of care is the requirement that a woman chaperone be male to male erotic massage during a gynecological pelvic exam.

The witness also reduces the risk that misconduct may occur. Before chaperoning became part of the standard of care, some women preferred not to have such a witness, especially if they had a long, trusting relationship with their physician or if the physician was a woman. However, today, not having a witness is considered practicing below the standard of care.

The danger that we face in mental health these days is that more and more risk management proscriptions may metamorphose into the standard of care. Bear in mind, though, that risk management is neither part of the ethics codes nor part of any treatment standard. Risk management is merely a set of precautions advocated by malpractice insurance vendors and attorneys, supposedly to minimize the chances of being sued.

When it comes to touch, good treatment and good risk management may sometimes call for mutually exclusive decisions regarding a given client. For example, it would probably be good risk management never to touch children and for male therapists never to touch female clients.

Most of us would agree that such risk management advice is utter nonsense, since helping those in need is a fundamental ingredient of the psychotherapy professions. This example, like the case of the psychiatrist who refused to hold the grieving mother, illustrates the faulty logic and drawbacks of risk management and its single-minded devotion to avoiding lawsuits and its equally single-minded lack of regard for the primary goals of our work.

We have seen how, over time, a new standard of care insinuates itself into psychotherapy. This results in a continuous rising of the risk management bar as to what constitutes acceptable clinical behavior.

Similarly and dangerously, many licensing boards have uncritically accepted risk management recommendations as their guidelines. Paradoxically and ironically, as the bar is raised and more interventions seem frowned upon by the boards, courts and attorneys, there is increased likelihood that insurance companies and therapists will be sued or sanctioned, sexual massage points.

Risk management, sexual massage points, without any doubt, has come to haunt the insurance companies, an unforeseen retribution for their shortsighted, cost-saving strategies. Sadly, it also impacts our profession negatively and often reduces our creativity and effectiveness, thus depriving our clients of the fullest measure of care. The fear campaign by the insurance carriers, attorneys and many ethicists and "risk management experts" has too often succeeded in paralyzing therapists and forcing them to restrict themselves to rigid and constipated ways of relating to clients and avoiding any physical contact with their clients.

As a result, clinical effectiveness is compromised. We cannot think of any more effective ways to enhance therapeutic alliance then a reassuring or comforting hug, sexual massage points, pat or hand holding. Very regrettably, most professional sexual massage points have jumped on the bandwagon and joined the fear campaign. They promote the practice of defensive medicine through their own risk management workshops and seminars. Some, as we see monthly, have given attorneys a regular column in their newsletters or journals where this paranoiac thinking is disseminated.

As risk management becomes more prevalent, its effect is clearly seen on new therapists. In the numerous Ethics with Soul workshops I have conducted across the country, I O. The opposite is true of the new graduates. Alarmingly, through the fault of most graduate schools and their ethics professors, many of the newer therapists believe that sexual massage points management practices are part of the standard of care.

In summary, a risk managed practice may sound as if it adheres to practical or pragmatic advice but, in fact, it is a misnomer for a practice in which fear of attorneys and boards, rather than feeling, caring and intelligent clinical considerations, determine the course of therapy.

As therapists, we are trained, hired and paid to provide the best care possible for clients. We are not paid to act defensively. This fear of board investigations and malpractice lawsuits pushes therapists to take protective measures. Consequently, we lower the quality of care for our clients. We must remember that the therapeutic effect of touch has been scientifically and clinically proven. We must also remember that we are hired to help rather than being hired to practice risk management.

Therefore we must touch clients when appropriate in a way that will help them grow and heal. This fear-based view has been most dominant in the discussion of employing or incorporating touch in psychotherapy. It underlines most arguments against the use of physical touch by therapists.

It asserts that a handshake, non-sexual hug or a re-assuring pat, are all just the first downhill steps towards inevitable deterioration, towards full- fledged sexual relationships. This poignant statement summarizes the opinion that the chance for exploitation and harm is reduced or nullified only by refraining from engaging in physical touch or any other boundary crossing.

Without doubt, touch tops this list. The link between non-sexual touch and sexual violation is almost an epidemic in the field. The slippery slope argument is grounded primarily in the assumption that touch or any boundary crossing, however trivial it may be, inevitably leads to sex and other boundary violations. This argument is based on the finding that most therapists who were engaged in boundary violation had been engaged in boundary crossings prior to their engagement in boundary violations.

We learn in school that sequential statistical relationships correlations cannot simply be translated into causal connections. It is important to reiterate that whereas the analytic contingent underscores that crossing boundaries will nullify therapeutic effectiveness and hence cause harm, sexual massage points, many other orientations have a different viewpoint.

Touch is extremely important for health, healthy development and healing. Touch triggers a cascade of healing chemical responses including a decrease in stress hormones and an increase in seratonin and dopamine levels.

In psychotherapy, there are many forms of touch. Among others, there are greeting, consoling, soothing, grounding, modeling and reassuring kinds of touch. In addition to the use of touch as an adjunct to psychotherapy there are several schools of thought, which are part of bodypsychotherapy orientations.

These include Reichian, Radix and several other somatic therapies. Most of them use touch as a therapeutic technique. Erotic or sexual touch are always unethical and can be harmful. There is a growing body of research that identifies the important clinical potential of touch as an adjunct to verbal psychotherapy.

As a result touch is highly effective in enhancing therapeutic alliance, which is the best predictor of positive therapeutic outcome. The meaning of touch can only be understood within the context of who the client is, the therapeutic relationship, and the therapeutic setting.

Accordingly, before employing touch, it is essential that the clinician consider unique treatment elements for each client including factors, such as culture, history, presenting problem, diagnosis, gender, history, etc.

Systematic touch should be employed in therapy only when it is well thought out and is likely to have positive clinical effects. Touch must be approached with caution with borderline or acutely paranoid clients. There is also a growing body of knowledge that shows the damage done by sexual massage points systematic and rigid avoidance of all forms of touch in therapy. The field of psychotherapy appears to be becoming increasingly polarized regarding the use of touch in psychotherapy.

At the extreme end of one pole are the proponents of risk management practices and the "slippery slope" ideology, whereby the simplest form of social touch, a handshake, a pat on the back, a comforting hug are seen as the first art erotic massage, incremental steps in the direction of the extreme misuse of power that will inevitably and unalterably result in sexual violation and psychological injury of the client.

Many therapists are motivated by fear of the appearance of wrongdoing and therefore avoid all forms of touch. For theoretical reasons, psychoanalytically oriented therapists are opposed to any form of touch. At the opposite end of the pole are those therapists from traditions, which have historically valued touch as a congruent aspect of the therapeutic bond and as an acceptable tool in assisting a client to reach therapeutic goals.

Unfortunately, due to the absence of attention to touch in most training programs, clinical supervision, outcome research and testing, most therapists do not think critically about incorporating the use of touch into treatment plans. Some touch in response to their own unexamined neurotic needs. Of course, these are the practitioners who are most likely to cause real injury to their clients.

Additionally, the possible negative consequences of never touching our clients must be taken into consideration. A professional responsible solution would be for all therapists to receive education and training that will allow the powerful therapeutic aspects of touch to be used responsibly and discriminatively in the care of their clients.

In summary, touch is important for healthy development and healing. Looking critically, not paradoxically, at the issue of touch in therapy one can easily see the fallacy and danger of the slippery slope ideology, risk management practices or rigid adherence to analytic guidelines.

Touching inappropriately can be damaging, as can be, the rigid and indiscriminant avoidance of touch. Touch, is one of the most basic forms of human relatedness, and has sexual massage points importance and positive potential for inclusion in psychotherapy. General Points And Ethical And Clinical Guidelines About Touch In Psychotherapy Touch is one of the most essential elements of human development: a form of communication, critical for healthy development and one of the most significant healing forces.

The effects of touch deficiencies can have lifelong serious negative ramifications. Bowlby and Harlow, among many others, concluded that touch, rather than feeding, bonds infant to caregiver. People of Anglo-Saxon origin place low on a continuum of touch while those of Latin, Mediterranean and third world ancestry place on the high end. The general western culture and its emphasis on autonomy, independence, separateness and privacy have resulted in restricting interpersonal physical touch to a minimum.

America is a low touch culture. In Western society, sex, love, power and dominance are dangerously confused. Americans tend to sexualize or infantilize the meaning of touch and as a result tend to avoid touch. Touch unleashes a stream of healing chemical responses including a decrease in stress hormones and an increase in seratonin and dopamine levels. Massage has been shown to decrease anxiety, depression, hyperactivity, inattention, stress hormones and cortisol levels.

Massaged babies are more sociable and more easily soothed than babies who have not been massaged. None of the professional organizations code of ethics i.

Touch should be employed in therapy when it is likely to have positive therapeutic effect. Practicing risk management by rigidly avoiding touch is unethical. Therapists are not paid to protect themselves, they are hired to help, heal, support, etc. Avoiding touch in therapy on account of fear of boards or attorneys is unethical. Rigidly withholding touch from children and other clients who can benefit from it, such as those who are anxious, dissociative, grieving or terminally ill can be harming and therefore unethical.

Stopping therapy in order to engage in sexual touch or sexual relationships is unethical and often illegal. Seeking ethical consultation is important in complex and sensitive cases. Ethical therapists should thoroughly process their feelings, attitudes and thoughts regarding touch in general and the often, unavoidable attraction to particular clients.

Critical thinking and thorough ethical-decision making are most important processes preceding the ethical use of touch in therapy.

Documentation of type, frequency and rationale of extensive touch is an important aspect of ethical practice. The meaning of touch can only be understood within the context of who the patient is, the therapeutic relationship, and the sexual massage points setting.

Touch increases therapeutic alliance, the factor found to be the best predictor of therapeutic outcome. Touch can help therapists to provide real or symbolic contact and nurturance, to facilitate access to, exploration of, and resolution of emotional experiences, to provide containment, and to restore significant and healthy dimensions in relationships. Sensitive, attuned touch gets etched into our developing neural pathways enabling us to feel of value, and to connect emotionally with others.

As such, touch can be a powerful method of healing. Language never completely supersedes the more primitive form of communication, physical touch. As such it can have a significant therapeutic value. The unduly restrictive analytic, risk management or defensive medicine emphasis on rigid and inflexible boundaries and the mandate to avoid touch interferes with human relatedness and sound clinical judgment.

Due sex messge the absence of attention to touch in most training programs, clinical supervision, research and testing, the majority of therapists tend not to incorporate the use of touch in therapy.

Traumatic memories are encoded in our sensorimotor system as kinesthetic sensations and images, while the linguistic encoding of memory is suppressed. Therefore, appropriate touch can have a significant therapeutic value, sexual massage points.

Disturbances in non-verbal communication are more severe and often longer lasting than disturbances in verbal language. Using touch in therapy may be the only way to heal some of these disturbances. To disregard all physical contact between therapist and client may deter or limit psychological growth.

Touch should be employed in therapy if it is likely to be helpful and clinically effective. Avoiding touch due to fear of boards and attorneys is unethical and a betrayal of our clinical commitment to aid clients.

Touch should be used according to the therapists training and competence. Extensive touch should be incorporated into the sexual massage points treatment planning. Therapists must be particularly careful to structure a foundation of client safety and empowerment before using touch.

The therapist should state clearly that there will be no sexual contact and to be clear about the process and type of touch that will be used. Permission to touch should be obtained from clients in a form of a written consent if therapy involves extensive use of touch, such as is utilized in some forms of bodypsychotherapy. Touch is usually contraindicated for clients who are highly paranoid, actively hostile or aggressive, highly sexualized or who implicitly or explicitly demand touch.

Special care should be taken in the use of touch with people who have experienced assault, neglect, attachment difficulties, rape, molestation, sexual addictions, eating disorders, and intimacy issues.

Therapists should not avoid touch out of fear of boards, attorneys or dread of litigation. Therapists are paid to provide the best care for sexual massage points clients not to practice risk management.

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To Touch Or Not To Touch:. Exploring the Myth of Prohibition On Touch In Psychotherapy And Counseling. Online course: Touch in Psychotherapy for CE Credit CEUs based partly on this article.

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