Is touch in psychotherapy a blurring of boundaries or the “next step” along the way in the process of psychotherapy? By Alison Ball
This was a brief paper given by Alison preceding a panel discussion on the above subject at the Psychoz Conference, Melbourne in 1999.
I am speaking today from my perspective as a Somatic Psychotherapist who has trained to work directly with the body and subsequently been strongly influenced by psychoanalytic psychotherapists and psychoanalysts, who themselves, were influenced by Freud, Melanie Klein, Winnicott and Bion. From this base I have learned to be extremely circumspect in my use of hands-on work with the body and learned that, when I do choose to touch, it must be done in the context of working within and interpreting the transference/ countertransference relationship.
In this 10 minutes, I will only try to cover two main things. First I will give you my short answer posed to this panel of whether touch in psychotherapy is a blurring of boundaries or the “next step” along the way in the process of psychotherapy. Secondly, I will briefly trace the origins and the base of the virtual taboo on touch in psychoanalysis and the psychoanalytic psychotherapies. Note that I am not a psychoanalyst and can give you only my limited understanding gained from my own struggle with the psychoanalytic literature.
Regarding the question posed to this panel. I first want to say that if your theoretical orientation allows for touch being a valid intervention then basically, you get a whole extra set of difficult clinical issues to deal with. I therefore highly recommend that you at the very least, read these books that I have here before you ever consider touching a client. Training or no training in the use of touch in therapy, it is perfectly valid and often wise and advisable, to decide that you will never touch a patient or client.
My short answer to the panel question is that there is no simple answer which is right for all clients all of the time or, in fact, for all psychotherapists or counsellors. In a very concrete way touch always poses the possibility of blurring boundaries. We are all more or less sensitive to that blurring and more or less able to maintain our own sense of boundary. At any time we may be more or less prone to becoming lost in a fog of the transference and our own countertransference- and are more or less able to retreat in order not to damage our clients, their process or our own professional reputations. I have no doubt that some psychotherapists and counsellors need to decide for themselves that they will never touch any client. Others may at times, be able to go some distance into the fog of blurred boundaries and, because the boundary they have in their own minds and in their actual practise is solid, the long term result for their clients may be extremely beneficial and, indeed, that willingness to make the foray into the fog may be the crucial- “next step”.
Now to my second task of briefly tracing the genesis of the virtual taboo on touch which has largely come out of the psychoanalytic theory and practise. Although when Freud began his work with hysterical patients, he used massage and held the heads of his patients in order to assist their remembering of childhood events, it seems he soon decided that actual touch was unnecessary to elicit what he wanted. In fact by 1905 he did not include touching patients in any way.
However, in the 1920’s his colleagues, Sandor Ferenczi and Wilhelm Reich were at one time using touch based on their belief that Freud’s methods did not work for some people. Reich’s ideas were largely seen as a distortion of psychoanalysis. He was discredited and his work was eventually continued outside psychoanalysis. Ferenczi (1994) treated patients who he said suffered from pre-oedipal and pre-verbal damage. His indulgence of the “child in the adult” of his patients was seen as leading to insatiability and to gross acting out on the part of patients which in turn led to endless and useless troubles for both patient and analyst. However, it is in this realm of early trauma, deprivation and environmental damage with associated regression in therapy that the so-called affective treatments- including touch of clients – has been considered as viable by some psychoanalysts and psychotherapists. It also seems that both Ferenczi and Reich were trying to find ways of dealing with transference, massive projections and their own countertransference, but these concepts were not then understood in the way they are now.
It can be postulated that Freud’s retreat from touching was largely political. The social climate was loaded against his outrageous ideas anyway. A rather cynical case can also be made that it stemmed from the fright he got when women clients fell in love with him or after his friend Breuer had embarrassing problems when a client claimed that she was about to give birth to his baby. She was not but, perhaps such incidents did give pause for thought and were almost certainly the source for Freud’s development of the notion of transference as a therapeutic tool. Certainly it does seem that Reich’s extremes and the fears engendered by the acting out of Ferenczi and his patients, along with the possibility of the dreaded “slippery slope” toward sexual abuse of clients by some analysts, meant that the taboo on touch became entrenched. However, I think we do Freud a disservice if we believe that such countertransference enactments or fears of the “slippery slope” were the only reason for the taboo on touch. I shall therefore, hope to show you his more technical reasoning.
Freud was dealing with patients suffering from what he termed hysterical or obsessive neuroses. At base he thought there was a painful, usually childhood experience and a subsequent conflict in their minds between underlying wishes and desires that were frustrated by more moralistic and social constraints. He believed that the conflicts drove the desires underground but later produced symptoms. Freud further said that we were destined to compulsively repeat in the present, these unresolved past experiences or elements of past conflicts in an effort of mastery and as a way of avoiding the realities of the original situation. Even if the repetition was painful it brought what he called “substitutive satisfactions” rather than coming to terms with reality. The transference, he said, was simply another form of the repetition compulsion and indulging the patient in any way simply fed the part of them that wanted to avoid reality. In short, my reading of Freud leads me to understand that Freud did not actually deny that real abuse or trauma may have occurred but- the critical thing for him as a psychoanalyst, was to understand what that particular patient had made of the events within their own mind.
From this standpoint, Freud therefore developed the concept of the “rule of abstinence” which required neutrality on the part of the analyst. Laplanche and Pontalis (1988) define this rule as requiring that “treatment should be so organized as to ensure that the patient finds as few substitutive satisfactions for his symptoms as possible. The implications for the analyst is that he should refuse on principle to satisfy the patient’s demands or to fulfil roles which the patient tends to impose on him”. In his 1915 paper, “Observations on Transference Love”, Freud had said that he did not only mean physical abstinence but that “those forces” … of… the patient’s needs and longing should be allowed to persist” and they should not be appeased “by means of surrogates”.
He further believed that, if the patient was indulged or provided with surrogate satisfactions or, indeed have the suffering mitigated too soon, then they would lose the motivation which “impelled them toward recovery”. Libido released by the treatment must remain “monopolised by the transference and deprived of any discharge other than through verbal expression.” And though others may disagree, Freud believed that indulgence or, as he called them, the “affective treatments”, might seem to give some immediate results but they did nothing in the longer term about what was unconscious in the patient.
Freud’s view of the psychoanalytic relationship seems still to underlie present day thinking in Kleinian and Freudian psychoanalysis. Later developments in theory and practice especially regarding the notions of transference and countertransference and projective identification seems only to have confirmed the view that abstinence and the neutrality of the analyst is essential for real long term gain and self understanding. Roger Money Kyrle (1956) later put the main argument in a nutshell when he said that analysts who were tempted to use affective techniques when their understanding failed them did so out of their own need to “satisfy parental and reparative drives”. Significantly, Money-Kyrle wrote that “if this goes unnoticed” a split may be fostered in the patient with the real parents as bad and the analyst as good.
To finish let me say that Donald Winnjicott was one of the few analysts who continued to believe that actual physical holding of some patients at specific times in their analysis was essential. His well known “holding environment” was not always only metaphorical. You can read more of my thoughts on this subject in my own book Taboo or Not Taboo. (Ball 2002)
References:
Ball A. (2002) Taboo or Not Taboo- Reflections on Physical Touch in Psychoanalysis and Somatic Psychotherapy.Psychoz Publications, Melbourne.
Ferenczi, S. (1994) Balint M. ed –1929, 1921 & 1923 Papers in “Final Contributions to the Problems and Methods of Psychoanalysis.” Karnac Books London.
Freud S. (1915) Observations on Transference- Love. (Further Recommendations on the Techniques of of Psychoanalysis 111). S.E. X11, 159-173. Hogarth Press, London.
Laplanche J. & Pontalis J.B. (1988) The Language of Psychoanalysis; Publisher: Karnac, London.
Money-Kyrle R. (1956) ‘Normal Countertransference and Some of Its Deviations” in The Collected Papers of Roger Money Kyrle (1978) (Ps 333-340). Clunie Press, Strath Tay, Perthshire.