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To Touch Or Not To Touch: Exploring the Myth of Prohibition On Touch In Psychotherapy And Counseling, by Ofer Zur, PhD., offered by Zur Institute for

To Touch Or Not To Touch: Exploring the Myth of Prohibition On Touch In Psychotherapy And Counseling, by Ofer Zur, PhD., offered by Zur Institute for Psychologists, MFTs, SWs and Counselors

INTRODUCTION
Touch is one of the most essential elements of human development, a profound method of communication, a critical component of the health and growth of infants, and a powerful healing force (Bowlby, 1952; Harlow, 1971, 1986). Ample research has demonstrated that tactile stimulation is extremely important for development and maintenance of physiological and psychological regulation in infants, children and adults (Field, 1998, 2003; Montagu, 1971, 1986). Touch has been an essential part of ancient healing practices. Touch has roots in shamanic and religious practices, and is reported to have been an integral part of health care practices and medicine since their emergence from the realms of religion and magic (Levitan & Johnson, 1986; Smith, Clance & Imes, 1998).

In his seminal work, Touching: The Human Significance of the Skin, Ashley Montagu (1971) brings together a vast array of studies shedding light on the role of skin and physical touch in human development. 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. "Among all the senses," Montagu states, "touch stands paramount" (1986, p. 17). Before Montague published his classic book in 1971, Harlow (1958) set the stage for our understanding of the importance of touch for emotional, physiological and interpersonal development in human and non-human infants. In line with Harlow, Montagu concludes: "When the need for touch remains unsatisfied, abnormal behavior will result" (1986, p. 46). Primarily Euro-American cultures in general, particularly that of North American white-Anglos, have developed a set of unspoken taboos in regard to touch. Based on Cohen (1987) and Hunter and Struve's, (1998) work, following are short descriptions of these cultural, mostly unspoken, taboos:

* "Don't touch the opposite gender!" This taboo is based on the belief or worldview that sexualizes all or most forms of touch.
* "Don't touch same gender friends!" This boundary is primarily based in the homophobic fears prevalent in our culture.
* "Don't touch yourself!" This injunction stems, in part, from some religious and puritanical doctrines and phobias around self-pleasure and masturbation.
* "Don't touch strangers!" This command is based on a cultural fear of "the other," a paranoid attitude towards unfamiliar persons and those who are outsiders of one's own group.
* "Do not touch the elderly, the sick and the dying!" This reflects a negative attitude in American culture towards the elderly, the sick, and the dying that manifests itself by segregating them from the rest of the population. 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.
* "Do not touch those who are of higher status!" This unspoken rule is prevalent in our culture, where it has been documented that people of higher status or power touch those of lesser status significantly more frequently than the converse.

Touch, in this article, refers to 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.e., Fridlund, 1994; Young, 2005). 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. This paper explores the rich duet of talk and touch and articulates how such a duet can significantly increase a sense of empathy, sympathy, safety, calm, and comfort, as well as enhancing a client's sense of being heard, seen, understood and acknowledged by their therapist (Hunter & Struve, 1998). Touch is also likely to increase the sense of connection and trust between a therapist and a client (Smith et. al., 1998).

[...]

Recent research done by the Touch Research Institute has demonstrated that touch triggers a cascade of chemical responses, including a decrease in urinary stress hormones (cortisol, catecholamines, norepinephrine, epinephrine), and increased serotonin and dopamine levels. The shift in these bio-chemicals has been proven to decrease depression (Field, 1998, 2003). Hence, touch is good medicine. It also enhances the immune system by increasing natural killer cells and killer cell activity, balancing the ratio of cd4 cells and cd4/cd8 cells. The immune system's cytotoxic capacity increases with touch, thus helping the body maintain its defense against pathogens (Field, 1998).

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. al., 1997). It decreases diastolic blood pressure, anxiety and cortisol (stress hormone) levels (Hernandez-Reif, et. al., 2000). One study examined the effects of massage therapy on anxiety and depression levels and on immune function. The subjects received a 45-minute massage five times weekly for a 1-month period. The findings were that: 1) anxiety, stress and cortisol levels were significantly reduced; 2) natural killer cells and natural killer cell activity increased, suggesting positive effects on the immune system (Ironson, et. al., 1996). Bulimic adolescent girls received massage therapy 2 times a week for 5 weeks. 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. al., 1997). Following five 30-minute massages, children/adolescents had better sleep patterns, lower level of depression and anxiety and lower stress hormone levels (Field, et. al., 1992). 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 less depression (Field, et. al., 1996).

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