A Touchy Subject: The Ethics of Touching To touch or not to touch. That is the question.

Transcription

1 A Touchy Subject: The Ethics of Touching To touch or not to touch. That is the question. Presented by Frances Patterson, PhD, LADAC, MAC, BCPC, CCJAS, SAP, QCS December 21, 2016

2 Thomas Durham, PhD Director of Training NAADAC, the Association for Addiction Professionals

3 Produced By NAADAC, the Association for Addiction Professionals

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6 Cost to Watch: Free CE Hours Available: 1 CEH CE Certificate for NAADAC Members: Free CE Certificate for Nonmembers: $15 CE Certificate To obtain a CE Certificate for the time you spent watching this webinar: 1. Watch and listen to this entire webinar. 2. Pass the online CE quiz, which is posted at 3. If applicable, submit payment for CE certificate or join NAADAC. 4. A CE certificate will be ed to you within 21 days of submitting the quiz.

7 Using GoToWebinar (Live Participants Only) Control Panel Asking Questions Audio (phone preferred) Polling Questions

8 Webinar Presenter Frances Patterson, PhD, MAC Phone: Fax: Footprints Your Consulting Services, LLC

9 Webinar Learning Objectives LO #1 Discuss how touch may be confusing for many counselors LO #2 Consider the role touch may have in counseling LO #3 Define guidelines for making an ethical decision when faced with touch in counseling clients

10 Physical Contact in Counseling A Controversial Topic!! What is appropriate touch? Nothing should be done in private that could not be done in public Research does NOT support the idea that non-sexual physical contact leads to sexual involvement with clients

11 Touch One of the most essential elements of human development: a form of communication critical for healthy development one of the most significant healing forces High degree of cultural relativity: Anglo-Saxons place low on a continuum of touch Latin, Mediterranean and third world ancestry place on the high end To Touch or Not to Touch Clinical Update By Zur Institute 2014

12 Polling Question #1 Do you believe it is acceptable to hug clients? 1. Yes 2. No 3. Sometimes

13 To touch or not to touch? Questions: Is it ever OK? Who s agenda? Why are you touching? Are there Rules?

14 Empowering Clients by Establishing Boundaries Clients need boundaries We model boundaries Appropriate touch is often misunderstood by clients Our job is to teach

15 Physical contact What is appropriate touch? Nothing should be done in private that could not be done in public. Research does NOT support the idea that non-sexual physical contact leads to sexual involvement with clients

16 Types Of Touch In Psychotherapy Ritualistic or socially accepted gestures Conversational Marker Consoling or reassuring Playful touch? Grounding or reorienting Task-Oriented Corrective experience Instructional or modeling Celebratory or congratulatory Experiential Referential Inadvertent Preventing someone from hurting self or others Self-defense Therapeutic intervention - A body therapy medical technique Inappropriate, unethical and mostly illegal forms of touch include sexual, hostile-violent and punishing touch. To Touch or Not to Touch Clinical Update By Zur Institute 2014

17 Why Prohibition Of Touch In Therapy? Western culture: emphasis on autonomy, independence, separateness and privacy The cultural tendency in US to sexualize most types of touch Separation of mind-body or mental-physical in Western culture Homophobia Some religious idioms have highly restrictive view of all forms of touch. The litigious culture and resulting risk management To Touch or Not to Touch Clinical Update By Zur Institute 2014

18 Why prohibited Traditional psychoanalytic emphasis on neutrality, distance, rigid boundaries Feminist scholars often state most touch by male therapists of female clients is disempowering and injuring to the women Fear-based, illogical slippery slope idea that non-sexual touch inevitably leads to sexual exploitation. Recent crisis in clergy and day-care incidents in regard to sexual exploitation

19 Ethical Consideration: Non-Sexual Touch Touch in therapy is not inherently unethical No professional code of ethics, including NAADAC, view touch as unethical Can be used when likely to have positive therapeutic effect Ethical touch: employed considering context of therapeutic relationship sensitivity to clients' variables, such as gender, culture, history, diagnosis, etc.

20 Polling Question #2 Do you document when there is touch with a client?

21 Ethical considerations Seek ethical consultation Critical thinking, thorough ethical-decision making a must prior to ethical use of touch in counselling Documentation!!!! Counselors: thoroughly process own feelings, attitudes, thoughts regarding touch in general and the often, unavoidable attraction to particular clients

22 Ethical Consideration: Unethical Practicing risk management by rigidly avoiding touch Therapists are not paid to protect themselves, they are hired to help, heal, support, etc. Avoiding touch in therapy due to fear of reporting or suit Stopping therapy in order to engage in sexual touch or sexual relationships is (often illegal too)

23 Ethical Consideration: 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 Sexual, erotic or violent touch in therapy is ALWAYS unethical.

24 Guidelines For Appropriate/Ethical Touch Used according to the therapists training and competence Thorough deliberation of the clients' potential perception/ interpretation of touch Foundation of client safety and empowerment before using touch

25 Guidelines Clarity regarding boundaries Clients' perception of being in control of physical contact that touch is for his/her benefit rather than therapists Stated clearly no sexual contact Clear about type of touch to be used

26 Special Care Touch is usually contraindicated for clients who are highly paranoid, actively hostile or aggressive, highly sexualized or who inappropriately, implicitly or explicitly demand touch. Special care with people who have experienced: assault, neglect, attachment difficulties, rape, molestation, sexual addictions, eating disorders, intimacy issues.

27 Risk of dual relationships How can touch lead to dual relationships? Could this be considered therapeutic? Why or why not?

28 Encouraging hugging/touch among clients Mike runs a family group which is attended primarily by women. One evening he closes group by asking everyone to close their eyes and remember a happy time in their childhood. One client begins to sob and when asked what he problem was she stated I can t remember any happy times. He then instructs the woman next to her to put her arm around the other client s shoulders. What problems could arise from this?

29 Making touch a ritual in treatment Larry runs a co-ed addictions treatment group. There is generally at least two or three women in a group of twelve. At the end of group Larry tells all to join hands and say the serenity prayer. At the end of the prayer, he states OK. Give each other a hug and I will see you next time. Is this appropriate? What should Larry consider in his closing remark?

30 Appropriate or Not? I held a client in my arms for an extended hug while the client cried. A client asked me for a hug and I said no A male client hugged me without asking

31 Physical touch considerations Agency policies Therapist s experience and comfort level with touch Client s: Personal history, Diagnosis, Culture Have client s permission Not a way to gain trust Who s needs are being met?

32 Protecting ourselves and clients All situations and behaviors, including touch in therapy, should be open to supervision Do you have resources? Talk to colleagues Network of people you trust Unwilling to talk to someone? What is that about?

33 Thank You! Frances Patterson, Ph.D., MAC, BCPC, CCJAS, QSAP, QCS (615) Your Footprints Consulting Services, LLC

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35 Cost to Watch: Free CE Hours Available: 1 CEH CE Certificate for NAADAC Members: Free CE Certificate for Nonmembers: $15 CE Certificate To obtain a CE Certificate for the time you spent watching this webinar: 1. Watch and listen to this entire webinar. 2. Pass the online CE quiz, which is posted at 3. If applicable, submit payment for CE certificate or join NAADAC. 4. A CE certificate will be ed to you within 21 days of submitting the quiz.

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