What is the importance of therapeutic touch in residential care facilities? and…
What are the issues with therapeutic/positive touch in residential care facilities?
I guess it is possible to cite all the research linked to touch and all the ethical dilemmas, etc., but in the end it comes down to this: We know from research that babies who are never touched, don’t survive. Touch is a basic human need and without it we either don’t survive, or we are deprived in many ways. It is therefore essential in residential care. Just be ethical, responsible and respectful with the way you touch, and remember that not everyone wants to be touched.
Werner van der Westhuizen
Research is absent for Therapeutic Touch (TT) since it is a method that has been disproved by several prominent researchers. Of course my definition of Therapeutic touch (TT) is a method in which the hands are said to "direct human energies to help or heal someone who is ill." Proponents claim that the patient's "energy field" can be detected and intentionally manipulated by the therapist. They theorize that healing results from a transfer of "excess energy" from healer to patient. Since Child and Youth Care is considered a social science one can quickly see how ridiculous this claim is and it was even disproven by a 9 year old student who was the youngest girl who had ever had research published in the Journal of the American Medical Association (JAMA).
Of course, you might mean actual touching the client
which is a different approach not referred to as Therapeutic touch but
Therapeutic touch does not always involve touch. People refer to it and sometimes mean different things but one of our therapists is a registered therapeutic touch practitioner and although she will touch at times with permission much of it is energy work.
However touch is extremely therapeutic and most kids in care have been touch deprived. The skin is the largest organ in the body. Touch allows for comfort, containment, but also significant it allows for a sense of where we are in relation to others (proprioceptive) for many struggling with a sense of derealization (am I really here, is this moment real etc). Which is why many often need to touch when talking to you. Dissociation and numbing blur our sense of reality and time.
Furthermore current neuroscience is now clearly demonstrating the impact the first year has on brain development. It is the right brain (sight, sound, smell, taste, touch) that is developing In utero and during the first year of life. It is developing in response to the rocking, holding, worms, feeding, eye contact, the vocal prosody, and smell of the caregiver and their surroundings. What we understand this does is sets our regulatory systems for either experiencing safety and comfort and reliability and being able to regulate later in life or dysregulation activating the stress response system helping us to see the world through the lens where people do not help, viewing the world as unsafe, and the world as unpredictable. When we do not receive the touch, rocking, and gentle bouncing that we require the brain does not develop as it is intended to. And as this is our foundation, everything else builds on top of this. This has drastic impacts on executive function, empathy, or ability to have inside around self and others, social engagement, ability to trust etc.
Additionally, when children don't receive enough touch some actively seek it out or avoid it altogether. As touch tends to have a down regulating effect for the nervous system, there are many great resources to help with regulation. Sensory-based approaches and tools such as weighted blankets, pillows, rocking chairs, hammocks, mini trampolines etc. all act as great regulatory tools. We are actually hosting a conference with today's focusing on the smart model which is sensory modulation developed by an occupational therapist and therapist and they will teach you during this training how to develop your own sensory rooms based on resources you have available. This would be something I would highly recommend within the classroom and residential treatment settings.
There is also an abundance of research emerging around the impact of therapeutic presence. That is the impact of the right brain to right brain attuned caring connection between a helper and the client. This allows for a felt understanding of being seen, validated, and worthy. Research is showing us that this is actually changing the attachment structures in people’s brains. Very powerful stuff! If you'd like to read more on the topic I have a brief blog posting for the National Institute for Trauma and Loss via this link: https://www.starr.org/training/tlc/blog/role-right-brain-right-brain-communication-and-presence-therapy
Therapeutic touch that does not involve touch would be very much consistent with therapeutic presence, being fully tuned, offering loving kindness, and holding space for those that we work with compassionately, curiously, and non judgmentally. What a beautiful gift for anyone to receive!
Bottom line...touch and therapeutic presence regulates and heals. Research suggests four hugs a day for survival! 12 hugs a day for healing and growth!
Wishing you a gentle day!
Jason, Sabrina and youth caring folks,
Perhaps I am more of a Luddite than most, but I found Jason's post to Sabrina's query most disconcerting. Was I the only one? Has our field come to the point where we cannot practice unless the practice has been validated by research? Have we become so technocratic?
I do accept the need to educate ourselves on trauma informed practice, but heck, Henry Maier wrote about the need for touch in caring work in the 1980's, and Fritz Redl wrote about it before that. And they didn't research it. They described how important touch is to human relatedness, attachment and soothing and healing and development. Massage is something else altogether.... something done to another in a specific setting. Something which can be healing too. But is different than the (small t) "therapeutic use of touch" which I think refers to "using touch in helpful and healing ways."
I sure hope our humanity as caring people who are acting in professional roles is not totally lost in the surge for evidence based practice in our medicalized and academicalized world of caring for youth and children. As if touching is not valid unless the experts codify it as such?!
Touch is key to connection and needs to be honored and respected as tantamount to two hearts touching. Children who are hurting need to be touched in ways that locate them in their own bodies as safe, honored and whole beings. When kids enter care they are torn from those they love, even those loved ones who have hurt them. Touch connects us to our humanness, to our body/spirit. Only western medical technology and dualistic worldview splits the body from the mind from emotion from intellect. Touch centers us.
It can also cause pain and hurt and revisit pain and hurt. Touch that is unwanted or disrespectful of the dignity and selfhood of the individual within context of their family or caring person, or when done to benefit ourselves, is hurtful, traumatic and bothering. We as caring persons in residential care settings and foster care must ask before we touch, use our words and our power wisely and mindfully, gracefully, lest we rob another of their dignity and integrity as human.
Thank you so much Peter!! You have written everything that I wanted to about the need that human beings have for physical contact. Well written.
"Has our field come to the point where we cannot practice unless the practice has been validated by research?"
I think you failed to understand my definition of “therapeutic touch” which is has not actual touching the individual (refer to http://www.sho.com/sho/schedules/titles/130996/new-age-medicine#/index)
I am not professing that every strategy that we employ is grounded in research that is evidenced based but rather I am saying that it must be evidence informed or at least based on common sense. Therapeutic touch clearly is not based on common sense and is simply silly, and has been discredited by a mountain good studies. That’s why our field is considered a social science. We make claims then prove or disprove them with good research studies. Why waste time on therapies that have no chance of success when we have in our toolbox a plethora of good tools that give our clients wellness and healing, as Lori has elucidated. Research on actual touch as Lori has suggested is based on good studies and one only has to refer to the old studies on Rhesus Monkeys by Harlow to see the results of nurturance and touch.
I might have missed your point, but Jason has in mind something more particular than your concern, so your criticism might not be fair. I think he’s talking about Ben Goldacre’s column in the Guardian newspaper in 2011, entitled, “Kids Who Spot Bullshit, and the Adults Who Get Upset About it.” It was recently republished in his book, I think you’ll find it’s a bit more complicated than that. In it Goldacre describes several nice examples of kids who did research on the claims of various kinds of “treatments.” One of them was by an enterprising 9-yr old, Emily Rosa, who did an experiment testing whether nurses who practiced “therapeutic touch” could detect a human energy field through which they healed patients, as they claimed. Emily tested whether therapists performed better than flips of a coin. Turns out they couldn’t. Hence the title, and Jason’s post.
The claims of these nurses seem whacked, but they aren’t far from ideas that occasionally circulate in our own CYC-related fields. And their use of authority to get patients to accept the treatment is uncomfortably close to what happens in many Child and Youth Care practice settings. The thread of these posts is about “therapeutic touch.” The claim to be “therapeutic” needs evidence, research and otherwise. Jason’s post is particularly relevant.
Of course there’s a lot of badly conceived research and bad uses of research. But there’s a lot of bad practice out there as well. And particularly relevant to my own occupation, bad teaching about practice!
Anyway, Emily Rosa’s experiment was brilliant and fun, and it should be a lesson to us. And Goldacre’s book has a section entitled “Bad Academia,” with a couple essays about problems with neuroscience research, worth a read if you’re concerned about what seem to be extravagant claims.
I just wanted to say that I am finding the discussion on therapeutic touch very interesting. It seems that there are three questions being raised. They are;
1) Is there any therapeutic validity in Reiki?
2) What is the therapeutic importance of physical touch when working with children in care?
3) Does everything we do in residential child care work need to be scientifically proven in order for it to be considered therapeutic?
Any one of these questions are worthy of considerable debate and to be honest I am not 100% sure that there is a right or wrong answer to any of them, but here goes...
In answer to question one, I am deeply skeptical, but my father in-law was knocked down by a car a few years ago and despite many medical interventions, the only thing that enabled him to raise his hand above his head was three sessions of Reiki. I have no idea how it worked, or if the problem was completely psychosomatic in the first place, but on some level it doesn't really matter. The point is that it worked for him and at the end of the day, that is what is important in any profession that claims to be 'client centered'.
In answer to question two, I think that the absence of physical touch in residential child care practice constitutes emotional neglect. I remain deeply concerned about the clinical sanitization of care practice in the name of 'professionalism' and the seemingly growing number of practitioners who adopt no touch policies in the name of child protection. I suspect that if the truth was known, those policies are about 'staff protection' and are born out of fear of litigation rather than anything to do with the child's best interests.
In answer to question three, the short answer is no. Having said that, if we want to achieve and maintain professional credibility we do need to have authority recognized by both the client and wider society. We cannot reasonably expect wider society to fund our work with their hard earned taxes if there is no actual evidence that our work is making any difference in the lives of our clients. Nor should we expect the client to engage in a process that may (at times) be very emotionally challenging, if it is not going to make any difference to his life situation. In Ireland we have got away with that for far too long. The culture of assuming positive outcomes and lack of accountability has enabled very many incompetent workers and service providers to coast along doing very little (if anything) to facilitate meaningful change in the lives of some of the country’s most troubled and troublesome young people. I don't think that is OK. I am not suggesting that everything we do must be evidence based because it is impossible to quantify the long term emotional benefits of something like kindness and compassion in a relationship. We do need however, to strike a balance between guess work and assumptions, and professional evidence based practice.
On a separate but related point, there was a program on last night on RTE television titled 'After Care'. It followed the lives of four teenagers in their transition out of the care system. If you get a chance to look at it (go to RTE.ie/player) you will notice that there is no mention of any form of structure therapy to enable the young people to cope with their emotional/behaviourall difficulties. One has to wonder how far we have really come!!!!!
With kind regards,
Doug and Jason,
I went back and re-read Sabrina's post. In it she asks what is "the importance of therapeutic touch in residential care facilities? and…
What are the issues with therapeutic/positive touch in residential care facilities?"
If she was referring to Intuitive Touch or some variant of pseudoscientific type of touch discussed in a Guardian article in 2011 than forgive my post.
However, if what she is asking is what are the concerns with touching kids in care in ways that help them heal and grow and trust and develop healthy boundaries and expectations than the point I am trying to make is, science does not tell us if touch is therapeutic, the person in care does. I have great concern we have programs of education churning out graduates who have very little actual experience touching or not touching and determining in real time in real experience what is good touch and what is bad touch and what is self determination and attachment etc. They have a ton of book knowledge about evidence based practice and research pumped out by medicalized care and legalized risk aversive practice.
This leads me to my rather simple concern illustrated in my kids book this morning (The Adventures of Ook and Gluk, by David Pilkey) in which two cavemen discuss the demerits of science.
Ook: "Scientists think they know everything."
"But they don't!" retorts Gluk. "They Just make guesses based on evidence they already discovered."
Scientist: "I Just call my guesses 'theories' so they sound important."
Ook: " But there are all kinds of new evidence discovered every day."
Gluk: "So the 'truth' is changing every day!
Ook: "Fortunately we have a time machine. We've been to the future and the past.
Gluk: So we have discovered lots of evidence that scientists don't even know about yet.
Perhaps Ook and Gluk agree with you, Doug and Jason, that much of what is called science is hooey. But if a kid wants me to pray with them, I will pray with them despite their being no evidence to support its efficacy. If they want to express themselves sexually in a residential care unit I am going to pay attention to context and safety and engage the young person in ways that lead us to respect, safety and dignity.
Last week in a residential unit I worked on for the first time, I worked with a teen girl who was dancing provocatively, going into her room and dressing in suggestive and revealing clothes calling me "boy" and trying to get me to react to her. I kept my distance, respectfully. If she moved into my space I communicated to her verbally or by moving away from her respectful boundaries. By the end of my shift she was less triggery and testing me and was able to give me a fist bump before bedtime. This is what I mean by the use of therapeutic touch. Sometimes not-touching, or creating boundaries and communicating respect and dignity is how we "touch." If I had told her to stop dancing or change her clothes I would be disrespecting her self-determining. Better for me to guard myself and demonstrate with my body and words what I healthy boundaries and dignified communication between strangers is.
I hope we child and youth caring persons are talking in these terms about how to use touch therapeutically. Evidence and research are important but at the end of the day that is all just theory. I hasten to use the word "Professionalism" here, but in the spirit of Hans Scott Myhre, dignified and respectful expectations of professional acts will only be fostered when we stay connected and imbedded with people in the moment and use or do not use touch in healthy respectful ways.
The rest is for the PhDs.
Just thought I would add some further insights re the topic.., just a few thoughts to ponder :)
There's actually fair amount of research regarding the benefit of therapeutic touch and its healing benefits. See link for details http://www.therapeutictouchontario.org/images/pdf_files/annotated_bib_04_12.pdf. Although I have not reviewed all of these journal articles I do understand and believe there's a great benefit to some. I have observed this first hand in sessions where TT has been administered to some very aggressive clients and I have used a very basic form between parents and children for attachment enhancing therapy and have watched them absolutely melt into their chair. It is a beautiful process and one where the individual is truly offering loving kindness to the other. It seems to have a very calming effect on their regulatory systems.
I do not find this surprising as it is something we certainly all need more of. The fields of energy therapies are growing with regards to efficacy evidence. In the psychotherapy field there is a growth of research demonstrating the incredibly powerful healing benefits of therapeutic presence. Therapeutic presence is the right-brain to right-brain attunement between the therapist and the client. This is been shown to actually impact brain structures impacted by attachment. Which makes good sense I think. For further information you can refer to Dr. Allan Schore's latest book on the Art and Science of Psychotherapy which provides good research around the impact of therapeutic presence. Dr. Stephen Porges and Dr. Sheri Geller have recently released an article on the benefits of therapeutic process as well. This is looking at the impact that loving and attuned presence has on our nervous system which is perceived through right-brain to right-brain communication then translated through our social engagement system.
Additionally there's good research being published on the impact of self compassion by Dr. Kristin Neff. This research is showing us that engaging in self compassion processes (such as offering ourselves a loving kindness meditation) can actually help balance the Limbic system and engage the empathy centres of the brain. This is all very powerful and exciting information.
EMDR, EFT, Sensorimotor and Somatic therapies (Dr. Peter Levine and Dr. Pat Ogden), Tension and Trauma Releasing Exercises (David Berceli) etc are energy and body based treatments that are all gaining more evidence based support through research studies. Dr. Bessel van der Kolk's latest book speaks to some of the research his leading edge centre has done on the topic. Essentially non traditional healing has been used for years however now through the benefits of neuroscience we are able to 'see' the impact it is having on the brain and body. I hope some of you find this as exciting as I do! Bottom line relationships, unconditional positive regard (Rogers theory), and connection help promote healing and wellness throughout life.
Links for those of you who are interested in
Dr. Bessel van der Kolk
Dr. Kristin Neff http://self-compassion.org/UTserver/pubs/listofpublications70714.htm
Harvard on loving kindness http://drdavidhamilton.com/can-loving-kindness-slow-down-ageing/
David Berceli http://traumaprevention.com/research/
I go away for a few days, and I return to find that the therapeutic touch conversation has gone in some interesting directions!
I’ll respond mainly to Peter, who has raised some interesting and important criticisms in the public forum and in an email to me.
First, it is a misinterpretation to say that Fritz Redl and Henry Maier never researched caring. They didn’t publish research using contemporary formats, but both of them carefully studied what it was that happened between caregivers and children. Fritz Redl in particular I suspect was systematic and rigorous, and both had a brutal quality—neither of them tolerated sentimental claptrap about caring— that made them excellent interpreters of practice. And both were keenly interested in evidence that particular approaches were effective—or not. And they worked in an era when a whole bunch of agencies in North America employed their own researchers and evaluators and studied their own programs.
I haven’t asked him, but it might also be somewhat of a mistake to assume that Skott-Myhre’s critique of professionalisation supports the claims about professionalism that were offered in previous posts. Hans is unpredictable that way, which is part of what makes him so fun, in addition to his rakish grin. By the way, Hans has TWO doctorates. He has no credibility if he’s being used to justify a critique of the phd!
Second, I enjoyed the criticism of academics, and the rest of this post is about those comments. In Canada, particularly, we get away with saying a lot of stuff that ought to be challenged, and there are lots of reasons to complain about us. It would be good for us if outsiders took us on more often and asked us to justify our claims. (It would also just be a lot more fun.) And I understand the frustration when it appears that only certain kinds of evidence count. Also, I understand the frustration when academics write about practices that they have never done and never studied, or studied badly, especially when we are critical of practitioners. There’s probably a lot of uninformed criticism of practice and practitioners.
Still, I call that contest a draw, and these distinctions between researchers not interested in practice and practitioners not interested in research results is nothing more than name-calling. It is irrelevant to this particular discussion that some academics are full of shit (and that I am sometimes full of shit). Why? Because I know a lot of practitioners who are full of shit and who are doing harm to children. Just as I also know a lot of practitioners who are amazing and awe-inspirng. We can throw stones at each other based on occupation, but stones are not a substitute for a reasoned argument and for evidence.
My own theory about the problem in both occupations
is that we’re all guilty of “intuitionism.” A lot of us believe that we
are right because of a mistaken confidence in “clear and distinct”
ideas. The Canadian philosopher, Charles Taylor, has a brilliant
take-down of intuitionism in the book, Sources of the Self. It
leads in practice to a certain kind of over-confidence in one’s own
practice judgement and, I believe, in academia over-confidence in
And this is why I reported the back story about 9-yr-old Emily Rosa. The point of her nifty little experiment was that we adults are too often completely and utterly wrong when we think we are being caring—and when we think we’re right without any evidence. If there’s any lesson we should take from Emily, it is that we need to collect evidence and test our claims. It doesn’t matter WHO collects the evidence. But someone should.
One of the things we know from research is that even when presented with contrary evidence, most of us will maintain our own beliefs and prevaricate. There’s no reason to think we are any better than the nurses Emily studied. They were certain that their scheme of therapeutic touch worked. We have enough Child and Youth Care practices in our history that we now know were not such a good idea that at the time were considered good practice. And there’s a 50-50 chance that the things we are doing now might later prove to be mistaken. The actual odds are worse than that for some things, because we continue to do things that we already know are bad. (Kiaras has written some things in a similar vein in CYC-online.)
One small example: there are plenty of parenting programs out there that have never been evaluated, and there are some programs for which the only evidence about them is negative. Yet we keep making parents sit through the damn things.
Another reason for us to be cautious about our own expertise: There are some really cool studies in counseling psychology and social psychology showing that therapists are routinely wrong when they are asked to predict a) which clients are doing well and which are poorly, b) which clients will succeed in the future and which will continue to struggle, c) which counseling techniques work and which don’t, and d) their own effectiveness. I’d love to replicate those studies in Child and Youth Care settings. Most of us think we’re way better than we are. I predict that it’s true of both academics and practitioners.
I await the evidence—and/or the critique of my argument—showing that I am wrong. Go nuts.