Ideally our earliest experiences of being soothed, nurtured and held in a bonded relationship happen through attuned touch. However, some of the deepest shock experiences held in the body occur when we are so young that our brains and nervous system are not yet sufficiently developed to process those experiences cognitively. When caregivers are unavailable or the source of distress, co-regulation and soothing often weren’t available, resulting in the body’s tendency to flip between hyper-arousal or dorsal vagal shutdown (freeze) as a way to cope with overwhelm. As demonstrated by the Adverse Childhood Experiences study, this can result in complex health syndromes when the body becomes highly sensitive and has to hijack or tax other systems as a management strategy.
Since early developmental trauma is largely pre-verbal and involves body memory, the skilled and appropriate use of touch can be an essential part of the healing process and provide corrective emotional experiences, especially when words are not available, when there were significant attachment ruptures that were never repaired, or when the body is stuck in survival mode as a baseline state. Touch work can involve no touch at all, focusing instead to resolve the activation associated with anticipating touch or closeness, or voicing the ability to say no without shame, guilt or overriding to please others.
Touch and table work are applied with hands and occasionally with forearm or foot contact, and can also be offered indirectly, such as providing support through a cushion. Touch work is done fully clothed, occasionally over blankets or a sheet if preferred, and is not used to manipulate, rehabilitate or repair the body as done in physiotherapy, kinesiology, chiropractics or massage. It does not constitute medical treatment and is not a replacement for other bodywork approaches, which are different in focus, intent and method. Touch and table work are used primarily to explore interpersonal processing and attachment, as well as self-regulation, safe touch, healthy boundaries, as well as work through early pre-verbal trauma and shock trauma. It can be incorporated while seated, as well as lying face up or standing during movement-based exercises.
Ethics of Touch
The United States Association for Body Psychotherapy has outlined ethical considerations for the use of touch and body-based approaches in therapy. To read the standards outlined for the safe and ethical practice of touch in psychotherapy, visit: www.zurinstitute.com/ethicsoftouch.html. A summary of these guidelines follows:
- Consent is required when using touch-related techniques in therapy, and can be withdrawn at any time. Sarah will ask your permission to use touch and you have the right to decline or refuse touch without fear of punishment, even if you previously provided consent. Sarah will ensure that you understand the nature and purpose of using touch. Sarah will explore with you and evaluate the appropriateness of the use of touch in your situation. She will also check in with you about your comfort level with regards to the location of touch, amount of pressure, length of contact, and her proximity to you both before and during each session. If touch is overwhelming, or the intention of appropriate touch is likely to be misunderstood by a particular client due to developmental or cultural reasons, touch is not used.
- Sexual touch of clients by therapists is unethical and illegal. Genital touching is not performed, nor do therapists use touch to sexually stimulate clients deliberately. Touch should not be used to foster dependency of the client on the therapist, and therapists are cautious about the potential to re-enact dynamics or trigger transference coming from early, vulnerable experiences/states. Clear boundaries are outlined prior to and during the use of touch in a manner that is not enmeshing, shaming or derogatory.
- Touch is only used in your best interest to benefit your healing with respect for your self-determination, and never to gratify the personal needs of your therapist. Your needs and wishes take priority over any clinical or theoretical approach. You may request not to be touched at any time during therapy without needing to explain it, if you choose not to, and without fear of punishment. You might also change your mind about touch and decide that you feel comfortable receiving touch support in areas that were formerly uncomfortable.