 We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is The Therapy Show, behind closed doors podcast, with Bob Cook and Jackie Jones. Welcome to Episode 110 of The Therapy Show, behind closed doors with myself, Jackie Jones, and the wonderful Mr Bob Cook. Yeah, I do need to find a new way of introducing you. And what we're going to be talking about in this episode is how to use touch in the therapy process. Yeah, it's a great touch, but I was just laughing because our fair, we talk about the use of touch in psychotherapy, you said without being arrested. Yes, how to not get arrested. It's a bit like that, in a way, because with the sort of increase, how can I explain this? People's fear of litigation, which I think leads to what are called defensive psychotherapy. People are very, and certainly beginning psychotherapists, are particularly sort of apprehensive about this whole subject of touch in psychotherapy. I mean, I think it's a very big area, and specifically for, as I said, from beginning psychotherapy, and also even sort of experienced practitioners sort of start to think, what should I do? Somebody asked, one of my clients asked me for a hug or if I decide to touch them in some ways. Where does that leave me? So even experienced psychotherapist, I think, may be apprehensive around touching psychotherapy. Absolutely, absolutely. There's a lot written about it. It's a controversial subject. Which is a shame because it is a form of connection when we touch another human being. It is a form of connection and empathy and relationships and all that sort of stuff. That's right, and I think we need to be clear about what you mean by therapy, because there's different types of therapy. There's body therapy, for example. There's all the spiritual therapies. There's cognitive therapy. There's emotional therapy, if you want to put it that way, and I can think of many therapies which seek your expression of emotion. So I think we need to be clear what we mean by therapy. And then a good way to look at this, I think, is look at the phase psychological contact. Because I think there's many articles written about what is psychological contact, as well as what is physical contact. And then in the therapeutic domain, it's important to think of, I think of it this way, that it's not just going to be at the non-verbal level. It's really important that you contract for any physical touch in therapy. That's the first tip I can give anybody, beginning or experience psychotherapists, that if you're going to make any physical contact, which you might argue as a psychological function, you need to get consent first. You need to ask and say, you won't need to ask about it. So if you're going to decide that you can't need a hug, for example, in terms of whatever treatment you're doing, then you need to ask them first, is that okay? You don't just go and hug them because you think they need a hug. Once you do that, several things happen. Your assumption might be totally incorrect. They might not need a hug, for example. You're also taking away the whole concept of self-agency once you start assuming and taking things into your own hand. There has to be a bilateral contract, I believe, for touch. Now, listeners here might disagree with me, but I think it's very, very important that that happens. When you're saying that, do you mean at the beginning of therapy, like in the written contract? No. You mean in the session before you write? Yeah. You might put it in the written contract. That's not a problem, is it? Of course. I've not put it in my written contract, but I would always verbally contract with them. Yeah. Yeah. Whenever you're going to physically touch somebody, and it's very important to ask their permission, if you want to put it that way, or their consent, because you leave yourself open to a whole minefield if you don't. Yeah. And I can't see any reason why any... I can't see any reason why any therapist wouldn't ask for consent and talk about this post-it in psychotherapy. No. I wouldn't. I suppose it depends on deceiting arrangements, whether it's kind of like the only way I can think it might happen without contract is if it was just an instinctive gesture. But I sit on a chair, and my clients sit on a couch opposite me, so I would have to physically get up and move towards them. So it's not something I would do unconsciously or out of my awareness, if that makes sense. Yeah. And I think it's very, very important that a therapist doesn't know what to do. So, for example, say they think there's a relational need for initiation to be met. I was thinking of clients who might be in their history had emotional physical neglect. Yeah. So the therapist might be thinking, oh, this person needs a hug, or if there's emotional expression, and they're crying, or whatever it is. I suggest, anyway, that of course, that the therapist does not take that assumption on their own bat. They ask the client first. You know, it's very easy to do it. Not only do they verbally do that, but they need to have a clinical thought process behind the initiation of contact, and not just out of some sort of spontaneous whim or some instinct. That's the clinical thought. Yeah, absolutely. Because I know for me, it can be quite, not so much now, but in the early days, it can be quite uncomfortable to witness outward emotion in a therapy room without feeling like you need to do something to kind of stop it or prevent it or make them feel better. But that isn't necessarily part of the therapeutic process. No, certainly isn't because a person or the client might need to express their emotion. And in fact, the hug, if the therapist desires, you know, even asked the client for a hug, may be counterproductive to the treatment and may close down on emotion in terms of soothing them when actually they need to get the emotions out. Yeah. So sometimes it is just sitting there and, you know, sitting in the space. One of the things that I do do is ask them if they need anything from me right now, rather than actually saying, do you need a hug? I'll say, is there anything that you need from me right now? Obviously, I don't just let them, you know, cry hysterically in the room and not do anything. But I don't tend to presume that they need anything. I think it's very important to have a contract, a moment-to-moment contract. Yeah. You think you are going to hug them without asking them? You have to ask yourself, play sprongly, the clinical reason for that. Yeah. Things do come up for me in therapy, not necessarily in the moment when it's needed, but I will say to the client, you know, things like, how will I know if you get angry at me in a session? So I'm, you're kind of aware of certain emotions that might come out. And, you know, if you do get upset in a session, is there anything that you'd like me to do at that point? So I've kind of, we've spoke about it. That's great. As a transaction analyst, I'd like to encourage the people who listen to this podcast or watching it on YouTube to think about what ego state the person is in, or coming from when you think they need a hug, or even when you think of asking the person, is it okay to have a hug? That's really important, because if you think about it this way, if you're working with regression developmentally, then, you know, if you think about this in terms of childhood ego state, the person could be seven, could be 10, could be three, most likely they'll go to the level of trauma, but you are going to be then in the land of a younger person. And, you know, physical contact might be very necessary in the, in way you started right at the beginning in terms of external communication, the deliver of empathy, the soothing, the nurturing other. I can think of many reasons why touch might be necessary in the healing process, and you need to ask them first, and also remember to think about it clinically, because they could also simply adapt to you. Yeah. Yeah. In particular, like you say, whatever ego state they're coming from, if they're coming from the adaptive child ego state, or yeah. And so if they are, if you are thinking they're adapting, you need to ask it again, see if you can get it from the adult ego state, the transaction back again, rather than taking an adaptive transaction. Yeah. Because we talked about, you know, one of the podcasts years and years ago about the please me driver. So if the young child in terms of the developmental aggressive position I'm talking about thinks they have to please you for strokes, and you're not getting an adult contract at all. No, absolutely. Yeah. And, you know, following on from that, this kind of like the, I'm okay, you're okay in the adult transaction, which is what you're saying rather than, you know, I'm okay, you're not okay. As much as you can, you need to contract the touch from the adult ego state. Now I understand in aggressive developmental work, the person might have gone to a younger place by spontaneously. So it may not be so easy to get an adult contract. But as much as you can, I think it's important that you do. Yeah. And it's, I always, I know it's, it might sound a bit, you know, heavy or not but I kind of always debrief afterwards. If ever I have, you know, we have touched that clients asked me for a hug specifically in a session when they were getting, I think they were feeling overly anxious and that she said, you know, can I have a hug please. So I did, I went and sat by and I gave her a hug, but we had a debrief after about how they felt rather than not talking about it after the fact. I think that can be quite therapeutic. You know, why did you feel the need to ask me for a hug and, you know, just, yeah, talk about it. Because potentially they could get a backlash when they're outside the therapy room. Absolutely. I think it's a very good professional stance that you take there, definitely. And I'll repeat again as well that though I see the many, many, many benefits of psychological contact through touch, for example, and all the ways you said, there is another way of looking at this and I'm repeating what I said five minutes ago, but I think it's important that touch may also close someone down. That probably might be strange for the podcast listeners to hear. But I think it's true. Yeah. Because the client may, it's in psychoanalytical terms, so it's an unconscious process and may manipulate you to give them a hug or soothe them so they don't go to where they need to go to. Yeah. Does that make sense? It does. It does. Absolutely. But it's how you would know that that's what they were doing. That's maybe what the confused look is for. I think it's going back about 20 transactions, Jackie, we were just talking about. The therapists are trained to look for adaptations and you know, it's try hard. You know, the drivers are all talking about maybe many of the podcast listeners coming from different modalities are trained also to look for the defense systems around adaptation as well. So I don't want to discount that. However, clinically, you need to think about is this person adapting to me here? Yeah. It's a very important question. So one of the reasons you'll know is if you feel that they're not being genuine, if you think they're over adapting to you, if you think that they're trying to manipulate in some ways to get some touch or hugs to not develop their own sense of expression of emotion or go to where they need to go to. I know it's a clinical judgment, but you should be thinking clinically all the time anyway. You could even ask the person if you felt in some ways there was a lack of authenticity or a defense system or adaptation, you could ask them, oh yeah, you know, I'd really like to give you a hug and I was wondering which ego state this request has come from or I was wondering what would happen if I didn't? Now, people again listening to this may want to have different thoughts on this process, but they are clinical options you can take without rushing in willy-nilly. Yeah, absolutely. And I do agree, I think it can be a way of avoiding certain things. Oh, well without doubt, without doubt. Yeah, I think, you know, hopefully the listeners might even notice that in, you know, not necessarily in a therapeutic relationship but in our own personal relationships that sometimes we can use, you know, touch and hugs and affections as a way of diverting from something. Absolutely. I'll tell you what it could be. It could be the encouragement of self-agency, the process where they move away from taking action. There's many reasons they may encourage that process to have touch, which actually shuts them down. This will all be done unconsciously, shuts them down. Yeah. Making action, for example. Yeah. Having said all that, I don't want people to listen to this to think that I'm not in favour in terms of relational work to look for relational needs. And for people who have had particular trauma or people who have had quite a lot of neglect in the history, I think touch can be extraordinarily important, but it needs to be done with a contract. Yeah. Touch can be really powerful if it's used appropriately and at the right time in, you know, in a therapy process. Definitely. Yeah. And most of the body therapists are therapists that come from the belief systems of embodied trauma. Well, I would imagine and hopefully have an adult contract for touch because often the trauma is held in the body. I was thinking of massage therapists here, particularly knowledge. I had a massage the other day and I didn't know the person particularly, but we were talking afterwards about the person's training. And I said, well, I think all massage people's training massage actually should have some training in counselling skills or understanding the whole process of trauma being held in the body because, you know, clients can go to particularly or be triggered back to particularly sensitive times and the massage person might even be unaware of that and not know what to do. Yeah. Absolutely. Yeah. There's a book in there. The body holds the score. Is it? Yeah. Yeah. Yeah. Talks all about body and body therapy and a lot of the trauma is held in the school. The body knows the score, I think the trauma is held in the body. So that's a plea for massage therapists to think about things in this way. And of course, you know, as I said earlier on, you know, body therapists, massage therapists, they all use touch and touch is really, really one of the quickest ways to get through people's defence systems. Yeah. Now, there has to be a contract that way. Other ways you could, and that's a strong word, I'm using it tentatively. If you don't get a contract, I think you could be in the world of abusing them. I was going to say, there's a very fine line, isn't there? There's a grey area there about, you know, whether you cross the line or not. That's very important. You know, another really big area to think about. And I think therapists are trained in this and are thinking more about this every day. It's a very common word now used a lot in training. And that's the area of neurodiversity. Yeah. Because with the neurodiverse clients, particularly I was thinking of people high on the Asperger's process or high on autism, or they certainly would feel very overwhelmed, I think, if the therapist decides to suddenly touch them. Yeah. They feel very overwhelmed and want to shrink back. Yeah. So we have to think about neurodiversity when we're thinking about touch, I think. Yeah. Because, you know, if they are on the spectrum, the spectrum is quite a wide ranging one. So we might not always have an awareness of that, you know, especially in the early days of seeing a client. Yeah. And I was, in fact, I don't see clients now, I was talking to a therapist about this, and they've gone on some training and they talked about the use of touch with neurodiverse people. And there was somebody in the room who was very high on the Asperger's scale and felt, what's the word? I want a slight better word than abuse, but certainly invaded. Yeah. The therapist helped them with that concept. Yeah. And I can see, I can see that, you know, yeah, definitely. I thought, I think it's really important, debriefs as well, what you said earlier on. I think that's a very good practice as a psychotherapist. If you're going to do any of this developmental work, even though you might have a contract, and even though it might be important for touch around the healing of trauma, I think it's important that's talked about. Yeah. What happened is that the client will probably move developmentally to a different eager state, an adult eager state. And in the debrief, you can talk about this and talk about treatment process in it. And the reason about what we're talking about here now. Yeah. Yeah, absolutely. Because it's about them being in an okay place when they leave the therapy room, that there isn't any shame or guilt or embarrassment or anything like that, which to prefer, even if there isn't any touch involved, if a client does get emotional, I usually do that before they leave anywhere. And there's a rise of what I would call cognitive therapy at the moment in 2023. You've got the NHS, which CBT is the favoured modality, cognition and behaviour has been the major method for cure. So there is a rise of cognitive therapies and behavioural therapies, who from that position, they would see cognition and behavioural processes as the way for cure and no need for touch at all. Now, we could call, by the way, looking at cognitive distortions and some of the behavioural tasks I'm talking about, psychological contact, through transactions, for example. But they wouldn't be taught about, I'm going to see the need, I think, for touch. Yeah. Now, the Gersholt Therapist or the EFT Therapist or the Developmental Regressive Therapist or some of the Integrative Therapists, they would think about the healing being in the past, not the present. So it would work regressively or developmentally where the trauma is and would certainly argue for the need for touch, as being a healing process with the traumatised child. Yeah. It's interesting because they are quite in therapy that we do. It's really emotive when people are touching the horse or when the horse makes a move towards them and the horse touches them. It physically brings up emotion for people. So touch is really powerful. It is immensely powerful and usually with a neglected child or a traumatised child, sorry, touch is an important process to utilise. So I think we know that and EQUI therapy I don't know much about, but I really understand that. I do have two dogs and one of the dogs would be a wonderful for a therapy dog. Yeah. And I think there's so much in touch here. Another thing I just want to say before we finish on the podcast here, and that is that we're talking about adult psychotherapy here. You do not touch, that's put in another way. Therapists who work with children below the age of 18 do not touch. No. Regardless. Yeah. They're sort of local parents if you like. And it's a very important tip for anybody listening. However you think the child might need a hug or pat on the back or whatever it is. Contract or no contract, you don't do it. Absolutely. 100% agree. Yeah. It's a very difficult situation. Having been a foster carer, we were always told that we would never be in a room with a looked after child with the door closed. You know what I mean? Obviously, I'm not talking about bedrooms and things like that. They could close the bedroom doors, but you know what I mean? We would never shut the living room door if I was on my own in the room with one of the looked after children. But confidentiality wise, you need to close the door in a therapy room. So you do need to protect yourself from anything in that room, really. Yeah. Yeah. Any interpretation. Exactly. Yeah. Finding truth. I mean, you worked with children in this whole area, so you must be very clear here. Yeah. Absolutely. Yeah. And it sounds awful, but it is about protecting yourself in that situation because, you know, they might not say something in malice, but, you know, accusations and allegations, you know, can be made. Absolutely. You've got it many times, unfortunately. Yeah. So that's sort of one thing I want to say because we've been talking about adult psychotherapy and there's many, many therapists who work with children and adolescents where it touches, we just don't do it. Yeah. Yeah. You need to protect yourself. You need to protect yourself as far as the adults are concerned, but even more so, where children are concerned. Yeah. I sort of wanted to say that for people listening and might be working with children adolescents. Yeah. It's a very controversial area this in terms of adult psychotherapy, I think, is a lot written about use of touch, not touch, but for the very beginning psychotherapists, I think the most important thing is if you think, oh, should I touch the client, should I not touch the client? I would like you to step back a moment in your head and think about two things. One, the clinical reason why you think that person might need a hug. And secondly, perhaps the most important, they'd be decided to go ahead with it. You ask them first. Yeah. And the third, and this is vitally important, and we've said many, many times in this podcast, you need to take that clinical intervention and what happens next to supervision and to discuss the reasons why you decided to ask the client, is it okay if I hug you or whatever you did? Yeah. And you need to discuss the response back again. And what was the clinical thinking about initiating touch in the process? Yeah. So contracts, clinical thought, and the use of supervision is vital when you want to bring touch into the therapy process. Yeah. I'm somebody who spent years working developmentally and aggressively and have used touch many, many times from clinical reasons and I could talk about here. I've taken this to supervision many times, but I have always, I think, well, I don't know, I've been going a long time, got consent first with the client. Yeah. The other thing, I wish we'd have had a second podcast is nice, Jackie, but the other thing we could talk a lot about it, we've got a couple of ways to talk about it. And that is, when you ask the client, here's the kind of scenario for you. So the client's getting distressed. And so you think, oh, well, the client perhaps needs a hug here. So you ask them and I say yes, then they give you a hug. And you think everything's okay. And they come back and then they talk about it not being okay, because you were just like, or you felt like, you know, my abuser for my history. And what you've forgotten in our process, or hopefully I've made this up so it wouldn't happen, is that the person's got a history of sexual abuse. So some clients, many, many, you know, I talked about traumas, but we're talking about sexual abuse here particularly. The hug may not be a hug. Yeah, I'd be a hug from you. But for the person on the other side of it, it can easily turn into, transferentially, the hug from the abuser. Yeah. Yeah, yeah, you do need to be very, very careful about, like you say, you know, even if you verbally contract and they say yes, it's what happens after that. Yeah, that it might bring up something for them. That's, yeah. Especially if people have been used inappropriately. They've been sexually abused. They have a history of sexualized and apropanous. In the transference, they can make you easily, they may not start out this way, into the abuser for my history in terms of projection. Yeah. Yeah, so it's not something to do lightly in a session. Especially again, if you work in the world of transfers, then you may think X. Yeah. In the transferential process, and you may never know this, you don't, you become someone else. And that's someone else might have been their abuser from their own history. Yeah. Now, then transfers gets all mixed up. And you, and in that process, you know, it's like, well, Claren repeats history. And therapy goes nowhere. Yeah. Yeah, it's kind of like, you know, like you say, it'll be a trust that's broken transferentially. That's what it'll feel like that something's changed in the relationship, definitely. Yeah. Yeah, I like, it's not something that I think there's only two occasions and on both occasions, I've been asked by the clients to give them a hug. Yeah, I do tend to use my body language and lean forward and, you know, to me, drop the tone of my voice and nurture them in that way. But it's not something that I would feel comfortable doing. No, what you're talking about there is you're transacting psychological contact by, you know, in that way. So, but once we get into this process of transferential worlds, yeah, working with aggressively, psychodynamically, developmentally, often, you know, you aren't who you think the client thinks you are. In other words, they often project to you the negative object into you and you may not even know about it and you end up repeating history. Yeah, which happens in therapy anyway, but if you put touch into the mix with somebody that's been abused, it's, yeah, it's a big deal. Okay, so the three tips. One is you make sure you have consent for your client. Secondly, you are aware of transference, like I've just said. Thirdly, that you take this to supervision. Yeah. Fourthly, you think about step back and think about this clinically. What is the reason I'm doing this for or offered this for? Yeah, and maybe having my ex foster carer head on making sure that you make a note of it in your notes potentially, if you do keep notes that, you know, on this occasion, what happened just so that you've got a term of reference for it. Yeah, because I've known where I've known things go dreadfully wrong, not just for the client in terms of whether there's been a repeating of history and, you know, therapy's gone, not the direction, not a healthy direction, but also for the therapist where they've been accused of something being sexually inappropriate or whatever we want to say here. And they know that wasn't their intention at all. Yeah, absolutely. Yeah. After projection and projective identification, the therapist can find herself suddenly in a transferential nightmare. Yeah. So not wanting to skirt the living daylights out of any therapist out there, but, you know, my advice would always be cover your back. That's what I always used to say as a foster carer. To think about it clinically, use supervision and ask the client. They're three golden rules. But also, yeah, well, those are the three golden rules. I use them all the time. And I'd really like what you said, which is debrief from an adult position. If you do go down that road at all. Yeah. Absolutely. So next time, Bob, I think it'll kind of follow on quite well from this. We're going to be talking about therapy by Roth, the inexperienced therapist. Oh, yes, that's a, I can't quite go back 40 years, but I certainly took a long time, I think, to move away from, you know, take things by wrote in the therapy process. So yeah. Okay, talk until next time, Bob. Thank you very much. You're welcome. Bye. You've been listening to The Therapy Show behind closed doors podcast. We hope you enjoyed the show. 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