TOUCH AND ITS IMPACT IN PSYCHOTHERAPY                                                        Self & Society, Volume 37, No.2. Winter 2009

By David Mazure

To be touched is a wonderful, exciting and moving thing. It is possibly one of the most important aspects of being alive. To touch one another deeply, or to be touched, is surely to taste the very best life has to offer.

       When it comes to touching our clients, however, we therapists are a little anxious. That is probably a good thing, but why?

       The reason is because our clients have placed in our hands a responsibility of care for their wellbeing, and to touch another consciously is very daunting if we really consider its implications.

       However, I am using the word touch in a particular way. I am using it to mean move, impact, transform, affect, stir etc. It is my view that without being touched, not on the surface, but deeply inside ourselves, we will not be changed. And it is only when physical touch is intended as a deeper form of contact that it becomes moving and generates change. Change is daunting because the stability upon which we rely is threatened; both our inner and outer worlds might no longer be the same. Yet, if we are not willing to court that danger in psychotherapy, the potential benefit is inevitably limited.

       It is my experience that touching our clients deeply is essential in accomplishing change in psychotherapy. It is the universality of that experience, I believe, that has brought the therapeutic relationship into the heart of our work. This is not the accidental relationship that we inevitably have in the day-to-day conduct of our lives, but a purposeful one, a particular relationship that is the very medium of the therapeutic process. And it must be a real relationship with all the complexity and difficulty and danger that a real relationship entails.

       The realisation of how deeply we touch our clients, and they us, causes us to be rightly cautious. This, for me, has been the basis for understanding the role of the therapist as an active participant at the core of our clients’ lives, rather than a passive reflective observer. And this has important implications.

A client complained to me that the therapeutic relationship was bound to be an artificial one by its very nature. He said that it was difficult to believe that I might be fond of my clients, that I might become attached to them. I responded by saying that I was aware he found it difficult to say that I might be fond of him. It was at that point that he began to cry as he realised how important it was for him that I might be fond of him and that I might really care about him. Just contemplating that possibility touched and moved him deeply. My client was right to question why I might be fond of him, why I might care.  In our lives such experiences are rare indeed, and they usually come with a considerable cost to our autonomy.

       It is my view that psychotherapy at its best engenders the capacity to be truly and wholly oneself in the world: to be revealed in one’s entirety, to flourish, to blossom into a particular and unique human being. Its task is to unravel the ways in which we keep ourselves hidden and untie the knots that bind and constrain us. These are the puzzles our clients bring us in the form of presenting problems, the defences that protect us until we dare to emerge into the light of day. I do not believe that intellectual understanding alone can accomplish such a goal.  The purpose of the therapeutic relationship with its realness is that it can be a safe and supportive space in which to explore that possibility. And what makes it a safe and supportive space is the attitude of the therapist.

Certainly, it was not until I felt truly touched by the care and love of another person, that the stuck and destructive relationship I had with myself could be transformed. And I am now absolutely clear that our willingness to reveal ourselves in the world and avail ourselves of what being in the world has to offer is entirely dependent upon the relationship we have with ourselves. This understanding is the most important that has emerged from nearly twenty years of practice, teaching and supervision.

I remember a particular experience, a simple event. My therapist expressed anger at something that had happened to me. At that moment I knew without doubt that he was indeed angry and that he was angry on my behalf. I do not believe that I had ever had an experience before in my life of someone really seeing me, of seeing how deeply hurt I was and genuinely caring. His expression of unequivocal care and support for me deeply impacted me in the most strange and profound way. I felt him reach forward with some part of himself and direct it with precision through all my defences and touch the most vulnerable part of myself. I literally mean that I felt touched by him as though he had put his hand inside me and touched me with what I can only describe as love. It shocked me for two reasons. Firstly, because I knew he had expressed genuine care for me, but more importantly, I knew he had stepped through my defences into the most hidden and protected part of myself and really seen and touched me. I sensed for the first time what was meant by a constructed false self and how I hid within that construction.

The most important outcome of that experience was that it changed my relationship with myself. Prior to that experience I had developed a fairly good sense of my inner world. I had mapped it according to sound psychotherapeutic theory. I understood how I had got so lost in my life and how I could become a better person. I had examined my behaviour, my beliefs and attitudes, my scripts, transferences and projections. I had looked into my past and seen how all these things had developed, but I had not looked at the relationship I had with myself. I had not seen how little I valued myself, or how little I believed I deserved care, love and appreciation. I can see how psychotherapy might have merely enabled me to become a more benignly defended person were it not for the impact of that experience.

My therapist had another way of showing me care and understanding. He was a formal man who shook my hand when I arrived and when I left; the kind of physical touch that forms the imperceptible ground of everyday relating and holds no other particular meaning. However, occasionally, when I had shown that I felt moved, whilst he shook my hand on leaving, he would extend his other hand and hold me at the elbow for a moment conveying a profound sense of care. That small physical gesture was like an embrace; at those moments he held me, all of me.

On one occasion I invited a client, with whom I had a good and trusting relationship, to lie on the rug in my room to feel fully supported by the ground, and to connect with her body and her breathing. To aid her in that process I asked her for her permission to place my hand on her belly so that she could breathe deeply into it and have a different experience of her breathing. She said that this would be ok, however I did not expect her response. When she sat back down in the chair she was obviously deeply moved and agitated. Whilst the exercise was interesting she said, and showed her something about her breathing, it was my willingness to touch her that had so deeply moved her and was something she never expected me to do. She loathed herself and thought she was ugly and undesirable; my willingness to touch her impacted her in a way I had not accomplished up to that moment.

Physical touch, as I have said above, can be nothing more than part of the imperceptible ground of our lives. My client was used to being touched by professionals and I was acting professionally; it was not the touch alone that impacted her. When I touched my client, I intended to bring to her awareness the way she restricted her breath and consequently the relationship she had with herself. What was unusual about this experience was that it was I who had touched her; it was the relationship she had with me that was unusual.  I know now that I had inadvertently crossed an important defensive boundary and touched her far more deeply than I intended. The realisation of the importance I had acquired at the core of her life moved me just as it had moved her.  Today I am fully aware that the extent of the change in my clients’ relationships with themselves will depend on the depth of the therapeutic relationship. And I am also aware of how critically important it is that the relationship we therapists have with ourselves is compassionate, deep and thoroughly understood. The understanding that the relationship we have with our clients is built upon the one we have with ourselves is one of the principle reasons why supervision is so vital.

This is at the core of psychotherapy’s appropriate concern with touch. That it is expressed only around the physical manifestation of touch is naïve. To touch another human being, in whatever ways touch can be experienced, is to step upon sacred ground and should be done with an aware, wise, open and honest heart.

I am lucky to have had trainings that not only included physical touch and an awareness of the body but also challenged our taboos around touch, intimacy and sexuality. Different cultures have different maps of their personal space and how to negotiate contact, and these maps will include rules for physical contact too.

One of those areas determined by such rules is the choreography of initial contact and in this I almost always take my client’s lead. I intend to enter my client’s world and I want to convey from the outset that I intend to respect my client’s particular culture. Some people would call this the construction of the therapeutic alliance or the working relationship. For me it is just how I ought to enter into any relationship. This means that there may not be any physical contact at all, at the outset or thereafter. It might mean that handshakes, or hugs, or even kisses become part of the co-created culture that forms the expression of our relationship. And all of this becomes, very quickly, the normal and therefore imperceptible ground of a particular relationship.

My task after this initial contact is twofold: I need to acquire a good and deep understanding of the inner world of my client, and I need to impact it. For my clients it is the latter goal that truly matters. They will accept the need for me to understand their inner world and, for that matter, for them to reach the same understanding, but only because such understanding will contribute to transforming something about them that resolves their presenting problem. Something has to change.

Another of my clients tried to explain what I meant to him. He said that he didn’t want to call me his rock because it was too frightening to consider the possibility that I might not be there one day. Although there was much sadness beneath the surface he managed to stay safely above it, and then, laughing he said that if it was frightening for him to be so dependent on me what must it be like for me to be so depended upon. Whilst he was acknowledging how deeply touched by me he felt, he was also acknowledging the challenge to me of being willing to be in that relationship, and the responsibility.

He is right; it is frightening. It is a huge responsibility to know how much I have come to mean to him and many others. Psychotherapy is a vocation; it is about care of the soul. And by soul I mean the experiencing part of us, the part that is conscious and aware, especially of ourselves. But it is not just my clients who are so deeply touched, who become dependent, and who are impacted and transformed. I often sit alone at the end of the day profoundly moved and impacted by the journeys my clients and I have made. I am indebted to them as much as they are to me for the richness we reveal about our humanity and the possibility for extraordinary intimacy and everything that means.

And so, at last, here we are at the difficult core of the problem. And it is love. But why is love problematic? I daresay that love is, and always has been, the most sought after commodity in the entirety of human existence. I need love, not to exist or survive, but to truly flourish, to grow to my fullest capacity, to become everything I have the potential to become. And to be touched by love as you stand before another, open and vulnerable, is overwhelmingly powerful. To be in such a position whilst carrying the responsibility of care for the other in that encounter is frightening. At least it is frightening for me.

To touch another physically and be touched by that, to be in an intimate embrace and be nakedly exposed in it, to feel love and loved and to feel fully accepted is a truly powerful experience. The kind of powerful experience that can transform the relationship we have with ourselves deeply and permanently. It requires more than skill, it requires a willingness to take a huge risk and go beyond the ordinary. It requires the courage to stand in a sacred place where our childlike innocence is revealed in all its vulnerability, where we can stand truly and wholly ourselves and discover acceptance and love.

One of my clients responded to the encroaching experience of her feelings of pain and terror by dissociating in a hysterical manner. She would recoil involuntarily in her need to hide, and would become incapable of speech. It frightened her to be so vulnerable, and her vulnerability frightened me. I had already made a commitment to her process and to ensuring that the boundaries were containing rather than restricting, and the impact of this on my life was enormous in terms of the time and energy it took. Her frequent dissociation and inability to speak had made physical touch a central part of our work. Even sitting and standing were so difficult and painful that chairs were abandoned in favour of a futon and cushions. And we both began a journey to an encounter with the most vulnerable part of her. I understood so well the need to impact the relationship she had with herself and the need for therapeutic depth. I knew that this required me to know myself deeply and to have the best possible relationship I could with myself. What I did not know was that this would be a journey deeper into my self than any I had undertaken thus far.

One of the most frightening things for her was what she described as her infinite need for me. I experienced her infinite need as love. And the vulnerable part of me yearned for this love. The deeper we went the more aware I became of that part of me awakening. In my counter-transference she had become my mother. So often in supervision I would describe how there were three people in the room: two vulnerable children and a therapist. The intensity of these feelings as I sat holding her in my arms, struggling to guide us safely and successfully through each experience, often threatened to overwhelm me. In its physicality, the sensuality and sexuality of our relationship could so easily have been acted out, I could have taken fright and fled, I could have lost faith. Instead we were transformed.

Opportunities like that are rare; to be touched in the deepest part of my being and be awakened to such need and love and to have such a profound, vulnerable sense of myself has been a real gift.

My fear at this time of regulation is that such opportunities will be lost because our work entails so much that is risky, wild and intimate. It is easy to see why anyone peering in from outside might misconstrue what is happening. And it is worrying that in the regulator’s efforts to make our work safe: its structures and processes determined and, in my opinion its passion and philosophy subservient to pseudoscience, (and with the NHS such a powerful emergent employer, symptom relief given priority over holistic wellbeing), any external regulator might end up severely limiting psychotherapy’s potential for deep understanding and change. Furthermore the distinctions being made between psychology, psychotherapy and counselling are dismaying, not just because they don’t make sense to me, but because they seem to lose sight of the core of our work; the care of the soul. I hope my fears are unfounded.

To touch the life of another is a serious responsibility when that other has placed their life in your hands. It is easy to see why it might be safer to stand back from such feelings and attachments and choose only to reveal to our clients how they have been starved of touch and love, and not be willing to provide a real experience of the depth of these feelings. I understand why it is so daunting to initiate a journey into what might become a deeply loving relationship. But I am aware, now more than ever, that it is only through being deeply touched that we will be transformed.