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A perspective on the use of touch in therapy.

Updated: Jun 11

*Details of case studies below have been changed to maintain confidentiality.

As I approach the end of my Somatic Trauma Therapy training, I have been thinking about the role of touch in the regulation and dysregulation of the nervous system and feeling very stimulated by Deb Dana’s writings in ‘The Polyvagal Theory in Therapy’. As a bodyworker, I know how important touch is in making us feel human and connected and the subtle nuances between touch that feels nourishing and touch that feels threatening.

During a bodywork session, we understand we will be touched even though there is and there should be ample space to clarify what feels adequate for each individual client. When a therapist says “a full body massage” that can actually mean very different things to different people so I always aim to be specific about exactly which areas I’m going to work on and which I’m not. This means I can work in a trauma informed way and avoid areas which the client might find triggering and actively dysregulating.

The humblest moment of my career as a body worker was when a client told me several months after receiving a massage from me that she spent the entire treatment hour in a flashback about being arrested during a stop oil protest because of the lying face down position. She had no idea that physical posture could send her into a very real trauma recall. Sadly she remained in a freeze state for the entire 60 minutes without uttering a word. What’s more, is that I completely ‘failed’ to perceive her sense of inner danger and I felt disappointed in myself for this perceived failure. But this gets me thinking about how - if indeed you are in the job of creating holding safe spaces - I can avoid this from happening in the future

There are of course many things that signal to an individual what is safe and what isn’t. Our bodies are constantly scanning for external and internal cues of safety and danger. Smells, images, sounds, tastes and touch all inform the nervous system about the environment and decisions are often at a visceral level. Of course that as a therapist it would be impossible to control every variable in the book to avoid triggering a client. What we can do, however, is create an environment where discussion is open, transparent, consent-led and trauma informed. But also an environment that is ‘touch-contracted’, a term used by Deb Dana in ‘The Polyvagal Theory in Therapy’. This is I want to talk about today.

Beyond the assumed touch in bodywork, when is it ok to touch a client? If we acknowledge and agree that appropriate touch is a fundamental aspect of being human and that we cannot survive without touch (which indeed we cannot as babies who are not touched will die) and that indeed so many of us are ‘touch hungry’ (as described by Tiffany Field, director of the Touch Research Institute at the University of Miami School of Medicine), then how can we - therapists of all kinds - introduce touch to our practices in a what that feels adequate and therapeutically valuable?

I am thinking about the many clients I work with who have had experiences of cancer where their bodies have been prodded, poked, injected, sliced and operated on. Sadly, how that kind of touch might affect them is a conversation that was never had with them either. They almost always reflect on never receiving from caring professionals a more nourishing kind of touch. Indeed, my belief is that this is because nourishing touch has 1) been advised against in therapeutic settings (and thus professionals are scared of it) and 2) we don’t know and/or haven’t been taught how to deploy appropriate touch in therapeutic settings.

But how do we navigate the complex issue of touching? What does therapeutic touch actually looks like in practice when working with clients? Different professions call for different approaches of course. During a Somatic Trauma Therapy session we might explore (when appropriate and relevant and with consent), what it feels like to sit by a client and place our hand on the client’s back as a means of getting closer to nervous system regulation. The important bit for me is to actually have a conversation about touch and thus create a sort of ‘touch contract’. This could be as simple as ‘How do you prefer me to greet you when you arrive?’. For some people you won’t have to ask the question as they’ll extend the hand to you before you can say ‘Hi’. That tells you that, for that client, a handshake is an important part of how that person establishes connection. Others, at the end of a nourishing session might ask me ‘Is it ok if I give you a hug?’. Discussion and consent are at the core of this topic - to understand what kind of touch regulates that client’s nervous system and what kind of touch actively dysregulates it, one must be curious to ask. For some clients any sort of touching (including a gentle touch on the shoulder on their way out of your therapy room) can just be too much to cope with.

Being able to communicate what kind of touch you need/want/prefer is no easy task however. It is virtually impossible to articulate what you really prefer when you are in a dysregulated state, leaning towards ‘people pleasing’ or ‘therapist pleasing’ (a different sort of ‘freeze’) to avoid ‘awckwardness’ or ‘confrontation’. ‘Touch contracting’ is part of the therapeutic relationship that grows organically by itself. Nobody can trust anyone by command. As such, don’t expect honest ‘touch contracting’ to take place immediately for everyone. Equally important is to remember that ‘touch contracts’ can and do change and as such they should be reviewed often.

I once massaged a client’s head after she booked a head massage. As soon as I touched her head, she flinched. I asked her if she was ok and she said that she was. But as I continued the massage I could see her shoulders rising and her jaw clenching. Her mouth wasn’t saying anything but her body was telling me loud and clear she wanted me to stop. I smiled at her and said “You’re not enjoying this are you? Shall I massage another part of your body?”. We laughed about it and I did a hand massage instead. The takeaway here is to of course understand that for one reason or another said client felt unable to tell me to stop.

The key for me is to continue to intentionally provide an environment that acts as a container of safety so that eventually your client feels regulated enough and feels safe enough to say:

You know, I really can’t stand it when you touch my toes and I’d rather you never do it again. I know you asked before but I just didn’t know how to say it. But, that massage was awesome!

For those interested in how touch affects the nervous system and how to welcome and work with it in therapeutic contexts, I recommend ‘The Polyvagal Therapy’ in Therapy by Deb Dana, forewrod by Stephen W. Porges, PhD.


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