Physical Contact in Psychotherapy

• Massaging of the buttocks is gestalt therapy? by T. Dunn, 3/2/97
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    • Something More Upon Which To Chew by Philip Brownell, 3/4/97
      
      

I have read this discussion of the place for touch in Gestalt Therapy with sadness. Other than Philip Brownell bravely standing up for his position that there may be a place for physical contact in therapy, all of the other opinions seem to run strongly against. For instance, Ed Riemann stated,

"I think this is one boundary that we as therapist should not even consider crossing. Many people who end up in therapy are there because they have been subjected to physical and or sexual abuse by their family, friends. and alleged lovers."

As a client over the years, I have experienced many occasions where touch was helpful in my own therapy. These ranged from supportive, nurturing touch as in a gentle hand on my back or hug, to pressing firmly on my chest and abdomen to help facilitate emotional discharge. These all came in the context of working with Gestalt Therapists (3 different therapists at different times).

As a Gestalt Therapist I have used touch to good effect in similar ways. One example: I was working with a male client dealing with feelings of shame. At one point he was struggling to say something good about himself. I asked if it was okay if I put my hand on his heart. He said yes and cried as soon as I did so. He later told me that that had been one of his more profound healing sessions. This makes sense given that the origin of shame is postulated to be the "breaking of the interpersonal bridge" (Gershen Kaufman, "The Psychology of Shame"). Putting my hand on his heart showed, in a way much more powerful than words, my support, caring and acceptance, thereby "restoring the interpersonal bridge" and countering the shame.

Now a caveat is that I would be much more hesitant to put my hand on the heart of a female client due to the proximity of her breasts. This is unfortunate, but a reality of the situation. With female clients I am more likely to ask her to put her own hand on her heart or to ask if it is okay that I put my hand on her shoulder. If a female client has a sexual abuse history, then I am extremely careful about any kind of physical contact but do not rule it out once sufficient trust and safety has been established.

Philip, I agree with you that touch can be an important part of any psychotherapy including Gestalt. It should be done carefully, with therapeutic goals clearly in mind, and always only with the client's direct permission. A therapist should also bring up occasions of physical contact in supervision to make sure that the therapist's issues were not involved. Given all of this, touch can be helpful and healing. I also don't mean to imply that physical contact with a client should happen frequently--only that it can have an important place in a healing context.

Setting the Record Straight

Joe Wysong wrote:

"No matter to what extent the physical (stop using "the body" when discussing Gestalt therapy) may be integral to the therapuetic process, physical contact with the client is not necessary and should, given the potential problems involved, be avoided. As I thought I made clear in my previous post, those body therapists who influenced the development of Gestalt therapy theory did not touch those they worked with. As you are able to work with the physical without touch, it is irresponsible to suggest that touching should be a psychotherapeutic tool whether you practice Gestalt therapy or use another approach."

"In addition to the theoretical contribution of the muscular armor, Reich broke with the classical psychoanalytic position by introducing techniques of intensive body contact with the patient. These body contacts were both diagnostic and therapeutic. First, by feeling the patient's body, Reich could assess the muscular armoring, locating the focal points of bound energy. Second, release of the energy sometimes could be facilitated by exerting pressure on these points of tension in the patient's body. In doing this, Reich set a precedent for the therapist to have direct physical contact with the patient as an integral part of psychotherapy."

So, I definitely support the careful use of physical contact in psychotherapy. The remaining question is whether physical contact is part of Gestalt theory or not. I don't personally know if touch is part of "pure" Gestalt Therapy. All I can say is this: I attended three training programs (two at Gestalt Institutes and one more general body-oriented psychotherapy training program which included Gestalt Therapy). I have also seen three Gestalt therapists in private practice. In all six settings, I either experienced being touched myself or witnessed other clients being touched to good benefit. This didn't happen frequently, but it did happen in each setting. So, in my experience, physical contact has been a part of the practice of Gestalt Therapy at Gestalt Institutes and with private Gestalt practitioners. This doesn't prove anything as far as "pure theory" goes, but does show that touch is used in the practice of Gestalt Therapy (at least at some places). I, for one, am in favor of its use.

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