Touching may be the most intimate type of self-disclosure and is one of the most controversial subjects discussed by analysts. Whether a pat on the back, a hug, a handshake or a comforting touch, therapists have a varied opinion about what is appropriate.
For many analysts, any physical interaction between analyst and patient is off-limits. A handshake initiated by the patient is usually considered the most acceptable form of physical interaction while erotic interaction, at the other end of the spectrum, can result in the forfeiting of a professional license and possibly more. But what about physical interactions that fall between the two poles? While some therapists consider that even a pat on the back exceeds acceptable professional boundaries, others tend to be more flexible about physical encouragement.
As analysts, comfort can serve as a barometer when we are faced with any form of physical interaction with a patient. A physical response by the analyst that’s tentative, awkward or uncomfortable may cause a rupture in the treatment. When I am presented with a physical request by the analysand that makes me uncomfortable, I explore the meaning of the overture with the analysand to disarm the awkwardness. Although I do not feel uncomfortable with a handshake, if I did, I would articulate my hesitation rather than reveal any tentativeness in an awkward action.
With a physical overture, I always follow the patient’s lead. Handshakes, initiated by male patients as a gesture of thanks, are not uncommon at the end of a session. Typically, I refrain from responding physically to other physical overtures or requests and instead tend to explore them in the course of the analysis. One exception was when I worked with terminally ill patients in their homes. In these instances, my therapeutic boundaries become much more fluid since any rigidity can feel unnatural and be experienced as non-empathic.
I once had a patient who for many years talked about the distance between us and about his strong desire to hold my hand. He claimed that my holding his hand would help him feel connected and comforted. At some point I realized that my declining his request was stalling the treatment. One session, after talking again about the request, I agreed to take the risk. I came and sat next to him and gently took his hand, but when I took his hand I immediately felt awkward and hesitant about how long to hold it. When should I pull my hand away? Should I wait until he pulled his hand away? I suddenly realized there would be a rupture when I took my hand away. After about 30 seconds, I gently pulled away and sat back down in my chair. What I thought would fulfill an aching need turned into rejection. Although for years we had talked about and explored the need, the decision I made to satisfy that need, with the best intentions, backfired. Eventually we recovered from the rupture the handholding had caused and I learned about the power and risk of satisfying even the most basic of physical requests.
The experience with my patient was illuminating. And while I still have set ideas about the role physicality plays in treatment, I am open to the power of touch in the therapeutic setting.