Client Experiences with Touch in Psychotherapy: An Empirical Study Principal investigator: April Corrice SMP mentor: Elizabeth Williams, PhD

Touch in Psychotherapy Defined as physical contact between clients and therapists –Handshakes, hugs, even sexual contact The current study –Client experiences with touch in psychotherapy Controversy over its practice –Potential benefits, potential harms, ethicality

Potential Benefits Better therapeutic relationship −Increased trust and openness (Horton, 1998) −Positive correlation between therapeutic alliance and positive perceptions of touch in therapy (Horton et al., 1995) −Better alliance related to better client outcomes (Crits-Christoph et al., 2006) Therapist’s expression of empathy and acceptance Positive impact on clients –Increased self-esteem (Geib, 1998; Horton, 1998) –Increased self-exploration (Pattison, 1973)

Potential Harms Premature termination –2% of clients and 3.8% of therapists terminated therapy because of discomfort after touch (Stenzel & Rupert, 2004) Therapist exploitation of client Potential for misinterpretation –Therapists’ most commonly expressed fear about touch (Clance & Petras, 1998) Relationship too affectionate (Ramsdell & Ramsdell, 1994) Clients with sexual abuse history −Some say dangerous (Durana, 1998; Toronto, 2001) −Some say beneficial (Horton, 1998; Rabinowitz, 1991) Touch may lead to sexual attraction or sexual contact

Occurrence of Touch in Psychotherapy How common is touch −90% of therapists report very rarely or never touching their clients (Stenzel & Rupert, 2004) −13% of therapists report never touching their clients (Tirnauer, Smith, & Foster, 1996) Types of touch −Handshakes are the most common, followed by hugging and holding hands (Stenzel & Rupert, 2004; Strozier, Krizek, & Sale, 2003) −Sexual contact is rare Discussion and initiation of touch −Therapists often ask for permission to touch, but do not regularly discuss the meaning of the touch with clients (Stenzel & Rupert, 2004)

Research Questions Occurrence of touch in psychotherapy –How common is touch? –Types of touch? –Who initiates touch? –Discussion of touch? Client evaluations of touch in psychotherapy –Overall positive or negative experiences? –What factors are related to client evaluations? Relationship between touch and the therapeutic alliance –How is touch related to the therapeutic alliance?

Methods Participants –74 SMCM students who had been to 3+ sessions of individual psychotherapy –Predominantly female (82.4%) and Caucasian (90.5%) Measures –The Working Alliance Inventory, Short-Form (WAI-S; Tracey & Kokotovic, 1989) 3 subscales (tasks, goals, bond) and a total score –Questionnaire on experiences with therapy and touch Psychotherapy history (e.g., length of time in therapy) Reasons for seeking therapy Information on therapist (e.g., sex and ethnicity) Experiences with touch in psychotherapy (e.g., types of touch) Evaluations of touch (e.g., impact on comfort) Sexual attraction to therapists

Results: Descriptives Occurrence of touch in psychotherapy –Of the 74 participants, 70.3% (n = 52) had experienced touch in therapy –Of the 52 who experienced touch, 69.2% reported shaking hands and 50% reported hugs –No sexual contact was reported –About 50% expressed that the touch was just a formality –66% experienced infrequent touch, while 34% experienced frequent touch –42.8% said the touch was initiated purely by the therapist –Only one participant discussed the touch with her therapist –No participants reported that touch increased sexual attraction

Results: Descriptives General client evaluations of touch –69.4% reported generally neutral experiences –26.5% reported generally positive experiences –4.1% reported generally negative experiences See handout for more detailed evaluations –Impact on therapeutic relationship, comfort, self-esteem, and feelings of acceptance –Clients’ stories about touch

Results: Significant Findings Handshakes vs. other touch types (e.g., hugs) –Participants who experienced other touch types had a more positive impact on their self-esteem from touch in therapy and engaged in more frequent touch. –Male clients and therapists were likely to engage in just handshakes, while female clients and therapists were likely to engage in other touch types. Formality vs. other touch reasons (e.g., support) –Participants who engaged in touch for reasons other than formality had more positive general evaluations of touch and had a more positive impact on their self-esteem from touch in therapy. Client’s psychotherapy history –Participants who had seen more therapists in their lifetime had more positive general evaluations of touch and experienced more feelings of acceptance due to touch.

Results: Significant Findings Touch vs. no touch –Participants who experienced touch in therapy had a better alliance with their therapists on the three WAI-S subscales and the WAI-S total.

Discussion Limitations –Sample Size (e.g., differences between participants with sexual abuse histories and participants without sexual abuse histories) Diversity –Could not pilot questionnaire Future research –Research on this topic contributes to ethical guidelines –Need more comparisons between participants who have experienced touch and those who have not –Methodological concerns Qualitative, quantitative, recruitment procedure