Touch in Child Counseling and Play Therapy

An Ethical and Clinical Guide

Janet A. Courtney, Robert D. Nolan, Janet A. Courtney, Robert D. Nolan

• Publisher: Routledge
• Year: 2017
• Print ISBN:
  9781138638525
• eBook ISBN:
  9781317241973
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Touch in Child Counseling and Play Therapy explores the professional and legal boundaries around physical contact in therapy and offers best-practice guidelines from a variety of perspectives. Chapters address issues around appropriate and sensitive therapist-initiated touch, therapeutic approaches that use touch as an intervention in child treatment, and both positive and challenging forms of touch that are initiated by children. In these pages, professionals and students alike will find valuable information on ways to address potential ethical dilemmas, including defining boundaries, working with parents and guardians, documentation, consent forms, cultural considerations, countertransference, and much more.

Part I

Overview and the Ethical Implications of Touch

1Overview of Touch Related to Professional Ethical and Clinical Practice with Children

Janet A. Courtney

The healing capacity of touch has been latent in our species all along, awaiting only the right culture and intellectual climate.

Renée Weber, PhD, “A Philosophical Perspective on Touch”

•A young boy you are meeting for the first therapy session runs toward you and wraps his arms around your waist giving you a hug. How do you respond?

•In later stages of therapy, a therapist reaches out and touches a child’s hand when she begins to cry. How do you think the child might respond?

•A school-aged girl wants to sit in your lap as you read a story. Do you let her?

•A young boy who was sexually abused abruptly grabs the breast of his female therapist. How should she respond?

The Professional Context of the Problem of Touch Related to Children

Child counselors and play therapists are challenged daily with ethical and clinical decisions related to touch, such as the ones listed above. Knowing how to best respond or intervene is not easy. What adds to the difficulty is that the topic of touch with children has seldom been addressed in the literature and there are few best-practice guidelines or competency standards available for handling touch-related boundary dilemmas. Lynch & Garrett (2010) advised that touch in practice with children appears to “occupy an unsure space and has tended to remain an ambiguous area for many” (p. 393). As well, many practitioners are understandably concerned about professional liability regarding touch issues that arise in sessions. In fact, the quandary about touch and children is not limited to the psychological field but is relevant for teachers in the classroom, medical personnel, religious institutions, and to the general consciousness of our society (Carlson, 2006; Field, 2014).

Prior to the 1980s there was only moderate concern over the issue of touching children within our schools and mental health systems—in fact, touch as treatment with children and families was promulgated, for example, Virginia Satir (Haber, 2002). However, the pendulum swung swiftly during the eighties as high-profile child sexual abuse cases came to the forefront (Carlson, 2006). The sobering reality of abuse by those who were placed in trusted positions to care for children had an enormous impact on policy changes that reverberated through many different institutions and systems that involved children. The vital need to create policies to protect children from abuse resulted in new and more rigorous procedures including the implementation of “no-touch” rules by many school systems and agencies; stricter hiring standards and background checks; increased education about the signs and symptoms of abuse; increased reporting mandates of suspected abuse; and more child-oriented programs that taught children about body ownership and appropriate and inappropriate touch (Carlson, 2006; NASW, 2012). However, as Carlson (2006) stated, “No-touch rules, however, do little to solve the larger society-wide problem of sexual abuse of children” (p. 61).

Some professionals have advocated that the unintended effect of no-touch policies has resulted in a negative impact on children as a consequence of caregivers withholding affection and nurturing necessary to the basic needs of young children (Brody, 1997; Carlson, 2006; Field, 2014). McNeil-Haber (2004) cautioned that no-touch policies with young children could have a “detrimental affect on the therapeutic process” and further reminded that children “may have difficulty understanding that a no-touch policy is not about their personal relationship with the therapist” (p. 132). In view of that, Field (2003) raised the question: “Can you imagine a therapist counseling a hospice patient without being able to touch him or her?” (p. 4).

Nonetheless, the apprehension related to touch with children (and the potential consequences associated with it) has infused itself into the therapy playroom—as well as other settings such as client’s homes, schools, hospitals, and even therapy held in outdoor environments. When this author has spoken to mental health professionals about their perspectives on touch in therapy, they often provided a brief case description where touch generated a pivotal point of positive change for a child in therapy. However, these conversations are quickly trailed by a cautionary look and statement of concern. Many clinicians fear the potential of being falsely accused of inappropriately touching a child. Consequently, they may try to remove any such predicament by refraining from touch (McNeil-Haber, 2004; Zur & Nordmarken, 2016)—even when they may consider it to be therapeutically appropriate. This could be especially true for male therapists who, much like male teachers (Cushman, 2009), may feel uncomfortable with touch when working with young children, or who may feel they are at a higher risk for allegations.

Clinicians train for many years to obtain their hard-earned credentials and the risk of a potential lawsuit due to a false allegation is a reality, albeit a rare one (Zur & Nordmarken, 2016). What compounds these trepidations is that touch is highly inevitable in a playroom environment (Courtney & Siu, 2017). Meaning: intended or not, touch can happen—whether it’s a child tapping a therapist on the shoulder, or hands touch while passing a crayon—touch happens! The wide range of dynamics of touch in providing counseling services to children are complicated, and policies, laws, regulations, and guidelines are needed to protect children from abuse (see Association for Play Therapy, 2015). Beyond that, the question arises: How best can practitioners walk the tightrope between providing child clients with attuned, empathetic, and responsive touch, and the same time protect themselves from a professional liability standpoint, while also proficiently managing the myriad of instances when touch happens—including acts of physical aggression by a child? It is these considerations and others that this book will be addressing.

Historical Context of Touch

Although touch has been used as a healing art since ancient times, attention to the topic historically is scant, as Weber noted, “touch as an interactional modality has been neglected” (1990, p. 13). In China around 2760 BCE, healing touch was described in an acupuncture manuscript, and around 400 BCE the Greek physician, Hippocrates advocated that a physician must be skilled in rubbing the body for health. And Greek philosopher Aristotle, who lived between 384–322 BCE, in trying to figure out exactly what organ touch is related to (such as the organ of seeing is the eyes), finally surmised that it must be the heart and that touch is so crucial to living that, “its absence spells doom to man and all animals” (as summarized by Weber, 1990, p. 18).

In the New Testament people wanted to be close to Jesus because they were miraculously healed through his touch. Many religions heal through laying-on-of-hands while Buddhist monks are often trained in the healing touch therapy, Reiki, founded in the 1800s. For centuries, we have known that children will not thrive, or may even die, without caring touch. In the thirteenth century the Holy Roman Emperor Fredrick II wanted to see if children would develop a natural language without human interaction. Fifty children were taken from their mothers and given to foster mothers who were instructed not to speak to or engage with the children, just to feed and bathe them. All the children died because they could not live without the “clapping of hands, and gestures, and gladness of countenance, and blandishments” (Davidson, 2011, p. 50).

The Feeling Dialogue of Touch

Montagu (1986, p. 128) informed us that the word “touch” is derived from the Old French word touche, of which the definition included the act of feeling something—the emphasis being on the operative word “feeling.” Thus touch, as Montagu enlightened us, was originally connected to emotion and we use the word touch in our common daily usage to denote different types of feeling states such as “That really touched my heart,” or “She is so touchy.” Fascinatingly, emerging research may support the notion that certain kinds of light touch may indeed be connected to emotion and may also play a part in attachment and bonding. Denworth (2015) advised, “This newly recognized system, known as affective or emotional touch, consists of nerve fibers triggered by exactly the kind of loving caress a mother gives to a child” (p. 32). Touch, therefore, is a powerful form of emotional communication and, unlike the other sensory systems, it is inherently reciprocal. Weber (1990) distinguished between them thus: “I can see but not be seen, and hear without being heard, but I cannot touch without being touched” (p. 24).

A very intriguing and moving conversation highlighting the reciprocity of touch took place between play therapy pioneers Gary Landreth and Viola Brody, when Dr. Landreth interviewed Dr. Brody about the role of touch in therapy with children in Developmental Play Therapy—a touch-based model of play therapy (see Center for Play Therapy, 1995, for the interview). In order to demonstrate the impact of touch in the therapeutic relationship, Dr. Brody initiated a sustained hand-holding experience with Dr. Landreth and asked him to comment on what he experienced. She listened as he stated that he could feel warmth and strength emanating from her, but she was also interested in what he felt and experienced for himself, with the emphasis on the touch-dialogue that was happening between them. The intention of the exercise being: what do children experience, assimilate, learn, and feel for themselves when touched in a caring way by a caretaker or practitioner who can be fully present with them? Thus interpersonal touch creates an emotional dialogue between the one touched and the one touching, and as Linden (2015) pointed out, “the sense of touch is intrinsically emotional (feelings!) and that social warmth and physical warmth are interrelated” (p. 173). (Developmental Play Therapy is elaborated on in Chapters 3 and 4; see also Theraplay in Chapter 5.)

Amazing personal stories demonstrating the power of touch for infants can be found on Youtube: View a mother and father’s astounding account of providing skin-to-skin contact to their non-breathing infant, Loving Touch and Mom’s Intuition: Kate Ogg and Jamie’s Story, retrieved: http://fb-232.dailymegabyte.com/doctors-say-theyve-lost-the-baby/. And watch a twin-sister story that actually changed medical protocols, The Rescue Hug, retrieved: https://www.youtube.com/watch?v=0YwT_Gx49os

The Relevance of Advances in Neuro...

Table of contents

• Cover-Page
• Half-Title
• Title
• Copyright
• Dedication
• Contents
• List of Illustrations
• List of Child Studies
• List of Vignettes
• About the Editors
• About the Contributors
• Foreword by Eliana Gil
• Preface
• Acknowledgments
• Part I Overview and the Ethical Implications of Touch
• Part II Play Therapy Models That Use Touch as an Intervention
• Part III Healing Children Traumatized by Touch
• Part IV Innovations and the Utilization of Touch with Children
• Part V Toward the Development of Core Competencies Supporting the Ethics of Touch in Child Counseling and Play Therapy
• Index