Transcript Document

Touch in Counselling Practice
Professor Craig A. Jackson
Head of Division of Psychology
[email protected]
Touch Among Health Professionals
Enhances treatment
Most agree touch is good
Differs between specialisms
Hand most common body part touched - To avoid
misinterpretation
Most likely in private services
Taught on curricula
Moy (1981)
Iatrogenesis
Induced inadvertently by the
medical treatment or procedures
or activity, examination, manner
or discussion of a physician.
The term is now applied to any adverse condition in
a patient occurring as the result of treatment by a
physician or surgeon, (e.g. acquired infections)
A disease produced as a consequence of medical
or surgical treatment.
Professionally Intimate Service
•What sort of issues come up in work?
• depression
• bereavement
• sexual difficulties
• abuse
• relationships
• self-esteem issues
Psychotherapist Surveys
•87% Psychotherapists touch clients
•(Tirnauer, Smith, & Foster, 1996)
85% Psychotherapists hug clients
(Pope etal 1987)
65% Psychotherapists approve of touch
(Schultz 1975)
Touch now not as common
(Stenzel & Rupert 2004)
Useful definitions of Intimacy
•One problem most central to advancing our
psychological understanding of the experience of
intimacy has been in defining or circumscribing the
phenomenon itself. While much has been written on
the topic of intimacy in a variety of contexts by both
academic and 'popular' authors, paradoxically, there
exists less research (and even less concurrence) on
essential matters such as the definition of intimacy.
•Register & Henley 1992
Intimacy
• Wide interpretations of intimacy
• Describes some delineations of intimacy as more central
than others (Monsour 1992)
• Self-disclosure is one widely used definition
• Amount of self-disclosure in a relationship is frequently used
as a measure of intimacy (Duck, 1988)
• Studies have shown that one person strategically releasing
more personal information can lead to the other person
responding with equally increased levels of intimate
response (Derlega and Margulis, 1983)
Intimacy
•An intimate relationship is
one in which neither party
silences,
sacrifices,
or
betrays the self and each
party expresses strength and
vulnerability, weakness and
competence in a balanced
way.
•Lerner (1993)
Intimate Communications
1. you self-disclose if you want to be liked and approved;
2. the amount of self-disclosure must not be too much in the
circumstances, particularly to start with;
3. self-disclosure should be matched to the intimacy level of
the relationship (which could be changing, therefore can be
used to escalate or de-escalate relationships);
4. one person reciprocates the other person's disclosures
(and likewise can influence the growth or decline of the
relationship);
5. self-disclosure changes & expands as relationship grows.
Two kinds of Intimacy
• Derlega and Margulis (1983) describe self-disclosure into
descriptive and evaluative intimacy
• Descriptive intimacy
• disclosure of unknown factual material
• e.g. you have two brothers and a sister.
• Evaluative intimacy
• disclosure of personal feelings or judgements
• e.g. you are feeling very angry after an examination failure.
• Evaluative intimacy, or "emotional expressiveness"
(Monsour, 1992), is seen as an important component of
intimacy.
Self Disclosure
•Self-disclosure can also be communicated non-verbally
•Paralinguistics
•the relative positioning of the people involved, the body
language all contribute to revealing the feelings of one
person to another (Argyle, 1983).
•However, unlike verbal self-disclosure, non-verbal selfdisclosure cannot be effectively withheld.
Be With Me Please
Can I trust you with my pain ?
To treat it with kindness and respect ?
To listen to it,
So I can speak the unspoken ?
Will you help me catch the tears
As the floodgates open ?
Swim with me into the unknown ?
Save me from drowning in my sorrow ?
If I entrust you with my grief.
Will you help me take care of it ?
Console it ? Soothe it ? Make it feel safe ?
Will you accept is as a gift to be protected ?
Be With Me Please
If I take the risk and end the drought,
Will you leave me alone and sodden after the storm ?
Will you reach for your umbrella,
And just walk away ?
I feel my need and I fear it
As I fear all that I do no understand,
Yet I ask you to be with me,
For I am tired of walking alone
Rogers' Core Conditions
• Assuming the counsellor uses Rogers' core conditions
(Rogers, 1957) at least as a foundation
• Counsellor exhibits a presence which invites intimacy
• The three core conditions
• empathy
• unconditional positive regard
• congruence
• assist the client in feeling valued and listened to nonjudgementally.
• Thus, the counsellor is providing the unconditional support;
one aspect of an inmate relationship (Monsour, 1992).
Perceptions of an Intimate Relationship
• Two participants come to a session with certain
preconceptions
• This affects the degree of intimacy in the relationship
• The counsellor expects to listen attentively to the client and
the client expects to talk about themselves and their
problems.
• With these expectations the client will self-disclose and will
be encouraged to explore themselves at a deep level.
• It is inevitable that the client will view this as an intimate
relationship.
Perceptions of an Intimate Relationship
•The client-counsellor relationship is frequently
governed by explicit boundaries
•Has a powerful effect on the degree of intimacy in the
relationship. e.g. confidentiality can help the client selfdisclose more easily.
•Confidentiality helps to provide an atmosphere of trust
(Monsour, 1992)
Perceptions of an Intimate Relationship
• Confidentiality, and therefore privacy, is an implicit part of
the encounter
• As is a level of intimacy that sometimes reaches, if not
exceeds, that of parent and child or husband and wife.
• We are privy to the secrets the client is barely willing to
share with himself. (Kottler 1993)
Professionally Intimate Service
•The counsellor communicates his or her characteristics to
the client in every look, movement, emotional response,
and sound as well as with every word
•Clients actively construe the personal characteristics,
meanings and causes behind the counsellor's behaviours
in order to evaluate the personal significance of the
counsellor's remarks (Egan 1986)
Physical Touch
•Physical touch is an important aspect of intimacy.
•Argyle (1983) has described the importance of physical
touch in relationships and how this varies for males and
females and between cultures
•Russell (1993) argues that counsellors need to be very
careful in using physical touch:
•Especially if it is not initiated by the client, as the boundary
between sexual and non-sexual touching can be perceived
as very narrow.
Physical Touch
•Controversial case of physical, non-sexual touch
•Case where counsellor and a client had a nude embrace
(Thorne, 1987).
•Thorne describes the risks as follows (Thorne, 1993):
•"Without doubt there was a risk involved in all this but I
would submit that there are few therapeutic relationships
of depth where risks are not involved. In this instance our
shared Christian allegiance, the involvement of Kenneth
(the client's husband) and the deepening sense of
mutuality between us were, I believe, more than
adequate safeguards."
Sexual Contact
•Sexual contact between counsellor and client is
acknowledged to have a detrimental effect on clients
•Forbidden by the codes of ethics of professional counselling
organisations (BACP, 1990).
•Rogers gave his own position against such contact in a
transcription of a session with a client who wished to have
sexual contact with him (Rogers, 1951).
•Evidence that such contact has and does take place
(Coleman and Schaefer, 1986), (Rutter, 1989) & (Russell,
1993).
Sexual Attraction
• In all the cases that she investigated, Russell (1993) found
clients felt that a betrayal of trust had taken place.
• Other common feelings by clients were:
• guilt
• anger
• frustration
• ambivalence
• distorted self-concept
• isolation
• Behaviourally, such feelings often manifest themselves by
destructive behaviour to the self or others.
Sexual Attraction - Counsellor to Client
• Sexual attraction towards the client from the counsellor can
occur.
• Thomas 1991 describes such a case with a client and
illustrates how he dealt with the situation by:
• being congruent
• taking the case to supervision
• undertaking his own therapy
• Emphasises the importance of supervision.
Intimacy Summary
• Counselling is a powerful activity and it can affect both
counsellors and clients.
• Is it intimate ?
• Yes
• Because it is intimate, can that be dangerous ?
• Yes and care needs to be taken
• It is challenging, often very emotional, but very satisfying.
• You do get close to people and that is satisfying
• (although it can also be hard saying goodbye).
References
•Acitelli, L.K., and Duck, S.W. (1987), 'Intimacy as the
Proverbial Elephant', in Perlman, D. and Duck, S.W. (Eds.),
'Intimate Relationships', London, Sage.
•
•Amodeo J. and Wentworth K. (1986), 'Being Intimate',
Penguin, London.
•
•Argyle, M. (1983), 'The Psychology of Interpersonal
Behaviour', 4th Ed., Penguin, London.
•
•British Association for Counselling (1990), 'Code of Ethics
and Practice for Counsellors', BAC, Rugby.
References
Coleman, E. and Schaefer, S. (1986), 'Boundaries of Sex and
Intimacy between Client and Counselor', Journal of
Counseling and Development, Vol. 64, 341-344.
Corey, G. (1991), 'Theory and Practice of Counseling and
Psychotherapy', 4th Ed., Brooks/Cole, Belmont, California.
Derlega, V.J. and Margulis, S.T. (1983), 'Loneliness and
Intimate Communication', in 'Social Psychology', Perlman, D.
and Cozby, P.C. (Eds.), Holt, Rinehart and Winston, New
York.
References
Deurzen-Smith, E. van (1994), 'Counselling and Intimacy:
Monologue, Duologue, Dialogue', Selected Papers from 2nd
Int. Counselling Conf., School of Education, University of
Durham.
Duck, S. (1988), 'Relating to Others', Open University Press,
London.
Egan, G. (1986), 'The Skilled Helper', 3rd Ed., Brooks/Cole,
Belmont, California.
Erikson, E.H. (1950), 'Childhood and Society', Penguin,
London.
References
Helgeson, V.S., Shaver, P. and Dyer, M. (1987), Prototypes of
Intimacy and Distance in Same-sex and Opposite-sex
Relationships', Journal of Social and Personal Relationships,
Vol. 4, 195-233.
Kottler, J.A. (1993), 'On Being a Therapist', Jossey-Bass, San
Francisco.
Lerner, H. (1989), 'The Dance of Intimacy', Pandora, London.
Monsour, M. (1992), 'Meanings of Intimacy in Cross- and
Same-Sex Friendships', Journal of Social and Personal
Relationships, Vol. 9, 277-295.
References
Morton, T.L. (1978), 'Intimacy and Reciprocity of Exchange: A
Comparison of Spouses and Strangers', Journal of
Personality and Social Psychology, Vol. 36, 72-81, 1978.
Register, L.M. and Henley, T.B. (1992), 'The Phenomenology
of Intimacy', Journal of Social and Personal Relationships,
Vol 9, 467-481.
Rogers C.R. (1951), 'Client Centred Therapy', Constable,
London.
Rogers, C.R. (1957), 'The Necessary and Sufficient
Conditions of Therapeutic Personality Change', Journal of
Consulting Psychology, Vol. 21 and reprinted in
Kirschenbaum, H. and Land Henderson, V. (Eds.) (1990),
References
Rogers, C.R. (1957), 'The Necessary and Sufficient
Conditions of Therapeutic Personality Change', Journal of
Consulting Psychology, Vol. 21 and reprinted in
Kirschenbaum, H. and Land Henderson, V. (Eds.) (1990),
'The Carl Rogers Reader', Constable, London.
Rogers, C.R. (1972), 'My Personal Growth' in Burton, A. et al,
'Twelve Therapists: How they live and articulate themselves',
Jossey-Bass, San Francisco.
Russell J. (1993), 'Out of Bounds. Sexual Exploitation in
Counselling and Therapy', Sage, London.
Rutter P. (1989), 'Sex in the Forbidden Zone', Aquarian,
London.
References
Strong, S.R. and Clairborn, C.D. (1982), 'Change through
Interaction: Social Psychology Processes of Counseling and
Psychotherapy', Wiley, New York.
Thomas, P. (1991), 'A Therapeutic Journey through the
Garden of Eden', Counselling, 2, 4, 143-145.
Thorne, B.J. (1993), 'Body and Spirit' in Dryden, W. (Ed.),
'Questions and Answers on Counselling in Action', Sage,
London.
Weigel, R.G., Dinges, N., Dyer, R., Straumfjorn, A.A. (1972),
Perceived self-disclosure, mental health, and who is liked in
Group Treatment', Journal of Counseling Psychology, 19, 4752.