Touch in the therapeutic encounter
The various ways of entering into an exchange, are the first signs or signals to the setting, reflect the tone of the engagement and set the dynamic of the interaction that is about to take place. Whether it is the more distanced, polite shake of the hand, the buddy pat on the shoulder, or the hugging embrace of friendship, almost all involve some form of physical contact.
The performance of greeting someone is also the very first contact of the practitioner and his patient in a homeopathic consultation. Think about it, how do you greet your patients? Is there a form of physical contact involved? The longer you have been with them on their journey to recovery, does that change the way you welcome them? Would you permit a patient to place those little socializing kisses on your cheek, unless you were practising in France where this is a habitual practice? Have you ever thought about touch and its impact in a therapeutic setting? Does touch happen during the consultation, aside of the ceremonious welcoming act? What is ok, what isn’t, and how may this impact the therapeutic dynamic?
It is uncommon to extend physical contact, beyond the greeting rituals, in the homeopathic consultation. We are after all not practising a manual therapy, and are reliant on the patients description of his or her presenting state, which in the event of a normal case-taking persists without bodily engagement . We have learnt that by being present, listening attentively, and being empathic we can create a space that the patient may find sufficiently comfortable, such that he or she may be inclined to share his or her story. We provide a comfortable space and emphasize its safety by expressing the unifying elements of the therapeutic relation, through our vocal explanation, physical gestures, and an unprejudiced disposition. This requires no physical contact. We are patient centred, and it is the sickly individual, seeking our service, that can best describe his or her own state.
In our homeopathic consultation the two habitual opportunities for touch; one welcoming the patient into the consultation, the other dismisses him or her from it, are the only forms of physical contact that are necessarily in employment. But what about physical contact during the consultation? What nature is this and what purpose may this serve? .
This third opportunity for touch may solely be one with strictly defined purpose, where deemed indispensable and only when absolutely necessary . This is a sensitive form of contact, as this may be one that is not necessarily interpreted as being positive by the patient. It is one born out of the situation within the consultation, in response to the patients account of his or her case. Incorrectly applied, such touch within a case-taking, can harm the patient.
Therefore, such touch must be very selective, and must serve the purpose of enhancing the therapeutic communication ; aimed at building rapport, creating a trusting and comfortable union . Such “ethical touch is non-erotic and based on clinical judgement” [4, (p.35)]. In such events, touch can promote self-disclosure and compliance , and may have a healing effect .
Albeit the positive aspects intended by such touch, there are times and specific cases, when it may also impact negatively on the patient. It may adversely influence the dynamic between the patient and therapist.“When touch is not in line with the emotional connection between the therapist and client, it can lead to discomfort” [4, (p.36)]. Instead of being perceived as an indicator of empathy, or as a comforting gesture, it may actually be interpreted as dominating or intrusive; as a violation of boundaries .
But what makes physical contact unethical? Tune  stresses that it is the intention that promotes the physical contact that is decisive of how touch is perceived! The motivations of bodily contact may be manifold, yet in a clinical setting, in particular that of homeopathy, a therapy that is not ‘hands on’, explicit boundaries and board instructed ethical guidelines seek to manage the use of touch in the therapeutic encounter. This applies to all CAM therapies . Ethical instructions are necessary, as the holistic consultation is a space less defined than that of the conventional medical consultation. The CAM encounter is an environment where there is a greater “emotional exposure” and a more “intimate atmosphere” [1 (p.195)], than is habitual in a conventional setting .
Therefore, the meaning of a comforting pat on the shoulder of a patient is dependant on the dynamic of the patient-practitioner union; the intent of it. There is a thin line on which all practitioners are moving. The comfort zone of the patient may not be violated. For homeopaths, physical contact is largely restricted to the greeting rituals ahead and at the end of a consultation, yet how this is done, and how all other incidences of touch in the therapeutic relationship are undertaken, is still is a careful choice that must have an ethical intent.
 Schiff, E., Ben-Ayre, E., Shilo, M., Levy, M., Schachter, L., Weitcherner, N., Golan, O. & Stone, J. (2010) Development of ethical rules for boundaries of touch in complementary medicines – outcomes of a Delphi process [online] Complementary therapies in clinical practice, 16, pp.194-197. Available at: doi: 10.1016/j.ctcp.2010.05.009
 McLeod, J. (2004) Touching and being touched The consellor’s workbook: Developing a personal approach, p.104. Maidenhead: Open university press
 Hoffman, S. & Gazit, M. (1996) To touch and be touched in psychotherapy? Changes, Vol. 14 (2), p.115-116.
 Joshi, P., Almeida, M. & Shete, P. (2010) Attitudes toward physical contact in a therapeutic setting: Role of gender and expertise [online] Journal of the Indian academy of applied psychology, Vol.36, pp.35-43 Available at: medind.nic.in/jak/t10/i1/jakt10i1p35.pdf
 Uphoff, A.  Touch and the therapeutic relationship: Shifting a paradigm. In S. Haugh & S. Paul (Eds.), The therapeutic relationship: Perspectives and themes (pp.213-216). Ross-on-Wye: PCCS Books.
 Tune, D. (2001) Is touch a valid therapeutic intervention? Early returns from a qualitative study of therapists’ views Counselling and psychotherapy research, 1:3, pp. 167-171. Available at: DOI: 10.1080/14733140112331385020
About the Author:
Uta Mittelstadt, BSc & MSc in homeopathic medicine: I am a homeopath, an artist, a writer and a vegegan, a traveller, and adventurer. I’m a crab born in June. I am passionate about homeopathy. I have a BSc and MSc in homeopathic medicine. I love to investigate and write about my findings, and I blog at Clever Homeopathy