Physical Contact with Clients

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The very topic of therapist-client sexual involvement as well as concern that we may be subject to an ethics complaint or malpractice suit may make many of us very nervous. We may go to great lengths to ensure that we maintain physical distance from our clients and under no circumstances touch them for fear that this might be misconstrued. A similar phenomenon seems to be occurring in regard to increasing public acknowledgment of child sexual abuse: adults may be reluctant to hold children and engage in nonsexual touch that is a normal part of life.

Is there any evidence that nonsexual touching of patients is actually associated with therapist-client sexual involvement? Holroyd and Brod-sky (1980) examined this question and found no indications that physical contact with patients made sexual contact more likely. They did find evidence that differential touching of male and female clients (that is, touching clients of one gender significantly more than clients of the other gender) was associated with sexual intimacies: "Erotic contact not leading to intercourse is associated with older, more experienced therapists who do not otherwise typically touch their patients at a rate different from other therapists (except when mutually initiated). Sexual intercourse with patients is associated with the touching of opposite-sex patients but not same-sex patients. It is the differential application of touching—rather than touching per se—that is related to intercourse" (p. 810).

If the therapist is personally comfortable engaging in physical contact with a patient, maintains a theoretical orientation for which therapist-client contact is not antithetical, and has competence (education, training, and supervised experience) in the use of touch, then the decision of whether to make physical contact with a particular client must be based on a careful evaluation of the clinical needs of the client at that moment in the context of any relevant cultural and other contextual factors. When solidly based on clinical needs and a clinical rationale, touch can be exceptionally caring, comforting, reassuring, or healing. When not justified by clinical need and therapeutic rationale, nonsexual touch can also be experienced as intrusive, frightening, or demeaning. The decision must always be made carefully and in full awareness of the power of the therapist and the trust (and vulnerability) of the client.

Our responsibility to be sensitive to the issues of nonsexual touch and explore them carefully extends to other therapeutic issues conceptually related to the issue of therapist-client sexual involvement. Our unresolved concerns with therapist-client sexual intimacies may prompt us to respond to the prospect of nonsexual touching either phobically—avoiding in an exaggerated manner any contact or even physical closeness with a client—or counterphobically—engaging in apparently nonsexual touching such as handshakes and hugs as if to demonstrate that we are very comfortable with physical intimacy and experience no sexual impulses. These unresolved concerns can also elicit phobic or counterphobic behavior in other areas, such as the clinician's initiating or focusing on sexual issues to an extent that is not based on the client's clinical needs. To respond ethically, authentically, and therapeutically to such issues, we must come to terms with our own unresolved feelings of sexual attraction to our clients.

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