Professor Craig A. Jackson

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Touch in Counselling Practice
Professor Craig A. Jackson Head of Division of
Psychology Craig.Jackson_at_bcu.ac.uk
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• 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)

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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.
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• Professionally Intimate Service
• What sort of issues come up in work?
• depression
• bereavement
• sexual difficulties
• abuse
• relationships
• self-esteem issues

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• 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)

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• 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

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• 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)

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• 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)

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• 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.
• 
  Duck 1988

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• 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.

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• 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 self-disclosure cannot be effectively
  withheld.

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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 ?
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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
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• 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 non-judgementally.
• Thus, the counsellor is providing the
  unconditional support one aspect of an inmate
  relationship (Monsour, 1992).

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• 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.

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• 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 self-disclose more easily.
• Confidentiality helps to provide an atmosphere of
  trust (Monsour, 1992)

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• 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)

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• 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)

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• 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.

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• 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."

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• 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).

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• 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.

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• 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.

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• 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).

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• 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.

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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.
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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.   Eriks
on, E.H. (1950), 'Childhood and Society',
Penguin, London.  
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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.  
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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), '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.   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. (1987), 'Beyond the Core Conditions', in
Dryden W. (Ed.), 'Key Cases in Psychotherapy',
Croom Helm, London.   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, 47-52.
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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.
31
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, 47-52.