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Setting Clear and Ethical Boundaries with Clients

Section 9
Use of Touch

Question 9 | Test | Table of Contents

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As you know, physical touch is a particularly potent form of nonverbal communication. With increasing concerns about child abuse, sexual abuse and harassment in all forms, touch can be misinterpreted and attitudes can vary widely.

However, people have always used different forms of touch to give comfort and support, to demonstrate acceptance, and to give reassurance. More recently, practice models have been developed. These models, as you know, emphasize hugging and use of physical self more directly in working with people.

If used to meet the need of the therapist rather than that of the client, physical contact is definitely counter indicated. On the other hand, because of the deep need within people that touching satisfies, touching can be extremely useful. However, as mentioned earlier, in light of the recent developments in the areas of sexual abuse, therapists need to be extremely cautious in setting this boundary.

♦ To Touch or Not to Touch?
Here are two cases in which I used touch with totally differing impacts on clients. Mrs. Fisher, a client in her 80's, is a woman without family and apparently without friends. She was facing the final weeks of a terminal illness alone and without family. She was not a verbal person, not easy to talk with, but I struggled along trying to find some way to connect with her. One day I noticed Mrs. Fisher was turning her head restlessly against the pillow in her chair and that her hair was becoming matted and tangled, I offered to brush it out. "You might as well," she replied.

When I finished, I asked if she felt more comfortable. She was obviously struggling with strong feelings and a lifetime of living within herself. However, she said, "My mother used to do that for me." She began to cry and for the first time talked about herself. She reached out for me as she spoke, and I held her hand.

♦ Robinson's Ethical Decision Making
Recall now Robinson's three step ethical decision making method. Ask yourself, "What was the context of this situation?" Was the hand-holding in conflict with the client's goals? In this situation, was there a potential for harm? It is my feeling, in this case, breaking the boundary of physical contact was ethical.

♦ Case Study: Jason
The second case, however, had quite different results. Jason was an angry, rebellious teenager forced to come in to see me. I felt he probably viewed me as a fatherly figure. As I walked with him from the waiting room to my office, prior to one session, I accidentally touched his shoulder as I reached for the edge of the door. "Get your hands off me!" he yelled. Unlike the hand-holding in the previous example, the brush of the client's shoulder was accidental and not intended. This served to increase my awareness to always stay a "safe distance" away from Jason, so as not to violate his space boundary.

Think of a client that you touch, perhaps via a hug at the end of the session. What is the client's situation that makes this okay? What are the context of the hug and the nature of the relationship between you? If you never touch any of your clients, is this an ethical boundary you might consider reevaluating or not?

Sexual Boundary Violations by Health Professionals -
An Overview of the Published Empirical Literature

- Halter, M. Brown, H., and Stone, J. (2007). Sexual Boundary Violations by Health Professionals – an overview of the published empirical literature. The Council for Healthcare Regulatory Excellence.
Reviewed 2023

Peer-Reviewed Journal Article References:
Bonitz, V. (2008). Use of physical touch in the "talking cure": A journey to the outskirts of psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 45(3), 391–404. 

Margolis, S., & Lyubomirsky, S. (2020). Experimental manipulation of extraverted and introverted behavior and its effects on well-being. Journal of Experimental Psychology: General, 149(4), 719–731.

Muran, J. C., & Eubanks, C. F. (2020). Introduction: Pressure in the therapeutic relationship. In J. C. Muran & C. F. Eubanks, Therapist performance under pressure: Negotiating emotion, difference, and rupture (pp. 3–12). American Psychological Association.

Muran, J. C., & Eubanks, C. F. (2020). Therapist performance under pressure: Negotiating emotion, difference, and rupture. American Psychological Association.

Stenzel, C. L., & Rupert, P. A. (2004). Psychologists' Use of Touch in Individual Psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 41(3), 332–345.

QUESTION 9
What is one good method to assess if your touching of clients violates an ethical boundary? To select and enter your answer go to Test.

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