"The important thing about the wounded healer (a therapist who has also suffered), is that he or she must be far enough along in their own healing process, not to harm their patients, but to be able to help them to heal too."
-- Pat Törngren

WHY THERAPEUTIC TOUCH IS IMPORTANT        

One of the most powerful tools in psychotherapy, is that of appropriate physical touch. The reason for this is that touch, can bypass the most complicated third-line defences and take us directly into second or even first-line (very early) memories. This is because the part of the brain that registers physical touch is much more primitive than the part of the brain that registers emotion (second-line pain) or rational thought (third-line pain). Personally, I am a primaller who normally finds it easiest to talk my way into my feelings. Even so, there are times when I find that using non-verbal tools such as listening to music, being touched by a therapist or being hugged by a primal buddy will give me access to feelings I can't reach any other way.

THE DEBATE ABOUT TOUCH IN THERAPY        

Most non-verbal ways of getting people to their feelings, (such as listening to music), are quite neutral, and nobody gets upset about them, but when the subject of physical touch comes up, the debate becomes heated. The reason is that touch can very easily turn into inappropriate sexual acting-out or the invasion of personal boundaries. So touch by a therapist, has to be handled very carefully indeed, especially by a therapist of the opposite sex to the patient. Therapists find themselves treading a very fine line, and when this issue is debated, the argument can become quite heated, as happened recently on the Primal Psychotherapy Page.

The bone of contention was a book written by Dr Paul Vereshack, in which he admitted to allowing a patient to touch him in a sexual way in order to relive memories of her own sexual abuse as a child. (Dr Vereshack now admits that this is a dangerous practice. Although the particular patient felt she was helped, and came to his defense, he has declared that he will never allow it to happen again). Dr Stephen Khamsi replied to this book with a very strongly worded article criticizing Dr Vereshack. Although I agreed with many of the points he raised, I found Dr Khamsi's article very confrontational in tone (which somewhat reduced the impact of what he was saying).

Dr Vereshack replied with an impassioned plea for therapists to be allowed to give nurturing touch to patients if they needed it. At that point the issue was taken up by various people on the Primal Psychotherapy Page Message Board and hotly debated, with several people taking sides. Some people praised Dr Vereshack for his honesty, while others attacked him. Someone else came out strongly in his defense, and was rebuffed for not leaving him to speak on his own behalf. Emotions ran high, and overall the debate seemed to generate far more heat than light!

MY EXPERIENCES WITH TOUCH IN PRIMAL THERAPY        

My own experience is in classical Primal Therapy, rather than with such therapies as Reichian, Rolfing or Radix, where touch is used a lot. Nevertheless, during my time as a patient at the Primal Institute in L.A. in the 1970s, several of the therapists used touch to help me to get to my feelings.

On the first occasion, I was talking to my therapist about why I am afraid of getting too close to people. I talked about my granny's death. I loved my granny very much indeed and I was the person she turned to for love after my grandfather died. Towards the end she became quite senile, and often didn't recognize other family members. But she always recognized me. I visited her every evening, and sat holding her hand. She would cling to me, not wanting me to leave. This was terrifying to me. Although I loved her very much, it brought up the fear that by holding onto me, she was trying to "pull me into death" with her.

I remember telling this to my therapist. I was sitting in the primal room, next to her, and with my eyes closed as I spoke. Suddenly she grasped my hand and held onto it, exactly as if she were my granny. For a few seconds I went into shock, and then I began to cry deeply. I had a long, connected primal telling my granny how very much I loved her, but that I couldn't go with her. She had to let go of me and allow me to go on living. (The feeling has never come up for me again, and I believe it was resolved in that one session, by my therapist taking my hand.)

On another occasion a different therapist did something similar. I stood up in "post-group" and started struggling to talk my way into a feeling. (I don't remember now what it was). I just remember the therapist, Sherry, saying to me, "Pat, you are always very articulate and can talk about your feelings easily. Don't say anymore. Just come and sit on my knee." I did that, and she held me while I cried. The insight that I had afterwards was that I needed to be held by my mother, but she wasn't a very tactile person. So for me, talking was the only way I could reach her. But it wasn't what I really wanted. I didn't want to have to talk in order to feel close to my mother -- I wanted to be hugged and held as Sherry had intuitively done for me.

The only other experience of touching that I had while at the Primal Institute was not so successful. It was during the last week of my "three week intensive". During that week we were introduced to a "co-therapist" of the opposite sex to the therapist we normally worked with. My co-therapist was a big man - gentle, kind and caring, but very big. To me, as a victim of childhood sexual abuse, he was a bit overwhelming. Nevertheless I had a deep primal in my session with him. Afterwards he said to me, "You've been through a lot today. Come and let me just hold you." I complied, and he sat on the floor and held me. But I felt very uncomfortable and literally "froze". If it happened to me today, I would be able to say, "No thank you. I know you mean well, but I would rather not be touched by a stranger."

NURTURANT TOUCHING VERSUS THERAPEUTIC TOUCH         

The illustration given above brings up an important point. My therapist holding me after a primal, to comfort me, is quite a different issue than touching someone in order to bring up their pain. While the latter type of touch by a therapist is often appropriate, the former can present all kinds of difficulties. We are all human creatures needing physical touch in order to flourish, but the question is, should we be getting it primarily from our therapists? Or should we be encouraged to find it in other appropriate ways? After all, if hugging and holding were all we needed in order to heal, we would all have become well years ago. In fact therapy would be the easiest thing on earth to do. All we would need would be hugs!

The whole point about primal therapy is that we have to feel the pain of what we didn't get in the past, and no amount of hugging and holding in the present is going to change that; in fact it may distract us from feeling it. The only thing a therapist can do to resolve it, is to help us feel our childhood deprivation. On the other hand, it is true that some people are totally overwhelmed by the pain of feeling alone in the present. They sometimes need the reassuring touch of a therapist or buddy to reduce the overload of pain. Only then can they access the primal memory of overwhelming early loneliness in their lives. This would once again be classed as therapeutic touch.

Also I don't feel uncomfortable with a therapist giving a patient a hug at the end of a session provided it is spontaneous or the patient requests it, and provided both the patient and therapist feel comfortable with it. But if it becomes something that is constantly being asked for, by either the patient or the therapist, we need to start looking at it and asking why. This is especially important if either the patient or the therapist starts feeling uncomfortable with the situation. When we do something we don't feel comfortable with, we become "incongruent" with our feelings, and this leads to confusion, and is particularly harmful in therapy.

What I do feel comfortable with is hugging and holding by primal buddies. We ran a primal-buddy support-group at my home in Cape Town for many years and most people hugged and greeted the others before and after each session. During the group session however, touch was limited to the kind that is used to bring up feelings in the other person. (We never made that a ruling, it just happened spontaneously). We were also free to reach out for touch if we needed it. For example, I remember one group session where I was deep in feelings about not having my needs met in infancy. Instinctively, and while crying like a baby, I crawled across the floor and into the arms of my best friend Twanee, who held me while I primalled.

But the relationship between primal buddies, and a therapist and patient, are quite different. There is an implicit doctor/patient relationship involved in formal psychotherapy, because of the fact that money changes hands, and the therapist is a professional. This results in the patient, regardless of their age, often symbolizing mommy or daddy or other significant childhood figures onto the therapist. For that reason, and because for most of us as children, our boundaries were constantly being violated by the adults around us, I would feel very uncomfortable if my therapist wanted to touch me in every session. (It would be a repetition of my childhood and I would start wondering if he were trying to meet my needs or his).

APPROPRIATE THERAPEUTIC TOUCH         

The therapist I am with at the moment touches me very rarely. It happened once when I was in a birth feeling, and I lay in the fetal position with my back towards him "asking" non-verbally for touch. He intuitively picked up on this and put his hands on my upper back, in exactly the right place, which helped me to go deeper into the feeling. When I had had enough, I moved away. I can think of only one other occasion when he has touched me. In spite of this, because of the warmth and caring he exudes, I feel as if I have been hugged and held after every session, even though he hasn't touched me physically.

Interestingly, when he was away on holiday, I worked with his "replacement" who was also very warm and caring. I was able to have a birth primal in my very first session with him. At the end of our series of sessions, I said to him, "I'd really love to hug you, but I know it's not appropriate, so may I shake your hand?" To my amazement, he said, "I'm fine with hugs". So I reached out to him and he hugged me warmly. That brought up a great deal of my pain about childhood-abuse by men. I knew there were issues being triggered that I needed to deal with. So I asked for several more sessions, and went back a few more times, till a brief hug at the end of the session no longer brought up any unresolved pain. But I was glad when I could return to my usual therapist. Although he doesn't offer hugs, I feel more safety and "containment" with him than I have ever had with any other therapist.

SEXUAL TOUCH IN THERAPY         

While non-sexual touch is a valid therapeutic tool, sexual touching is another matter altogether. Recently, I heard about the following two incidents. In the first, the therapist offered her breast to a male patient to suckle on. In the second, a group session, a female therapist removed her clothes and invited her patients to massage her naked body (except for the sexual areas). I simply could not believe what I was hearing. For many years I have been openly critical of Arthur Janov for constantly labelling all therapists not trained by him as "mock primal therapists". But when one hears stories such as these, one can have some sympathy for him. If this is primal therapy, then it's primal therapy gone mad! And incidents like this will certainly give primal therapy a bad name.

In the case of the lady who offered her breast to her patient to suckle on, she made three bad errors. Firstly, even Dr Vereshack who allows nurturing touch, says that his rule is that it must always be requested by the patient, not the therapist. Secondly, the patient said that although he found it pleasant and enjoyable to suckle at his therapist's breast, it didn't bring up any primal feelings. This indicates that even if it had been non-sexual touch that she offered, her timing was wrong. But thirdly, and most importantly, any kind of sexual touching of each other by either the therapist or the patient, is absolutely and totally off limits!

There is a good reason for this. The therapist is the one who has to be clear headed and in control during a therapy session. And none of us are able to think rationally when we are in a state of sexual arousal. We have a wonderful Afrikaans proverb that goes like this, "Met die piel in die lug, is die verstand in die balle". (When the penis is up in the air, the intelligence is in the testicles). The same is true for a woman. Suckling at the breast causes the release of the hormone oxytocin, which contracts the uterus, and is one of the hormones of sexual arousal. (Some women experience orgasm while nursing their babies.) There is no way that a therapist who is allowing a patient to suckle at her breasts is going to be able to act wisely and rationally.

But what should the therapist do if the patient asks for sexual touching? Essentially in therapy, the therapist is the one who has to set appropriate boundaries. People undergoing therapy frequently regress into a childhood state, and children do not always know what appropriate boundaries are. In many cases of sexual abuse, a small child has innocently asked an adult for some kind of sexual touching. The abuse occurs because the adult, instead of gently and lovingly setting appropriate boundaries, exploits the situation.

So by saying no to requests for sexual touch, the therapist can help the person to learn what appropriate boundaries are. On the other hand a therapist who concurs, but feels uncomfortable doing it, is being emotionally incongruent. The patient will pick this up, and be left feeling confused. Refusing a request for sexual touch, and then offering emotional support, is more likely to help the patient to relive the childhood trauma, than allowing the patient to act it out.

CONCLUSION - THE WOUNDED HEALER         

The truth is that we spend a good deal of our lives in pursuit of two things. We may either spend our time overtly struggling to get love and caring from people in the present to compensate for what we never got as children. Or we may covertly try to get our unmet needs met, by symbolically giving to others what we never got ourselves. This is especially true of people in the helping professions.

It is common knowledge that most people who become psychotherapists, social workers or counselors, are doing so in order to unconsciously deal with and resolve their own childhood pain. It's true in other helping-professions too. (I spent many years working as a childbirth educator, helping to ensure that babies got the kind of gentle, loving non- violent birth that I myself never had). There is nothing wrong with this, provided we remain conscious of what we are doing; in fact we can often do a great deal of good. But we need to become very aware of when we are acting out, because when we act unconsciously, then we become a danger to the people we are trying to help.

It is also terribly important that therapists should not use their patients to meet their own unmet needs, especially tactile ones (like the lady who took off her clothes and asked her patients to massage her, rather than getting someone else in her life to meet those needs). If a therapist attempts to do this, they must be stopped. Unfortunately their patients are often vulnerable and are not always assertive or clear-sighted enough to be able to do this. Also patients should not be the ones to have to set appropriate boundaries with their therapists. The setting of boundaries in therapy is the therapist's responsibility.

A good way to guard against the problem arising, is for all practicing therapists to be in therapy themselves, so that they are dealing with their own unresolved childhood issues away from their patients. Every one of us to a greater or lesser extent carries a load of childhood pain and unmet needs. For therapists, this does not mean that they should not be practicing.

Having suffered themselves, can make a therapist even more empathetic and skillful in their work. This is what Jung referred to as the "wounded healer". The important thing about the wounded healer, is that he or she must be far enough along in their own healing process, not to harm their patients, but to be able to help them to heal too.