What Films Can Teach Psychotherapists About Appropriate and Ethical Touch in Psychotherapy
By: Ofer Zur, Ph.D. and Birgit Wolz, Ph.D.
Touch in Psychotherapy
Adopted from: Zur, O. & Nordmarken, N. (2004). To Touch Or Not To Touch: Rethinking The Prohibition On Touch In Psychotherapy And Counseling: Clinical, Ethical & Legal Considerations. Online publication at: https://www.zurinstitute.com/touchintherapy.html.
Touch in therapy has probably been one of the most controversial ethical concerns due to the general and incessant cultural and professional associations of touch with sexuality. The major concern is that non-sexual touch may lead to sexual touch and sexual exploitation by therapists (Bersoff, 1999; Gabbard, 1989; Pope & Vasquez, 1998; Rutter, 1989; Simon, 1992). The general injunction against touch in therapy is in sharp contrast to the vast scientific data that has been acquired in the last half century on the importance of touch for bonding, human development, healing and communication (Bowlby, 1969; Field, 1998; Harlow, 1971; Montagu, 1971). The clinical utility of touch in therapy has also been studied extensively and has conclusively determined that touch enhances therapeutic alliance and increases a sense of trust, calm and safety (e.g., Hunter & Strive, 1998; Smith, Clance, & Imes, 1998). Research has revealed that most psychotherapists’ surveys reveal that 87% of therapists touch (Tirnauer, Smith, & Foster, 1966) and 85% hug (Pope et al., 1987) their clients and 65% of therapists approve of touch as an adjunct to verbal psychotherapy (Schultz, 1975). It seems that, while from an analytic and risk management viewpoint touch is taboo, most therapists do touch their clients, appropriately, in the privacy of the consulting room.
Touch between therapists and clients represents one of the most recognized psychotherapeutic boundaries. Harmful boundary violations occur, typically, when therapists engage in exploitative sexual relationships with current or recently terminated clients. In contrast to sexual boundary violations, a client-initiated handshake at the beginning or end of a session, an appropriate, encouraging pat on the client’s back, supportive handholding or a non-sexual hug can be exceedingly therapeutic. Specially trained body psychotherapists, such as Reichian or Bioenergetics therapists, who utilize thoroughly researched and established hands-on techniques, are obviously engaged in extensive therapeutic touch.
Some differentiations between sexual and non-sexual touch in therapy focus on the areas touched (i.e., hand vs. genitals), others focus on whether the intent is to sexually arouse the client or the therapist, or not. Yet others propose an encompassing view that “erotic touch” is any behavior that leads to sexual arousal. Help with differentiation between sexual and non-sexual touch in therapy comes from one of the key studies that found correlations between non-sexual touch and sexual touch. The study showed that the sexual boundary violation was positively correlated, not with touch per se, but with the frequency that therapists touched clients of the opposite sex in comparison with the frequency of touch of clients of the same sex (Holroyd & Brodsky 1980). The important conclusion of the findings was that therapists’ own attitudes towards touch, and their tendency to sexualize touch rather than the touch itself, are the chief factors in contributing to the blurring of sexual and non-sexual forms of touch.
The debate about touch in therapy started with the inception of the new profession early in the 20th century. Ferenczi, originally trained in the psychoanalytic model, at one point spoke out as a proponent of non-erotic hugging, holding and kissing of clients, believing that the use of such therapeutic touch would provide corrective parenting to clients with early injuries. Initially, Freud was supportive but withdrew his support when he became protective of the budding psychoanalytic method from falling into disrepute. Ferenczi refused to stop touching his clients altogether and was subsequently expelled from the ranks of orthodox psychoanalysis (Fosshage, 2000). Reich (1972), who developed the most comprehensive method of clinical touch, was, like Ferenczi, one of Freud’s inner circle and prominent in the International Psychoanalytic Association (IPA). He, too, was ousted for his professional stance on touch in therapy.
Since that time, regardless of the very extensive scientific data accumulated on the importance of touch for human development and healing, in general and specifically in psychotherapy, the field of psychotherapy has generally shied away from discussing it as clinical intervention and a valid ethical, rather than risk-management, concern. The ambivalence regarding touch was initiated by the psychoanalytical concern with the impact of touch on the therapeutic frame and transference analysis. The other source of concern has focused on the power differential and the potential for sexual exploitation of clients by their therapists. Since the early 1990s, the primary concern has shifted to the concern that even casual touch might lead to therapists going down the slippery slope into sexual boundary violations (Gabbard, 1989; Gutheil & Gabbard, 1993; Pope & Vasquez, 1998; Strasburger et al., 1992). Sexualizing therapeutic touch and most other forms of touch, as well, reflects modern Western cultural beliefs that relationships between sensuality, physical sensation and sexuality are intertwined (Dineen, 1996). Part of the problem with differentiating sexual and non-sexual touch in therapy stems from the lack of differentiation between sexual feeling and sexual activity. While about 90% of therapists report being sexually attracted to their clients at some time, an estimated less than 10% have ever consummated a sexual relationship with their clients (Pope et al., 1993; Pope & Vasquez, 1998). Pope et al. (1987), top researchers on therapists’ ethical attitudes and behavior, reflected on the carry over between risk management concerns and the legitimate utility of touch in therapy. They accurately state, “The focus on erotic contact in therapy has raised questions about the legitimacy and effects of ostensibly non-erotic physical contact” (p. 1001).
Following World War II, psychologists explored children’s responses to separation and how parenting styles affect the quality of attachment. They concluded that bonding occurs, not only in response to the reduction of primary drives, but also to “primary object clinging,” ergo a need for intimate contact (Bowlby, 1969; Ainsworth, 1978). In the ’50s, Harlow (1971) conducted his breakthrough experiments, demonstrating the importance of touch for bonding and healthy development through his controlled laboratory research on infant monkeys. He discovered that “comfort contact” proved to be a more significant parenting quality than feeding and that touch, not food, binds infant to caregiver. His studies also revealed that at least one half hour per day of interactive touch was needed to support normal development and that monkeys deprived of interactive touch became neurotic, asocial and exhibited various abnormal behaviors as adults. Harlow’s studies support what has been discovered about the needs of human infants, as well. The absence of loving touch has been documented to have a profound impact on the will to live and when the need for human touch remains unsatisfied, abnormal behavior results (Montagu, 1971).
Montagu (1971) identifies touch as humans’ first language. Long before infants can see an image, smell an odor, taste a flavor or hear a sound, they experience themselves and others through touch, their only reciprocal sense. Touch is, indeed, the first sense to develop in the embryo and all other senses-sight, sound, taste and smell are derived from it. Loving touch in the early years is essential to adequate neurological and emotional development (Bowlby, 1969; Harlow, 1971). Studies in bonding also show that human babies who are held often and touched frequently in their earliest stages of development have higher scores on physical, emotional and interpersonal scales (Field, 1998). The tactile system is the earliest sensory system to become functional in the embryo and there are indications that it may be the last to fade (Fosshage, 2000). It remains a potent form of communication throughout the course of one’s life.
North Americans, in general, are wary of touch, although within the culture there are differences regarding touch among different regions, classes and ethnic or minority groups, which align well with the continuum mentioned above. Research on touch has revealed that many unspoken protocols continue to inhibit touch between classes and racially or ethnically diverse groups, e.g., between Caucasians and African Americans in post-millennial America (Hunter & Struve, 1998). Euro-American cultures, in general, and particularly that of North American white, Anglo-Saxon Protestants, have developed a set of unspoken taboos or rules regarding touch (Cohen, 1987). These taboos or rules include, “Don’t touch the opposite sex!” “Don’t touch same gender friends!” “Don’t touch yourself!” “Don’t touch strangers!” “Do not touch the elderly, the sick and the dying!” “Do not touch those who are of higher status!”
In American culture there is often a propensity to infantilize or sexualize physical contact or to link it with aggression. That means that touch is, primarily, culturally reserved for children or sexual or aggressive contacts. As a result, Americans tend to avoid touch for fear of being misunderstood (Hunter & Struve, 1998). Children are touched more frequently and most comfortably compared to adults, while most public displays of affection between adults are held suspect. This is especially true of males touching males, who are, however, allowed to touch in competitive sports and in military action.
Over the last couple of decades touch in psychotherapy has become increasingly accepted as a valuable therapeutic tool. While conservative therapists continue to avoid touch and risk management warns against it, many other therapeutic orientations accept and employ the use of touch as an aspect of a well-considered treatment plan based upon clinical needs and a clinical rationale (Smith et al., 1998). Touch in therapy has been reported to provide real or symbolic contact and nurture, to facilitate access to, exploration of, and resolution of emotional experiences, to provide containment and to restore significant and healthy dimensions to relationships (Hunter & Struve, 1998). Recent research also supports the efficacy of touch as a healing practice and has demonstrated that touch triggers a cascade of chemical responses including a decrease in stress hormones and increased serotonin and dopamine levels. The shift in these bio-chemicals has been proven to decrease anxiety and depression (Field, 1998; Hernandez-Reif, Field, Krasnegor, Theakston, Hossain, & Burman, 2000).
Sources of the Prohibition of Touch in Therapy
- The general western culture and its emphasis on autonomy, independence, separateness and privacy.
- The cultural tendency in the USA to sexualize most forms of touch.
- The traditional dualistic Western mind-body or mental-physical split.
- Homophobia.
- Some fundamentalist religious denominations that have a highly restrictive view of all forms of touch.
- The litigious culture and the resulting risk management and defensive medicine practices.
- Psychoanalysis and its emphasis on neutrality, distance and rigid boundaries.
- Those feminist scholars who assert that any touch by male therapists of female patients is disempowering and injuring to the women.
- The fear-based, illogical slippery slope idea that non-sexual touch inevitably leads to sexual exploitation.
- The more recent crisis in the clergy and the not too distant daycare hysteria in regard to sexual exploitation.
Therapists can deliberately employ many forms of touch as an adjunct to verbal psychotherapy. These forms of touch are intentionally and strategically used to enhance a sense of connection with the client and to sooth, greet, relax or reassure the client. Their use is also intended to reduce anxiety, slow heartbeat, physically and emotionally calm the client, or to assist the client in moving out of a dissociative state. Therapeutic touch, in this context, most often includes a hug, light touch, stroking the head, rubbing a client’s back, shoulder or arm, rocking or hand-holding.
Types of Touch in Therapy:
- Ritualistic or socially accepted gestures for greeting and goodbye or arrival and departure: These gestures figure very significantly among most cultures and include handshakes, a greeting or farewell embrace, different forms of kissing and other socially and culturally accepted gestures.
- Conversational marker: This form of light touch on the arm, hand, back or shoulder, is intended to make or highlight a point, and can also take place at times of stillness, with the purpose of accentuating the therapist’s presence and conveying attention.
- Consolatory touch: This important form of touch, holding the hands or shoulders of a client, or providing a comforting hug is most likely to enhance therapeutic alliance.
- Reassuring touch: This form of touch is geared to encouraging and reassuring clients and usually involves a pat on the back or shoulder.
- Playful touch: This form of touch may take place while playing a game with a child or adolescent client.
- Grounding or reorienting touch: This form of touch is intended to help clients reduce anxiety or dissociation by employing touch to the hand or arm, by directing a client to touch the fabric of the chair they are sitting on or by leading them to touch their own hands or head.
- Task-Oriented touch: This involves touch that is merely ancillary to the task at hand, such as offering a hand to help someone stand up or bracing an arm around a client’s shoulders to keep them from falling.
- Corrective experience: This form of touch may involve the holding or rocking of a child or adult client by a therapist who practices forms of therapy that emphasize the importance of corrective experiences.
- Instructional or modeling touch: Therapists may model how to touch or respond to touch by demonstrating a firm handshake, holding an agitated child or responding to unwanted touch.
- Celebratory or congratulatory touch: The therapist may give a pat on the back or a congratulatory hug to a client who has achieved a goal.
- Experiential touch: This form of touch usually takes place when the therapist conducts an experiential exercise, such as in family sculpturing or in teaching gestures during assertiveness training.
- Referential touch: This is often done in group or family therapy when the therapist lightly taps the arm or shoulder of a client, indicating that he or she can take a turn, be silent or to reference certain body parts or movements.
- Inadvertent touch: This is touch that is unintentional, involuntary, and unpremeditated, such as an inadvertent brush against a client by the therapist.
- Touch intended to prevent a client from hurting him/herself: This type of touch is intended to stop self-harming behaviors, such as head banging, self-hitting, self-cutting, suicide attempts or suicidal gestures.
- Touch intended to prevent someone from hurting another: This form of touch is intended to stop or restrain someone from hurting another person, as sometimes happens in family, couple or group therapy, or when working with extremely volatile, antisocial or chronically mentally ill clients.
- Touch in therapists’ self-defense: This form of touch is used by a therapist to physically defend himself or herself from the assault of a violent client by utilizing self-defense techniques that restrain clients with minimum force.
Therapeutic touch by Body Psychotherapies is different from the employment of touch as an adjunct to verbal psychotherapy. Somatic and body psychotherapists regularly utilize touch as part of their theoretically prescribed clinical intervention. Massage, Rolfing or other hands-on techniques incorporated or implemented consecutively with psychotherapy also fit into this category.
In contrast to the above-mentioned forms of touch, there are also inappropriate forms of touch. The following three forms of touch in psychotherapy – sexual, hostile and punishing – are unethical and, depending on the state, are often illegal. They are counter-clinical and should always be avoided.
- Sexual Touch: The initiator of this form of touch, between therapist and a current client, intends to sexually arouse the therapist, the client or both. This is always unethical and counter-clinical. It is illegal in many states.
- Hostile-Violent touch: It is always highly inappropriate and unethical for a therapist to touch a client in a physically hostile or violent manner. Depending on the state, it may be illegal.
- Punishing touch: Physical punishment, by a therapist, is never appropriate in the context of psychotherapy.
Like almost all psychotherapeutic interventions the meaning of touch can only be understood relative to the client, the therapeutic relationship and the therapeutic setting. With all three touch can have radically different contextual meanings (Hedges et al., 1997; Koocher & Keith-Spiegel, 1998; Smith et al., 1998). Accordingly, the employment of touch in full context must be thoroughly considered. This includes presenting problem, diagnosis, personality, personal touch history, culture, class and gender. What is highly appropriate and effective with one client, in a certain situation, may be inappropriate and even damaging with another. Hugging a child or letting him or her jump onto the therapist’s lap may be highly appropriate in the course of child therapy but not in the case of a borderline client or most adult clients. Reaching out gently and respectfully to hold the hand of a grieving mother may not have the intended positive effect if the same is done in early stages of therapy with a survivor of sexual abuse. It should be noted that timing is an essential factor as well. In large part clients’ individual experiences constitute the context of touch and, therefore, are of extreme importance.
Ethics and Standard of Care Considerations
Nonsexual, clinically appropriate touch in psychotherapy is neither unethical nor below the standard of care. Like the APA Code of Ethics (2016), ethics codes of all major psychotherapy professional associations (e.g., AAMFT, 2015; ACA, 2014; CAMFT, 2011; NASW, 2017) do not prohibit the use of appropriate non-sexual touch in therapy. All psychotherapy professional codes of ethics view sexual or violent touch with current client as unethical. As with any clinical intervention, touch should be ethically employed with the client’s welfare in mind, taking into consideration client factors. The ethics of touch receives the most extensive coverage in the Ethical Guidelines of the United States Association of Body Psychotherapists (USABP) 2007. This code articulates clearly the ethical guidelines for the use of touch in therapy, the importance of informed consent and concerns with respect, diversity, consultation, record keeping, treatment plans and many other pertinent issues for ethical touch in psychotherapy.
Ethics and Law of Touch in Therapy
This section covers the codes of ethics on non-sexual touch in therapy, Consent Form for use of touch in therapy and California Law and Regulations on sexual touch in therapy.
Codes of Ethics on (non-sexual) Touch in Therapy
This section refers to ethical guidelines in regard to touch or physical contact that is intentionally employed as part of or adjunct to verbal psychotherapy. Counter to common belief non-sexual or non-erotic touch, like many other boundary crossings, are not always unethical. Ethics codes of all major psychotherapy professional associations (e.g., AAMFT, ACA, ApA, APA, NASW, NBCC) do not prohibit non-sexual or non-hostile touch in therapy. All of them view sexual or violent touch with current clients as unethical. However, a couple of these codes (i.e., APA, CAMFT) do not even mention the words “touch” or “physical touch” in their entire codes of ethics.
American Psychological Association (APA) Ethical Principles of Psychologists and Code of Conduct (2016) does not specifically mention any guidelines in regard to touch or physical contact that is intentionally employed as part of therapy.
California Association of Marriage and Family Therapists (CAMFT) Ethical Standards for Marriage and Family Therapists (2011), does not specifically mention any guidelines in regard to touch or physical contact that is intentionally employed as part of or adjunct to verbal psychotherapy.
The National Association of Social Workers (NASW) Code of Ethics (2017):Standard 1.10 Physical Contact:
Social workers should not engage in physical contact with clients when there is a possibility of psychological harm to the client as a result of the contact (such as cradling or caressing clients). Social workers who engage in appropriate physical contact with clients are responsible for setting clear, appropriate, and culturally sensitive boundaries that govern such physical contact.
United State Association for Body Psychotherapy (USABP) Ethical Guidelines (2007)Introductory section:
Body psychotherapists recognize the intrinsic unity of the human being in our somatic nature. Body psychotherapists, therefore, work in ways that foster the integration of bodily sensation, thought, affect, and movement to promote more integral human functioning and the resolution of psychotherapeutic concerns. Body psychotherapeutic methods, including language, gesture and touch, when used in responsible, ethical and competent ways, make an essential contribution to the psychotherapeutic process by including the missing and often alienated aspects of our being which are rooted in our bodily nature and experience.
(It continues in section VIII. Ethics of Touch:)The use of touch has a legitimate and valuable role as a body-oriented mode of intervention when used skillfully and with clear boundaries, sensitive application and good clinical judgment. Because use of touch may make clients especially vulnerable, body-oriented therapists pay particular attention to the potential for dependent, infantile or erotic transference and seek healthy containment rather than therapeutically inappropriate accentuation of these states. Genital or other sexual touching by a therapist or client is always inappropriate, never appropriate.
- Body psychotherapists evaluate the appropriateness of the use of touch for each client. They consider a number of factors such as the capacity of the client for genuine informed consent; the client’s developmental capacity and diagnosis; the transferential potential of the client’s personal history in relation to touch; the client’s ability to usefully integrate touch experiences; and the interaction of the practitioner’s particular style of touch work with the client’s. They record their evaluations and consultation in the client’s record.
- Body psychotherapists obtain informed consent prior to using touch-related techniques in the therapeutic relationship. They make every attempt to ensure that consent for the use of touch is genuine and that the client adequately understands the nature and purposes of its use. As in all informed consent, written documentation of the consent is strongly recommended.
- Body psychotherapists recognize that the client’s conscious verbal and even written consent for touch, while apparently genuine, may not accurately reflect objections or problems with touch of which the client is currently unaware. Knowing this, body psychotherapists strive to be sensitive to the client’s spoken and unspoken cues regarding touch, taking into account the particular client’s capacity for authentic and full consent.
- Body psychotherapists continue to monitor for ongoing informed consent to ensure the continued appropriateness of touch-based interventions. They maintain periodic written records of ongoing consent and consultation regarding any questions they or a client may have.
- Body psychotherapists recognize and respect the right of the client to refuse or terminate any touch on the part of the therapist at any point, and they inform the client of this right.
- Body psychotherapists recognize that, as with all aspects of the therapy, touch is only used when it can reasonably be predicted and/or determined to benefit the client. Touch may never be utilized to gratify the personal needs of the therapist, nor because it is seen as required by the therapist’s theoretical viewpoint in disregard of the client’s needs or wishes.
- The application of touch techniques requires a high degree of internal clarity and integration on the part of the therapist. Body psychotherapists prepare themselves for the use of therapeutic touch through thorough training and supervision in the use of touch, receiving therapy that includes touch, and appropriate supervision or consultation should any issues arise in the course of treatment.
Consent Form for use of touch in therapy:
Informed consent is one of the most important aspects of psychotherapy and counseling. Having clients sign a specific consent form prior to the employment of physical touch in therapy has been suggested by some experts and professional organizations. It is the author’s opinion that such an additional consent form is essential in body psychotherapies whose primarily tool is touch. While verbal or implied consent is always important, such written consent is only optional when touch is used as an adjunct to verbal psychotherapy. When psychotherapists use touch to greet, depart, comfort, consol, model, etc. as an adjunct to psychotherapy, written consent is generally not required.
As with all consent forms, this consent form must be written in simple language that an average person with average education and intelligence can easily understand. It should not include legalese or sophisticated professional jargon. Therapists should take into consideration the patient’s mental state, intelligence, cognitive functioning, level of acculturation and comprehension of English before they give the consent form to a client. Of course clients are entitled to a copy of the consent form.
While separate consent is a valid option, a simple way of dealing with the consent issue is by adding a section to the standard informed consent that all clients should read and sign before the onset of therapy. Such a paragraph may include some of the following sentences:Dr./Ms./Mr. xx may also incorporate non-sexual touch as part of psychotherapy. Sexual touch of clients by therapists is unethical and illegal. Dr./Ms./Mr. xx will ask your permission before touching you, and you have the right to decline or refuse to be touched without any fear or concern about reprisal. Touch can be very beneficial but can also unexpectedly evoke emotions, thoughts, physical reactions or memories that may be upsetting, depressing, evoke anger, etc. Sharing and processing such feelings with the therapist, if they arise, may be a helpful part of therapy. You may request not to be touched at any time during therapy without needing to explain it and without fear of punishment.
When psychotherapists use touch more extensively, such as in body psychotherapies, they may consider using a separate consent form. For more information contact United States Association for Body Psychotherapists (USABP) or any of the individual organizations, institutions or schools that employ somatic or body psychotherapy or training.
Codes of Ethics on Therapist-Client Sexual Relationships (which are always unethical):
American Psychological Association (APA) Ethical Principles of Psychologists and Code of Conduct (2016):
10.05 Sexual Intimacies With Current Therapy Clients/Patients:
Psychologists do not engage in sexual intimacies with current therapy clients/patients.
10.06 Sexual Intimacies With Relatives or Significant Others of Current Therapy Clients/Patients:
Psychologists do not engage in sexual intimacies with individuals they know to be close relatives, guardians, or significant others of current clients/patients. Psychologists do not terminate therapy to circumvent this standard.
10.07 Therapy With Former Sexual Partners:
Psychologists do not accept as therapy clients/patients persons with whom they have engaged in sexual intimacies.
10.08 Sexual Intimacies With Former Therapy Clients/Patients:
(a) Psychologists do not engage in sexual intimacies with former clients/patients for at least two years after cessation or termination of therapy. (b) Psychologists do not engage in sexual intimacies with former clients/patients even after a two-year interval except in the most unusual circumstances. Psychologists who engage in such activity after the two years following cessation or termination of therapy and of having no sexual contact with the former client/patient bear the burden of demonstrating that there has been no exploitation, in light of all relevant factors, including (1) the amount of time that has passed since therapy terminated; (2) the nature, duration, and intensity of the therapy; (3) the circumstances of termination; (4) the client’s/patient’s personal history; (5) the client’s/patient’s current mental status; (6) the likelihood of adverse impact on the client/patient; and (7) any statements or actions made by the therapist during the course of therapy suggesting or inviting the possibility of a post-termination sexual or romantic relationship with the client/patient.
California Association of Marriage and Family Therapists (CAMFT) Ethical Standards for Marriage and Family Therapists (2011):
Section 4.1:
Marriage and family therapists are aware of their influential position with respect to students and supervisees, and they avoid exploiting the trust and dependency of such persons. Marriage and family therapists therefore avoid dual relationships that are reasonably likely to impair professional judgment or lead to exploitation. Provision of therapy to students or supervisees is unethical. Provision of marriage and family therapy supervision to clients is unethical. Sexual intercourse, sexual contact or sexual intimacy and/or harassment of any kind with students or supervisees is unethical.
Section 1.2.1:
Sexual intercourse, sexual contact or sexual intimacy with a patient, or a patient’s spouse or partner, during the therapeutic relationship, or during the two years following the termination of the therapeutic relationship, is unethical.
Section 1.2.3:
Marriage and family therapists do not enter into therapeutic relationships with persons with whom they have had sexual relationships.
Section 3.9:
Marriage and family therapists do not engage in sexual or other harassment or exploitation of patients, students, interns, trainees, supervisees, employees or colleagues.
The National Association of Social Workers (NASW) Code of Ethics (2017), Standard 1.09 Sexual Relationships:
(a) Social workers should under no circumstances engage in sexual activities or sexual contact with current clients, whether such contact is consensual or forced.
(b) Social workers should not engage in sexual activities or sexual contact with clients’ relatives or other individuals with whom clients maintain a close personal relationship when there is a risk of exploitation or potential harm to the client. Sexual activity or sexual contact with clients’ relatives or other individuals with whom clients maintain a personal relationship has the potential to be harmful to the client and may make it difficult for the social worker and client to maintain appropriate professional boundaries. Social workers — not their clients, their clients’ relatives, or other individuals with whom the client maintains a personal relationship — assume the full burden for setting clear, appropriate, and culturally sensitive boundaries.
(c) Social workers should not engage in sexual activities or sexual contact with former clients because of the potential for harm to the client. If social workers engage in conduct contrary to this prohibition or claim that an exception to this prohibition is warranted because of extraordinary circumstances, it is social workers — not their clients — who assume the full burden of demonstrating that the former client has not been exploited, coerced, or manipulated, intentionally or unintentionally.
(d) Social workers should not provide clinical services to individuals with whom they have had a prior sexual relationship. Providing clinical services to a former sexual partner has the potential to be harmful to the individual and is likely to make it difficult for the social worker and individual to maintain appropriate professional boundaries.
Section 1.11 Sexual Harassment:
Social workers should not sexually harass clients. Sexual harassment includes advances, sexual solicitation, requests for sexual favors, and other verbal or physical conduct of a sexual nature.
California Laws and Regulations
Those parts of California Law most relevant to the topics of law and dual relationships, sexual relationships and boundaries in psychotherapy and counseling are in the following sections of the Business and Professional Code of California.
- Psychologists: Chapter 6.6
- MFTs: Division 2, Chapter 13, Articles 1-7, Sections 4980 – 4989.
- LCSWs: Division 2, Chapter 14, Articles 1-4, Sections 4990 – 4998.7.
For complete regulations online:
California Law and Regulations on Therapist-Client Sexual Relationships
The California Department of Consumer Affairs published the brochure, Professional Therapy Never Includes Sex, which states, click here.
The brochure states that according to California laws:
“Touching” means physical contact with another person, either through the person’s clothes or directly with the person’s skin (Business and Professions Code section 728) (p. 7)
Any kind of sexual contact, asking for sexual contact, or sexual misconduct by a therapist with a patient is illegal, as well as unethical, as set forth in Business and Professions Code sections 726, 729, 2960(o), 4982(k) and 4992.3(k). “Sexual contact” means the touching of an intimate part of another person, including sexual intercourse (p. 7).
Sexual contact can include sexual intercourse, sodomy, oral copulation, fondling and any other kind of sexual touching. Sexual misconduct also covers a broader range of activity, including nudity, kissing, spanking, verbal suggestions, innuendoes or advances. This kind of sexual behavior by a therapist with a patient is sexual exploitation. It is unethical, unprofessional and illegal (p. 7).
Sexual exploitation of patients by therapists is wrong. The law makes it a crime for a therapist to have sexual contact with a patient. For a first offense with only one victim, an offender would probably be charged with a misdemeanor. For this charge the penalty may be a sentence of up to one year in county jail or up to $1,000 in fines or both. Second and following offenses, or offenses with more than one victim, may be misdemeanors or felonies. The penalty in such felony cases can be up to three years in prison or up to $10,000 in fines or both.
This law applies to two situations: The therapist has sexual contact with a patient during therapy, or the therapist ends therapy primarily to start having sexual contact with the patient (unless the therapist has referred the patient to an independent and objective therapist who has been recommended by a third-party therapist) (p. 19).
Provide brochure for clients who allege sexual relationships with former therapist/s.
BBS and BOP both mandate that any psychotherapist who becomes aware through a patient that the patient had alleged sexual relationships (notice the term “alleged”) with a previous psychotherapist during the course of a prior treatment, shall provide to the patient a brochure Professional Therapy Never Includes Sex. Further, the psychotherapist or employer shall discuss with the patient the brochure prepared by the department.
Summary and Guidelines on Touch in Therapy
Following is a summary of most relevant issues of touch in therapy (Adapted from: Zur & Nordmarken, 2004 at: https://www.zurinstitute.com/touchintherapy.html)
THE GENERAL SIGNIFICANCE OF TOUCH
- Touch is one of the most essential elements of human development: a form of communication, critical for healthy development and one of the most significant healing forces.
- In his seminal work, Touching: The Human Significance of the Skin, Ashley Montagu (1971) brought together a great array of studies demonstrating the significant role of physical touch in human development.
- The effects of touch deficiencies can have lifelong, serious, negative ramifications.
- Bowlby and Harlow, among many others, concluded that touch, rather than feeding, bonds infant to caregiver.
- Touch has a high degree of cultural relativity. People of Anglo-Saxon origin place low on a continuum of touch while those of Latin, Mediterranean and third world ancestry place on the high end.
- The general western culture and its emphasis on autonomy, independence, separateness and privacy have resulted in restricting interpersonal physical touch to a minimum. America is a low touch culture.
- In Western society, sex, love, power and dominance are dangerously confused.
- Americans tend to sexualize or infantilize the meaning of touch and as a result tend to avoid touch. Watson, parenting expert of the early 1900s, cautioned mothers not to sexualize their infants by kissing or hugging them affectionately.
- The medicinal aspect of touch has been known and utilized since earliest recorded medical history, 25 centuries ago.
- Touch unleashes a stream of healing chemical responses including a decrease in stress hormones and an increase in serotonin and dopamine levels.
- Touch increases the immune system’s cytotoxic capacity thereby helping our body maintain its defenses.
- Massage has been shown to decrease anxiety, depression, hyperactivity, inattention, stress hormones and cortisol levels.
- Massaged babies are more sociable and more easily soothed than babies who have not been massaged.
ETHICAL CONSIDERATION OF NON-SEXUAL TOUCH IN THERAPY
- Touch in therapy is not inherently unethical.
- None of the professional organizations codes of ethics (i.e., APA, ApA, ACA, NASW, CAMFT) view touch as unethical.
- Touch should be employed in therapy when it is likely to have positive therapeutic effect.
- Practicing risk management by rigidly avoiding touch is unethical. Therapists are not paid to protect themselves. They are hired to help, heal, support, etc.
- Avoiding touch in therapy on account of fear of boards or attorneys is unethical.
- Rigidly withholding touch from children and other clients who can benefit from it, such as those who are anxious, dissociative, grieving or terminally ill, can be harming and therefore unethical.
- Sexual, erotic or violent touch in therapy is always unethical.
- Stopping therapy in order to engage in sexual touch or sexual relationships is unethical and often illegal.
- Ethical touch is the touch that is employed with consideration to the context of the therapeutic relationship and with sensitivity to clients’ variables, such as gender, culture, history, diagnosis, etc.
- Seeking ethical consultation is important in complex and sensitive cases.
- Ethical therapists should thoroughly process their feelings, attitudes and thoughts regarding touch in general and the often, unavoidable attraction to particular clients.
- Critical thinking and thorough ethical-decision making are most important processes preceding the ethical use of touch in therapy.
- Documentation of type, frequency and rationale of extensive touch is an important aspect of ethical practice.
CLINICAL CONSIDERATIONS FOR TOUCH IN PSYCHOTHERAPY
- The meaning of touch can only be understood within the context of who the patient is, the therapeutic relationship and the therapeutic setting.
- Touch, like any other behavior and interventions used by therapists, should be employed if they are likely to help clients.
- Touch increases therapeutic alliance, the factor found to be the best predictor of therapeutic outcome.
- Touch can help therapists to provide real or symbolic contact and nurturance, to facilitate access to, exploration of and resolution of emotional experiences, to provide containment and to restore significant and healthy dimensions in relationships.
- Clinically appropriate touch must be employed with sensitivity to clients’ variables, such as history, gender, culture, diagnosis, etc.
- Sensitive, attuned touch gets etched into our developing neural pathways enabling us to feel of value and to connect emotionally with others. As such, touch can be a powerful method of healing.
- Language never completely supersedes the more primitive form of communication, physical touch. As such it can have a significant therapeutic value.
- The unduly restrictive, analytic risk management, or defensive medicine, emphasis on rigid and inflexible boundaries and the mandate to avoid touch interferes with human relatedness and sound clinical judgment.
- Due to the absence of attention to touch in most training programs, clinical supervision, research and testing, the majority of therapists tend not to incorporate the use of touch in therapy.
- Fear, misguided beliefs and lack of training often lead to therapists employing an approach of “touch but don’t talk.”
- Touch that is inappropriate, sexual, cold or abusive can be harmful.
- Traumatic memories are encoded in our sensorimotor system as kinesthetic sensations and images, while the linguistic encoding of memory is suppressed. Therefore, appropriate touch can have a significant therapeutic value.
- Disturbances in non-verbal communication are more severe and often longer lasting than disturbances in verbal language. Using touch in therapy may be the only way to heal some of these disturbances.
- To disregard all physical contact between therapist and client may deter or limit psychological growth.
GUIDELINES FOR CLINICAL AND ETHICAL TOUCH IN THERAPY.
- Touch should be employed in therapy if it is likely to be helpful and clinically effective.
- Avoiding touch due to fear of boards and attorneys is unethical and a betrayal of our clinical commitment to aid clients.
- Touch in therapy must always be employed with full consideration to the context of therapy and client factors, such as presenting problems and symptoms, personal touch and sexual history, ability to differentiate types of touch, the client’s level of ability to assertively identify and protect his or her boundaries, as well as the gender and cultural influences of both the client and the therapist.
- Touch should be used according to the therapist’s training and competence.
- Extensive touch should be incorporated into the written treatment planning.
- The decision to touch should include a thorough deliberation of the client’s potential perception and interpretation of touch.
- Therapists must be particularly careful to structure a foundation of client safety and empowerment before using touch.
- Factors that are associated with congruence are: clarity regarding boundaries, patient’s perception of being in control of the physical contact, patient’s perception that the touch is for his/her benefit rather than the therapist’s.
- The therapist should state clearly that there will be no sexual contact and to be clear about the process and type of touch that will be used.
- Permission to touch should be obtained from clients if the form involves more than a handshake. Extensive use of touch, as utilized in some forms of body psychotherapy, is likely to require a written consent.
- Touch is usually contraindicated for clients who are highly paranoid, actively hostile or aggressive, highly sexualized or who implicitly or explicitly demand touch.
- Special care should be taken in the use of touch with people who have experienced assault, neglect, attachment difficulties, rape, molestation, sexual addictions, eating disorders and intimacy issues.
- Therapists should not avoid touch out of fear of boards, attorneys or dread of litigation. Therapists are paid to provide the best care for their clients not to practice risk management.
- Consultation is recommended in complex cases.
- Therapists have a responsibility to explore their personal issues regarding touch and to seek education and consultation regarding the appropriate use of touch in psychotherapy.
Important Resources
Cohen, S. S. (1987). The magic of touch. New York: Harper and Row.
Downey, D.L. (2001). Therapeutic touch in psychotherapy. Psychotherapy, 36/1, 35-38.
Field, T. (1998) Massage Therapy Effects. American Psychologist, 53, 12, 1270-1281.
Fosshage, J.L., (2000) ‘The Meanings of Touch in Psychoanalysis: A Time for Reassessment. Psychoanalytic Inquiry, 20/1 (On-Line). Retrieved from http://www.psychoanalyticinquiry.com/vol20no1.html
Harlow, H. (1971). Learning to love. New York: Albion.
Heller, S. (1997). The Vital Touch . New York: Henry Holt and Company.
Holroyd, J. C., & Brodsky, A. M. (1977). Psychologists’ attitudes and practices regarding erotic and nonerotic physical contact with patients. American Psychologist, 32, 843-849.
Holroyd, J. C., & Brodsky, A. M. (1980). Does touching patients lead to sexual intercourse? Professional Psychology, 11, 807-811
Horton, J., Clance P.R., Sterk-Elifson C., Emshoff J., (1995) Touch In Psychotherapy: A Survey of Patients’ Experiences. Psychotherapy, 32, 443-457.
Hunter, M., & Struve, J. (1998). The Ethical Use Of Touch In Psychotherapy. Thousand Oaks, CA Sage Publications.
Lowen, A. (1976). New York: Penquin.
Montagu, A. (1971). Touching; The Human Significance of the Skin. New York: Columbia University Press.
Pert, C., (1997). Molecules of Emotion, New York: Scribner.
Reich, W. (1972). Character analysis. New York; Simon & Schuster.
Smith, E., Clance, P .R. & Imes, S. (Eds.) (1998), Touch in Psychotherapy: Theory, Research and Practice, New York: Guilford Press.
United States Association For Body Psychotherapy. (2003). Description of Body Psychotherapy. Retrieved from http://www.usabp.org/displaycommon.cfm?an=1&subarticlenbr=30
Zur, O. & Nordmarken, N. (2004). To Touch Or Not To Touch: Rethinking The Prohibition On Touch In Psychotherapy And Counseling: Clinical, Ethical & Legal Considerations. Online publication. Retrieved from https://www.zurinstitute.com/touchintherapy.html on December 6, 2005.
Touch in Therapy In the Movies
A number of movies have presented issues of touch in therapy in different lights and different contexts. Following is a description of the movies and a summary of the cinematic presentation of touch in therapy.
For a description of the movies, click here.
Antwone Fisher
Antwone Fisher, an African American in the U.S. Navy, has trouble with his anger. An African American psychiatrist, Dr. Jerome Davenport, helps him work through his extensive childhood trauma.
Assertive or Restricted Touch
When Antwone skips his second session, the psychiatrist has two officers escort him to the therapist’s office the following week. They hold him at both arms to bring him to his appointment by force.
In a military environment these boundary crossings and forms of touch appear to be acceptable and, apparently, sometimes necessary. Similar forms of such restrictive or aggressive touch are likely be found in psychiatric hospitals and psych wards in prisons or jails.
Supportive Touch
In order to acknowledge his deep inner work, Davenport pats Antwone on the shoulder after his client reads a touching self-reflective poem to the therapist.
A pat on the shoulder is one of the most common forms of expressing support, care and approval. At times no words can replace such a basic expression of connection and care. As with any form of touch, even a simple pat on the shoulder should be done with sensitivity to the client’s background, history, presenting problems, gender, age, etc.
Handshake
In the final scene, when they run into each other on the military base, Antwone tells his therapist that he “is not a virgin any more.” Dr. Davenport shakes Antwone’s hand to congratulate him.
A handshake is probably the most common form of touch in therapy. Usually it takes place at the beginning and end of sessions. In this case the handshake was Dr. Davenport’s way to express approval and to congratulate his ex-patient. As with any form of touch, even a handshake should be done with sensitivity to client’s culture, age, history, etc. Some cultures may consider a handshake as a cold and overly formal way for a therapist to greet a client. In other cultures, class or age group this will be highly acceptable.
Bliss
Maria and Joseph see Alfred for couples therapy, while Maria secretly consults sex therapist Dr. Baltazar Vincenza. The latter therapeutic relationship ends when Baltazar starts teaching Joseph “the ways of love.”
Sexual Touch
The movie indicates that Dr. Baltazar engages with Maria sexually to help her achieve orgasm and to heal her psychological problems. Later, Joseph is taught what he needs to do: not just bring Maria to orgasm, but to break through the emotional wall to discover her hidden secret that is preventing her from enjoying sex with her husband. Baltazar explains to Joseph that he doesn’t use sex to satisfy his own needs, but as a therapeutic act. For example, the therapist states, “The only way that the mind can heal itself is through the body. …There is no psychoanalytic cure for Borderline Personality Disorder. … The mind cannot heal the mind. … Conscious sex achieves bliss that heals. Ecstasy heals the unconscious”.
This is a case where a therapist employs sexual acts as a part of clinical intervention with a client. According to the therapist this is not a dual relationship, which is defined by “the existence of an additional role or roles between therapists and clients in addition to the clinical relationships”. Dr. Baltazar, according to the movie, does not take on an additional role besides the role of a therapist or teacher. In the 60s and 70s therapists used sex surrogates to provide patients with actual sexual experiences. All professional codes of ethics and most states’ laws (definitely in California) prohibit any sexual contact between therapists and clients regardless of the clinical rationale or the expressed intention of the therapists. In short, these intervention are clearly unethical, most likely to be illegal and always below the standard of care.
Non-Sexual Touch in Dance
Maria visits Baltazar briefly after he had promised Joseph that he would not continue therapy with her any more. They dance for a short while in a non-sexual way before the therapist sets a clear boundary and withdraws.
A male therapist dancing with a female client could be easily misinterpreted by the client and others. In this case Baltazar had much more intimate contact with Maria during prior sessions (see discussion above). If she had gotten attached to him, dancing might be a gentle way to help her let go.
Dressed to Kill
After Kate Miller is brutally murdered, Dr. Elliot, her psychiatrist, and Detective Marino try to find her killer. Kate’s teenage son teams up with a prostitute, Liz Blake, who witnessed the murder, to do an investigation of their own.
Sexualized Touch in Greeting
Elliott reaches his arms out to greet Kate, initiating a level of intimacy that would be appropriate for a friend or romantic partner.
The therapist is attracted to the client. Instead of seeking consultation or dealing with his attraction in a professional way, he seems to be on the edge of acting it out. He admitted his attraction and greeted Kate inappropriately.
Frances
The actress Frances Farmer was a rebel since her teenage years. To gain control over her life, Frances’ mother, Lilian Farmer, orchestrates a series of hospitalizations. After an evaluation by a psychiatrist, Dr. Symington, Frances undergoes shock treatment and a lobotomy.
Touch as a Means to Constrain or Restrain Clients
When Frances resists her involuntary hospitalization and her treatment in the hospital, she is restrained.
Restraining clients physically in order to stop them from hurting themselves can be ethically and legally justified if done appropriately with minimal necessary force. Therapists who work in psychiatric inpatient units or psychiatric wards should have specific training in restraining clients physically and should follow clear protocols. Similarly, when involuntary hospitalization is ordered by the appropriate authorities, restraints may be legally used to hospitalize or restrain patients. However, one must also consider the moral implication of taking one’s freedom due to diagnosis that may or may not be relevant or justly applied. The fact that the mother orchestrated the hospitalization calls on all of us to be very cautious and extremely careful when we initiate an action that will restrict someone’s freedom.
Girl, Interrupted
After a half-hearted suicide attempt and being evaluated by psychiatrist, Dr. Crumble, Susanna Kaysen spends one year at Claymoore. In this psychiatric hospital she receives treatment from Dr. Melvin Protts and Dr. Sonia Wick, while nurse Valerie looks after her. Susanna befriends the other patients, Lisa, Daisy, Janet and Georgina.
Aggressive Touch
Susanna stays in bed because she is depressed when her friend, Lisa, is taken to another ward. Nurse Valerie picks her up and throws the patient into a bathtub with cold water. She even pushes the patient’s head under the water when Susanna yells, “fuck”. Valerie says, “Sorry, too cold?” After an angry exchange, Valerie says, “You are a lazy, self-indulgent little girl who is driving herself crazy”.
Aggressive touch must be used in extreme situations with equally extreme caution. Intervening with a depressed client requires a treatment plan. Valerie seems to act out of anger and behaves inappropriately even though subsequent scenes indicate that she seems to have Susanna’s best interest at heart. Throwing a client into a cold bath is reminiscent of the old abusive practices where clients were placed in boiling water to help them get rid of the demons within them. This is clearly below the standard of care.
Restraining Touch
During her first day at Claymoore, Susanna watches through a window and sees Lisa being handcuffed when she is brought to the hospital because she had run away two weeks earlier. Lisa gets restrained again after she attacks the newcomer because Susanna was given Lisa’s best friend’s bed. Lisa’s friend has hung herself because Lisa had run away. After another escape Lisa is caught again, restrained and held in solitary confinement.
As was noted above, physically restraining clients who are a danger to self or others can be ethically appropriate and within the standard of care. Staff must be specially trained to deal with such situations and protocols should be in place giving therapists guidelines and directions. If Lisa is a threat to herself or others, these interventions are appropriate boundary crossings.
Good Will Hunting
Will Hunting, a working-class young math genius, is wasting his talent. Mathematics professor Lambeau takes him under his wing and finds a therapist for his proteg. In his therapy with Sean McGuire he begins the healing process of his childhood trauma.
Aggressive Touch
Toward the end of their first session, McGuire, the therapist, fends off a series of verbal attacks during which his client Will insults the therapist’s painting. The dark image of an empty boat that floats on the waves of a stormy ocean represents McGuire’s loss and grief of his deceased wife. For quite a while Will doesn’t seem to be successful in his attempts to hurt his therapist. Eventually Will says, “Maybe you married the wrong woman,” and McGuire stops responding. Now his client, knowing that he hit a vulnerable spot in the therapist, repeats this statement and asks, “What happened? Did she leave you? Was she banging another guy?” At this point McGuire angrily grabs him by the throat, pushes him against the wall and threatens him, “If you ever disrespect my wife again, I will end you, I will fucking end you! Got that chief?” With this physical attack the therapist gains control for the first time. But Will still tries to regain the upper hand as he responds with “time’s up” and leaves the office.
This scene has caused an uproar within the psychological community who were concerned with how therapists are generally being depicted in the movies (i.e., http://www.apa.org/monitor/nov98/film.html). The use of physical and aggressive behavior seems to be legitimized in the movie due to the ultimate positive outcome of therapy. The self-revealing and self-involving response seems to be spontaneous and unplanned. While a strong verbal response may have helped the client relate better to the therapist as a fellow human being, the aggressive and threatening physical behavior is below the standard of care.
Supportive Touch (hug)
In a pivotal intervention, when they work with his abuse-induced attachment problems, McGuire says, “Look at me son, it’s not your fault” and then continues saying repeatedly, “It’s not your fault,” moving closer to his patient and increasing the volume of his voice with each utterance. Will experiences a cathartic transformation, sobs and recognizes that he doesn’t need to carry the responsibility for his abusive childhood as an orphan. They hug as he cries.
The therapist displays a supportive gesture and authentic connection with his client when he gave him a hug at the end of a highly emotional session. Such a physical expression of support seems to be highly important and equally effective in complementing the verbal message and helping the client work through a life long block.
Therapist and client hug each other again at the end of their last session when Will thanks his therapist for their work. When Will asks him whether this is ethical, McGuire responds jokingly, “As long as you don’t grab my ass”.
Hugging a client at the end of the last session seems to be very common. As always, it is important that the client feels comfortable and open to such a goodbye gesture.
K-Pax
Dr. Mark Powell is intrigued by his new patient, Prot, who claims to be an alien from the planet K-PAX. In order to evaluate his knowledge in astronomy the psychiatrist takes his patient to his astronomer friend, Steve Becker, and a group of astrophysicists. Later he brings Prot to a garden party with his wife, Rachel, his children and friends. Powell’s superior, Claudia Villars, does not agree with his approach.
Constraining-Restraining Touch
At the beginning of the movie the police restrain Prot, who is taken to a mental hospital. When he tries to protect Powell’s daughter at a garden party, the hospital personnel misinterpret his behavior and restrain him again.
Restraining a client physically is justified when it is done in order to protect the client from himself or herself or others. Minimum force should be used, and hopefully the therapist or the staff has undergone training in the ethical and legal application of physical restraints.
Mr. Jones
Dr. Libbie Bowen treats Mr. Jones for Bipolar Disorder in a mental hospital. They fall in love and start a romantic relationship.
Sexual Touch
The psychiatrist finds herself falling for Jones with her eyes wide open. She became sexually involved with her client.
Obviously, sexual touch and sexual relationships with current clients are always unethical, always below the standard of care and illegal in most states.
Prime
Rafi Gardet dates a younger man, David Bloomberg. After hearing about this relationship in their sessions for some time, her therapist, Dr. Lisa Metzger, finds out that Rafi’s boyfriend is her own son.
Touch As Part of Sequential Dual Relationships
After therapy ended Dr. Metzger’s son David invites Rafi to a dinner party at his mother’s house. To welcome her ex-client and to thank her for a present, Lisa gives Rafi a kiss on the cheek.
This is definitely appropriate social (non-sexual) touch that takes place after therapy ended. They are engaged in the unavoidable sequential social relationship.
Prince of Tides
Tom, an unemployed, aimless ex-high school football coach from the South meets his sister’s psychiatrist, Dr. Susan Lowenstein, who wants him to shed light on their family life.
Aggressive Touch
In one of their first meetings the psychiatrist demonstrates her lack of emotional stability and professionalism by throwing an ashtray at Tom, the patient’s brother.
Needless to say throwing an ashtray is inappropriate in almost all situations.
Sexual Touch
The psychiatrist entered a sexual relationship with her patient’s brother.
Obviously, sexual touch and sexual relationships with current clients or their immediate family members is always unethical, always below the standard of care and may be illegal in some states. See details on the Ethics Codes on sexual relationships between a therapist and a client’s family members in the Dual Relationships chapter.
What About Bob?
After one therapy session Bob Wiley follows his psychiatrist, Dr. Leo Marvin, to his lakeside summer home in order to further discuss his problems. There, Bob befriends Marvin’s son Sigmund, daughter Anna, and wife Fay.
Touch-Containing/Restraining Client
In order to get rid of his patient, Leo Marvin admits Bob into a mental hospital. He gives the admitting physician, Dr. Catherine Tomsky, misleading information about Wiley. The hospital staff temporarily restrains him until Tomsky discovers the mistake. Consequently, Marvin has to pick Bob up again. As they are leaving the hospital, the two psychiatrists have the following dialog:
Tomsky: If you want to get rid of Bob, just tell him you won’t treat him anymore.
Marvin: Catherine, that’s easy for you to say. The man is human Crazy Glue!
Tomsky: You should’ve never let him sleep in your pajamas, Leo.
Marvin: I can’t believe that I’m hearing this!
Tomsky: Relax, Leo.
Marvin: I’M RELAXED!
Tomsky: Take a vacation.
Marvin: I’M ON VACATION!
Restraining a patient who resists a psychiatrist’s involuntary hospitalization may be ethical and legal. This particular example supports Thomas Szasz’s and others’ assertion that involuntary hospitalizations are immoral coercion and abuse of power. This movie presents a parody of psychotherapy, psychotherapists and clients. Within this comedy a lot of boundaries are crossed and violated by the client himself, which lead to several unusual behaviors on the part of the therapist.
For extensive references list, click here.
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