Faculty and student curricular experiences of nonerotic touch in counseling.
Touch is one of the most vital senses and a requirement for the healthy development of humans across the lifespan (Kertay & Reviere, 1993). This truth has contributed to a belief in the healing power of physical touch that is still present today in many cultures and health professions, including counseling (Frank, 1974). Nonerotic touch has had a role in counseling since the emergence of psychoanalysis in the late 1800s. Freud initially valued touch in therapy, stroking the client's neck or forehead to increase receptiveness to hypnotic suggestion, but soon rejected this practice in favor of a therapeutic stance of detachment (Strozier, Krizek, & Sale, 2003). Freud's rejection of nonerotic touch permeated psychotherapy and laid a foundation for the widespread touch taboo (Horton, Clance, Sterk-Elifson, & Emshoff, 1995).
Freud's rejection of touch met with resistance from psychoanalysts like Sandor Ferenczi, who placed great value on the powerful therapeutic effect touch could produce (Toronto, 2002). Ferenczi's departure from Freud sparked a debate over the appropriateness of physical contact between counselor and client. Beyond prohibitions against sexual contact, physical touch in the therapeutic milieu continues to generate controversy (Alyn, 1988; Willison & Masson, 1986).
As Stenzel and Rupert (2004) reported, the controversy about nonerotic touch is both theoretical and ethical. The theoretical perspectives span a continuum from strict exclusion of all physical contact to advocacy for its use (Alyn, 1988; Durana, 1998; Holder, 1982; Hunter & Struve, 1998a; Leijssen, 2006; Willison & Masson, 1986). Studies addressing ethical issues and guidelines relevant to nonerotic touch consider the potential for exploitation, because touch may distort therapeutic boundaries or be misinterpreted by the client (Holub & Lee, 1990). Like the theoretical perspectives, ethical guidelines demonstrate a lack of clarity and consensus and leave it up to clinicians to "rely on their own best clinical judgment" (Durana, p. 279). Although some recent studies offer concrete guidelines for using nonerotic touch (Bonitz, 2008; Hunter & Struve, 1998) and define different types of touch within psychotherapy (Zur, 2007), they have not produced significant change within counseling curriculums or codes of ethics.
Other studies have gone beyond theoretical perspectives and ethical guidelines. In an empirical study, Hubble, Noble, and Robinson (1981) discovered that clients who were touched perceived their counselors as more expert than those who were not touched. Another study affirming the use of touch (Driscoll, Newman, & Seals, 1988) revealed that participants who observed counselors touching their clients rated those counselors as more caring than those who did not do so. Suiter and Goodyear (1985), however, found that counselors who engaged their clients in a semi-embrace were perceived as less trustworthy; and Bacorn and Dixon (1984) and Stockwell and Dye (1980) both found that the presence or absence of touch did not affect ratings of the counselor or counseling.
Several studies sought to capture participants' attitudes and perceptions regarding nonerotic touch. Pope, Tabachnick, and Keith-Spiegel (1987) surveyed 456 members of the psychotherapy division of the American Psychological Association and found that 41.2% felt hugging clients was ethical only in rare circumstances. Stenzel and Rupert (2004) surveyed 470 practicing psychologists on the subject of touch in adult individual therapy. Approximately 90% of respondents reported never or rarely touching their clients, and the handshake was the only common form of touch. Horton, Clance, Sterk-Elifson, & Emshoff (1995) surveyed 231 psychotherapy clients, of whom 69% felt touch engendered a bond, trust, and increased openness with their therapist, and 47% felt touch communicated acceptance and increased their self-esteem. Finally, Stake and Oliver (1991) surveyed 320 master's and doctoral-level licensed psychologists regarding a range of touching behaviors. They reported that psychologists with less experience expressed increased sensitivity to touch misconduct, and psychologists with a doctoral degree reported fewer questionable touch behaviors than master's-level psychologists.
These conflicting findings indicate the complexity and ambiguity surrounding nonerotic touch. Although the majority of studies recommend further research, studies on this controversial subject are scarce, and most are outdated. However, as is common with any ethics-related scenario, explicit universally accepted guidelines may be either impractical or impossible. It would therefore seem reasonable to expect that mental health counselors exercise their clinical judgment in therapeutic situations involving nonerotic touch.
For the beginning counselor, a significant element of clinical judgment will consist of the training they received in graduate school. Legal and ethical concerns such as nonerotic touch are mandated for inclusion in counseling students' training by the Council for Accreditation of Counseling and Related Educational Programs (CACREP, 2001). Because counselor educators are the primary disseminators of information on legal and ethical issues, they bear the primary responsibility for preparing counselors to deal with complex issues like nonerotic touch. The research contains many exhortations for better training on nonerotic touch (Bonitz, 2008; Durana, 1998; Milakovich, 1998; Stake & Oliver, 1991; Strozier, Krizek, & Sale, 2003; Willison & Masson, 1986).
The call for increased training is not a new one, yet a review of the literature revealed no studies that examined counselor educators' perceptions and teaching about nonerotic touch. Moreover, no studies were found of the experiences of counseling students with regard to preparation for touch between counselor and client. Consequently, the purpose of this research was to illuminate the experiences of both educators and students in training and being trained on nonerotic touch in counseling.
METHOD AND PROCEDURE
The researchers (two doctoral candidates in counselor education, one recently graduated educator, and one faculty member) used a constructivist phenomenological approach for this study. Such an approach describes the meaning for several individuals of their lived experiences of a phenomenon (Moustakas, 1994). The fundamental goal of a constructivist phenomenological approach is to condense individual experiences of a phenomenon into an explanation of the phenomenon's universal essence. Researchers achieve this goal by identifying a phenomenon and then collecting data from participants who have experienced it. The researchers then build a combined description of the essence of all the participants' experiences of the phenomenon. The resulting description is composed of both what the persons experienced and how they experienced it.
A constructivist phenomenological study was critical to our research goals. No studies have been found describing the experiences of counseling students in regard to preparation for touch between counselor and client, or examining educators' perceptions and teaching about nonerotic touch. A phenomenological investigation of student and faculty curricular experiences involving nonerotic touch in counseling will provide an initial understanding of this phenomenon and directions for future research.
Sampling Procedure, Setting, and Sample
Participants were chosen using criterion sampling, a form of purposive sampling. Thus, participants were chosen in an intentional manner to provide information that could not have been acquired from other choices (Maxwell, 2005). In criterion sampling participants are chosen based on their having experienced the phenomenon being investigated, which ensures quality (Creswell, 2007).
To illuminate the experiences of counselor educators, seven faculty members from CACREP-accredited counseling programs in the midwestern United States were chosen as participants. Three were male and four female; the average age was 51.0 years. All were Caucasian. The average numbers of years as a faculty member in a counselor education program was 15 years. All were licensed counselors, and five possessed the supervisory endorsement. Six provided direct counseling services; one did not. Their theoretical orientations were one Rogerian, one cognitive-behavioral, two Adlerian, two gestalt, and one symbolic experiential. The faculty members were each paid $15. in compensation for their time and mileage to the focus group site.
To understand the experiences of students in being trained on the use of nonerotic touch in counseling, 16 master's-level counseling students were chosen from the host university as participants. Seven were in their second year of study and nine in their third year. Twelve were Caucasian, two African American, one Asian, and one Hispanic American; the average age was 29.6 years. Fifteen participants provided direct counseling services; one did not. Their theoretical orientations were nine cognitive-behavioral, three existential, two Adlerian, and two gestalt.
Data Collection and Analysis
Four 90-minute, audiotaped, in-depth focus groups (three separate groups with counseling student participants, one with faculty participants) were used to generate data for analysis. Focus groups were chosen because of their natural affinity with counseling and their compatibility with the goals of qualitative research (Kress & Shoffner, 2007). The recently graduated counselor educator and one of the doctoral student researchers for this study moderated the group comprised of faculty participants. The three groups of counseling student participants were moderated by the two doctoral student researchers and the recently graduated educator. The moderators served to help participants focus on the phenomenon under investigation and discuss it in depth; they used open-ended questions to generate significant statements and themes related to participant experiences.
In accordance with presuppositions discussed by Moustakas (1994) about formulation of questions in a phenomenological study, the questions used for the focus group interviews were drafted to guide the interview process and grew out of the authors' interest in the topic. The initial interview questions to the faculty member participants were (a) "Does your program include the topic of nonerotic touch in the curriculum? If so, where and how?" (b) "If a student asked about nonerotic touch, how would you define it and describe it to your students?" and (c) "What should counselor education programs be teaching on the topic of nonerotic touch in counseling?"
The initial questions for the student participants were (a) "How would you define or describe the term nonerotic touch?" (b) "How does that definition impact your counseling?" (c) "What do you think about giving or getting hugs from clients?" (d) "What would have been helpful to know about touch during your coursework?" and (e) "Describe your experiences with the use of touch."
At the conclusion of the focus groups, each audiotape was transcribed and checked for accuracy. The data analysis, which followed the recommendations of Creswell (2007) for analyzing phenomenological data, consisted of three basic steps: (a) analyzing the data for significant statements; (b) formulating meanings from the significant statements and grouping them into themes; and (c) generating a composite description of the phenomenon.
Thus, the researchers began by isolating significant statements within the transcripts about how participants were experiencing nonerotic touch in counseling. As statements were identified, horizontal mapping (Creswell, 2007) was used to create a list of nonrepetitive, nonoverlapping statements of equal value. From the significant statements, formulated meanings were extracted, which were then grouped into units of data called themes. The emergent themes were representative of the participants' common experiences with the phenomenon. For example, one counselor educator stated, "[Nonerotic touch] has to do with intention and the context of the situation," which was selected as a significant statement. That statement was given a formulated meaning of "Variables such as motive and context impact the definition of nonerotic touch," which was grouped within the first theme for counseling faculty, "An Elusive Definition."
Drawing from these themes, textural descriptions were written of what the participants were experiencing and structural descriptions were written of how participants were experiencing them. Textural descriptions included verbatim quotes and structural descriptions included the contexts in which the phenomenon was experienced. A composite description was then assembled from the textural and structural descriptions that articulated both the "what" and the "how" of the participants' experiences of nonerotic touch in counseling. This final articulation represented the essence of participants' experiences.
Researchers, Bias, and Triangulation Procedures
Throughout this study the doctoral student researchers and the recently graduated counselor educator moderated the focus groups. The faculty member, who had more than 15 years of counselor education experience, had no contact with the participants during the study.
The researchers shared several assumptions about the curricular experiences of counselor educators and counseling students concerning nonerotic touch. These assumptions were generated from review of the literature, the researchers' experiences as practicing counselors, and their experiences of teaching and being taught. The primary assumptions were that (a) physical touching of clients is a volatile issue within the profession of counseling, about which there is significant disagreement; (b) this disagreement has resulted in confusion among counselor educators on when and how to address the topic with students; and (c) counseling students require better training to be adequately prepared to confront this issue.
Phenomenology demands that a researcher transcend or suspend prior knowledge; "the everyday understandings, judgments, and knowings are set aside" (Moustakas, 1994, p. 33) so that a phenomenon can be recognized at a purer and deeper level. To achieve this, at the onset of this study and throughout data analysis the researchers bracketed all assumptions to promote fidelity to the phenomenon (Colaizzi, 1978).
Triangulation procedures were used to enhance the trustworthiness of the data analysis procedures and results (Lincoln & Guba, 1985). These procedures included multiple researchers, literature triangulation, audit trails, and the use of an outside reviewer whose area of expertise was qualitative research. Multiple researchers employed different perspectives in order to deepen the interpretation of the data and help build the emerging themes. Literature triangulation demonstrated that our research findings corroborated with previous research and the theoretical literature. The literature described the disagreement about nonerotic touch within the counseling profession (Alyn, 1988; Willison & Masson, 1986) and called for better training on nonerotic touch in counseling programs (Durana, 1998; Milakovich, 1998; Strozier, Krizek, & Sale, 2003; Willison & Masson). The verbatim transcripts and documents created during data analysis were kept as audit trails so that this research might be confirmed by others. An outside counselor education faculty member with expertise in qualitative research was used to clarify, authenticate, and challenge the conclusions reached by the authors. Generally, the outside reviewer verified the overarching themes of the research.
The researchers did not have prolonged engagement with participants, which may affect data trustworthiness. Readers must be aware of this when considering these results within their own context. Due to this limitation, further research is encouraged. Throughout each focus group, the moderators consistently gave participants opportunities to clarify and reflect on their statements through open-ended questions and prompted them to expand on their answers in order to thicken and enrich their descriptions. The moderators observed that participants also questioned and prompted each other during all of the focus groups. We assert that the questioning and prompting by both moderators and participants constituted a form of member checking, and as a consequence the themes emerging in this research reflect the participants' experiences.
We recognize that, within the context of positivist and postpositivist approaches, the emergent themes here are narrow in scope and generalizability. From those perspectives, limitations of our research would include small sample size; the homogeneity of participants, both educators and students; and a lack of randomization procedures used to select participants. These features would, according to the positivist and postpositivist traditions, limit the ability of our research "to isolate facts, causes, and 'truth'" (Kline, 2003, p. 83). However, the philosophy, methodology, and aim of our study are not bound to the rationale of positivist and postpositivist research. The constructivist phenomenological approach is concerned with descriptions of experiences and the emphasis is on core meanings, not explanations, analyses, or generalizations (Moustakas, 1994). Readers must reflect on the phenomenological approach and the participants and their statements when judging if the themes presented are useful to them.
The verbatim transcript of the faculty focus group produced 27 significant statements. Table 1 demonstrates the transmutation of these statements into their related formulated meanings. Organizing the formulated meanings into theme groups resulted in five themes for faculty participants. The three transcripts of the counseling student focus groups produced 28 significant statements and formulated meanings, which were then organized into four themes for the student participants.
Faculty Member Theme 1: An Elusive Definition
The difficulty in reaching an agreed definition of nonerotic touch was evident as participants voiced a myriad of definitions. Descriptions ranged from "a touch on the body parts that are not covered by a two-piece swimsuit" to "I think it has to be connected to some other action that is going on at the time, either part of the conversation or part of the experience." Another participant conceptualized nonerotic touch as "It depends on the theory. If you are an analyst it's going to be zero and if you are gestalt there is the body process track, body workers. A whole continuum."
A sense of the here and now and counselor motive were evident as one participant said of nonerotic touch, "It has to do with intention and the context of the situation." Another echoed this sentiment: "I think it's very situationally defined ... there is the whole context thing."
One participant confronted the difficulty with the term "nonerotic" itself. The feelings of struggle and frustration were apparent as this participant articulated:
And we are all hitting on that, that the language is a real hang-up, that nonerotic brings up that dichotomy of it's either sexual or it's not. And there are other things. We are really struggling with that language.
Faculty Member Theme 2: Multiple Factors When Deciding
Participants expressed multiple factors to consider when deciding whether or not to implement nonerotic touch. One participant reported, "I think there are differences, and culturally some clients might be offended by a Eurocentric or standoffish kind of thing and wonder why this person doesn't like me ... not to generalize but there are cultural values." Another participant focused on the attributes and qualities of the client and the counselor: "It plays a lot into the age of the client, possibly the gender of the client, and even the development of the counselor as well."
The comforting and healing power of nonerotic touch was reflected in one participant's expression:
But yet when we think about what we are trying to do in terms of how people heal and grow and how healing touch can be and how affirming that can be and really how starved some people are for contact....
Similarly, another participant focused less on rationale and logic when determining the appropriateness of nonerotic touch: "As we are thinking about this, there is a tendency to just have the cognitive component about the decision, but yet it is such a holistic process ... the intuitive and emotional parts."
One participant took an idiosyncratic approach when deciding to use nonerotic touch, stating, "I go back to Milton Erickson's quote, 'Follow the client and stay the hell out of the way.' So you individuate for each person."
Faculty Member Theme 3: Training Students: Difficulties and Differences
The task of training counseling students on nonerotic touch was perceived by participants as difficult and produced differing responses. Some concerns expressed by the participants were practical: "I am concerned about where it can fit in the curriculum. We have a 60-hour program ... everyone is lobbying to put more into the curriculum." One participant identified the inadequacy of discussion alone and felt that training on nonerotic touch belonged outside the classroom: "It probably needs to come outside of the curriculum ... something that addresses these questions more than just sitting around and talking about it."
The lack of intentionality within training on nonerotic touch was evident in the statements of two participants. One said, "It's something that always comes up but it's not laid out in the syllabus as a specific topic." Another agreed, saying, "I don't really think it's formally integrated."
Participants saw the value in engaging counseling students in discussions and case studies focused on nonerotic touch to enhance their training. Typical statements were, "If we don't address it prior to them starting, then they have no direction when a client initiates it," "I think it's also important for us to validate with counselor trainees that we don't always get it right or won't always know what to do, or even when we think we do, we may not," and "I do like the ideas of setting up scenarios for students."
The daunting challenge of clearly and consistently training students on nonerotic touch was voiced by two participants. One identified the inherent complexity of nonerotic touch, stating, "So I don't think there is an across the board 'these are appropriate touches, you can always do this.' Obviously there are those that are never appropriate." Another participant articulated the multiplicity of viewpoints among counselor educators regarding nonerotic touch:
What you see is that even faculty aren't coming from the same place on that, so if you think about a curriculum for students, how would we all decide what would be taught when we all come with such different viewpoints and ideas about a situation?
A final idea for training counseling students on nonerotic touch focused on the personal experiences of students:
I think students have sort of their own experience of what touch is. If I could create something experiential, a professional development experience for them, it would be about them having a better understanding of their own boundaries around touch, their own experience of what is therapeutic touch, and that might help them.
Faculty Member Theme 4: Perceived Struggles of the Counseling Student
Participants were aware of the struggles counseling students experience with nonerotic touch. One noted that these struggles may begin with how nonerotic touch is presented to counseling students: "Ours is stated as boundary issues, not touch." Participants also reflected on a dilemma students have faced when working with clients; one said,
There have been several instances where students have described a situation where their client was very upset, was crying, was overwrought, and it felt like a pat on the back or a hug, some sort of physical connection felt appropriate, but they really didn't know what to do.
This statement was confirmed by another participant, who observed, "Touch can be very comforting. I think that's one of the areas where that dilemma comes up."
Another participant's perception of counseling student struggles with nonerotic touch conveyed both the intricacies of the issue and a sense of skepticism:
It goes back to the fact that there [are] a lot of things going on when someone decides to make that move and it's almost symphonic, there are so many different instruments being played at the same time. It's a very complicated situation....
Faculty Member Theme 5: The Frustration with Boundaries
As participants discussed and reflected on nonerotic touch, the majority began to express frustration and sadness relating to the current professional climate concerning boundaries in counseling. One participant identified frustration and a sense of a loss of control, stating,
My frustration is from thinking about the kinds of things that have created these boundaries for us around touch in therapy. They are created because people misuse those boundaries ... and then we have to create a new wall that changes the nature in which we work.
This sentiment was confirmed by another participant, who responded, "As I recall, differences in boundaries have more to do with litigation and less with therapy."
Nostalgia and sadness were voiced by two participants as they offered their own perspectives on nonerotic touch in the current climate. One said, "I started my training in the days when we did give backrubs and I can't picture myself doing that in class. I think that would be really cool. I miss those days," and the other said, "That's the part of this whole conversation that makes me sad ... we have rules ... I think they were created for good reason, but at what point do they really bind us up and limit us from normal interactions?"
Mental Health Counseling Student Theme 1: An Elusive Definition
Participants offered an array of descriptions of nonerotic touch that demonstrated the almost indefinable nature of the phenomenon. One defined nonerotic touch based on what it was not, stating, "Physical contact without any sexual reason, erotic thoughts, or feelings intended." Another participant considered nonerotic touch to be defined by the supportive intention of the one touching, stating, "It would mean just a comforting, supportive touch." Another identified the circumstances surrounding the touch as determining the definition, stating, "I think the context of it would matter, too, if it happened at the beginning of the session, if you are shaking their hand as a greeting." One participant felt that the definition of nonerotic touch was determined by the one receiving the touch: "It's all in the intent and the perception of the person who is receiving the touch. I think it's important to understand."
Mental Health Counseling Student Theme 2: A Hug Is a Confusing and Complex Thing
Participants expressed numerous issues to take into consideration when considering hugging a client. Several reported confusion. One said,
So what if my client needs a hug and feels like that's okay for them but I'm actually uncomfortable doing that? I'm not sure where the line is between ... I don't want to make anyone feel badly about not doing that. I'm confused as to whether I should hug despite my own discomfort.
Another participant expressed confusion and lack of preparedness to address hugging a client, stating, "If a client is crying, should you give him a hug? I just don't know enough about the topic to know the answers."
Participants illustrated the complexity of hugging and touch in counseling by verbalizing opposing viewpoints about the influences of age and gender. Participants stated, "Age and gender would play a part in it too ... if it were a female rather than a male," "I think that as a female, I'm not going to be hugging male clients," "I don't necessarily use age, gender, ethnicity, or socioeconomic status as a prototype to define what response I would have to touch or not to touch," and "I don't think sex is necessarily relevant." Dissimilar viewpoints were also conveyed when participants discussed the scenario of a client-initiated hug. Participants stated, "If it's requested ... if it's needed for them and not for you, then I think it's okay," but "If it's a client's need, is it a need we should be [filling]?"
One participant filtered the decision whether to hug through a client's diagnosis, reporting, "At times it can be appropriate depending on diagnosis." Another described the quality of the counselor-client relationship as the critical factor in deciding to hug, stating, "I think too it would depend on the type of relationship you had with the client." Another warned against counselors having self-serving motives for hugging, stating, "You have to ask yourself who you are doing it for, yourself or your client."
Mental Health Counseling Student Theme 3: Potential Pitfalls
Participants were aware of the risks involved in using nonerotic touch in counseling. One identified the risk of the unknown, observing, "You never know what you are going to trigger inside your client." The blurring of boundaries was implicit in the statement of a participant who cautioned, "If we set it up as this professional relationship, this isn't a friendship; we aren't going to slap high five and hug." Another participant described the potentially dishonest motives of a client who requests physical touch: "Some clients may want physical contact for shady reasons."
Mental Health Counseling Student Theme 4: Inadequate Training
In this theme, the responses of the participants consistently revealed inadequacies in their academic training related to nonerotic touch. This was evident in statements like "You can't have sex, but that's all they really tell you," "It's very grey ... they just said the rest is up to you ... I don't think there is much discussion," and "I really haven't seen the topic covered over the course of the program." One participant was skeptical of the ability of counselor educators to consistently elucidate nonerotic touch to students:
I'd be curious to see what kind of consensus there was even among the counseling department faculty, if they have a clear sense of what they are saying consistently to students. My hunch would be that they probably talked about it and they all have different opinions.
One participant described training as disjointed, stating,
It appears to me that the coursework here ... doesn't make a clear connection between the theoretical and practical. That's what I see from where I am and that creates ambiguity in us and you don't know what to do.
A similar sense of ambiguity and insecurity was expressed by a participant who reported,
What do you do? For me particularly, I get insecure, do I do it, do I not? And I wish the coursework would tell you this is appropriate, this is not appropriate, and which situations and circumstances it would be okay in.
Participants also had ideas about how their training could be more helpful, with an emphasis on case examples and role playing: "Maybe you could play out some situations when it might be more appropriate to do it," "The coursework could provide a context," "Maybe more case examples than speaking about it in passing," "Yeah, more cases and discussion," and "Then we could actually role play and practice that element along with everything else that we are practicing." One participant indicated that self-disclosure from counselor educators would be useful, stating, "It would have been good to hear from some of the professors about some of their own experiences." The final suggestions from participants centered on which classes should cover the topic; they had a variety of ideas: "Ethics and theories," "I think it belongs in multicultural as well," "The first class that popped into my head was the techniques class," and "This may be a stretch but maybe to bring it up during human growth and development in the physical aspects ... and how important that is for healthy development."
The purpose of this research was for both counselor educators and mental health counseling students to illuminate their experiences of training and being trained on nonerotic touch in counseling. Because no similar research has been reported, this study was singular in seeking to investigate how counseling faculty train their students and how students perceive the training they receive. This study did not aim to produce generalizations that apply beyond the research sample.
Nevertheless, it is essential to compare what was discovered in this study with what is documented in the literature. Positioning research findings alongside the current literature increases the value of a qualitative study (Merriam, 2002). The major themes that emerged in this study are consistent with previous studies on nonerotic touch. A discussion of this study's themes and the current literature provides a context and foundation for the curricular recommendations that follow.
A Lack of Consensus
Faculty participants expressed a variety of opinions and confusion about the definition of nonerotic touch, as well as differing views on when and how to implement touch in therapy. Students echoed the variety of opinions and the confusion, reporting multiple definitions of nonerotic touch and confusion about how to navigate touch in therapy. The lack of consensus among both counselor educators and mental health counseling students mirrors the lack of consensus in the literature. Theoretical perspectives on the use of nonerotic touch vary (Alyn, 1988; Willison & Masson, 1986), and therapists exhibit differences in attitudes toward what kinds of touch might be appropriate (Stake & Oliver, 1991). As Bonitz (1988, p. 396) asked, "What kind of touch interaction is appropriate and ethical, and where does one have to draw the line?" As this research and previous studies demonstrate, producing a definitive answer to this question may be impractical, which has resulted in the present confusion among both faculty and students.
Issues of Training
Both faculty and students expressed frustration about aspects of training and being trained on nonerotic touch. Faculty recognized that training on nonerotic touch was not explicitly included in the curriculum and was not intentionally taught but rather "brought up" incidentally. They also expressed concerns ranging from where training on nonerotic touch would fit into the curriculum to how faculty could ever agree on what to teach students about nonerotic touch. Students consistently expressed insufficiencies in their academic training on nonerotic touch, reporting a lack of connection between the theoretical and practical, a lack of classroom discussion, and doubt about the ability of counseling faculty to clearly teach the subject. As a result, students expressed insecurity about confronting the issue of touch in therapy.
Although no study was found on how counseling faculty train their students on nonerotic touch, it is reasonable to assert that the difficulties expressed by faculty are linked to the lack of clarity and consensus among helping professionals concerning nonerotic touch (Alyn, 1988; Leijssen, 2006; Stake & Oliver, 1991; Willison & Masson, 1986) and the lack of clarity within ethical codes concerning touch in therapy (Durana, 1998). The insufficiencies in training expressed by the students are confirmed by the frequent calls in the literature for better training on the topic of nonerotic touch (Bonitz, 2008; Durana, 1998; Milakovich, 1998; Stake & Oliver, 1991; Strozier, Krizek, & Sale, 2003; Willison & Masson, 1986). In fact, the insufficiencies are not surprising given the confusion among helping professionals relating to touch in therapy.
Counseling faculty articulated two central concerns about training students on nonerotic touch: (a) where to site such training in the current curriculum; and (b) the ability of faculty to reach agreement about what content should be taught. No previous research provides clear recommendations for counseling faculty on how to prepare students. The recommendations that follow are intended to offer faculty practical suggestions.
Addressing the first concern, curriculum placement, the authors recognize the challenges of adding more material to the curriculum and that counseling programs have differences in the way a curriculum is structured. However, because of the confusion surrounding this topic and the risk involved in not preparing students to navigate this complex issue, counseling programs must be intentional in introducing the subject of touch in therapy to their students. We suggest that wherever ethical issues are discussed in a counseling program curriculum, the faculty intentionally include the topic of touch within the therapeutic setting. Also, faculty should consider including the subject of nonerotic touch in practicum and internship courses as a content area reflected in the syllabi. These suggestions are reinforced by the results of this study as well as frequent examples in the literature recommending improved training (Bonitz, 2008; Durana, 1998; Milakovich, 1998; Stake & Oliver, 1991; Strozier, Krizek, & Sale, 2003; Willison & Masson, 1986).
Counseling faculty also expressed doubt about the ability of counseling programs to agree on what to teach students. This concern reflects the disagreement among helping professionals about nonerotic touch in therapy. We acknowledge that mental health counseling programs are comprised of faculty who represent a multiplicity of theoretical orientations and worldviews that affect their perspectives on nonerotic touch in therapy. Because of this and because of a lack of clear ethical guidelines, we recognize the difficulties faculty would encounter in attempting to produce a standard curriculum. As a result, we suggest not a standardized curriculum but rather offering learning opportunities to challenge students in order to increase their cognitive complexity (Brendel, Kolbert, & Foster, 2002) and equip them to confront therapeutic situations involving nonerotic touch. The learning opportunities presented here are both theoretical and experiential and are grounded in this study and the literature.
Exposure to literature: Counseling faculty can begin to introduce students to this complex topic through exposure to the literature on touch in therapy. Comprehensive reviews (Hunter & Struve, 1998b), book chapters (Zur, 2007), and journal articles (Bonitz, 2008) can provide critical information and serve as catalysts to engage students in critical thinking and discourse. Faculty may find particular value in presenting opposing viewpoints (Alyn, 1988; Willison & Masson, 1986) and giving students the assignment of writing position papers both for and against the use of nonerotic touch in therapy.
Case studies." Moving beyond the theoretical, students can be challenged to apply their emerging knowledge about nonerotic touch through case studies. As one educator observed in this study, "I do like the idea of setting up scenarios for students." Case studies specific to nonerotic touch can be found in the literature (see Zur, 2007) and faculty could create their own for students to consider. Such assignments can challenge students to think more deeply about the issue of touch in therapy and stimulate valuable discussion.
Experiential activities: Bringing students into the experiential can provide creative challenges and also move the students into the practical realm of touch in therapy. Two possibilities are for faculty to have students debate both sides of the issue and to have them engage in role-playing scenarios involving nonerotic touch. A final idea was offered by an educator participant in this research, who stated,
If I could create something experiential, a professional development experience for them, it would be about them having a better understanding of their own boundaries around touch, their own experience of what is therapeutic touch, and that might help them.
The recommendations outlined are beginning suggestions. For future research, it will be valuable to implement the recommendations and investigate their impact on training students on nonerotic touch. Future research should also examine additional methods of training students on nonerotic touch.
Because of the impact multicultural issues have on touch in therapy (Zur, 2007), this study's faculty sample of Caucasian individuals is narrow. Any future research investigating issues of training students should tap into a diverse sample of counseling faculty to better illuminate the multicultural aspects of touch in therapy.
In this study mental health counseling faculty and counseling students expressed confusion when discussing nonerotic touch in therapy. Faculty reported uncertainty and varying perspectives on how best to train students, and students reported insufficiencies in their training and insecurity about how to address nonerotic touch in therapy. The confusion the participants expressed matches the confusion and varying perspectives in the literature. Improved training of counseling students is required so that beginning counselors can better face this issue. This study is a beginning attempt to offer mental health counseling faculty guidelines on how to better train students on nonerotic touch in therapy.
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David Burkholder is affiliated with Monmouth University. Michele Toth is in private practice in Barberton, Ohio. Kevin Feisthamel is affiliated with Portage Path Behavioral Health in Akron, Ohio. Paula Britton is affiliated with John Carroll University. Correspondence should be addressed to David Burkholder, Monmouth University, 400 Cedar Avenue, West Long Branch, NJ 07764. Email: firstname.lastname@example.org.
Table 1. Selected Examples of Faculty Member Significant Statements and Related Formulated Meanings Significant Statement Formulated Meaning It absolutely depends on the Deciding to use nonerotic touch person and the context of the in counseling can only be made whole situation ... it is on a client-by-client basis. absolutely idiosyncratic to that person. I think my understanding of The beginning of training touch occurred through my own students should start with them work around it ... I got more gaining insight into their own comfortable understanding how feelings and experiences with touch had an impact on me and touch. that got me understanding how touch either did or didn't have an effect on the clients. Part of me too is going back to There are temporal and the 60s and 70s and thinking how contextual variables to consider the context has changed over when judging nonerotic touch in history. If we were in the 60s counseling. we'd all be hugging ... there weren't those concerns. I think it's timed with other Nonerotic touch is best ways in which you are having understood as a support and contact with the individual at enhancement for what is that moment in that it supports occurring in the moment. and enhances what is going on with the client.
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|Author:||Burkholder, David; Toth, Michele; Feisthamel, Kevin; Britton, Paula|
|Publication:||Journal of Mental Health Counseling|
|Date:||Apr 1, 2010|
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