The Role of Touch in Occupational Therapy

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1. Principles of Therapeutic Touch: Application to Practice Areas

2. Understanding Sensory Systems: Using Touch Therapeutically

3. Integrating it All: Effects of Touch on Mind, Body and Spirit

1. Principles of Therapeutic Touch: Application to Practice Areas

            As OTs, we touch our clients for many different purposes and in many different ways in almost all areas of practice. Our professional roles require this, of course, but we must remember that in our personal lives we also have the need to touch and be touched (Figure 1).

Figure 1
Figure 1

            It is important that we are knowledgeable about the effect of touch on people, including ourselves. Tactile communication is usually more powerful than verbal.

            What exactly is touch? What does the word mean to the general population?

            The Thorndike Barnhart World Book Dictionary defines touch as "the sense by which a person perceives things by feeling or handling them." Our language is full of references to touch: "keep in touch," "out of touch," "handle with care," "touchy," "you really touched me," "he's a soft touch," "she rubs me the wrong way," "let's touch base," etc. I'm sure you could think of other phrases.

            At the 1976 annual American Occupational Therapy Conference, Joy Huss, then an occupational therapy professor at the University of Minnesota, presented a lecture "Touch with Care or Caring Touch?" that was later published in AJOT. She urged us to tune in to this most vital form of communication. She believed that as occupational therapists we had adequate knowledge of biological and behavioral sciences to understand the implications of caring touch, but we needed more awareness of our feelings as human beings before we could use touch effectively with others.

            It's not that touch was foreign to us. Rather, I think, it was included within a broader context in our training. When I was an OT student 55 years ago at the University of Illinois, we didn't talk much about touch. The concept that was drilled into us all (one that has become the core of my own professional philosophy) was the "therapeutic use of self." At that time, we were somewhat unique in our holistic approach. OT was one of the few professions attending to both the physical and the psychological needs of our patients. Therefore, we understood the importance of the therapeutic relationship, and we were taught how to use that relationship as our most important tool.

            Today, other professions have become more aware of this relationship. An article in a 2003 issue of the Journal of the New York State Nurses Association states that "a Spirit of Healing enters into the nurse-client relationship or any care-giving situation. This spirit is defined as a universal energy source accessed through therapeutic touch and other related interventions". The Scientific World Journal published a paper in March, 2004 from the Quality of Life Center in Denmark, pointing "to the power of physical contact between physician and patient . . . highly beneficial for the process of healing."

            Another important concept of occupational therapy that we learned is therapeutic adaptation of the environment. This can take many forms, but it basically means attending to the patient's sensory as well as motor needs. We can adjust levels of sound and light, and the size, shape, texture, weight, and temperature of materials. We consider what kind of proprioceptive and vestibular input is appropriate for a particular individual at a particular time. Those of us in pediatric practice have tried to be alert to children's responses that may require further environmental modifications. These principles apply throughout the human lifespan.

            As you know, aging in American society is viewed as a series of changes or losses, out of the person's control. It is true that certain physiological and anatomical changes during aging have a profound effect on how the central nervous system operates, particularly how the brain organizes sensory input from the environment. Studies of aged subjects showed decreased visual and auditory perceptions and significantly decreased or increased sensitivity to temperature, pain, and touch.

            We know that an elderly person, particularly one with impaired mobility or even confined to bed, will experience a certain amount of sensory deprivation. But the primary sensory receptors are not always the problem. The person may be able to see and hear, and know when he or she is being touched, but cannot assign accurate meaning to that sensory input. Disorganized, inadequate, poorly processed signals do not provide orderly data for interpretation or storage. Thus, many elderly people appear to respond inappropriately to their environment. The College of Nursing at the University of Arkansas studied of the effects of therapeutic touch on the frequency and intensity of behavioral symptoms of persons with dementia in long-term care facilities, and in 2005 published their results, that therapeutic touch decreased prevalent symptoms such as restlessness and persistent vocalizations.

            Gentle, caring touch, especially therapeutic in geriatric practice, is an important treatment modality during terminal illnesses in people of any age. It helps not only the dying person, but the family members as well, because they too must deal with the impending separation. AIDS patients find the dying process particularly difficult because so few people are willing to touch them.

            Pain, especially of long duration, is a big issue in many types of diseases and injuries. In 2004 the Holistic Nurse Practitioner published a pilot study of the effectiveness of therapeutic touch treatments on the experience of pain and quality of life for persons with fibromyalgia syndrome. Its findings showed a statistically significant decrease in pain as well as significant improvement in quality of life. In 2005, the Swedish Dental Journal reported positive responses to tactile stimulation on both clinical signs and subjective symptoms of temporomandibular disorders (TMDs), as well as on general body pain.

            Guy McCormack, an OT who wrote the book Therapeutic Use of Touch, presents an operational model of therapeutic touch that can be applied to every area of our clinical practice. He tells us that the most powerful therapeutic tools ever invented are our hands. But how many of us have come close to reaching our potential in using our hands to communicate caring and to facilitate healing? Is it because we don't have the intent? Do we lack the skills? Can we really separate the two?

            McCormack refers frequently to "touch with intentionality" a term that is defined by Dolores Krieger, (a nurse who developed the treatment modality Therapeutic Touch), as "the use of hands by the caregiver with the intent to help or heal". Touch with intention depends on the therapist's efforts to consciously focus on the patient, as well as the preparation of a therapeutic environment. If successful, it empowers the patient to participate in his own natural healing process. We are only the guides; we should be partners with the patient in this process toward wellness. It's truly a dynamic interaction, as touching keeps us connected and in tune with the changes taking place. Regi Boehme, who in my opinion had the most therapeutic hands of any occupational therapist in this country, said that during the act of touching, we are as affected as much as the patient. Changes always occur in our bodies, too. The Journal of Alternative Complementary Medicine reported in June, 2005 that givers and receivers of healing sessions experienced a comparable increase in positive emotional state.

            The Western philosophy of medicine has generally neglected touch, in comparison with the rich framework for it that Eastern philosophies provide because they believe human beings and nature are inherently linked. A healthy organism with abundant energy is believed capable of consciously directing that vital energy to someone else whose energy is depleted or almost depleted. I was in China several years ago with a delegation of doctors, nurses, therapists, and teachers who were invited by the Chinese Medical Association for a scientific exchange. We observed how the Chinese are trying to blend our Western techniques with their Eastern methods, such as acupuncture, acupressure, moxibustion, and Qi Jong.

            McCormack does a wonderful job of describing both Eastern and Western medicine, how they interface, and how energy can be directed for healing with:

 focal touch (which is applied to midline plexuses),

 localized touch (which is pressure to acupoints), and

 scanning touch (which does not require physical contact, such as Qi Jong).

            When touch is viewed as an organizer, (a method of restoring homeostasis), emphasis is on the whole person. This is compatible with the current reform in medical education, where a less fragmented and more humanistic approach really is in progress. The central premise is that touch with compassionate intent somehow synchronizes our innate energies with those found in nature, and that we touch through our hands as well as with our hands. Experts generally agree that intent is more strongly communicated through nonverbal rather than verbal modes. Compassion, defined as a pure form of love given without expectations of return, will convey warmth, respect, and acceptance. Compassion creates a climate of trust, particularly integrative for those who are ill and often feel a sense of disintegration.

The Role of Touch in Occupational Therapy:
Principles of Therapeutic Touch: Application to Practice Areas
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