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Danny's client is a mother who is deeply grieving over the death of her child. He feels compassionate with a gentle touch on her arm. In this case, Danny's touch expressed the caring to his client. Corley (2007) believed that a touch is a key therapeutic tool and if it is given in right moment can convey far more empathy than words do. His client seems comforted by the touch. However, he had failed to ask permission to touch. To touch or not to touch is always a difficult decision for the therapist. It is not only considering its effectiveness in helping clients or engaging them in therapy, but involves lots of the ethical, cultural and legal issues. Therapist must carefully assess the correctness, motivations and interpretations of the touching. They can inform client at the beginning of the therapy and ensure that touching is not violent codes of ethnic. A touch is for the best interest of client, but not for satisfying therapist's own needs.
Erotic contact with client is unethical. However, if the nonerotic contact applied appropriately, it can have significant therapeutic value. An appropriate nonerotic touch from the therapist can increase the sense of empathy, safety, calm, and comfort for the clients. Researchers believed that a nonerotic touch to client can engage in deeper self-exploration and can evaluate their experience more favorably (Alagna, Whitcher, Fisher, & Wicas, 1979; Pattison, 1973). It also promotes the trusting relationship and increases the sense of connection between a therapist and a client. A nonerotic touch increased the client's perception about the counselors who touched them as more expert. (Corley, 2007)
Holub (1990) told that touching can reassurance the client in the psychotherapy, it is important for transference and countertranferece analysis. Rabinowitz (1991) stated that appropriate touching can increase verbal interaction and produce more positive attitudes towards the counseling process. Some researchers think that touch play an important role on human development. It is a profound method of communication, a critical component of the health and growth of infants, and a
powerful healing force (Bowlby, 1952; Harlow, 1971, 1986).
Touching can have significant therapeutic value. However, therapists must use their clinical judgment to justify whether providing or withholding touch is ethical and clinically advantageous in each therapeutic situation. Due to the poor legal climate, therapist must formulate clear guidelines and consider healthy boundaries to the client. Like the situation of Danny, he may beget into trouble if his touch misinterpreted as sexual or exploitative, and it may lead to sexual harassment and lawsuits over sexual misconduct in professional relationship. Therefore, in a clever way, therapist can discuss the physical support manner with client and explain the necessary of touching to client and their families before therapy begins. They can ask client to sign an informed consent at the beginning of therapy and often discuss the content with clients within sessions. A genuine touch can be an expression of caring and foster the trusting relationship between client and therapist, but client can detect the non genuine and that will erode their trusting relationship. If the client does not want to be touched, therapist should follow the client's request. Besides that, therapist must be sensitive on how clients think about the touch. They can discuss with the client what level of contact that the client can be tolerated.
Lazarus & Zur (2002) mentioned that non-erotic touch is the first step on the slippery slope towards sexual relationships. It is one of the major erroneous beliefs and obstacles to understanding the importance of touch in therapy. It is critical to determine the touching is fulfilling whose needs. The therapist must clearly understand the use of touch is for the best interest of client instead of meeting his or her own needs. On the other hand, touching has a high degree of cultural relativity. Therefore, the meaning of touch can only be understood in its cultural context. The therapist must consider the client's cultural understanding of touching and how the client reacts to the touch. (Corley, 2007)
Robert, who was attracted to his client Helen, decided that it would be appropriate to meet her for a "lunch session" at a nearby restaurant since Helen had a hectic schedule one particular week. Helen subsequently asked Robert if they could hold their sessions over lunch more often.
In some situation, client may find more relaxed and open outside the therapy room. Sometime it can be a turning point to consolidate in the working alliance. However, boundary crossing can be complicated and harm to the therapeutic relationship.
Sexual attraction for clients is normal in the counseling relationship. It is crucial for therapists to increase the self awareness and feel free to disclose these feelings and experiences to their supervisors. Ethic codes provide only general guidance on sexual attraction, therapist must think thoroughly on all the possible variables before making decisions about what boundaries to establish in the professional relationships. Lazarus & Zur (2002) suggested that boundary crossing only allow when it is helpful to client. The therapist must consider the potential positive and negative consequences for the boundary crossing. Corley (2007) stated that non sexual dual relationships are often complex and defy simplistic solutions. Gabbard (1994) thought it is danger to develop the dual relationship with client due to the sexual attraction based on the slippery slope phenomenon He stated that boundary crossing may foster the sexual relationship and seriously lead to exploitation of ethical behavior and harm to clients. According to APA (2002), sexual misconduct is considered to be one of the most serious of the ethical violations for a therapist. "Psychologists do not engage in sexual intimacies with current clients/patients; 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."
In this situation, if Robert found himself sexually attracted to his clients, it is important for him to have self-examination. He must examine carefully on the feelings towards Helen.
Corley (2007) suggested that counselors need to set boundaries when sexual attraction occurs. Robert must be aware if he finds himself treating Helen in different ways regarding to time spent, intimacy and touch. He can establish an appropriate boundary with his client. Pope, Sonne, and Holroyd (1993) believe that exploration of sexual feelings about clients is best done with the help, support, and encouragement of others. Robert is suggested to seek help from a colleague or request sessions on supervision. He can receive a personal therapy which can provide him guidance and support in handling his feelings towards Helen. He must manage well on those feelings towards Helen as they affect the therapeutic relationship. He needs to consider making a referral to terminate the therapeutic relationship with Helen when the sexual feelings affect his objectivity.
In case 1, to touch or not to touch involves ethical and legal issues. It is not an easy decision for the therapist to choose. Therapist must carefully assess the correctness, motivations and interpretations of the touching. A nonerotic touch can be a powerful therapeutic tool if appropriate. On the other hand, if it applies inappropriately, it can be destructive. Discussing the informed consent with client at the beginning of the therapy is necessary to avoid misinterpretation.
In case2, sexual attraction for clients is normal in the counseling relationship. Seeking consultation and have the honest dialogue with colleagues can help to ease the problem. Therapist frequently self examine can monitor the feelings and behaviors towards clients. Learning the possible adverse consequences for clients can help to dealing with the sexual attraction. Making referral to terminate the relationship if the counseling session is no longer effective and the sexual feeling affected the objectivity. (Corley, 2007)
Dueling with those dilemmas, always remember stick to the six moral principles-autonomy, nonmalefience, beneficence, justice, fidelity, and veracity. All the decisions must focus on the clients' best interests.