Touch is one of the most primal forms of communication, and its potential role in psychotherapy is both powerful and controversial. While some clinicians find therapeutic touch helpful for building rapport and promoting healing (e.g. Yalom), others warn against its potential to breach ethical boundaries. This article explores the advantages and disadvantages of using touch in psychotherapy, grounded in clinical research and ethical guidelines.

What Is Therapeutic Touch?

Therapeutic touch in psychotherapy refers to intentional physical contact between therapist and client within the bounds of a therapeutic relationship. This could include a handshake, a pat on the shoulder, or—more controversially—a hug. Unlike bodywork or somatic therapies that focus on touch as an intervention (e.g. massage therapy), therapeutic touch in psychotherapy is typically incidental, supportive, or symbolic.

The Case For Using Touch in Therapy

1. Supports Non-Verbal Communication

Touch can convey empathy, warmth, and attunement beyond what words can express. Research suggests that non-verbal cues, including touch, can enhance the therapeutic alliance—a crucial predictor of treatment outcome (Norcross & Wampold, 2011).

2. Reduces Stress and Activates Soothing Systems

Studies have shown that gentle touch can reduce cortisol levels and increase oxytocin, the so-called “bonding hormone,” which promotes a sense of safety and trust (Field, 2010). For clients with developmental trauma, safe and appropriate touch may help to co-regulate their nervous system.

3. Validates Emotional Experience

For some clients, especially those experiencing grief or loss, a simple supportive touch may affirm their emotional state and provide a sense of connection. Clinical literature on grief therapy, for example, describes how a compassionate touch can reduce feelings of isolation (Durana, 1998).

The Case Against Using Touch in Therapy

1. Risk of Boundary Violations

The most commonly cited concern is the risk of crossing or violating ethical boundaries. Touch, even if well-intentioned, can be misinterpreted or may unintentionally replicate dynamics of past abuse or neglect (Zur, n.d.). For this reason, many clinicians avoid touch altogether.

2. Cultural and Individual Differences

The meaning and acceptability of touch vary widely across cultures, genders, and personal histories. A gesture considered benign by one client may feel intrusive or confusing to another. Therapists must navigate these variables with caution (Smith et al., 1998).

3. Legal and Professional Risks

In some jurisdictions, touch between therapist and client—outside of structured therapeutic modalities like somatic experiencing—may be considered unethical or even illegal. Professional bodies such as the British Association for Counselling and Psychotherapy (BACP) emphasise the need for clear contracting, supervision, and client consent (BACP, 2018).

Ethical Considerations

The ethical use of touch requires:

• Informed consent: Clients should understand the intention and boundaries of any physical contact.
• Supervision: Regular discussion in supervision helps manage transference and countertransference issues.
• Contextual awareness: Therapists must remain attuned to power dynamics, cultural meanings, and trauma histories.

According to the American Psychological Association (APA), the use of touch must be clinically justified and handled with sensitivity to the client’s needs and boundaries (APA Ethics Code, 2017).

When Might Touch Be Appropriate?

Touch may be more appropriate when:

• Working with children, where light supportive touch may be common (e.g. holding a hand).
• Supporting clients in acute distress or during moments of crisis.
• Practicing in cultures or modalities where touch is culturally normative or explicitly integrated (e.g. Gestalt therapy, some somatic practices).

Conclusion

Touch in psychotherapy can be healing or harmful, depending on the context, intent, and individual client. While it offers potential benefits in creating safety and connection, it must be used judiciously, with full attention to ethical, cultural, and clinical factors. For many practitioners, the key is not whether to use touch, but how—and whether—it supports the therapeutic process for that individual client.

References

• American Psychological Association. (2017). Ethical Principles of Psychologists and Code of Conduct. https://www.apa.org/ethics/code
• British Association for Counselling and Psychotherapy (BACP). (2018). Ethical Framework for the Counselling Professions. https://www.bacp.co.uk/ethical_framework/
• Durana, C. (1998). The use of touch in psychotherapy: Ethical and clinical guidelines. Psychotherapy: Theory, Research, Practice, Training, 35(2), 269.
• Field, T. (2010). Touch for socioemotional and physical well-being: A review. Developmental Review, 30(4), 367–383. https://doi.org/10.1016/j.dr.2011.01.001
• Norcross, J. C., & Wampold, B. E. (2011). Evidence-based therapy relationships: Research conclusions and clinical practices. Psychotherapy, 48(1), 98–102. https://doi.org/10.1037/a0022161
• Smith, E. W. L., Clance, P. R., & Imes, S. (Eds.). (1998). Touch in Psychotherapy: Theory, Research, and Practice. New York: Guilford Press.
• Zur, O. (n.d.). To Touch or Not to Touch: Clinical and Ethical Considerations in Non-Sexual Touch in Psychotherapy. Dr. Ofer Zur. Retrieved 16 April 2025, from https://drzur.com/clinical_updates/touch-in-therapy/