Touch and psychiatry have become like vinegar and oil – they don’t mix. It is hazardous if not contraindicated for a psychiatrist to touch a patient, particularly one with a history or trauma, intimacy issues, or poor boundaries. Then there is a hygiene matter: primary care doctors have easy access to soap and sinks to wash their hands after every encounter with a patient; psychiatrists don’t.
This taboo against touch rankles me, for I know the the value of Touch. Touch is powerful, therapeutic, and healing. We reach out to hug and hold those upset and scared. In medical school I was trained to always find someway to make physical contact with each patient, even if they are only coming in for some paperwork item. Sometimes this contact is disguised via ‘let me take your pulse’ or listening to their breathing. Hands are shaken when saying hello and farewell.
Traditionally I do not shake hands or make contact with my patients. When meeting new ones I would make a slight bow to indicate politeness but convey we are not going to shake hands. This safe move has mostly backfired: I sense patients, particular the males, find it rude and/or disappointing I don’t shake hands. Lately I decided to risk the scorn of Public Opinion and find some way to make some physical contact. Outstretched hands are being offered at the beginning or end of the appointments. My desk is located so that when I get up to go around a sitting patient I can momentarily place my hand on their shoulder as I pass, or tap their shoulder with an index finger to say ‘follow me’. It ain’t much but at least I made contact. My family practice mentors would be pleased although the psychoanalyst professors would be rolling in the graves.
I am limiting this experimentation of touch to male patients, so as not to risk being accused by the females as being inappropriate.
So far I have not been arrested or dragged off by the APA secret police, nor have I been arrested.
Quite the contrary, I think my patients are more relaxed, see me as more friendly, and – do I dare think it – they are more healthy for this contact?
Spo-Reflections 
19 comments
August 22, 2012 at 7:48 PM
Erik Rubright
Wasn’t there that whole psychological study done about touch/lack of it with monkeys in the long ago, and how it corresponded to humans? It seems odd that a profession of healing would cut out that one basic thing.
August 22, 2012 at 8:01 PM
Urspo
Indeed But monkeys don’t accuse others of harassment
Sent from nowhere in particular.
August 22, 2012 at 8:25 PM
Erik Rubright
Yet more proof that we’re not evolved: Monkeys don’t litigate.
August 22, 2012 at 7:58 PM
Jay
Hugs are very important to well being. We used to get hugs from our (elementary) students but no more. Now we must discourage it. I don’t like to shake hands because my right shoulder has arthritis and it hurts but I do it because it is expected. I still prefer hugs.
August 22, 2012 at 10:27 PM
anne marie in philly
{{{{{hugs}}}}}
August 23, 2012 at 1:30 AM
Cubby
Yes, when you fail to perform an expected and common social nicety, that will pretty much ruin the entire session. I’m sorry to say it, and I hope I’m not hurting your feelings, but it’s certainly true.
I wouldn’t dream of shaking my physician’s hand. Who knows whose anus he had just had his finger up. I shudder to imagine it. But on the other hand, I wouldn’t dream of NOT shaking my psychiatrist’s hand. Not that I have one. I’m sane! I swear! 😉
August 23, 2012 at 1:49 AM
Tai
HUGS!!! 🙂
August 23, 2012 at 4:07 AM
Mitchell Block
I think the idea that you can’t even shake hands in greeting is absurd. What have we come to? I met with a couple of psychiatrists in the States who did not shake my hand when we met and I found it extremely awkward and off-putting. Thanks for enlightening me as to why but also thanks for being more enlightened yourself.
August 23, 2012 at 4:08 AM
Mitchell Block
Oh, yeah, one other thing: Purell!
August 23, 2012 at 4:45 AM
Laurent
There is a continuous debate in society about touching and appropriateness. This debate is usually in women circles, there is a level of hysteria over touching and I think it hides a deeper problem in individuals who are against touching. Instead of asking why they are so against touching we go along with it. Here in Ottawa we have gone from no touching to no speaking, people will not even acknowledge good morning. The issue is you do not have to talk to anyone if you do not want too. In the long run such societies don’t have a future.
August 23, 2012 at 5:11 AM
Tony Davis
like you, michael, i shake hands with new clients, both male AND female. after that, touch is limited to a hand on the shoulder as we walk down the hall after the session, and it is done outside of the therapy room, in public. but there are clients i have hugged, at times when the pain they are experiencing cries out for more than passive empathy. as practitioners, i think we know when to do that, and when not to. so far i have called it well.
August 23, 2012 at 6:44 AM
Fritz Bell
Having been ivolved with studnets for well over 50 years, I believe very strongly in the power of touch. Many years ago there was a wonderful program on( maybe) Nova that was on the power of touch. You might be able to find it somehow. Of course as a teacher one has to understand good touch – bad touch. But touch has made a huge difference in my teaching and interaction with others. Even the slight touch on their shouder is enough. Human contact -= very much needed. Think of the study of Romanian orphans who were well housed and fed but not touched. Their brains were one third the size of a normal brain. TOUCH!
August 23, 2012 at 6:45 AM
Raybob
So sad. I’m a touch therapist, and I end up touching almost the entire bodies of my clients. I can’t imagine NOT touching someone, as I know how much this impacts health. Read Ashley Montagu’s book “Touching: The Human Significance of the Skin” if you don’t believe me.
Touch lowers blood pressure. It reduces stress hormones. It stimulates the creation of red blood cells. Tons of studies (peer-reviewed ones at that) at Touch Research Institute.
I would never entrust my psychological OR physical health to someone who didn’t shake my hand: for me it’s a basic marker of care and compassion. If you’re unwilling to give me even that basic level of societal courtesy and connection when you greet me, how can you muster and engage your compassion sufficiently to help me? We care about people we touch. Not so much about those we don’t or won’t.
I understand the litigation issue. I’ve seen more than one music educator career ruined and completely ended because a student brought a sexual harassment suit based on *appropriate* touch during lessons when angry at the grade he or she earned. Even when the story was recanted later.
This sort of thing signals to me that something is very, very wrong with our society that basic touch among us is feared so. Stupid and ridiculous.
August 23, 2012 at 6:56 AM
Ron
My natural tendency is to touch, either lightly on the shoulder or arm when making a point. However, I know in today’s PC climate, touching is considered “inappropriate” in my position as a hotel front desk clerk. I have to watch myself but sometimes I’m touching the guest before I realize I’m touching. It is a hard habit to break.
August 23, 2012 at 7:04 AM
William Fregosi
Fritz has already posted on touch but I will just mention that a significant portion of the work that is done by groups who rent his Center here is devoted in whole or in part to touch. Touch is vital and the lack of it (particularly during all those decades when men were trained not to touch each other as part and parcel of teaching them to have no feelings) was the cause of tremendous problems.
I’m Italian — I hug, I touch, I throw an arm around the shoulder.
August 23, 2012 at 8:27 AM
Shawn
I think I would find myself reserved and not likely to open up if a handshake was not an option….A bow is kind of cold, unless your of an Asian culture….or The Queen.
August 23, 2012 at 9:58 AM
Urspo
I have been called Queen on more than a few times, although I prefer God Emperor.
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August 23, 2012 at 7:54 PM
Will J
Oh fer goodness sakes — ask! I learned this at a healing service. The custom is to lightly put your hand on the shoulder of the person with whom you are praying. For some reason on one particulat evening, I asked the woman with whom I would be praying if it would be OK. She recoiled in horror. After the service she explained that she has a physical condition that would have made that painful. I recovered from my embarassment and she did not have any unnecessary pain. I am certainly glad that, for whatever reason, I thought to ask that evening.
August 27, 2012 at 5:58 AM
Birdie
For all its disadvantages, one advantage of being a woman is the permission to touch. I often take it for granted, this privilege for intimacy. Touch engenders trust and openness. I think Will has the right idea for men and for all when in doubt: ask.