One of the most controversial subjects in dance/movement therapy (DMT), or any psychotherapy, is the use of touch. By this I mean when the therapist makes physical contact with a client. It may be a pat on the back, a handshake or even a hug. The use of touch is provocative because although the relationship between therapist and client is deeply personal, ultimately it is a professional relationship. No matter how close I get to a client, DMT is my profession and I am getting paid to do the work. Yet, I know that the relationship, the attachment, is the crux of the therapeutic process and it is the main motivating factor in therapeutic growth. Touch is a natural component of most relationships, so how do I mindfully integrate the use of touch when working with my clients in a clinical setting?
It is important to note that the use of touch in DMT is dictated by the type of clinical setting a dance/movement therapist works in. The use of touch may be more acceptable in certain settings than others. It’s probably more appropriate to give a client a hug if you work in a nursing home rather than, say, a state prison. I work in a day training program for adults with developmental disabilities (DD) and handshakes, fist-bumps and hugs are commonplace. The treatment culture of the program allows for and approves mindful physical contact with clients. To successfully integrate the use of touch, the dance/movement therapist must first check with the treatment culture and rules/regulations of the clinical setting.
The rapport I have with clients is also an important indicator of whether or not I engage in physical contact with clients. How long have I worked with this individual? How comfortable is the individual in DMT group and with me as the facilitator? Rapport can work both ways. It may take months of even years for a client to feel comfortable enough to engage in a seemingly simple gesture as a handshake. Whereas other clients want to hug you, sit in your lap practically, upon first meeting you. The difference between the two points to the relevance of a client’s diagnosis and how this informs my practice and use of touch. I have one client, who in addition to DD also is autistic and has schizoaffective personality disorder. I know to give him considerable distance when communicating with him. I literally stand ten feet back and use lightness and sustained time when waving hello to him. With another client, who in addition to DD has Bipolar Disorder, I have to extend my arm out to physically demonstrate my personal space bubble as well as offer the individual a fist-bump when I’m asked for a hug. Each client’s interpretation and comfort with physical contact is unique and informed by their preference, diagnoses and history of physical contact in other interpersonal relationships.
If and when I do decide to make physical contact with a client after considering the many factors, I makes sure to use specific energy when making contact. Although each moment may call for different qualities (a light brush of the shoulder v. a strong hand squeeze), touch should always be supported by clear and healthy boundaries. The intent of the touch should always be to facilitate clients’ therapeutic growth in the present moment. I have some experience in contact improvisation where I’ve learned that those you are moving with are informed by the touch cue you give them. I’ve learned that the more clear, direct and “clean” the touch is the better you inform your intent to the person/s you’re moving with. If you sort of touch a mover’s shoulder, the mover may be confused as to what your intention is and how to respond to it. Yet, if you confidently touch a mover’s shoulder the person will know that’s the point of contact and can respond accordingly. The more clear, direct and confident the touch is the more healthy the touch is because it has clear boundaries. Although this is a core tenet of contact improvisation, I’d say it is also true in DMT group.
I often make physical contact with clients in my daily practice. I hug, high-five or hold hands while dancing with clients. Sometimes the physical contact I make with clients can be even more intimate. The other day in DMT group I noticed a client showing signs of anxiety. I have known this client for four years and thus I know her effort life well. Her unsettled movement was a clear indicator that she was upset. I danced over to her, said that I noticed that she looked uncomfortable and that I was here to support her. Her eyes began to water so I sat next to her. She began to tell me about her bus ride to the day program and after a few short sentences she began to cry. In the moment I had the urge to put my arm around her to support her while she cried- so I did. As I wrapped my arm around the client’s shoulders she softened into my embrace and cried harder. After her release, we verbally processed her anxiety/sadness about the loss of people in her life. We then opened the topic to the group to discuss too. It was powerful.
If I am unsure if whether or not it is appropriate to make physical contact with a client in DMT group then I ask the recipient before I commit to the action. Simply saying, “Client, is it okay if I place my hand on your shoulder?” or, “Client is it okay if I give you a hug?” By asking I am empowering my clients by providing choice- they can say yes or no. I have noticed, though, that sometimes when I ask for permission, it can sometimes cause a pause or stumble in the organic healing process. Usually when I decide to wrap my arm around a client or grab a client’s hand, I just go for it while maintaining awareness of my physical sensations that give me clues about my choice. If I use my embodied ethical decision-making skills I can assess whether or not my choice to use touch was the right intervention choice. Maybe I notice a drop in my stomach when I make contact with the client, informing me that the touch is too much and I should retreat. If my muscles relax upon the contact then maybe the client is able to relax too in response to our physical bond. The experience around which way to approach physical contact is complex, subtle and nuanced. Either way, going for it or asking for permission, I must be mindful of how my clients respond. I must respect their boundaries whether they express this verbally or non verbally.
As a dance/movement therapist, I am constantly integrating the use of touch in my practice. I am mindful of the rapport I have with each client, as well as the client’s diagnosis, prior personal experience and comfort with touch. I also know that the treatment culture of where I work allows for staff and clients to make appropriate physical contact. Maybe in this way I am a lucky dance/movement therapist. I am lucky that my work setting allows for me to make physical contact with clients. I know that in my own personal therapy work that the use of touch has been very powerful. I have been deeply moved by one simple touch. As a body-based therapist I know the healing power in the use of touch.