Losing touch in social work practice.

Touch in social work practice may carry both positive and negative connotations. Although there are reasons to avoid the use of touch in practice, there are also reasons to address the topic of touch in working with clients. According to the NASW (2010) Code of Ethics (standard 1.10), social workers are not to engage in physical contact with clients if there is a risk of psychological harm. The use of touch needs to be exercised using "clear, appropriate, and culturally sensitive boundaries" (para. 1.10). It is possible that social workers may allow their fear of crossing professional boundaries (Reamer, 2003) to inhibit an important element of needed support, exploring with clients their recent experiences of gentle and respectful touch in their lives. In an article addressing the debate over whether to touch young children in child care settings, Piper and Smith (2003) stated, "A moral panic has led to the production of guidelines that are concerned with protecting children from abuse and adults from false allegations, but where the needs of children are lost" (p. 890). This concern may inhibit work with adults as well. Given the basic necessity of touch in our lives, it seems important to ask our clients, "When is the last time you touched or have been touched with love and kindness?" This commentary explores the importance of touch in relationships and provides suggestions on integrating touch in social work practice. IMPORTANCE OF TOUCH The basis of much of our understanding of the importance of touch comes from research with animals. Montagu (1971) cited numerous animal studies demonstrating the importance of licking soon after birth. This licking seemed to elicit a necessary physiological response in newborn animals that promoted survival. For human infants, touch by caregivers may serve the same need (Feldman & Eidelman, 2007). The absence of touch in infancy has been shown to alter the physical structure of the brain and body, to lower IQ scores, and to increase abnormal types of behavior such as flat affect and stereotypical behaviors (Blackwell, 2000). "Stereotypical behaviors" are often seen when working with people diagnosed with autism. It is a repetition of behaviors that do not serve a purpose in a particular context (for example, clapping one's hands above one's head continuously without any apparent stimuli). Hammett (1921) and Harlow (1959) both discovered that if their experimental animals had been handled gently, as a mother might handle its young, the animals' abilities to handle stressful situations were far better than were those of animals not handled gently. Similar findings for human infants and young children who were orphaned have been found in observational studies (Skeels & Dye, 1939; Spitz, 1945). TOUCH AS THERAPEUTIC In recent touch research with humans, Dunbar (2010) has shown touch to be directly linked to the release of important neurochemicals in the brain, oxytocin and endorphins--both important in securing bonds and reducing felt pain. Tiffany Field (1998) (see also the Touch Research Institute Web site: http://www6.miami.edu/touch-research/) and her collaborators have published seminal findings on the beneficial effects of therapeutic massage on the growth of premature babies in neonatal intensive care (Field et al., 1986). The Touch Research Institute has conducted over 100 research studies on the therapeutic benefits of touch, and one of these benefits could be to recommend that clients explore whether massage might be indicated for their treatment goals. For a detailed description of the physiological response to massage therapy, see Field, Diego, and Hemandez-Reif (2007). In general, massage therapy has been shown to affect hormones and neurotransmitters in a positive, mental health-promoting way. Strozier, Krizek, and Sale (2003) suggested that touch facilitates "getting in touch" with emotions that are not readily available to clients in psychotherapy, and they mention five situations in which touch is indicated: (1) for "symbohc mothering" when clients are not attuned to their ability to communicate verbally, (2) to encourage acceptance when clients are excessively self-depracating, (3) to bring clients back to reality when their feelings of anxiety are too overwhelming, (4) to explore aggressive feelings in a safe manner (for example, screaming obsenities in a pillow), and (5) to express genuine concern for and acceptance of clients. …