NONVERBAL COMMUNICATION:

A HOLISTIC APPROACH
TO THE EFFECTS OF TOUCH

by

JANIS SCOTT HALL

A SENIOR THESIS

IN

GENERAL STUDIES

IN

COMMUNICATIVE AND CREATIVE SKILLS

Submitted to the General Studies Committee

of the College of Arts and Sciences
of Texas Tech University in
Partial Fulfillment of
the Requirements for
the Degree of

BACHELOR OF GENERAL STUDIES

Approved

Chairman of 61le @'udy Comrni ttee

Accepted

Director of General StuaYes

April, 1982
h^

j a. -y '

This Thesis is dedicated to my mother,

the late LaWanda Blakeley,

who touched my life in so many ways,

and to my son, Mark Scott.

 TABLE OF CONTENTS

Page
ACKNOWLEDGEMENTS i

LIST OF FIGURES ii

I. INTRODUCTION AND OVERVIEW 1

Introduction 1
Physiology of Touch 2
History 4
Interpretations 5

II. TAXONOMY OF TOUCH 7

Duration 9
Location 9
Action 11
Intensity 11
Frequency 11
Sensation 12
III. THE EFFECTS OF TOUCH
ON HUMAN DEVELOPMENT AND INTERACTION 14
Child and Adolescent Development 14
Adult Interaction 19

IV. TOUCH WITHIN THE HEALTH CARE FIELD 25

Nurse Touch 25
Physician Touch 31
Tactile Communication in Psychotherapy 32

V. THERAPEUTIC USES OF TOUCH: A REDISCOVERY 38

Therapeutic Touch 39
Healing with Hands 46
Massage 50
Touch for Health 52
LIST OF REFERENCES 61
 ACKNOWLEDGEMENTS

I would like to express my appreciation to Dr. William

Jordan, committee chairman, who unselfishly gave his time
and guidance for this research thesis. I am also very
thankful to Dr. Virginia Wain, committee member, for her
enthusiasm and expertise in the field of nonverbal communi-
cation and her helpful criticism during this project. My
thanks also goes to Dr. Jeffrey Elias, committee member,
and Dr. James Culp, Director of the General Studies
Program.

I appreciate my friends Pat Williams, Charlie Snuggs,

and my typist, Belinda Winton, for all their help. I am
deeply greatful to Dr. Matt Stricherz for the positive
influence he has had concerning my investigating new fron-
tiers and for all his help in completing this thesis.

%
 LIST OF FIGURES

1. The Semiconductor Effect Observed in

"Paranorroal" Healing 49

2. Neuro-lymphatic Massage Points 55

3. Neuro-vascular Holding Points 56

4. The Meridian Cycle 58

11
 CHAPTER I

INTRODUCTION AND OVERVIEW

Introduction

Humankind's first medium of communication is the sense of

touch, "the Mother of senses" (Montagu, 1971). Touch can

range in extent from a casual, almost unnoticed touch with a

stranger, to the intimate touching of lovers. Its wide range

of functions can include attention getting, healing, expressing

sympathy, caring, or anger. Touch can adequately portray emo-

tions in a way that words can never do. It can efficiently

contradict false spoken language or enhance genuine verbal mes-

sages. It can be therapeutic to both the physically and men-

tally ill. The purpose of this research project is to provide

a description of investigations of the effects of touch as a

holistic communicative tool in human development, human inter-

action, and mental and physical health. Specifically, this

research will include the areas of information concerning the

language of touch, tactile communication and its relation to

human development, the use of touch in the field of health care,

and new and re-discovered frontiers of touch for therapeutic

use.

Since touch appears to be a multi-dimensional, physical

and emotional occurrence, an attempt to acquaint the reader with

a basic understanding of touch will guide this writing. The

present chapter will discuss some physiological components of

touch and offer a brief historical definition and several cate-

gorical definitions of touch. Chapter II will emphasize the

taxonomy associated with the use of touch. Chapter III will

relate to human development. Chapter IV will explore the uses

of touch in the health care field, emphasizing nursing and psy-

chotherapy. Chapter V will investigate re-discovered areas

and new frontiers in the use of therapeutic touch.

Physiology of Touch

The communicative process begins with external physical

events acting directly on living tissue of the human organism

(Christman, 1979). The largest organ of the body is the skin

and, next to the brain, it is probably the most sensitive organ.

The various elements of the skin have a large representation

in the brain, and as a general rule, the size of a particular

region or area of the brain is related to the multiplicity of

the function it performs. Nerve fibers which conduct tactile

impulses to the brain are generally larger than those asso-

ciated with the other senses (Montagu, 1971).

The biological system pertaining to tactile sensations is

called the haptic system. The activity of the central nervous

system which registers and associates sensory impressions is

determined largely by impulses received from the receptors

located at the surface of the body. Stimulation of receptor

organs in the skin causes physiologic excitation of the body

surface which is replete with nervous pathways. These pathways

contain neurons which receive the stimulation and transmit the

nerve impulse to the central nervous system (Weiss, 1979).

Some evidence exists that indicates the initial neural

pathways that develop carry kinesthetic and tactile information.

In citing previously published research, Weiss (1979) explained

that sensory pathways involving kinesthetic and tactile acti-

vities are the first to complete myelinization in the infant,

followed by the auditory and visual senses. This earlier de-

velopment gives one a base for higher order operations and

determines many of the initial "cell assemblages" which form the

roots for future learning.

A cell assembly is a diffuse structure comprising cells in

the cortex and diencephalon. It is formed by frequently repeated

sensory stimulation and experienced as neuromuscular excitations

of the body. "In this way, each separate tactile impression

which a person experiences becomes related to the next and is

mentally strung out in an orderly fashion so that initially

developed cell assemblies afford the core experiences and re-

sulting meanings which an individual comes to understand" (Weiss,

1979, p. 77). Thus, initial tactile stimulations provide develop-

ment of perceptions and conceptions which provide each indi-

vidual with meaning. Accordingly, tactile encounters throughout

adult life reinforce and affect perceptions toward both self and

environment. More than likely, these self perceptions are a

result of a many-faceted biochemical reaction. Although some

research has focused on the effects of touch and the way touch
affects neurological impulses, other research has focused on

touch effects on energy forms that have no specific neural or

psychological corollary.

The sensory elements of touch induce neural, glandular,

muscular, and mental changes (Bruhn, 1978). Although specific

research has not detailed the neurological effects of tactile

stimulation by cortical representation, there has been specu-

lative research on cortical functioning and kinesthetic stimula-

tion. Many neurophysiologists believe that processing of non-

verbal communication is accomplished by the right hemisphere of

the brain. Since this is acquired as an earlier neurological

system, nonverbal cues such as touch are interpreted faster than

verbal cues (spoken language) and thus override verbal inter-

pretation (Knapp, 1978).

Inyushin and Grischenko (Riscally, 1975) have stated that

all living organisms have a physical body of energy. This body

acts as a unit and gives off its own electromagnetic fields and

is the basis of biological fields. The use of Kirlian photo-

graphy has provided evidence that this electromagnetic energy

can be transferred from one organism to another (Miller, 1979).

History
Historically it was believed that great persons had healing

power in touch. There are many instances mentioned in the Bible

where Christ touched and healed persons.

 Certain historical figures, such as the Roman emperors,

Vespasian and Hadrian, and the Norwegian king, Olaf, were known

to use laying-on of hands. The "King's touch," as it was known

in early France and England, was considered especially good for

curing ailments such as goiter, scrofula, and other throat

ailments (Krieger, 1978). "In the ancient past the Indians and

the Chinese placed special emphasis on massage" (Krieger, 1978,

p. 212).

Interpretations of Touch

Current formal interpretations of touch differ from anec-

dotal portrayals of touch historically. Ortega (Montagu, 1971)

points out that touch differs from all the other senses in that

"...it always involves the presence, at once and inseparably, of

the body that we touch and our body with which we touch it" (p.

108) .

However, Henley (1977) believes that touch is not a short-

lived event that is finished when a hand is removed from the

person, but rather it is perceived as part of one's history and

creates some permanent change. Whitcher and Fisher (1979)

suggested that touch has some long-term consequences and indi-

cated that it may have powerful multi-dimensional effects over

time, in addition to short-term effects.

It has been suggested that touch is more than a transient

occurrence. Although neurologically touch has definitive points

of demarcation, existentially the boundaries go beyond temporal

continuity.
 Bruhn (1978) defines touch as being a reciprocal exper-

ience in the sense that what a person touches also touches

him/her. The act of touching can signify that a special type of

relationship exists because those involved have eliminated the

space between them.

Downing (1972) delicately states, "The least touch becomes

a statement, like drawing with a fine pen on sensitive paper.

Trust, empathy and respect, to say nothing of a sheer sense of

mutual physical existence, for this moment can be expressed with

a fullness never matched by words" (p. 1 ) .

Touching can be categorized into two forms: instrumental

and expressive. Instrumental touching involves deliberate phy-

sical contact which facilitates the performance of an act such

as a nurse applying a bandage to a patient. Expressive touching

is spontaneous and affective, not required by instrumental

reasons (Watson, 1975).

This chapter introduced the reader to the topic of touch

by including a discussion of some physiological components of

touch, a brief historical definition and several categorical

definitions of touch. The following chapter will deal with

the taxonomy of touch, including an in-depth description of the

qualitative symbols in the language of touch.

 CHAPTER II

TAXONOMY OF TOUCH

In the preceding section the reader was acquainted with

several global conceptualizations in, and definitions of, touch

as well as a brief indication of the physiological components

of cortical representation. This chapter will detail the manner

in which touch has been defined, reified, and applied in empiri-

cal settings. Specifically, the explanation of the use of adap-

tors and the aspects of the intricately represented states of

touch called duration, location, action, intensity, sensation,

and frequency will provide the reader with an understanding of

touch.

The English language is colorfully present with kinesthetic

descriptors of tactile sensations. Tactile sensations have made

their way into our verbal language in the form of colloquialisms.

"Rubbing" someone the wrong way, getting in "touch" with someone,

having a "soft" touch, or being "thin skinned" are all examples.

It has been suggested that touching can explain the meaning

of what is being said, replace speech, convey inner feelings, and

control the flow of conversation. Habitual touching gestures

can be clues to one's emotional state. Gestures and involuntary

movements which unconsciously reveal a person's inner state are

called "adaptors." Harrison (1974) defines adaptors as "behav-

iors originating in the adaptation of the individual to his

environment" (p. 199). Use of adaptors is usually done without

awareness of the user and interpretation of adaptors is a specu-

lative endeavor. Examples of adaptor use include placing the

hand over the mouth in order to prevent speaking, wiping around

the eyes as if wiping tears in grief, covering the eyes which is

synonymous with warding off unpleasant stimuli (Bruhn, 1978).

Three types of adaptors include: self-adaptors, alter-

adaptors, and object-adaptors. An individual's feelings about a

situation or about others within the personal environment may be

revealed by the use of self-adaptors. Examples include self-

touch such as scratching, soothing, biting, or cradling some

part of the body. When another person is involved, alter-

adaptors are used and include such actions as touching, nuzzling,

kissing, or holding. Object-adaptors refer to activities in-

volving the playing with, stroking, or punching of an object.

According to Weiss (1979), there are qualitative symbols in

the language of touch. Giving the touch its meaning, a

tactile symbol serves as a visible modifier of a tactile act

which signifies something invisible or intangible. The language

of touch includes six major tactile symbols and these are dura-

tion, location, action, intensity, frequency, and sensation.

"The significance of these particular symbols lies in their

power to affect an individual's perceptual ability for sensory

discrimination of his body, the pleasure/pain balance of the

body, and self-cathexis, specifically for approval or liking of

one's body" (p. 77).

In order to more completely understand these tactile sym-

bols, a more detailed explanation of each follows.

Duration

Duration is defined as length of the touch from initiation

to the cessation of the interbody contact. Duration can deter-

mine available opportunities for knowledge of body boundaries as

well as awareness of autonomy in a person (Montagu, 1971).

Weiss (1979) indicated that longer durations of touching have

been shown to foster a knowledge of body detail and boundaries

and create a high level of body esteem.

Location

Location refers to the area or areas of the body which are

contacted by the persons initiating or receiving touch. Weiss

(1979) subdivided location into three dimensions: threshold,

extent, and centripetality.

Threshold. "Threshold denotes the degree of innervation

within a body area and that body area's resulting sensitivity to

touch" (Weiss, 1979, p. 7 7 ) . Citing earlier studies, Weiss

(1979) stated:
Body areas that have the most cerebral repre-
sentation are richly endowed with afferent
sensory fibers that cause high sensory acuity
and fine discrimination. Body areas of les-
ser innervation yield dull, vaguely localized
impressions such as in the back or arm; while
highly innervated body areas such as the
face... yield bright, discrete, sharply
localized impressions (p. 77).

Referring to her own earlier study, Weiss (1979) stressed

that mothers' touching of highly innervated body areas of their

children was significantly related to both high body concept

 10

and high body esteem in their children. However, low body con-

cept and low body esteem in children was related to touching of

the same areas by fathers. Weiss offered no ass\imption con-

cerning the possible difference experienced in gender differen-

tiated touch. There appears to be no indication of whether a

father's touch producing a negative effect on the child's self

image is a function of the father's electro-magnetic field, the

child's more positive bonding with the mother or perhaps quality

of touch (soft hand versus hard or large hand) that is sex

specific.

Extent. The extent of touch refers to the number of areas

of one's body which are touched in relation to the number of

areas available to be touched over the entire body surface.

While some individuals may touch or be touched essentially on

their hands or arms, with other body parts rarely being in

contact with another human, some persons may regularly exper-

ience contact over their entire body. A positive evaluation of

self has been correlated with perception of how much of the body

is touched by others (Jourard, 1966) .

Centripetality. Centripetality refers to the degree to

which the trunk of the body is touched rather than the limbs.

It is believed that primary perception of self is concentrated

in the trunk area.

 11

Action

The rate of approach to a body surface is called the action

of touch and can be abrupt or gradual. The abrupt approach can

actually cause muscular resistance which encourages a different

degree of discrimination in neural representation than is found

in gradual action.

Intensity

The extent of indentation applied to the body surface by

the pressure of the touch defines the intensity of touch and

can be strong, moderate, or weak. In citing others, Weiss

(1979) stated that moderate intensity of touch appears to be

the least therapeutic. It appears that variation in the type

of intensity has potential for furthering body esteem, accurate

perception of body characteristics, and one's view of self as a

sexual and autonomous person.

Frequency

It is believed that frequency of touch, referring to the

overall amount of touching which an individual experiences

in everyday life, affects metabolism. Positive elements of

psychological health including liking of self, awareness of

one's body, a sense of closeness with others, health, biological

development, increased cognitive and emotive ability, and

healthy sexual identity have been linked to high frequency of

touching.
 12

Sensation

Sensation refers to a reaction of the skin as being either

pleasurable or painful following some type of neural stimula-

tion. There are two cutaneous systems which respond to tactile

stimulation. One is the protective system which warns the body

tissues of potential harm and the discriminative system which

involves higher differentiating functions. The protective

system overrides the discriminative system in order to signal

pain. Previous studies have shown that painful tactile stimuli

destroy the body image by preventing adequate functioning of the

body's perceptual system. Conversely, development of a positive

cathexis of one's body can be derived through pleasurable

tactile interaction which allows for maximal discrimination.

The adaptive or maladaptive meaning of a

tactile symbol is made available to an
individual through the ever varying afferent
impressions on the skin. These impressions
are transmitted through the reticular forma-
tion of the brain stem and then to the cortex
where they create levels of activation that
affect one's perceptions and awareness of his
body.... This level of arousal is determined
by the qualitative use of the tactile symbols;
duration, location, action, sensation, and
frequency (Weiss, 1979, pp. 78-79).

Tactile integration refers to the body's experience of the state o

arousal. Integration is a balance between tactile deprivation

and tactile satiation. Prescott (Weiss, 1979) referred to

tactile satiation as providing excess somatosensory stimulation

 13

which results in a defensive blockage of information to the

brain concerning the body. Tactile deprivation understimulates

resulting in a lack of information to the brain concerning the

body. Tactile integration lies comfortably between these two

extremes and functions to arouse cognitive and affective per-

ception of the body.

Weiss (1979) exemplified the message of integrative touch

by exchanging the symbols of a verbal language for the symbols

of a tactile language. She stated, "You are a likeable phy-

sical and social being, whom I enjoy being close to frequently

(frequency) and for long periods of time (duration). I like

all of your body, not just some of it (location). I want you

to feel good about yourself (sensation) because you are capable

of experiencing a variety of feelings in an often powerful and

intense way (action, intensity)."

This chapter specified a variety of interpretations of

touch that are found in relevant literature. It included an

in-depth description of qualitative symbols represented in the

language of touch. Included in that discussion were the major

categories of duration, location, action, intensity, sensation

and frequency. The following chapter will discuss the effects

of touch on human development ranging from infancy through

gerontological stages, including sex, culture, and status differ-

ences.
 14

CHAPTER III

THE EFFECTS OF TOUCH

ON HUMAN DEVELOPMENT AND INTERACTION

In the previous chapter, various definitive components of

touch were provided. Those definitions provided the reader with

schemata and a common language for application of touch. This

chapter will develop a framework specifying the effects of touch

within the developmental process. Specifically, the manner in

which touch affects the developing embryo, neonate, and child

will be described. Following, a brief description of touch in

adolescent development will be offered along with more detailed

description of touch effects in adulthood. Some cultural,

status, and sex differences in research paradigms will be dis-

cussed.

Child and Adolescent Development

Integrative touching appears to be an important develop-

mental necessity. "Our first lessons in loving and responsibility

are learned through the cuddling received while an infant"

(Goodykoontz, 1979, p. 11). Montagu (1971) stated, "Tactile

experience plays a fundamentally important role in the growth

and development of all mammals thus far studied, and probably also

in non-mammals" (p. 183).

 15

The human embryo when less than eight weeks old and only an

inch long will respond to light stroking of the upper lip or

wings of the nose (Montagu, 1971), thus leading to the belief

that tactual sensitivity may be the first sensory process to

become functional. "The nature of the significant touch experi-

ences which facilitate development in the child and which later

reinforce maintenance of health in the adult are extremely im-

portant, for the actual occurrence of each tactile act carries

physiologic impact with psychosocial meaning" (Weiss, 1979, p. 77).

Christman (1979) cited Riesen's study that prolonged with-

holding of visual stimulation can have profound effects on the

subsequent development of visual skills. Deprivation of tactile

stimulation in infants can likewise have a profound effect on

their development, even through adulthood. A variety of behavioral

disorders including schizophrenia, as well as failure to develop

interactional relationships, have been traced to the lack of

tactile stimulation as an infant. Surprisingly, such respiratory

disorders as asthma have also been linked to this deficiency

(Montagu, 1971).

Parental tactile stimulation is the primary and most dominant

communication for the infant. Many children who have delayed

walking or talking, or tend to have difficulties in reading or

speech, are known to have early deprivation of tactile communica-

tion (Knapp, 1978). Montagu (1971) believed that the brain and

nervous system of the human being develop more fully in response

to stimulation than when there is a deficit of stimulation.

 16

Yarrow (1961) stated, "The mother as a social stimulus provides

sensory stimulations to the infant through tactile, visual, and

auditory media, i.e., through handling, cuddling, talking, and

playing with the child, as well as by simply being visually

present" (p. 485).

Experimental studies with animals have supported the hypo-

thesis that early tactile deprivation can cause subsequent abnor-

mal behavior. Coleman, Butcher, and Carson (1980) have cited

the Harlow experiments with Rhesus monkeys. In one experiment

young monkeys were separated from their mothers and raised in

isolation with "artificial" mothers which consisted of wire frames

covered with terry cloth. These monkeys treated the surrogate

mother like real mothers, spending hours clinging to them. Al-

though these monkeys appeared to develop normally, as adults they

failed to establish normal sexual relations. Those that bore

young were helpless and dangerous mothers.

Another experiment involved four motherless monkeys which

were raised together in a cage. The monkeys spent their early

months huddled together, holding and caressing each other as they

would their mother. Fear and withdrawal were exhibited by young

monkeys that were raised under conditions of relatively complete

social deprivation (Coleman et al., 1980).

Philosophical changes regarding infant handling have occurred

since the beginning of this century. In the early 1900's, nurses

and mothers were encouraged to NOT handle their infants because

of the fear of geirms and the problems of infection (Goodykoontz,

 17

1979). More than half the infants in their first year of life

died during the nineteenth century from a disease called marasmus.

Marasmus is a Greek word which means "wasting away." The disease

was also known as debility or infantile atrophy (Montagu, 1971).

These infants were simply deprived of tactual stimulation. The

large majority of these unfortunate infants were institutionalized

and did not receive the nurturing that seems to be so vital to

physical well-being.

In examining parental touching of infants and children. Clay

(Knapp, 1978) discovered that children between the ages of four-

teen months and two years of age received more touching than

infants. This study also revealed that girl babies tended to

receive more physical acts of affection than boy babies.

It has been shown that premature infants benefit from more-

than-average tactile stimulation. Solkoff, Yaffe, Weintraub,

and Blase (1969) studied the behavioral and physical development

of premature infants in relation to handling. Five infants

were stroked in their isolettes for five minutes of every hour

of every day, for ten days. A control group of five infants was

provided with routine nursery care. The handled infants were

more active, regained initial birth weights faster and were

healthier in terms of growth and motor development.

Knapp (1978) stated, "Some children grow up learning 'not to

touch' a multitude of animate and inanimate objects; they are told

not to touch their own body and later not to touch the body of their

dating partner; care is taken so children do not see their parents

 18

'touch' one another intimately" (p. 247). It is true that

touching is an innate quality controlled by social environment.

There appears to be a difference between paternal and maternal

touching behavior toward children. Rosenfeld, Kartus & Ray (1976)

replicated a study done earlier by Jourard on the frequency of

interpersonal touching. The findings supported Jourard's conclu-

sion that fathers tend to touch daughters more than sons, whereas

mothers tend to touch both equally. Frequent touching between

father and son is thought to be unmasculine in American culture

(Knapp, 1978).

Apparently, both the gender of teacher and pre-school student,

and the type of interpersonal contact, affects the amount of

touching exhibited. The frequency and types of physical touching

that occurred between pre-school teachers and children was the

focus of a study by Perdue and Connor (1978). All of the teachers

were undergraduates. It was found that teachers touched children

of their own sex more often than children of the opposite sex.

When a female child was touched by a male teacher, this touch was

more likely to occur in the context of a helping situation than

when the child was male. Boys showed varying differences in the

rates of touching male or female teachers, whereas girls' touching

behaviors were similar.

There appear to be some race related touching character-

istics through the onset of school and into adolescence. Touching

steadily declined in white children from kindergarten through

sixth grade. No decline has been observed with black children.

 19

The declining trend in white children continued in junior high

with about half as much touching as the primary grades. Junior

high students used more shoulder-to-shoulder and elbow-to-elbow

touching, whereas elementary students usually initiated touching

with the hands. Most touching occurred between same-sex dyads and

black females tended to exhibit more touching behavior. After a

childhood "latency" period, adolescents became increasingly aware

of the importance of touch, first with members of the same sex

and then with members of the opposite sex (Willis and Hoffman,

1975) .

Adult Interaction

Only within the last few years have researchers begun to

explore the dynamics of touch with human adults. Henley (1977)

found American norms reflect the notion that touch is a privi-

lege which can be shared with those closest to us, but is care-

fully guarded from strangers. One sometimes goes to extreme

lengths to avoid touching strangers in public and takes great pains

to apologize for accidentally touching another.

Touch, even when out of the conscious awareness of the reci-

pient, can have profound and intense interpersonal effects. Evi-

dence that even a slight impersonal touch, unnoticed by most sub-

jects, could have a positive effect was demonstrated in an experi-

ment by Fisher, Rytting, and Heslin (1976). Library clerks at a

university library either did not touch or briefly touched the

hands of some of the library patrons. These patrons were inter-

viewed when they left the library and it was found that the
 20

female patrons who had been touched expressed more positive feel-

ings toward the clerk and the library than those females who were

not touched. Males did not express similar feelings.

Some research has shown differential effects of touch per-

ception and marital status, touch and self-disclosure and social

expectations of touch. Nguyen, Heslin, and Nguyen (1976) found

that married subjects generally considered touch more pleasant,

more loving and friendly, and as conveying more sexual desire

than did single subjects. Married men, as compared to single

men, and married women attributed much less love or pleasantness

to sexual touching.

Jourard and Rubin (1968) conducted an experiment relating

touch with self-disclosure. Using questionnaires, they found

that there was a tendency for males to touch and disclose more

to a same-sex friend, and a similar tendency for females to dis-

close more to an opposite-sex friend. Analysis of body acces-

sibility questionnaires suggested that the degree to which males

were touched by their mothers was predictive of how much they

would allow their father or same-sex friends to touch them.

In a questionnaire study done by Henley (1977), it was found

that individuals have expectations about touching and being touched

by others in particular role relationships. The exchange of touch

is more likely to occur with those close to us, such as family or

close friends. Those considered superior such as employers are

more likely to touch subordinates. It was also found that touching

is affected by situational context. Specifically, touching is

 21

more likely to occur by a person when that person has some domi-

nance over the other, or is attempting to be dominant.

As are nearly all patterns of nonverbal interaction, tactile

do's and don'ts are culturally determined. Some cultural dif-

ferences have been noted. Americans as well as the English are

very untouching people (Henley, 1977) . Japanese touch less than

Americans (Knapp, 1978). Cultural variations within the United

States show that persons of Jewish and Italian descent, Puerto

Ricans and Chicanes are believed to use more tactual expression

than Anglo-Saxons (Henley, 1977).

The maximum amount of touching done by American men is usu-

ally found in the handshake. Conversely, Hispanic men engage in em-

bracing and Frenchmen exchange kisses on the cheek. Expectations

about touch and its meanings will be greatly influenced by our

backgrounds (Bruhn, 1978).

Although Henley's (1977) questionnaire study indicated that

women do more touching, especially of their own sex, she noted

that Morris' (1971) observational study indicates that men did

more touching. In an analysis of 10,000 photographs, it was con-

cluded that men are five times more likely to perform the shoulder

embrace than women.

Watson's (1975) research supported the hypothesis that "...the

likelihood of interpersonal touching will increase in frequency

and on a wider range of body regions, the greater the distance of

the target regions from the culturally taboo areas of the body"

(p. 110). His observations of touching in the area of the mouth

 22

suggested that it is a region highly restricted just as is the

genital area. It has been suggested that orifice areas of the
body are regions which Americans feel should be kept inviolate
(Goffman, 1971) .

Touch can induce either a positive or negative emotional

effect. Fisher, Rytting, and Heslin (1976) observed that females

who were touched experienced more positive affective and evalua-

tive reactions than no-touch subjects.

The idea that touch is a means of self-disclosure was

supported by an experiment conducted by(.Silverman, Pressman, and

Bartel (1973) . They studied the relationship between self-

esteem and tactile communication using male and female under-

graduates as subjects. They found that the higher the subject's

self-esteem, the more intimate the subject was in communicating

through touch. This is especially true when the subject was female,

Status is an important variable in tactual encounters. Status

involves such factors as age, sex, situation, and relationship

of the parties involved (Knapp, 1978) . Those perceived as having

higher status, i.e., employers, elders, those higher socio-

economically, parents, males, etc., were seen as the initiators

of touch. Henley (1977) argued that an indication of power as

opposed to affection is exhibited in the male-initiated touch to

a female. Since presently the implication of power is "unaccep-

table" for women, a woman-initiated touch to a man is associated

with sexual intent.

 23

Huss (1977) believed that humans have a constant emotional

need for comfort, reassurance, and security and that this is

particularly true when there is increased stress. He stated

that body contact which signifies love, comfort, acceptance

and protection, is affected by illness, anger, anxiety, and de-

pression. Hollender (Henley, 1977) cited that female psychiatric

patients in their desire to be held resorted to sexual entice-

ment. He believed that a major factor in "promiscuity" for some

women is a need to be held.

It is possible that touch is an important variable in some

cognitive judgmental processes. Silverthorne, Noreen, Hunt, and

Rota (1972) investigated the effects of touch on subjects'

aesthetic ratings of neutral stimuli (slide presentations).

Regardless of the sex of the experimenter, touch was shown to have

a significant effect on the aesthetic ratings of all the subjects.

, ( In a geriatric setting, Rinck (1980) found that touching

patterns were quite different from younger generations. Touch was

initiated more often by elderly females rather than males. He

suggested that the elderly females were probably in better health

than the males, thus causing them to be more active. Changes or

perceived changes in our body image may intensify the need for

the communication of acceptance. An elderly person may be

reassured of being lovable when family members or nursing

staff members use caring touch (Goodykoontz, 1979). 5.^"'l

 24

Loneliness for the elderly can be compounded by failing vision

and hearing, impersonal care, or loss of loved ones (Huss, 1977).

The use of touch, therefore, becomes extremely important for the

emotional health of the aged.

This chapter reviewed the effects of touch on various stages

of physical and emotional development. First the reader was

offered a review of the ways in which touch affects the infant,

adolescent, and adult development. The specific ways in which

sex, culture and status affect touch were offered in the adult

section. A cursory analysis of touch in geriatric settings was

offered.

The next chapter will specify the manner in which touch is

applied in health care settings, including the effects of

nurse/patient touch and response to illness, and the effects of

physician/patient and therapist/patient touch.

 25

CHAPTER IV
TOUCH WITHIN THE HEALTH CARE FIELD

This chapter will provide a review of relevant literature

on touch as it is applied within health care settings. Emphasis

will be on nurses' use of touch and possible beneficial outcomes

for patients. Included will be a brief discussion of physi-

cian/patient uses of touch. A more in-depth discussion of the

use of touch in psychotherapy will be offered, along with a

review of advantages and disadvantages of its use in that area.

Nurse Touch

' "Touching is a form of nonverbal communication which, when

used with care and sensitivity by the nurse, can coiranunicate

caring, promote well-being, and perhaps even facilitate the

patient's recovery" (Goodykoontz, 1979, p. 5).' Nursing touch

can be either procedural or nonprocedural. Procedural touch

involves performing certain duties such as applying a bandage

to a wound. Nonprocedural touch occurs when tactile contact

with the patient is spontaneous. "Even though patients may

remark that nurses don't need to touch them unless they are per-

forming a task, nonprocedural touch may often be helpful to the

patient's psychological or physical well-being" (Goodykoontz,

1979, p. 9 ) . ^

Interpersonal communication, behavioral and affective inter-

actions are affected by touch. Aguitera (1967) urged nursing

 26

services to consider the possibility of orientation and education

of nurses in the use of touch gestures. Her limited experi-
mentation supported the hypothesis that touch gestures would
increase verbal interaction between nurses and patients and would
show positive attitude changes of patients toward nurses.
Touch may have powerful multi-dimensional effects over time
as well as short-term effects. Whitcher and Fisher (1979)
studied the value of nurse/patient interactions. They assessed
the effects of nurses touching patients as well as assessing the
patients' affective, evaluative, behavioral, and physiological
responses. Results indicated that female subjects in the touch
condition experienced more favorable affective, behavioral, and
physiological reactions than a no-touch control group. Males
in the touch condition reacted more negatively than control
subjects on these dimensions. They stated that the negativeness
of the male subjects may have been that males are socialized
to be relatively uncomfortable with dependency which might have
been associated with the hospital setting. When dependency cues
are pervasive, males and females will react differently to touch.
Another explanation may be that females usually experience a
richer and more varied tactile history, i.e., touched more often
by mother, father, or friends (Jourard, 1966; Jourard & Rubin,

1968) .
i Touch can affect the amount and quality of information re-
ceived from a patient. Goodykoontz (1979) stated that a nurse
 27

can get information more quickly from an injured person in the

emergency room by simply using touch. Touch can be used to gain

the patient's attention and focus on what is being said.!

Nurse/patient touch can affect assessment of nurses' inter-

personal demeanor as well as verbal interchange between patient

and staff. A study conducted by McCoy (1977) investigated the

effects of touch on rapport between nurses and patients, and

found a positive correlation. Forty patients were used, twenty

in a control group who were not touched and twenty in an

experimental group who were touched. All the patients in

the experiment had to (1) be awake, alert, and oriented, (2)

have no neurological deficit, (3) have no sensory deprivation, and

(4) have no hearing or speech problems. While doing an initial

assessment interview, the nurse stood approximately three feet

from the bed and had no physical contact with those in the con-

trol group. With those in the experimental group, she stood

close to the bed and touched the patient's wrist or forearm

periodically throughout the interview. Following each interview,

the patients were asked if they thought the nurse interviewing

them was preoccupied with herself (source oriented), interested

only in getting her job done (message oriented), or concerned

about the patient as a person (receiver oriented). Patients

were encouraged to be open and honest and were assured that their

responses would not affect the care they received. Results of

this study showed that those who were touched accounted for over

85% of the total positive responses, while those who were not
 28

touched accounted for under 15% of the positive responses.

/ In assessing the effects of touch on patients' heart rhythms.

Lynch (1978) noted a case involving an 11-year-old girl who had

been struck by a car. The child's injuries included a skull

fracture and multiple fractures in her pelvis. After being in

a coma she gradually recovered during the next eight days. Then

she suddenly became restless, confused, and in great respiratory

distress. It was noted that three minutes prior to the nurse's

approach, the girl's heartbeat was cycling rhythmically from a

maximum of 125 beats per minute to a low of 105 beats per minute.

As the nurse held the patient's hand, no unusual change in heart

rate was observed. However, as the nurse released the girl's hand,

her heart rate increased to a peak of 136 beats per minute, and

then fell to about 95 beats per minute. Then it returned to its

previous pattern. The highest and lowest heart rates occurred

within 30 seconds after the nurse released her hand. Lynch

stated, "Our data convinced us that the effects of holding a

patient's hand could be seen even in the most intense clinical

environment. The more traumatic the environment, the more

important human contact seemed to be" (p. 3 6 ) . \

Hospitalized children need an accelerated amount of touching

from parents. Jay (1977) described parental reactions to

children entering a Pediatric Intensive Care Unit. Strategies

were investigated that help both the parents and children adjust

favorably to the situation. This included involving the parents

in the care of the child. Parents had to accept that their

 29

child was acutely ill and this seemed to cause fear of seeing

or touching their child. Parents were encouraged to touch

their children because a child's dependence on touch increases

during illness. The sequence of touching responses proceeds as

it does in new mothers with their infants, that is initially using

the fingertips and progressing to palm contact.

/Touch behavior by nurses can encourage family members to

communicate tactually with the ill. Goodykoontz (1979) cited a

situation in which a hospitalized man was very ill. His family

members were physically present but stood at a distance from

the patient and had no physical contact with him. As an alert

nurse began to exhibit tactile communicative behavior, the family

members soon followed her example. A distinct change was noted

in the patient in that he smiled more and seemed more relaxed.

The exchange between family members and the patient became

livelier.j

It was emphasized by Goodykoontz (1979) that nurses need

to re-examine their custom of asking loved ones to leave the

room while a medical procedure is carried out on the patient.

The patient might benefit from a handholding or simply the

presence of a family member.

Research on touch has examined many facets of touch within

procedural interactions between nurses and patients. Several

areas include status differences of nurses, sex differences,

area of body touched, and quality of touch. According to Watson

(1975) , more expressive touch was used by nurses who ranked

 30

higher, i.e., R.N.'s rather than nurses' aides. In observing

touching differences of personnel in a home for the elderly,

he found that 6 8% of the touching occasions were procedural such

as applying a bandage. Nurses' aides were less willing than

nurses to touch the bodies of male patients. He concluded that

elderly male patients, particularly those with physical defects

were most likely to be deprived of the medium of touch. The

reason for not touching a patient may be a matter of personal

preference, but Goodykoontz (1979) urged that the patient may

assume that the nurse is reacting to the illness and may feel

rejected. She emphasized that a nurse, even one who is not a

"touching" person, should try to overcome the "untouching"

tendency when on duty.

The lower arm and upper back regions are target touching

areas of patients by nurses. Watson (1975) believed that these

areas are considered sexually unrestricted and can therefore be

used by nurses on male patients.N In his observations, scalps

of male patients were never touched by nurses or aides. Scalps

and foreheads of female patients were touched only when combing

or brushing the patient's hair or while tilting the patient's

head in order to apply eye drops.

In dealing with the confused elderly patient, Kerstein and

Isenberg (1974) suggested steps that can be taken to minimize

or eliminate the confusion by simply using verbal communication

and touch. "Physical contact is most effective when it is offered

as a qualitative expression, not a quantitative one" (Waddell,

 31

1979, p. 290). n:n directing her article to nurses, Waddell

(1979) cited an instance when an elderly woman in a mental health

facility responded to touch. The woman had a lack of reality and

was a victim of senile dementia. Additional care which involved

rubbing the patient's arms and face with lotion caused the

patient to respond coherently .A

Touch can be a powerful communicative tool that can both

instill a motive to live and help one deal with the finality

of death. Just as the newborn needs tactile communication, the

dying person needs to know that he/she is not alone. Many times

the only communication channel available is touch. Although the

dying person may not acknowledge this communication, it is my

belief that the person is aware and comforted by this contact.

Goodykoontz (1979) believed that by permitting the family members

to touch their dead loved ones, the reality of death may be more

easily accepted, j

f A study by Lynch (1978) showed that the lack of human

contact as evidenced by loneliness can be the cause of premature

death. This study showed that even a touch on the wrist to take

the pulse of the patient had a positive effect on the patient's

heartbeat.

Physician Touch
Physicians' touching patients has not fully been explored.

However, some information suggests that physician/patient touch

is an under-utilized treatment modality. Ryan (1978) suggested

 32

that the most important aspect of touch in the physician/patient

dyad is the transmission of power and caring from the physician

to the patient. Touching of the patient by the physician has been

minimized due to the use of instrumentation as a mode of con-

ducting a clinical examination. "New types of health professionals

-such as physician assistants and nurse practitioners conduct

clinical examinations under physician supervision, thus the

physician may not 'touch' the patient" (Bruhn, 1978, p. 146).

There are factors which affect physician/patient relation-

ships and reduce physical contacts. "In a time when suits for

malpractice abound and when one can read of physicians acknow-

ledging sexual relationships with patients, the physician may fear

that physical contact with a patient may be misunderstood or mis-

interpreted, even when a third party is present"(Ryan, 1978, p.

17) . \
(I
It is interesting to note that the medical profession has

the use of instruments such as the microscope which aids in the

sense of vision, and the stethoscope for aiding the sense of

hearing, but there are no instruments for the aid of the sense of

touch.

Tactile Communication in Psychotherapy

Awareness of tactile communication effects are emerging

within the definition of a counseling relationship.

 33

Many contemporary therapists have moved away

from the traditional principles of psycho-
therapy. A review of their tenets finds a
variety of attitudes toward touching ranging
from nontouch to somewhat mechanical use of
tactual input; to the use of contact as a
natural part of the relationship; and to its
use as a means of knowing through feeling
(Huss, 1977, p. 14).

Therapists who advocate the use of touch professionally

argue that touch can provide useful feedback and promote the

analytical process (O'Hearn, 1972; Bosanquet, 1970). Pattison

(1973) examined the role of touching in relation to self-

exploration in a counseling relationship. Counselors partici-

pated in an experiment involving hand-touching with clients when

more information was being sought from the client. As pre-

dicted, greater depth of self-exploration was experienced by

the clients. However, the touching did not alter client per-

ception of their relationship with the counselor.

y Alagna (1979) conducted an experiment investigating the use

of touch gestures by counselors to determine the effect of touch

on the client's overall affective response to the counseling

experience. A more positive evaluation of the counseling

experience was reported by those clients who were touched during

the interview than by those who did not receive touch. Spe-

cifically, during career counseling interviews, the counselor

touched the client's hand, arm, or leg while interrupting to

ask for clarification or to reflect or summarize. The most

effective use of touch occurred in those counseling sessions in

which the counselor was female and the client was male. \
 34

A similar and more recent study failed to replicate the

Alagna (1979) and Pattison (1973) studies. Counselor touch

was not found to have a significant effect on level of self-

exploration or evaluation of the counseling experience (Stock-

well and Dye, 1980).

The use of touch is often the most effective way of soothing

very disturbed psychotic patients. The psychotic condition may

have begun with the patient denying himself or being denied

nonverbal modes of exchange such as tactile stimulation. The

use of touch in the form of stroking and holding has been effec-

tive in bringing institutionalized schizophrenic patients back

into contact and awareness of their bodies (Bosanquet, 1970).

Schiff (19 77) demonstrated reparenting processes with chronic

schizophrenics by using touch modalities of stroking, holding,

rocking and cradling. Her research provides profound, defini-

tive conclusions that touch, when integrated into psycho-

therapy, can produce marked effects.

Apparently a large number of therapists use touch in counsel-

ing sessions although they feel they are violating a taboo. In

his interview of twenty-five experienced group psychotherapists,

O'Hearn (1972) discovered that the psychotherapists felt that

the use of touch was not "acceptable" but did use it because

it had often been helpful in therapy sessions.! Most of these

therapists touched patients more in group than in individual

psychotherapy.

A
 35

Tactile communication has been found useful in group therapy.

O Hearn (197 2) found that patients became more open when group

leaders or members stood close by or touched distressed parti-

cipants. Touching in a cooperative spirit such as helping someone

in putting on a coat, shaking hands, or giving a comfortable

embrace to a distressed person, can facilitate constructive

emotional interchange and be effective in resolving resistance.

The recipient may become more open about inner feelings.

O'Hearn (1972) emphasized that the use of touch does not

have to be restricted to therapist and patient. It can include

members within a group. He cited an example of group therapy in

which one of the members started to reach out to touch another

member who needed comforting, but withdrew his hand because he

felt she did not want any comfort from him. After discussing

the incident with the group, the second member realized that she

seemed relatively "untouchable" to others which gave her insight

into some of her previous problems.

There are optimal times when touch should be used. Touch

can be used as an alternative to strictly verbal interaction,

perhaps because the patient may profit from receiving a different

type of feedback than is usually received. The use of touch

may profit a patient whose conviction about his unlovableness

is at maximal intensity. It may also benefit the patient who

is showing despair and anxiety while rigidly positioning the

body (O'Hearn, 1972).

 36

/ '
V Di!sturbances in functioning can occur if touch is not used

judiciously by the therapist. It is possible that even a light

touch can stimulate the anxieties of a neurotic patient and

may cause the patient to act violently. "The more difficult it

is for a person to control himself, the more likely he is to

respond to the therapist's touch as a releaser for action"

(Spotnitz, 1972, p. 456). The use of touch has been known to

arouse deep infantile cravings in unstable patients, causing

severe regression. Spotnitz (1972) warns that therapist-touch

can cause the patient to have strong cravings for sexual inti-

macies. This unfulfilled desire may then provoke anger, rage,

or depression in the patient.

The use of touch evokes countertouch, called counter-

transference. This countertransference can be either positive or

negative, subjective or objective. The response is subjective

and negative when the initiation of touch by one person causes

another to react atypically,' such as wanting to hit the initiating

person. The response is objective and positive when the re-

spondent allows the initiator to touch and then countertouches

in a positive way (Spotnitz, 1972). Touch can be considered thera-

peutic when the response is objective and positive.\

I The appropriate use of touch can express reassurance and

strengthen the patient's sense of reality, and make the patient

become more aware of feelings for others. It can have a strong

maturational effect when used for personality-growth potential

rather than for pleasure value.

 37

The literature cited above seems to indicate that the posi-

tive effects of touch in psychotherapy, i.e., greater self-

exploration, constructive emotional interchange, and greater

personal insight, far outweigh the negative effects of possible

violence or depression, arousal of infantile cravings, or

regression.

It is possible that misinterpretations of either verbal

or nonverbal interactions by the therapist or a client can occur.

However, it appears that the positive outcomes of the use of

touch in psychotherapy are preferable to the avoidance of its use,

This chapter specified thoughts on touch within health care

paradigms. First a definition and description of procedural

touch was offered. Next, a variety of effects of touch on

patients' health and assessment of treatment and physiological

effects were offered. Following this, a brief discussion of

touch, dying and chronic illness was offered along with a brief

discussion of physician/patient touching. Finally, a discussion

of the use of touch within psychotherapy showed both positive

effects and theoretical misgivings.

The next chapter will specify various procedures found in

therapeutic uses of touch within nursing, health care and

home/lay usage.
 38

CHAPTER V

THERAPEUTIC USES OF TOUCH: A REDISCOVERY

The purpose of this chapter is to acquaint the reader with

the philosophies, history, and some basic techniques of thera-

peutic touch and other hand healing techniques. This chapter

provides a review of relevant literature, schemata of applying

therapeutic touch and the indices of therapeutic touch within a

clinical setting, hand healing models, massage, and a new home

touch/chiropractic technique called applied kinesiology/Touch

for Health. A clarification of the use of "laying on of hands"

is needed. By definition, the techniques discussed in this

chapter are all laying on of hands techniques which involve

easing pain or discomfort, promoting relaxation, and creating a

state of well-being. The therapeutic touch technique, although

not actually requiring a practitioner to touch the healee, is a

scientifically validated approach that finds its home in the

nursing and health care professions. The other techniques,

except Touch for Health, do not have the acceptance by a pro-

fessional community in a similar manner. Therefore, each will be

discussed in separate sections. Although a variety of tech-

niques are discussed in this chapter, a myriad of other touch

and hand healing techniques exist within scientific, holistic,

and "lay" literature. Several of the major approaches are

 39

presented in this chapter. For the purpose of clarification

in this writing, the person applying the touch technique,

whether trained or untrained, will be referred to as the

"healer." The person receiving the touch treatment will be

referred to as the "healee."

Therapeutic Touch

Krieger (Krieger & Peper, 1976) coined the term "therapeutic

touch" as the act of healing or helping. It is akin to the

ancient practice of laying on of hands. Therapeutic touch is

not a new phenomenon. Hippocrates believed that aches and

illnesses could be drawn away by laying hands on the affected

part. "More than 25 centuries ago, yogis wrote of healing

energy, or prana, which could be directed to a sick person by

rubbing the body with the hands, placing hands on the skin

surface, or passing hands above the skin" (Miller, 1979, p. 278).

References to the laying on of hands can be found in his-

torical cave drawings, early Eastern, European, and religious

literature, and Greek mythology (Boguslawski, 1979). The Indians

used the laying on of hands in their "Veda system of healing"

(Kroeger, n.d.). Historically it was common for Egyptian phy-

sicians to touch the wound. The gesture of touching wounds

suggests deeper meanings such as control, reassurance, and

healing (Bruhn, 1978).

Therapeutic touch is steadily gaining acceptance in the

health care field. According to Krieger & Peper (1976) , it is

 40

part of the masters curriculum in nursing at New York Uni-

versity. Nurses are also taught therapeutic touch in con-

tinuing education courses and workshops at universities through-

out the United States. Also, several hospitals include it as

part of their in-service program and leadership seminars. The

technique is easy to learn, and with practice, the healer's

sensitivity to deviations in the healee's body becomes greater.

According to Rogers (Miller, 1979, p. 278), "...healing

occurs through the mutual simultaneous interaction of man/

environment energy fields when one of the two fields actively

works in the direction of change." It is believed that each

human energy field has a corresponding environmental field

which can include other human energy fields. Those (healers)

who have an intent and commitment to help others can participate

in the mutual process of interaction with others who may be

ill (healees). This can be accomplished by therapeutic touch

or other touch strategies.

Krieger (1975) believes that the energy which is trans-

ferred and redistributed to the ill person is excess energy

of the healer. Boguslawski (1979), however, believes that

the personal energies of the healer should not be used; the

energy which should be used is the ever-available "universal

energy." The healer is merely used as a medium in trans-

mitting this energy.

Boguslawski (1979) defined four major levels of man's

energies which are most directly related to health, illness.

 41

and the healing process. These levels, or energy fields, are

the physical level, the etheric level, the emotional level,
and the mental level.

The physical level which is the only visible level to most

humans, is the physical body. The level which extends 1 1/2 to

2 inches beyond the physical level is the etheric level. Fre-

quently referred to as the astral, aura, or psychodynamic, the

emotional level is immersed within the physical and etheric

energies and generally extends about 12 to 18 inches beyond the

physical. The mental level is immersed in the physical and

etheric levels as well as the emotional level, and is usually

thought of in relation to the brain. When the various energies

are flowing harmoniously within each level, between levels, and

with the environment, the person is healthy, happy and stress is

minimal. This optimal state can promote the harmonious inte-

gration of energies with other individuals (Boguslawski, 1979).

Most illnesses are manifested by a "disrhythm" primarily

in emotional and mental energy fields. If this disrhythm is

prolonged, it will manifest itself within the physical level as

disease. Developing this disrhythm, or imbalance of energy pat-

terns could stem from a person's interaction with the environ-

ment. Financial matters, accomplishments, recognition, and

acceptance by others can be major sources of anxiety. Stress

can be attributed to environmental pollutants, inappropriate

nutrition, inadequate relaxation and exercise patterns, or

 42

smoking and alcohol intake. "The solution to such habit

patterns is the repatterning of energies" (Boguslawski, 1979,

p. 11) .

A simple formula for the therapeutic touch model includes

(a) centering, (b) assessment of energy fields, (c) unruffling

the electromagnetic field, and (d) applying the therapeutic

touch.

Centering. In order to successfully use therapeutic touch,

the healer must have a genuine intent to help another and must

be able to "center" which is the harmonizing of energy levels

in relation to each other and universal order. Centering

requires the healer to be able to concentrate and totally

focus upon the touch technique, with no other thoughts entering

awareness. According to Boguslawski (1979), the inability to

center during therapeutic touch may lead to the use of personal

energies, which will leave the healer drained of energy. The

using of personal energies can also occur if the healer is

not in a state of "wellness" and is feeling tired. Boguslawski

(1979) also believes that the healer needs to have the

ability to mentally visualize, feel a oneness with the environ-

ment (including the client), and have a sense of confidence.

Assessing the Field. In the process of healing through

therapeutic touch, energy is balanced and distributed in the

ill person through the hands of the healer who first assesses

by searching for temperature changes or other energy devia-

 43

tions as clues to underlying pathology. This can be accom-

plished without actually touching the healee. These devia-

tions may be in the form of a tingling sensation, pulsing

feelings, temperature deviations, or intensification of energy.

Deviations in energy from top to bottom, left to right, and front

to back indicate imbalances of electromagnetic energy. Each

deviation is specific to each person, healer, and healee

(Krieger, 1975). Each deviation indicates an imbalance in

energy is present. The healer becomes quiet and passively

"listens" with the hands while scanning the patient's body.

Unruffling the Field. After the healer completes the assess-

ment and processes variations and deviations in the energy or

temperature, an assumption is made, if variations exist, that

an imbalance is needed to be rectified. The healer then uses

a cupping of the hands and stroking motions over the area of

the body in which the deviation was felt. This motion eliminates

or modifies imbalance in electromagnetic energy. The thera-

peutic touch can then be used.

Boguslawski (1979, p. 9) posited, "There are three basic

concepts that are germane to the understanding of the healing

process inherent in using therapeutic touch." They are (1)

each human is an energy field; (2) humans and the environment

are continually, simultaneously, and mutually exchanging energy

with each other (environment refers to everything external to

 44

humans including other humans); and (3) universal order is a

force innate to all energy fields.

Applying Touch. When areas of accumulated tension are

found, these energies are redirected by placing the healer's

hands over the area where the deviation is found. The healer

helps the patient to raise the energy to a state that is com-

parable to that of the healer (Krieger & Peper, 1976).

In order that the healee does not receive too much energy

in one place, the hands are never kept still in any one place

for a period of time that is excessive to the healee. "If too

much energy is received in one place, the client will experience

a feeling of heaviness in that area" (Boguslawski, 1979, p. 13-14)

This can be corrected by the use of sweeping movements (brushing)

of the hands over the area.

Several behavioral indices are observed in the healee

following therapeutic touch. The indices most commonly seen

include:

(1) The voice level of the healee will go down

several decibels.
(2) The healee's respirations will slow down and
deepen.
(3) There will be some audible sign of relaxation
in the healee, such as a sigh or a deep
breath; or the healee may say something such
as "Oh, I feel so relaxed."

(4) There will be an observable peripheral flush,

a pinking of the skin, apparently due to a
dilation of the peripheral vascular system in
the healee. This peripheral flush will be
first noted in the face, but it is a general
effect to the whole body.
 45

Citing her own research for the previous four years,

Krieger (1975) conducted experiments to see if the use of

therapeutic touch could increase hemoglobin levels in ill

persons. Hemoglobin is the oxygen-carrying pigments of the

red blood corpuscles which transfers oxygen to the tissues.

Using an experimental group of registered nurses who included

treatment by therapeutic touch while caring for their patients,

and a control group of registered nurses who gave nursing care

without using therapeutic touch, Krieger repeatedly showed

support for the hypothesis.

The extent to which improvement of patients is related to

therapeutic touch is not known. Controlled studies are useful

to gather data and few controlled studies have been done in this

area. Subjective analysis has been the primary tool in support-

ing the effectiveness of therapeutic touch. After a touch

treatment, many patients have reported a lessening of pain

and a feeling of well-being.

In one controlled study, physiological indices of both

healer and healees were recorded. Several electrode configura-

tions were used to explore the therapeutic touch process. These

included the electroencephalogram (EEG), the electrooculogram

(EOG) , the electromyograph (EMG) , and the galvanic skin response

(GSR). Heart rates and temperature were also recorded. The

most significant finding was the healer's EEG which showed an

unusual amount of fast beta activity. This can be interpreted

as a healing meditative state.

 46

No significant changes were recorded for the patients'

physiological indices. The EEGs did indicate a high abundance

of large amplitude alpha activity which indicates the relaxed

state. After the treatment, the patients did show improvement

in follow-up examinations. Some of these improvements included

the reduction of fibroid tumors and the diminishing of migraine

headaches (Krieger, Peper & Ancoli, 1979).

Healing with Hands

Many laying on of hands techniques have been discussed in

professional literature and empirically validated. There

appears to be consensus concerning the metaphysical and spiri-

tual aspects of laying on of hands techniques. Much of the

scientific community, including the medical profession, tends to

dismiss healing by the laying on of hands as quackery. This is

due largely to the lack of a satisfactory scientific explanation

for healing activity (Riscalla, 1975). However, the use of

Kirlian photography has provided evidence of the flow of energy

or interaction between humans and their environment. Miller

(1979) refers to a 1972 study in which a well-known healer was

asked to demonstrate his ability with the laying on of hands.

Kirlian photographs of the healer's and patient's finger pads

were taken before and after the experiment. The photographs

showed a decrease in emanations from the healer's fingers and an

increase in the patient's fingers.

 47

Miller (1979) cites another study in which a healer placed

his hands on the lower backs of twelve dialysis patients. The

patients described sensations such as intense heat coming

from the healer's hands, tingling, a 'force' entering them, and

a sense of well-being after treatment" (p. 283). Some patients

showed physical improvements such as lowered blood pressure and

lowered hematocrit. Kirlian photography showed the healer's

corona usually grew smaller after treatment, whereas the pa-

tient's corona grew larger and brighter. In repeating the

experiment using persons that claimed no healing talent, there

was no indication of energy transfer from "healer" to patient

except one who was himself a medical doctor.

Riscalla (1975) indicated that in using laying on of hands,

the ill person becomes aware of the potential for health due to

a receptivity and responsiveness to the qualities of the healthy

healer. Some evidence exists that relates the interchange of

energy following a healing touch procedure. Since electro-

magnetic energy apparently exists within all objects, the

transfer of that energy, either on purpose or serendipitously,

apparently leaves both the healer's and the healee's energy

systems altered. Much of the research on transfer of energy

using healers and healees has been done in the Soviet Union.

One such experiment involved the "semi-conductor" effect

which utilizes variations of electrical potentials with sym-

metrical acupuncture points on the left and right sides of the

 48

body. The difference between these electrical potentials

is called the semi-conductor effect. The experiment involved

measuring the electrical potential of both healer and healee

before and after the touch treatment in which the healer concen-

trated on projecting energy via his hands to the healee. The

data in this experiment is shown in Figure 1. It was found

that, after the treatment, the healee's energy circuit became

more balanced and the healer's became slightly unbalanced. It

appeared that the healer transferred energy in a particular loca-

tion of his body to the healee in order to balance the circuitry

of the healee (Tiller, 1971). This transfer of energy may be

what is responsible for both "psychosomatic" cures as well as

physiological changes within a healee's immunological system.

Kroeger (n.d.) referred to the laying on of hands as mag-

neto-therapy. She stated that the entire body is a field of

flowing electromagnetic energy, and referred to a discontinua-

tion of this flow in a particular area as a "short circuit." By

the proper use of the laying on of hands, she believed that the

"short circuit" will be repaired and energy will return to a

full flow. Kroeger (n.d.) stressed that magneto-therapy does

not replace the need for a physician, but rather complements the

work of the physicians.

 49
Figure 1

TTie Semiconductor Effect

Observed in "Paranormal" Healing

RULATIVL:
AR

I "2 3 ^ ^ 5 6 i
OF<f;AN ['Of NT LOCATION

I'ATIIiNT lil'FORl': TKKATMKNT

I'ATii;N'f Arii:K TRKATMKNT

iiKAi.KR Ai'TKR rRi':A'nii':NT mmtmrn^trnk

IIKAJJ'.R Hl'FORK TRliATMHNT •/////

Source: W. A. Tiller. Some energy field observations

of man and nature. In S. Krippner & D. Rubin
(Eds.) The kirlian aura. Garden City: Anchor
Press/Doubleday, 1973, 128.
 50

Massage

A less metaphysical and easier understood form of touch

than the "laying on of hands" is the manipulation of muscle

tissue, electro-magnetic energy and acupuncture energy of

massage. Humans instinctively use massage in various forms

for relief from muscular pain, numbness, or hyperactive

nerves. Massage is derived from massa, an Arabian word

meaning "to press" and massein, a Greek word meaning "to knead"

(Serizawa, 1978) . "Massage refers to ways of kneading or

rubbing various parts of the body, usually with the hands, in

order to stimulate circulation, relieve muscle tension, and

enhance joint flexibility" (Frager, 1980, p. 210).

Mental or emotional tension is usually correlated with

physical tension, and relieving tension with massage in one area

will tend to alleviate tension and promote more effective func-

tioning in other areas. There are different styles of massage

ranging from sensual stroking to moderately painful digging into

sore or tense muscles. A style of massage used to relax and

tone up muscles is the Swedish massage which involves fairly

heavy pressure. Esalen-style massage which is used primarily in

relaxation involves smooth, rhythmical stroking which is soft

and gentle (Frager, 1980).

A highly specialized style of massage for relieving muscle

tension and fatigue through the use of direct pressure is called

Shiatsu. This massage consists of pressure application in a

specific sequence and is designed to affect certain muscle

 51

systems. By relieving muscle tension, energy blockages are

alleviated. These energy blockages are believed to be related

to energy imbalances in different major organ systems of the

body (Frager, 1980) . Shiatsu utilizes the meridian systems of

acupuncture. Within the system of acupuncture is the concept of

"Ki" or life essence and vital energy. Feldman and Yamamoto

(1974) relate the process of Shiatsu and the movement of Ki

through touch.

The masseur generally attempts to make two

sorts of adjustments in the treatment of the
patient. The first is to balance and har-
monize the Ki of the patient by massage
techniques similar to those needle techniques
used in acupuncture, namely tonification and seda-
tion of particular points on the exterior of
the body. These points lie along certain
pathways of Ki known as "enruduabs." Secondly,
the masseur attempts to stimulate or charge
the Ki of the other person by channeling his
own Ki into the patient. In orthodox practice
this is usually done by utilizing the fingers,
palms or thumb pressure; other techniques
utilized depend upon the condition of the
patient and his size or weight in relation to
the practitioner. Although treatment using
fingers alone for stimulation is often
adequate, many practitioners incorporate other
techniques such as using the feet or back,
as well, especially in treating a number of
subjects in succession, as the constant utili-
zation of one part of the body can be tiring
and therefore a hindrance to the passage of
Ki. (p. 155)

Of the various forms of massage currently in vogue, Shiatsu has

as its roots the oldest system of medicine available to modern

man, oriental medicine.

 52

Body alignment involves the spatial relationship of the

major body parts—head, neck, spine, pelvis, etc. A system for

improving body alignment is structural integration, better known

as rolfing, and was developed more than forty years ago by the

late Ida Rolf. An ideally aligned body is one that enables

the effective functioning with less muscular effort due to the

body being balanced and aligned in its gravitational field.

Rolfing is deep tissue massage which involves stretching the

facial tissue to reestablish balance, muscle movement, and flex-

ibility (Frager, 1980).

The Alexander technique is also used to improve alignment

and use of the body. Improvement of awareness of one's body

movement and attending to the process of body usage are its

main purposes. Students of the Alexander technique learn

freer, more effective movement patterns through direct touch

(Frager, 1980).

Touch for Health

Many applications of touch have been developed for use by

the lay person. Found within many paradigms of touch are the

techniques that can be applied in home settings. Included in

those techniques are the touch procedures of laying on of hands,

i.e., therapeutic touch, massage, and applied kinesiology (home

chiropractic) called Touch for Health. Touch for Health,

originally developed for and used in chiropractic medicine

entails the use of massage, acupuncture systems, and the theory

 53

of kinesiological muscle testing (Thie, 1979). The paradigm

IS applied by the practitioner as a touch method called muscle

testing on a person whose energy forms are out of balance. The

technique requires a practitioner to assess a person's energy

system by using touch that demonstrates the quality of energy

within a muscle system. This technique, muscle testing, requires

isolating a muscle and applying gentle yet steady pressure against

the motion of the muscle. If the muscle is weak and exhibits

a collapse, wavering, fluctuation or a failure to lock, the

practitioner assumes that the acupuncture energy system is not

functioning appropriately and applies various touch corrective

procedures.

The practitioner/healer realizes that the energy assess-

ments done through the muscle test indicate the quality of

energy within the organ associates with one of the body's four-

teen energy rivers called meridians. The quality of energy is

such that the organ can either be receiving an under or over

amount of energy. Both over and under amounts of energy are

related to illness. Balance of energy is health. The healer

then applies one of the following touch corrective techniques:

neuro-lymphatic massage, neuro-vascular holding, meridian

massage, or acupuncture reflex point holding (Thie, 1979).

 54

Neuro-lymphatic Massage. These massage points exist on

both pectoral and dorsal sides of the body. The healer

applies a deep pressure into the neuro-lymphatic points to

add energy to the body while an application of light pressure

on these points causes a weakening within the muscle and acu-

puncture system. Figure 2 illustrates the neuro-lymphatic

points on both the rear and front of the body as well as which

muscle is effected by either light or deep touch of the point

(Thie, 1979).

Neuro-vascular Holding Points. These points are located

on the skull, between the sternal clavicular knobs, and behind

the knees. These points are correlated with early neural and

vascular bundles that existed in pre-natal development. A light

touch on these points strengthens, and adds energy to a muscle

and the related acupuncture meridian. A deep touch on a

neuro-vascular point will cause a decrement in the quality and

quantity of energy in both the related muscle and acupuncture

meridian associated with the points. Figure 3 illustrates the

neuro-vascular point locations on the skull (Thie, 1979) .

Meridian Massage. A meridian massage is accomplished by the

healer when touch is applied in either the direction of

meridian energy flow or in the opposite direction. When touch

is applied in the direction of flow, energy is added to the

meridian system and a muscle is strengthened along with the

 Figure 2

Neuro-Lymphatic Massage P o i n t s

N«cti Extensors
Lawator Scapula*
Upper Trapuiius

l^l^fe?
Teres Mator
Teres Minor
Subscapulans
Ot»lto>ds
v: I \ Anterior Serratus
I Cordcobrjchidlis
Peciomlis Cinvicular - Adductors
Brachior^didlis Pectoralis Sterna
Lalissiinus Dorsi Poplitttus Rhomboids
• ^
Otaphrjgm' PtfClor.ilit Cljvicuijr
Tficop*
Qu<idricepi , BiAchioiddijiis
MtJfll* TitlpH/MIt
S'MtlHIUS / J I .ti-.Mii.u\ Outll
LoMVf f(.ii>n(M(«
Giacilis Vi Tj T'ltopS
Opponens
Gti&trocnemius ^ Middle Tr«peiius
Polltns Longus
Sol*ius I L'<Mer Ti4pu/ius
Qu<tclfntii«
, O M tJ' 11 > *- n »
Luiitboruin' PsOilS
lll.lCUS PoMiCiS Lonqus
P«(Oii..
Sjcroipindlis
Anterior Tibial
Posterior Tibial
Pintormit
Gluteus Mediua
Gluteus Maaimus
Fascia Lata
Quadratus Lumborum
Hamstrings
Transverse Abdommals
Rectus Abdominals

Source: J . F. T h i e . Touch for h e a l t h , Marina d e l Ray: DeVorss &

Company, 1979, 2 3 .
 56

Figure 3

Neuro-Vascular Holding Points

1 Occlpitcil Prf)tul)eriince:
Psoas

2 I'lisicrior l-'iiiiiaiii-l:
::vv^
S.irtorius. (>riicilis, Soleus, ..-.;.',|io;_...--:i
("laslrocnemms. HainMlrinKs,

3 Trapezius
Oppunens I'ollicis Loii^UM

4 Aiilcriiir Konlani;!: Delloicls,

Anlcrinr SiTraliis
('orarubrai liiali-i.
l)i.iplir.i;;iii, S>ili-.< apii laris.
Siipraspinaliis, Khuiiil xilils. >
Anli.'ricir 1 )(lt<iifl 10
4

5 ' il.ilii'lla: i'lT'iiii'iis

12
f
6 Kaiiiiis III law. Neck 'v.
Mtist.lis 0 11

7 I'pper I'rape/ms

8 Tcri-s Minor, i'l-rcs Major

> • ' •

9 Lalii^iiiius Dorsi, Trici-ps

'-' 4
1 0 Parietal Kinini-nt-v:
Alxloininals, ({uadriceps,
Kasciu l^ata, (jiuteus
Mc-(lius, AdduL'lofH,
Pirilbrinis. Iliacus
()uudratus Lumborum

1 1 Knmtal Eminence:
Pectoraliit Major Clavicular,
I^evator Scapulae,
HrnchioradialiH,
Supraspinatus, Peroneus, 1 4 Back of knee
Tibials Sacrospinalis Popliteus

1 2 Pectoralis Major Sternal 1 5 Sternal notch

Teres minor
1 3 Lumbdoidal Suture:
Adductors, Cilutcus 1 6 Sternoclavicular joint
Maximus Popliteus

Source: J. F. Thie. Touch for health. Marina del Ray;

DeVorss & Company, 1979, 25.
 57

organ associated with that meridian. When touch is applied in

the opposite direction of meridian flow, energy is removed from
the system and a muscle is weakened. The heart meridian is the
only meridian that is not to be massaged in reverse. Figure 4
illustrates both the fourteen energy meridians as well as the
direction in which the energy flows within the meridian system
(Thie, 1979) .

Acupuncture Holding Points. Acupuncture holding points are

used to obtain both tonification and sedation and are reflex

points that are found along the various fourteen acupuncture

meridians. There are two sets of points, a primary and secondary

pair, that when touched in sequence, will cause a collection of

energy within the acupuncture meridian as well as strengthen a

muscle when the tonification points are used. Using the seda-

tion points causes a diminishing of energy within the acupuncture

system and a weakening of associated muscles (Thie, 1979).

Touch for Health is one of the many laying on of hands

techniques that can be applied by lay persons without fear of

negative effects on the person receiving the touch.

The purpose of this chapter was to acquaint the reader

with various laying on of hands techniques and the therapeutic

uses associated with these techniques. Some empirical data

as well as some non-data information was presented to validate

the therapeutic uses of laying on of hands.

 Figure 4

The Meridian Cycle

Source: J. F. Thie. Touch for health. Marina del Ray: DeVorss & Company, 1979, 18-19,

Ul
00
 59

This thesis has attempted to present research on tactile

communication including the psychological and physiological
components. An effort has been made to present the findings in
a non-biased manner. A broad spectrum has been covered
including history, physiology, taxonomy, human development and
interaction, the use of touch in the health care field, and
therapeutic uses of touch.

The findings indicate that touch has a valuable role in

developing healthy personality and productive human interaction.
Lack of tactile stimulation in infancy can have negative effects
in the form of subsequent maladaptive behavior such as schizo-
phrenia.

In reviewing the research, it has become clear that many

of the findings, especially in the therapeutic uses of touch, are

based on subjective information. Perhaps some of the physio-

logical healings could be contributed to the "placebo" effect,

although some empirical evidence does exist. Kirlian photo-

graphy has shown transference of electro-magnetic energy from

one human to another, and laboratory studies showing physio-

logical changes after touch treatments represent some of that

evidence. Perhaps there is yet undiscovered scientific evidence

that touch actually increases the state of well-being; perhaps

the "placebo" effect is the key. It is possible that a com-

bination of these two elements can decrease pain and create a

balanced state of well-being.

 60

Clearly what is needed in the study of tactile behavior is

a broad based data pool of scientifically verifiable findings

concerning the impact of touch in all of the areas reviewed

in this paper. Such a data base should be an ultimate goal of

future tactile research. Despite the gaps in scientific know-

ledge, it appears that tactile communication has an astounding

effect on human life.

b
 61

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