Yesterday one of my students asked me a question, one that is asked often, one that I asked my professors not too long ago. Is it ok to hug your patients. He said that he has asked this before of other professors, but my being in active practice, he wondered if I had different views on this.
This can be somewhat complex. You open a persons mind up in therapy, raw emotions are oozing out, you turn them inside out, revisit painful experiences, their inner self is exposed for judgement. You emphasise, you feel their emotions, you often will revisit the painful experience with them…. it is instinct to hug.
You may find when a hug is offered, your patient may recoil, withdraw, they do not want to be touched. Even when raw emotions are just barely hidden below the surface, they may not wish to be touched, perhaps this is why they are sitting in this room with you, because they were once touched… Touch for some disorders is very unwelcome, OCD as a prime example, whilst with other disorders, contact is very comforting, those that suffer with BPD will often feel great benefit from hugs.
Offering hugs with each therapy session can lead to a diminishing effect, the hugs will begin to mean less and less, or attachment issues may develop.
Touching, is something that in a professional relationship, is not always proper. Sexual undertones often emerge. A hand touch during therapy can be grounding, but it can also trigger a patient.
Connotations are often perceived, there could be feelings of sexual undertones, your patient may feel something from you that is not there. They may feel that you are feeling this way toward them, this can bring on a very uncomfortable relationship.
When, during a session a patient is perhaps a quivering mass and seeks a hug, withdrawing from that hug can be damaging.
There are times, when you know that a session is going to go deeply, to expose emotions, before starting, it is not so hard to talk to your patient, to tell them this, to ask if a patient if a hug is an upsetting thing for them. this is good to know at any rate. If touching their hand during a session is something that would trigger them, or upset them, or help them relax.
A patient may really need a hug during or at a sessions end. To ask though, is often something that is very difficult for them. Sometimes to ask for a hug demeans it. An open conversation about hugs or hand touching before a session, or at one of the first sessions, a conversation that should also be revisited, is very wise. Setting boundaries, so there is no misinformation, no assumption, no wondering, no pressure.
When setting boundaries, you can establish that there will be no hug unless requested, but then the patient may feel that, because they are not comfortable with a hug, but feel you are waiting for one, that you begin to judge them, because a hug has not been requested. Pressure evolves in the patient to hug, even if they may not wish to.
Just because you as a therapist feel the urge to comfort, the urge to hug, it may not be what the patient wants or is comfortable with. Crossing established boundaries must not be done by the therapist.
Some people are not comfortable with hugs, some give poor hugs as a result. When a patient asks for a hug and a poor hug is offered, this can damage the relationship, the trust that has been built up.
When establishing boundaries, a patient may tell you that a hug or a touch does not bother them, but then a patient does not always say what they truly feel. Perhaps they tell you what they think you want them to say.
If a hand touch evokes withdrawal, this should be discussed. Do not send your patient away feeling uncomfortable.
It is advised to avoid physical contact with a patient, this does not always apply though, so when is it ok?
I gave my student the same answer that I received when I asked my professor. “Amber, you will know when it is right”.