⌚ Placed Under A Social Prohibition

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Placed Under A Social Prohibition

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Prohibition - OverSimplified

Survivors of Childhood Trauma The use of touch with survivors of childhood trauma has been much debated. Due to the nature of their original injuries, many of these clients are likely to feel intense vulnerability at the suggestion of touch in the intimate setting of psychotherapy. There is the possibility that touch used with clients who are survivors of childhood trauma may recreate, or evoke, previous client-experienced dynamics of submission and victimization, entrapment, anger, fear, vulnerability and feelings of worthlessness.

Because of this, Lawry states that the use of touch is contra-indicated in early sessions due to the potential for retraumatization, and Cornell suggests that language based interventions may allow more adequate time for developing rapport, trust and a sense of safety in which deeper affect and profound pain can be released and tolerated. Once a strong therapeutic alliance has been formed, Cornell indicates:. The use of touch will evoke, address and hopefully help correct such historical experiences and distortions as: deprivation and neglect; over stimulation, intrusion and bodily violation, sexualization, parental narcissistic use of the child; deadening of vitality or use of the body as an instrument.

Studies done in the context of post-traumatic stress disorder have explored the relationship between trauma and memory Allen, ; Herman, ; Van der Kolk, et al. The concept of memory and trauma is highly controversial. Many studies document that traumatic memories are encoded in our sensorimotor system as kinesthetic sensations and images. This results in the client having great difficulty reconstructing a narrative of their traumatic memories as they experience them instead as emotional and sensory recall Van der Kolk et al. Bar-Levav reports that physiological patterns in the body can be changed by touch to correct early injurious experiences. To this end, clients should be encouraged to express their preferences, to practice boundary-setting exercises, and to participate in creating a treatment plan.

Many abuse survivors respond to anxiety by having difficulty in protecting their boundaries. Therefore, it is helpful for the therapist to state clearly that he or she accepts full responsibility for ensuring that there will be no sexual contact with the client and to be clear about the process and type of touch that will be involved. Hunter and Struve suggest that it is helpful to draft written ground rules as many survivors are highly dissociative and have difficulty retaining verbal information in stressful situations.

Helfer developed a program, which includes a series of graduated exercises through which a client can address developmental tasks that were missed in childhood as a result of abusive or neglectful parenting. Since most survivors of abuse have learned to mistrust touch, he begins by helping the client get in touch with his or her five senses that may have been undeveloped, underdeveloped, or overdeveloped. These exercises explore the distinction between good touch and bad touch and help the client to enjoy the benefits of soothing supportive touch.

The therapist may then guide the client in nurturing, supportive self-touch such as self-massage or self-stroking. Another approach is to direct the client in the use of imagery to reconnect with his body, to recognize bodily sensations and to name them. It can also be less threatening for a client to experience safe, nurturing, non-erotic touch through the use of imagery. Clients might further be instructed to deliberately engage in various types of touching activities, such as touching trusted friends or animals, massage, or contact sports.

Any touching in therapy should be solely for the benefit of the client and great caution must be taken if the client is dissociated. The hippocampus, amygdala, hypothalamus and thalamus function by laying down memory traces that are subsequently regulated by stress hormones. Flashbacks can occur when a current stressor activates traumatic memory traces and the client dissociates and loses full contact with essential details in the current environment. Positive therapeutic results have been demonstrated in the cognitive-behavioral treatment of psychological trauma survivors.

It is essential that the therapist be familiar with the dynamics of dissociation before working with a trauma survivor. Asking communicates respect for her and her body; it says that her preference will be respected and that no intrusion however slight will occur against her will Courtois, Many therapists consider touch of any kind to be inappropriate with clients who have been abused through violations of the body. At the same time however, many therapists and all somatic therapists believe that a client will have great difficulty in fully recovering from such trauma if only verbal or cognitive approaches to therapy are used. Clients traumatized in childhood are often unable to make distinctions between affectionate touch and sexual touch Ball, Durana states that touch is usually contraindicated for clients who are paranoid, actively hostile or aggressive, or who implicitly or explicitly demand touch.

Hunter and Struve suggest that special care should be taken using touch with populations that have experienced assault, neglect, attachment difficulties, sexual addictions, eating disorders, and intimacy issues. Rothschild suggests that a better strategy for these clients is to assist them in learning how to perceive and respect his or her own boundaries and to teach how to meet the needs of touch among close friends and family due to the complication of the possible provocation of transference and countertransference.

Berendsen offers several core strategies when incorporating the body into work with clients who have a history of abuse, using the acronym SAFETY: S, stabilize and go slowly; A, attunement, awareness, and acceptance; F, focus on the felt sense of the feeling; E, empathize, educate, explore; T, take time, titrate; Y, your needs matter too p. Children and Adolescences Clinicians who do use touch in session, tend to do so in ways that reflect biases inherent in the larger culture. In this regard, it has been found that therapists tend to touch child clients more often than they do their adult clients and that female therapists touch child clients more often than male therapists do Cowen, et al.

Hyperactive children tend to have negative reactions to being touched Bauer, , and clinicians are alerted to be aware of the profound social implications of this sensitivity Thayer, Adolescents may be particularly sensitive to dimensions of control with regard to touch and may react negatively to touch that could be interpreted as patronizing or unduly familiar Jones, ; Smith, et al. A growing body of literature has linked aggressive, violent, and antisocial behaviors to early childhood touch deprivation Katsurada, ; Mitchell, ; Older, In one study, the staff of an adolescent treatment program modeled nonsexual, nonviolent touch to incorporate physical contact as an acceptable aspect of the milieu.

They found that the adolescents demonstrated a marked decrease in violent and sexual behaviors Dunne, et al. This is in contrast to high touch cultures in which elders are generally cared for at home in the company of extended family. Most people experience some level of decrements in physical faculties and general perceptual skills but the sense of touch generally remains intact for most older people and actually is valued as increasingly important as a source of contact and communication Hollinger, Gender issues Touch in psychotherapy occurs between female and male clients as well as same-sex therapist-client dyads, but the highest frequency of physical contact occurs between male therapists and their female clients Brodsky, In this context, attention should be paid to power dynamics whereby women touched by male therapists might feel devalued because of social stereotypes Alyn, The Report of the Task Force on Sex Bias and Sex-role Stereotyping in Psychotherapeutic Practice appropriately cautions that any treatment modality reserved for only one sex may be interpreted as being sexist Redleaf, Rigid application of touch along gender lines fits the definition of sexism and is clinically inappropriate.

From birth, American women receive more affectionate touch from males and females and are given greater permission to touch either gender and be touched by either gender. They are more likely to have and expect a broader repertoire of touch. American males are given less affectionate touch in infancy and early childhood and this has been linked with higher rates of violence and aggression in later life Redleaf, For most men in our society, touch has been limited to violent and sexual encounters with the exception of rough yet affectionate touch that is allowed in sports and the military Montagu, Clinicians are cautioned that for men, who generally do not give or receive nonsexual touch, regression transference may be elicited by the use of nonerotic touch in psychotherapy Downey, Psychoanalysis traditionally has placed an almost total interdiction on physical touch between client and analyst within the analytic arena.

Yet touch, based on our largest sensory organ, the skin, provides a fundamental and elaborate form of communication. Psychoanalysis, from the days of its inception, has been highly concerned with the effect of physical touch in analysis. The issue erupted, beginning with Freud, back in scolding Ferenczi for letting a female client kiss him. Freud wrote to Ferenczi:. You have not made a secret of the fact that you kiss your patients and let them kiss you… Now I am assuredly not one of those who from prudishness or from consideration of bourgeois convention would condemn little erotic gratifications of this kind… But that does not alter the fact… that with us a kiss signifies a certain erotic intimacy… Now picture what will be the result of publishing your technique… A number of independent thinkers will say to themselves: Why stop at a kiss?

And then bolder ones will come along who will go further, to peeping and showing and soon we shall have accepted in the technique of analysis the whole repertoire of demiviergerie and petting parties, resulting in an enormous interest in psychoanalysis among both analysts and patients. Jones, , pp. Clearly Freud felt that physical contact would almost certainly lead to sexual enactments. By his own admission, he was equally concerned with the reputation of psychoanalysis and forced the issue of touch to go underground. As psychoanalysis emerged, an entire analytic ideology was created around the prohibition of touch. It is based on the conviction that any touch is likely to gratify sexual and instinctual infantile longings or drives, subsequently contaminating the analytic container and nullifying the possibilities for analysis to help the clients work through their issues Fosshage, The effects of touch, like any boundary crossing, such as self-disclosure, gift giving or home visits, is a major concern in therapy, for almost all psychoanalysts and psychoanalytically oriented therapists.

Psychoanalytic theory emphasizes the importance of boundaries and the neutral stance of the analyst. According to traditional analysts, effective management of transference and other therapeutic work requires clear and consistent boundaries and therefore no physical contact so the analyst can preserve the analytic frame of therapy Langs, Simon operates from a similar perspective and has numerous publications that epitomize the case against boundary crossings.

Refusal to touch and refusing to provide gratification, forces infantile sexual wishes into awareness that ultimately facilitates their renunciation. Touch is prohibited for it is viewed as an intrusion of the analyst and an interference with the free associational process and therefore the transference analysis Fosshage, More recently, additional reports of the facilitative use of touch have emerged in the literature Fosshage, Hilton has also added the importance of touch in psychodynamic psychotherapy and its inclusion in the transference and countertransference analysis. The argument is that the power differential enables and, some argue, encourages therapists to sexually exploit their clients.

Kitchener describes the power differential between therapists and clients as one of the three most important factors in determining the risk of harm to clients engaged in exploitative relationships with their therapists. Similarly, Gottlieb lists power differentials as the first dimension in the decision-making model for avoiding exploitative relationships in therapy. The argument of power differential put forth by feminists like Alyn or Brown does not view women as capable of asserting or having power in therapeutic relationships.

Instead, it views them as weak and defenseless in the hands of their powerful, dominant male therapists. Therapists are generally hired for their expertise and this, in most cases, gives them at least some measure of being an expert, with knowledge and information that increases the power advantage over their clients. What is often forgotten in such discussions is that many relationships with a significant differential of power, such as parent-child, teacher-student or coach-athlete, are not inherently exploitative Zur, , a, Power is, in itself, neither positive nor negative; it is neutral.

Few, if any, marriage, business, friendship, or therapy relationships are truly equal. The problem of abusive or exploitative power in therapy is not going to be resolved by avoiding all touch and other boundary crossing in therapy. The problem with the argument of power differential is that all patients are portrayed as malleable, weak, and defenseless in the hands of their powerful, dominant, compelling therapists. The disparity in power is regarded as extreme, which is disempowering to the client. It is possible that many therapists cling to the false ideals of the segregated therapy session and avoid dual relationships because it increases their professional status Dineen, ; Zur, , , a.

These therapists are thereby imbuing themselves with undue power that can all too easily be translated into exploitation Zur, Many therapists work with clients who are much more powerful than they. Often, these clients do not regard their therapists as particularly powerful or persuasive, and their therapists experience them as more powerful and successful than they. Such cases are a prime example of when therapists have to work hard at cultivating an aura of power so as to appear credible. In summary, therapists must be very careful not to abuse the trust and power they often have in the therapeutic relationships.

At the same time it is important that therapists humbly accept that some clients are more powerful than they are and acknowledge the limitation of how much power and influence they really have. We must all remember that power by itself does not corrupt, but lack of personal integrity does. The intersection of boundaries, touch and psychotherapy presents a unique and complex matter as it involved two types of boundaries Zur, a. The first one is the distinct boundary of the physical body and the second one is the more illusive concern with psychotherapeutic boundaries.

The boundary of the body is clear and well defined by the skin. It is, at once, the demarcation of physical, separate identity as well as the reciprocal experience of connection. While the skin is physically, distinctively defined, the numerous physiological and emotional regulatory systems affected when the skin is touched, are extremely complex and mysterious. Boundaries in therapy are, at least as complex as the body boundary. This section will focus on the boundary issue aspect of touch in psychotherapy.

Boundaries in psychotherapy have been a topic of growing debate in the past several decades, with touch being a central element of the issue. Therapists who touch their clients have often been viewed as problematic and their actions judged as a boundary problem that is often linked to, or equated with, sexuality and harm. Lazarus and Zur have emphasized the lack of definition of what constitutes appropriate boundaries in psychotherapy. They illuminate that there is a lack of differentiation between boundary crossing and boundary violation.

As a result, confusion, false accusations and fear run rampant. In the field of psychotherapy, there is neither agreement nor a single definition of what constitutes clinically and ethically appropriate boundaries between therapists and clients. Boundary crossing has been confused and equated with boundary violations Guindon et al. As Lazarus and Zur articulated in their book, Dual Relationships and Psychotherapy , boundary violations in therapy are distinctly different from boundary crossings. While boundary violations by therapists are harmful to their clients, boundary crossings are not and can prove to be extremely helpful.

In contrast to boundary violations, boundary crossings can be an integral part of well-formulated treatment plans. Examples include when a Reichian or Bioenergetics therapist uses hands-on techniques. A handshake, an appropriate pat on the back, handholding or a non-sexual hug are all also legitimate and often helpful boundary crossings. These forms of touch are similar to other common boundary crossings, such as when a therapist makes a home visit to a bed-ridden or immobile elderly client or when a behavioral therapist, as part of systematic desensitization, flies on an airplane with a client who suffers from a fear of flying Zur, , a.

Boundary crossing may be simply seen as a departure from the traditional, rigid psychoanalytic approach or inflexible risk management proceedings. At the heart of the opposition to touch in therapy is the argument that places immense importance on separation and clear and inflexible boundaries in therapy. Most of the support for this argument comes from ethicists, attorneys, licensing boards, psychoanalysts, and rigid proponents of clinically restrictive risk management practices. These professionals generally view any deviation from these rigid boundaries as a threat to the therapeutic process.

As noted throughout this paper, the concern with boundaries has been intricately integrated as a primary focus of psychoanalytic theory and practice. They have advocated an adherence to rigid therapeutic boundaries and oppose most boundary crossings. In fact, many analysts have viewed even appropriate and helpful boundary crossings, such as a comforting hug or hand holding, as poor boundary management. The concern with boundaries is not limited to analytically oriented therapists. What is often ignored by almost all analysts, ethicists and risk management experts is the basic fact that therapeutic orientations, such as humanistic, behavioral, cognitive behavioral, family systems, feminist or group therapy, are inclined to endorse boundary crossings, such as physical touch as part of effective treatment Williams, ; Zur, a.

Even though cognitive behavioral, family systems and group therapy are currently the most practiced orientations, they are ignored and marginalized when it comes to ethical discussions of boundaries. They, therefore, judge the appropriateness of touch differently. Cultures, such Latino, African American or Native American, are more likely to integrate touch into the communication between therapists and clients. As articulated above, this belief claims that minor boundary crossings inevitably lead to boundary violations and sexual relationships Black, ; Lazarus, Touch and many other boundary crossings with certain clients, such as those with borderline personality disorders or other severe disorders, must be approached with caution.

Effective therapy with borderline clients, for example, often requires a clearly structured and well-defined therapeutic environment. Histrionic personality disorder and dependent personality disorder are other diagnoses necessitating cautious approach Guindon et al. It is recommended that the rationale for boundary crossings be clearly articulated and, when appropriate, included in the treatment plan. Rigid boundaries and rigid avoidance of all forms of touch can conflict with acting in a manner that is clinically helpful to clients.

Inflexible boundaries, distance and coldness are incompatible with healing. Lambert and many others affirm, through outcome research, the importance of rapport and warmth for effective therapy. Boundary crossings, including touch, are likely to increase trust and connection and hence increase the likelihood of success for the clinical work. Whitfield also describes how the most serviceable boundaries are those that are flexible, as opposed to those that are implemented in such a rigid manner as to cause harm through excessive and inappropriate distance.

In summary, the exclusive reliance on analytic theory and adherence to risk management practices, which results in the eschewal of virtually all forms of touch and boundary crossings, has been detrimental to the overall impact of psychotherapy. Behavioral, cognitive-behavioral, humanistic, group, family and existential therapeutic orientations are the most practiced orientations today. These treatment approaches tend to endorse touch and other boundary crossings, which are considered clear boundary violations by most ethicists, psychoanalysts and risk management advocates Williams, In fact, feminist, humanistic and existential orientations view the tearing down of artificial boundaries and introducing touch and other normal human interaction as essential for therapeutic effectiveness and healing Greenspan, Risk management has become one of the most influential forces in medicine in general including psychotherapy.

Similarly, WebMD announces:. A Hug-Free Zone: The threat of lawsuits, the already strong language in the APA code, and the general litigiousness of society have prompted many therapists to erect barriers between themselves and their clients when it comes to any physical contact. No more hugs for a sobbing client. No encouraging pats on the back. Section 2, para. Like male preschool teachers who no longer hug young children, or camp counselors who would no longer hold a child in their lap for fear of being accused of inappropriate sexual behavior, many therapists, for similar reasons based on fear, have generally abandoned the practice of touching their clients.

Defensive medicine, fueled by fear, is the defining forces behind risk management practices. The teaching of risk management principles seems to dominate ethics classes in graduate school and legal-ethical continuing education workshops. In all these formats, we are told never to hug, pat or hold our clients. Basically, we are told not to touch beyond a handshake and when possible even to avoid a handshake too.

When we listen closely to the risk management dogma, it is clear that no one really disputes the scientific fact, and the common knowledge, that touch is one of the most elementary human ways to relate and can be a powerful method for healing. Ironically, these are also the orientations most practiced by psychotherapists. Misleadingly, many of these attorneys, ethicists and so called risk management experts have mislead the therapeutic community, clients and licensing boards and courts to believe that non-sexual touch is unethical and below the standard of care. Unlike most commonly held beliefs, boundary crossings, such as touch are neither unethical nor below the standard of care. Ethics codes of all major psychotherapy professional associations e.

All psychotherapy professional codes of ethics view sexual or violent touch with a current client as unethical. In principle, nothing is wrong with managing risk if it is done thoughtfully by applying sensible clinical judgment and employing critical thinking rather than paranoid thinking. There must also be a sound knowledge of the professional codes of ethics and laws of states. All actions and clinical interventions involve some risk. For that matter, we often forget that inaction can be risky and even damaging to clients, as well McGuirk, For example, I have been working with a woman who, 10 years prior to our first session, lost her infant son in an automobile accident.

In an emergency appointment with a psychiatrist right after the death of her son, as she sobbed uncontrollably, she begged him to hold her. He refused, citing something about professional boundaries. Instead, he prescribed Valium. Eight years later, addicted to Valium and alcohol, she began therapy with me. It was the first time she had visited the grave. While the psychiatrist followed risk management guidelines to perfection, he also may have inflicted immense harm.

Did he sacrifice his humanity and the core of his professional being, to heartless protocol? All therapists may, of course, with due consideration, attempt to reduce their own risks and the risks to their clients when employing touch in therapy. This is especially important when working with cases involving borderline or dissociative proclivities. This attempt to reduce risk goes side by side with clinical integrity, relevant training, and sound employment of treatment plans.

What do I risk if I do not touch and what do I risk if I do? Complete guidelines for the use of touch in therapy will be found at the end of this article. While the actual likelihood of a lawsuit or of licensing discipline for psychotherapists is extremely low Williams, , in the rare event that it takes place, it can be very costly to the insurance company and emotionally and financially devastating to the practitioner. The rare, but nevertheless outrageously costly, judgments drive the malpractice insurance companies to advocate strict risk management practices and the avoidance of any behavior that may give a jury reason to suspect inappropriate behavior and levy an expensive penalty.

Ironically, this strategy, as will be discussed later, is more likely to backfire on the insurance companies. Aiding and abetting the insurance companies and attorneys has also fueled the risk management fire, inspiring paranoia and widespread instruction in risk avoidance behavior. Scheduled sessions with legal professionals abound at our professional conferences. Often, without any clinical training whatsoever, they sternly give us long lists of what we should avoid. They tell us never to leave the office even though going to an open space with an agoraphobic client, as part of a systematic desensitization is the appropriate, if not mandated, clinical intervention. They tell us never to socialize with clients even though it is often impossible to avoid doing so in rural areas and in small communities.

Risk management and the fear it induces effects not only mental health, but also our entire society. It is part of a bigger and more complex phenomenon: the American litigation explosion and the rights movement. Even though, as has been stated, litigation is rare in our profession, the mere possibility of such a consequence is daunting and affects us strongly. We have become a culture where everyone tramples everyone else in the fight for his or her rights and entitlements Etzioni, , Zur, Ministers, teachers, and youth counselors avoid touching — especially children or women.

Litigation gone wild, indeed. The rationale is that the physician will not be accused of not having done everything in his power to rule out even the most unlikely diagnosis. Shockingly, some also estimate that this is the amount that could buy health insurance for the 40 million uninsured Americans. While attorneys laugh all the way to the bank, our risk management-intoxicated, phobic culture ends up settling for inferior care of every kind; children are deprived of touch and opportunities for play; and spiraling medical costs continue to bankrupt the country. One of the major concerns inherent in risk management is that fear induced, defensive behaviors, and the systematic avoidance of many behaviors have gradually stolen in through the back door to become the perceived standard of care in medicine and mental health Zur, a.

A prime example of how risk management affects the standard of care is the requirement that a woman chaperone be present during a gynecological pelvic exam. The witness also reduces the risk that misconduct may occur. Before chaperoning became part of the standard of care, some women preferred not to have such a witness, especially if they had a long, trusting relationship with their physician or if the physician was a woman. However, today, not having a witness is considered practicing below the standard of care.

The danger that we face in mental health these days is that more and more risk management proscriptions may metamorphose into the standard of care. Bear in mind, though, that risk management is neither part of the ethics codes nor part of any treatment standard. Risk management is merely a set of precautions advocated by malpractice insurance vendors and attorneys, supposedly to minimize the chances of being sued.

When it comes to touch, good treatment and good risk management may sometimes call for mutually exclusive decisions regarding a given client. For example, it would probably be good risk management never to touch children and for male therapists never to touch female clients. Most of us would agree that such risk management advice is utter nonsense, since helping those in need is a fundamental ingredient of the psychotherapy professions. This example, like the case of the psychiatrist who refused to hold the grieving mother, illustrates the faulty logic and drawbacks of risk management and its single-minded devotion to avoiding lawsuits and its equally single-minded lack of regard for the primary goals of our work.

We have seen how, over time, a new standard of care insinuates itself into psychotherapy. This results in a continuous rising of the risk management bar as to what constitutes acceptable clinical behavior. Expert witnesses have often encountered testimonies by prominent experts that boldly and falsely asserted that touch, like gifts, extending a session beyond the allotted time or bartering always fail to meet the standard of care Williams Similarly and dangerously, many licensing boards have uncritically accepted risk management recommendations as their guidelines.

Paradoxically and ironically, as the bar is raised and more interventions seem frowned upon by the boards, courts and attorneys, there is increased likelihood that insurance companies and therapists will be sued or sanctioned. Risk management, without any doubt, has come to haunt the insurance companies, an unforeseen retribution for their shortsighted, cost-saving strategies. Sadly, it also impacts our profession negatively and often reduces our creativity and effectiveness, thus depriving our clients of the fullest measure of care. As a result, clinical effectiveness is compromised. The danger that risk management poses to clinical effectiveness can be clearly seen in its injunction against touch which obviously has a significant negative effect on therapeutic alliance, the number one predictor of effective therapy Lambert, We cannot think of any more effective ways to enhance therapeutic alliance then a reassuring or comforting hug, pat or hand holding.

Very regrettably, most professional organizations have jumped on the bandwagon and joined the fear campaign. They promote the practice of defensive medicine through their own risk management workshops and seminars. Some, as we see monthly, have given attorneys a regular column in their newsletters or journals where this paranoiac thinking is disseminated. As risk management becomes more prevalent, its effect is clearly seen on new therapists. The opposite is true of the new graduates. Alarmingly, through the fault of most graduate schools and their ethics professors, many of the newer therapists believe that risk management practices are part of the standard of care.

In summary, a risk managed practice may sound as if it adheres to practical or pragmatic advice but, in fact, it is a misnomer for a practice in which fear of attorneys and boards, rather than feeling, caring and intelligent clinical considerations, determine the course of therapy. As therapists, we are trained, hired and paid to provide the best care possible for clients.

We are not paid to act defensively. This fear of board investigations and malpractice lawsuits pushes therapists to take protective measures. Consequently, we lower the quality of care for our clients. We must remember that the therapeutic effect of touch has been scientifically and clinically proven. We must also remember that we are hired to help rather than being hired to practice risk management. Therefore we must touch clients when appropriate in a way that will help them grow and heal. This fear-based view has been most dominant in the discussion of employing or incorporating touch in psychotherapy. It underlines most arguments against the use of physical touch by therapists.

It asserts that a handshake, non-sexual hug or a re-assuring pat, are all just the first downhill steps towards inevitable deterioration, towards full- fledged sexual relationships. Strasburger et al. This poignant statement summarizes the opinion that the chance for exploitation and harm is reduced or nullified only by refraining from engaging in physical touch or any other boundary crossing. Germaine, Without doubt, touch tops this list. The link between non-sexual touch and sexual violation is almost an epidemic in the field. Almost all ethics texts, like the widely used one by Koocher and Keith-Spiegel , place the section of touch in the midst of chapter on sexual violation. The slippery slope argument is grounded primarily in the assumption that touch or any boundary crossing, however trivial it may be, inevitably leads to sex and other boundary violations.

This argument is based on the finding that most therapists who were engaged in boundary violation had been engaged in boundary crossings prior to their engagement in boundary violations. We learn in school that sequential statistical relationships correlations cannot simply be translated into causal connections. It is important to reiterate that whereas the analytic contingent underscores that crossing boundaries will nullify therapeutic effectiveness and hence cause harm, many other orientations have a different viewpoint. Behavioral, humanistic, group, family, existential, feminist or gestalt therapies at times stress the importance of tearing down interpersonal boundaries and strongly dispute that this will lead to exploitation and harm Greenspan, ; Williams, ; Zur, , , a, b.

Touch is extremely important for health, healthy development and healing. The medicinal aspect of touch has been known and used since earliest recorded medical history, 25 centuries ago. Touch triggers a cascade of healing chemical responses including a decrease in stress hormones and an increase in serotonin and dopamine levels. In psychotherapy, there are many forms of touch. Among others, there are greeting, consoling, soothing, grounding, modeling and reassuring kinds of touch. In addition to the use of touch as an adjunct to psychotherapy there are several schools of thought, which are part of body psychotherapy orientations. These include Reichian, Radix and several other somatic therapies.

Most of them use touch as a therapeutic technique. Erotic or sexual touch are always unethical and can be harmful. There is a growing body of research that identifies the important clinical potential of touch as an adjunct to verbal psychotherapy. As a result touch is highly effective in enhancing therapeutic alliance, which is the best predictor of positive therapeutic outcome. The meaning of touch can only be understood within the context of who the client is, the therapeutic relationship, and the therapeutic setting.

Accordingly, before employing touch, it is essential that the clinician consider unique treatment elements for each client including factors, such as culture, history, presenting problem, diagnosis, gender, history, etc. Bio sketches of major figures of Prohibition in America. Peck, G. New Brunswick: Rutgers U Press, Sinclair, A. London: Four Square, References Lerner, M.

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The laws targeted opium smoking, but not other methods of ingestion. Britain passed the All-India Opium Act of , which limited recreational opium sales to registered Indian opium-eaters and Chinese opium-smokers and prohibiting its sale to emigrant workers from British Burma. Following the passage of a regional law in , Australia's Aboriginals Protection and Restriction of the Sale of Opium Act addressed opium addiction among Aborigines , though it soon became a general vehicle for depriving them of basic rights by administrative regulation. Opium sale was prohibited to the general population in , and smoking and possession were prohibited in Despite these laws, the late 19th century saw an increase in opiate consumption. This was due to the prescribing and dispensing of legal opiates by physicians and pharmacists to relieve menstruation pain.

It is estimated that between , and , opiate addicts lived in the United States at the time, and a majority of these addicts were women. Foreign traders, including those employed by Jardine Matheson and the East India Company , smuggled opium into China in order to balance high trade deficits. Chinese attempts to outlaw the trade led to the First Opium War and the subsequent legalization of the trade at the Treaty of Nanking.

Attitudes towards the opium trade were initially ambivalent, but in the Society for the Suppression of the Opium Trade was formed in England by Quakers led by the Rev. Frederick Storrs-Turner. By the s, increasingly strident campaigns were waged by Protestant missionaries in China for its abolition. Due to increasing pressure in the British parliament , the Liberal government under William Ewart Gladstone approved the appointment of a Royal Commission on Opium to India in After an extended inquiry the Royal Commission rejected the claims made by the anti-opium campaigners in regard to the supposed societal harm caused by the trade and the issue was finalized for another 15 years.

The missionary organizations were outraged over the Royal Commission on Opium 's conclusions and set up the Anti-Opium League in China; the league gathered data from every Western-trained medical doctor in China and published Opinions of Over Physicians on the Use of Opium in China. This was the first anti-drug campaign to be based on scientific principles, and it had a tremendous impact on the state of educated opinion in the West.

In , Broomhall formed and became secretary of the Christian Union for the Severance of the British Empire with the Opium Traffic and editor of its periodical, National Righteousness. He lobbied the British parliament to ban the opium trade. Broomhall and James Laidlaw Maxwell appealed to the London Missionary Conference of and the Edinburgh Missionary Conference of to condemn the continuation of the trade. As Broomhall lay dying, an article from The Times was read to him with the welcome news that an international agreement had been signed ensuring the end of the opium trade within two years.

In , a motion to 'declare the opium trade "morally indefensible" and remove Government support for it', initially unsuccessfully proposed by Arthur Pease in , was put before the House of Commons. This time the motion passed. The Qing government banned opium soon afterward. These changing attitudes led to the founding of the International Opium Commission in This was the first international drug control treaty and it was registered in the League of Nations Treaty Series on January 23, The treaty became international law in when it was incorporated into the Treaty of Versailles. The role of the Commission was passed to the League of Nations , and all signatory nations agreed to prohibit the import, sale, distribution, export, and use of all narcotic drugs, except for medical and scientific purposes.

In the UK the Defence of the Realm Act , passed at the onset of the First World War , gave the government wide-ranging powers to requisition the property and to criminalize specific activities. A moral panic was whipped up by the press in over the alleged sale of drugs to the troops of the British Indian Army. With the temporary powers of DORA, the Army Council quickly banned the sale of all psychoactive drugs to troops, unless required for medical reasons. However, shifts in the public attitude towards drugs—they were beginning to be associated with prostitution , vice and immorality —led the government to pass further unprecedented laws, banning and criminalising the possession and dispensation of all narcotics, including opium and cocaine.

After the war, this legislation was maintained and strengthened with the passing of the Dangerous Drugs Act Home Office control was extended to include raw opium , morphine , cocaine , ecogonine and heroin. Hardening of Canadian attitudes toward Chinese-Canadian opium users and fear of a spread of the drug into the white population led to the effective criminalization of opium for nonmedical use in Canada between and the mids. The Mao Zedong government nearly eradicated both consumption and production of opium during the s using social control and isolation. Remaining opium production shifted south of the Chinese border into the Golden Triangle region.

In , China was estimated to have four million regular drug users and one million registered drug addicts. In the US, the Harrison Act was passed in , and required sellers of opiates and cocaine to get a license. While originally intended to regulate the trade, it soon became a prohibitive law, eventually becoming legal precedent that any prescription for a narcotic given by a physician or pharmacist — even in the course of medical treatment for addiction — constituted conspiracy to violate the Harrison Act.

In , the Supreme Court ruled in Doremus that the Harrison Act was constitutional and in Webb that physicians could not prescribe narcotics solely for maintenance. United States , [30] the court upheld that it was a violation of the Harrison Act even if a physician provided prescription of a narcotic for an addict, and thus subject to criminal prosecution. Soon, however, licensing bodies did not issue licenses, effectively banning the drugs. The American judicial system did not initially accept drug prohibition. Prosecutors argued that possessing drugs was a tax violation, as no legal licenses to sell drugs were in existence; hence, a person possessing drugs must have purchased them from an unlicensed source.

After some wrangling, this was accepted as federal jurisdiction under the interstate commerce clause of the U. The prohibition of alcohol commenced in Finland in and in the United States in Because alcohol was the most popular recreational drug in these countries, reactions to its prohibition were far more negative than to the prohibition of other drugs, which were commonly associated with ethnic minorities, prostitution, and vice.

Public pressure led to the repeal of alcohol prohibition in Finland in , and in the United States in Residents of many provinces of Canada also experienced alcohol prohibition for similar periods in the first half of the 20th century. In response to rising drug use among young people and the counterculture movement, government efforts to enforce prohibition were strengthened in many countries from the s onward. Support at an international level for the prohibition of psychoactive drug use became a consistent feature of United States policy during both Republican and Democratic administrations, to such an extent that US support for foreign governments has often been contingent on their adherence to US drug policy.

A few developing countries where consumption of the prohibited substances has enjoyed longstanding cultural support, long resisted such outside pressure to pass legislation adhering to these conventions. Nepal only did so in In , New York introduced mandatory minimum sentences of 15 years to life imprisonment for possession of more than grams 4 oz of a so-called hard drug , called the Rockefeller drug laws after New York Governor and later Vice President Nelson Rockefeller. Similar laws were introduced across the United States. California's broader ' three strikes and you're out ' policy adopted in was the first mandatory sentencing policy to gain widespread publicity and was subsequently adopted in most United States jurisdictions.

This policy mandates life imprisonment for a third criminal conviction of any felony offense. A similar 'three strikes' policy was introduced to the United Kingdom by the Conservative government in This legislation enacted a mandatory minimum sentence of seven years for those convicted for a third time of a drug trafficking offense involving a class A drug. The terms relegalization, legalization, and decriminalization are used with very different meanings by different authors, something that can be confusing when the claims are not specified.

Here are some variants:. There are efforts around the world to promote the relegalization and decriminalization of drugs. These policies are often supported by proponents of liberalism and libertarianism on the grounds of individual freedom, as well as by leftists who believe prohibition to be a method of suppression of the working class by the ruling class. Prohibition of drugs is supported by proponents of conservatism as well various NGOs. In , five former police officers created Law Enforcement Against Prohibition , a NGO that has gained a lot of media attention, showing that support for a regulation of drug sales also comes from the "other side" of the drug war and that maintaining a global corruption pyramid for the tax-free Mafia monopoly isn't a good idea, compared to controlling access, age and quality.

Walters , has described the drug problem in the United States as a "public health challenge", and he has publicly eschewed the notion of a "war on drugs". He has supported additional resources for substance abuse treatment and has touted random student drug testing as an effective prevention strategy. However, the actions of the Office of National Drug Control Policy continue to belie the rhetoric of a shift away from primarily enforcement-based responses to illegal drug use. On February 22, the President of Honduras , Manuel Zelaya , called on the world to legalize drugs, in order, he said, to prevent the majority of violent murders occurring in Honduras. Honduras is used by cocaine smugglers as a transiting point between Colombia and the US.

The conflict between state and federal law is, as of , unresolved. The following individual drugs, listed under their respective family groups e. The regulation of the above drugs varies in many countries. Alcohol possession and consumption by adults is today widely banned only in Islamic countries and certain states of India. The United States, Finland, and Canada banned alcohol in the early part of the 20th century; this was called Prohibition. Although alcohol prohibition was repealed in these countries at a national level, there are still parts of the United States that do not allow alcohol sales , even though alcohol possession may be legal. Bhutan is the only country in the world where possession and use of tobacco is illegal. New Zealand has banned the importation of chewing tobacco as part of the Smoke-free Environments Act In some parts of the world, provisions are made for the use of traditional sacraments like ayahuasca , iboga , and peyote.

In Gabon, Africa, iboga tabernanthe iboga has been declared a national treasure and is used in rites of the Bwiti religion. The active ingredient, ibogaine , [41] is proposed as a treatment of opioid withdrawal and various substance use disorders. In countries where alcohol and tobacco are legal, certain measures are frequently undertaken to discourage use of these drugs. For example, packages of alcohol and tobacco sometimes communicate warnings directed towards the consumer, communicating the potential risks of partaking in the use of the substance.

These drugs also frequently have special sin taxes associated with the purchase thereof, in order to recoup the losses associated with public funding for the health problems the use causes in long-term users. The sentencing statutes in the United States Code that cover controlled substances are complicated. For example, a first-time offender convicted in a single proceeding for selling marijuana three times, and found to have carried a gun on him all three times even if it were not used is subject to a minimum sentence of 55 years in federal prison. Drug sentencing guidelines under state law in America are generally much less harsh than the federal sentencing guidelines, although great irregularities exist.

The vast majority of drug felonies and almost all drug misdemeanors in the United States are prosecuted at the state level. The federal government tends to prosecute only drug trafficking cases involving large amounts of drugs, or cases which have been referred to federal prosecutors by local district attorneys seeking the harsher sentences provided under the federal sentencing guidelines. In rare instances, some defendants are prosecuted both federally and by the state for the same drug trafficking conduct.

Drug prohibition has created several legal dilemmas. For example, many countries allow the use of undercover law enforcement officers solely or primarily for the enforcement of laws against use of certain drugs. On occasion these officers are allegedly allowed to commit crimes if it is necessary to maintain the secrecy of the investigation, or in order to collect adequate evidence for a conviction. The War on Drugs has stimulated the creation of international law enforcement agencies such as Interpol , mostly in Western countries. This has occurred because a large volume of illicit drugs come from Third-World countries.

Siegel explain how drug prohibition can be used for selective social control:. The role of drugs in the exercise of political control is also coming under increasing discussion. Control can be through prohibition or supply. The total or even partial prohibition of drugs gives the government considerable leverage for other types of control. An example would be the selective application of drug laws Academic Noam Chomsky argues that drug laws are currently, and have historically, been used by the state to oppress sections of society it opposes: [44] [45]. Very commonly substances are criminalized because they're associated with what's called the dangerous classes, poor people, or working people.

So for example in England in the 19th century, there was a period when gin was criminalized and whiskey wasn't, because gin is what poor people drink. In the European Monitoring Centre for Drugs and Drug Addiction reported that there are new legal drugs, known as legal highs, available in Europe.

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