10 Types of Touch That Can Happen in Therapy

Knowing touch is the foundation of human experience and that it is essential for healthy growth and development, we need to pause and ask ourselves… When did touch become a bad word?

In the 13th century, the Holy Roman Emperor Frederick II took 50 infants from their mothers and placed them with foster mothers. The foster mothers were instructed to feed and bathe the children, but not to touch, speak or interact with them in any other way. While his experiment was intended to discover what natural language the infants would speak, Frederick II would never find his answer because the children perished: unable to live and thrive without the clapping of hands and interaction of touch.

It should come as no surprise how crucial touch is to our development. It is the first sense that we develop in the womb, and the last sense we use before death. Knowing touch is the foundation of human experience and that it is essential for healthy growth and development, we need to pause and ask ourselves… When did touch become a bad word?

No touch rules were instituted to try to stop sexual abuse of children. These rules, while well intended, placed additional pressure on therapists, and started a new ethical battle.

  • How do you respond to a client’s spontaneous hug?
  • How do you ethically incorporate touch with play therapy?
  • Do you need a consent form to touch your client?

Today, there are many ways you can include touch in therapy sessions while maintaining your ethical standing. Here’s a list of 10 types of touch identified by Janet Courtney that can happen during therapy if deemed developmentally appropriate.

  1. Greeting touch
    • Shaking hands with child or parent
  2. Patterned playful touch
    • Quick, synchronized hand movements (such as pat-a-cake)
  3. Reorienting touch
    • Touching a child that appears to be drifting off
  4. Task-oriented touch 
    • Hands touch passing a toy, paper, markers, etc.
  5. Physical (related to an injury) touch
    • A child shows you a hurt finger
  6. Excited/happy touch
    • When a child is sharing good news
  7. Containment touch
    • When a child is in danger (like standing on a chair)
  8. Intentional touch
    • Measuring a child’s height on the wall
  9. Assistance touch
    • Help standing or completing a task
  10. Attentional touch
    • When a child is touched to gain their attention about something

Want more training on the ethics of touch? We invite you to learn more with Janet Courtney’s Ethics of Touch in Child Psychotherapy & Play Therapy DVD.

Before you leave, watch this TED talk from Janet Courtney on the Curative Touch of a Magic Rainbow Hug.

The Timing Therapy Exercise Every Therapist Needs

Give us four minutes, and we’ll show you how you can see up to 30% gains in the executive-function skills of your clients with ADHD.

Timing and synchronization are crucial to our brain’s ability to function. Our brain has a master clock and circuitry devoted to keeping cells and signals synchronized. When the timing of this circuitry is imprecise, brain processes can suffer and we experience a degradation of motor skills, senses, cognitive skills, emotional regulation and other functions.

Timing therapy is an approach to re-syncing the brain’s timing circuits. Research has shown that when we regularly practice timing precision, we can repair out-of-sync timing circuitry in the brain, which in turn increases brain and body functionality in a significant way.

Key elements of timing therapy include:

The beat: It should match the natural rhythm of the activity.

The tempo: A comfortable clapping speed for most people is about 54 beats per minute (BPM). However, a typical child with ADHD will be more comfortable at a slightly higher tempo (try 63 BPM).

Precision: Keeping an imprecise beat or not caring about the beat will not produce desired results.

Feedback: The most powerful forms of timing therapy provide sensory feedback on how well the beat is being maintained.

Much of the research in timing therapy has been done in conjunction with the Interactive Metronome. Studies show that children with ADHD who did 15 hours of tapping and clapping exercises using the Interactive Metronome made 30% gains in their executive-function skills. This includes attention skills, working memory, motivation ability to plan and problem-solve, as well as the ability to stay organized.

Want to implement timing therapy with your clients and see similar results, but don’t have the funding to purchase equipment? Teresa Garland, MOT, OTR has a method for you. By combining a metronome and a ball, you can get the same sensory feedback for under $2.

Master the simple method in under four minutes.



This blog is based on the writing of Teresa Garland, MOT, OTR. Check out her award winning book Self-Regulation Interventions and Strategies: Keeping the Body, Mind & Emotions on Task in Children with Autism, ADHD or Sensory Disorders.

How About Some Botox for Depression?

A new study has found that when Botox is injected between the eyebrows, it delivers an antidepressant effect.

Botox, botulinum toxin A, has certainly been on a run in recent years—spreading its wings way beyond its use as an anti-aging treatment. Known primarily for the ability to reduce the appearance of some facial wrinkles, Botox injections are also used to treat such problems as repetitive neck spasms, excessive sweating and overactive bladder. Botox injections may also help prevent chronic migraines in some people.

Now a new study has found that when Botox is injected between the eyebrows, it delivers an antidepressant effect. Researchers at the University of Texas Southwestern conducted a 24-week randomized, double-blind, placebo controlled study that included 30 subjects (93% women in the study) with major depressive disorder. At week 12, the Botox and placebo groups crossed over. That is, those receiving Botox were instead delivered placebo; those getting placebo were then administered Botox.

The subjects who received Botox from the outset or at week 12 had a statistically significant reduction in depressive symptoms compared to those getting placebo. Interestingly, depressive symptoms continued to decline over the full 24-week period after a single Botox injection, while the anti-aging improvements had ceased at the 12–16 week mark.

What’s behind Botox’s antidepressant properties? We don’t know for sure, but it is suspected that Botox’s antidepressant effect is “cosmetically” driven, providing an esteem and image boost which in turn improves personal fulfillment. Another possibility is that positive feedback to a happier looking face received from the Botox user’s social network provides a sustainable emotional boost. A final suggestion is that the facial muscles communicate with the brain and the act of frowning adversely affects neurotransmission; whereas smiling activates nerve impulses.



This post is an excerpt from the recent release of Psychopharmacology: Straight Talk on Mental Health Medications, Third Edition, by Joe Wegmann, RPh, LCSW.


Six Steps of the Self-Mutilation Sequence

Join Daniel J. Fox, Ph.D., as he talks about self-sabotage and self-mutilation. Get the worksheet “Six Steps of the Self-Mutilation Sequence” to help you significantly decrease the probability of your client’s self-mutilating.

Download the Self-Mutilation Sequence Worksheet

This blog was brought to life by Daniel J. Fox, Ph.D. 

Daniel J. Fox, Ph.D. has been treating and specializing in the treatment and assessment of individuals with personality disorders for the last 14 years in the state and federal prison system, universities, and in private practice. He is a licensed psychologist in the state of Texas and has published several articles on personality, ethics, and neurofeedback. He is the author of The Clinician’s Guide to Diagnosis and Treatment of Personality Disorders. His specialty areas include personality disorders, ethics, and neurofeedback.

Beyond Chemistry: Exploring Our Relationship with Our Meds

Medication is about more than just taking the right pill. It’s about your client’s relationship with their meds.

The following is an excerpt by Frank Anderson, M.D.

The clients referred to me for psychopharmacology consultation often seem to feel a certain relief once they’ve let me know that, when it comes to meds, they’ve tried “everything” and so far “nothing” has worked. After we’ve run down the list of what they’ve taken and how it’s failed, they sit back as if to say, “Now it’s your turn.” What else is there for them to say?

My answer? Plenty.

Here’s where I explain that I work a bit differently than most prescribers. I believe that the chemical effect of pills is only part of their impact. I emphasize that for some people, more may be riding on this relationship with medication, the source of so much hope and potential disappointment, than on any other relationship in their life. Understandably, this notion gives many people pause; they’re not used to considering the chemical agents in their daily lives to be like a living, breathing psychological presence in their minds, whether conscious or not.

But then I say something that’s often even more startling to them: I don’t prescribe medications to a person unless all the inner parts of that person are on board with the decision to take them. If they have doubts or fears about meds and their possible impact, I tell them that we need to focus on the root of these feelings, not just go through the motions of a standard med check.

I then suggest that we try to get to know the different thoughts and feelings they might be having about taking a medication for anxiety. This invitation to look at their relationship with their medications is rarely, if ever, part of a dialogue with a prescriber, but it’s often not even brought up by therapists, the people who should be inquiring most about the important relationships in their clients’ lives.

Why this huge chasm between psychology and psychopharmacology?

Typically, I find that therapists are reluctant to get involved in the prescribing process, viewing the subject as beyond their scope of knowledge and professional expertise. Others reject medications as a legitimate form of treatment, turned off by the excesses of Big Pharma and disdainful of the idea of a quick fix for the complex psychological issues a client needs to sort out in treatment.

On the other side, psychiatrists and primary-care physicians often have just 15 minutes with patients and feel the constant pressure to do something to justify insurance reimbursement for the office visit or for another day in the hospital.

How can we bridge this gap?

One step is for therapists to understand that bringing the same internal curiosity and focus to psychopharmacology with clients that they would when addressing any other clinical issue in therapy encourages compliance, increases the effectiveness of meds, and deepens and strengthens the treatment. Another step is for prescribers to acknowledge that unresolved psychological issues around people’s strong, largely unacknowledged feelings toward the drugs they’re prescribed regularly interfere with the physiological impact of those drugs.

Psychopharm Course

Between Two Worlds

As both a prescriber and a therapist, I do much of my work using the Internal Family Systems (IFS) model of therapy. I help my clients clarify the relationships between themselves and their internal parts-the various aspects of them that may hold entirely different emotional positions about the issues in their lives, including taking psychiatric medications. Engaging different parts within the client’s own psyche about meds—their usefulness, desirability, side effects, unintended consequences, and so on—helps them tune into their own mental/physical system in a deeper, more focused way.

Often, I’ve found that simply acknowledging and thereby validating these types of feelings can be enough to alter a physiological response to medications. Indeed, I invite any skeptics to consider the placebo effect.

If people can get positive responses from a medication even when they only think they’re taking it, why can’t a part of them block a medication response too?

Symptoms vs. Feelings

Another important step is to help clients differentiate symptoms from feelings. When I ask clients how they think a medication can be helpful, they say something like, “I don’t want to feel sad all the time,” or “I’m tired of being so lonely,” or “I want to be less angry with my kids.” I then explain that these are feelings, and medications are intended to treat symptoms, not feelings.

Symptoms include panic, depression, inability to concentrate, irritability, and insomnia, whereas feelings include sadness, loneliness, anger, and distress. Generally, symptoms are biologically based, and feelings are psychologically mediated. Also, symptoms tend to affect the whole system-in contrast to feelings, which tend to encompass a specific part of the inner self experiencing a specific emotion for a particular reason.

Of course, symptoms frequently cause uncomfortable feelings, and psychological issues often trigger biological responses. The task at hand, then, is to determine how much of a client’s experience is psychological and needs to be worked out in therapy, and how much is biological and might be appropriately addressed with medication. Usually, it’s not one or the other, but a combination of both.

When asked, however, clients can often differentiate how much of each is at play. Sue, for instance, a college freshman who came to see me because she was struggling in school, was able to say after checking inside, “I think 80 percent of my struggling is due to being away from home and missing my family, but 20 percent feels like depression.” Clearly, Sue identified her feelings in missing her family, and her symptoms in describing depression.

Educating, Not Deciding

Just as unrecognized biological issues can undermine psychotherapy, unacknowledged psychological issues can negatively affect biology and ultimately the effect of medications and the therapeutic processes.

My approach with medications rests on one basic principle: I educate clients about meds, but they must decide whether or not to take them. In other words, although I can explain which are most appropriate and their possible side effects, it’s up to my clients to decide with the full awareness of all their thoughts and feelings about taking the medication.

Too often, when medication is prescribed, therapists assume that the job is done and therapy can proceed. In this way, it’s as if the client had just been vaccinated and doesn’t have to worry about the onset of untoward symptoms.

The reality, however, is that beginning meds is just the first step in the ongoing work of psychopharmacology, which also involves helping clients stay attuned to their reactions and assessing the effects of medications so that they’re better able to express what’s going on with them during their follow-up appointments with their prescriber.

Activating the Prescriber’s Parts

Clients are certainly not the only ones who have reactions and feelings about taking medications. I can also get emotionally triggered or feel as if I’ve failed when a medication doesn’t work and the client gets frustrated with me. Sure, my inner helper likes it when my clients feel better, but like a lot of therapists, I often struggle with suggesting a medication trial. At times, I’ve agreed too readily with a client’s request for medications.

Dan, whom I was seeing for both therapy and medication management, came to our session asking for an antidepressant for what he described as increasing depression over the previous month. The progress we’d made over a few years of therapy was reassuring, and I’d come to look forward to seeing his name on my schedule each week. He had been on medication in the past with good success, so without much hesitation or my own inner 30-second check-in, I quickly agreed. Dan left feeling hopeful, but over the next several weeks, he came into sessions complaining of being numb and disconnected. Was the medication not working, did he need a higher dose, or was something else going on? That’s when I got curious.

“Dan, can you check inside to see if you have any feelings or reactions to being on this medication?” I asked.

He took a few moments and then said, “All I feel is numb. I’ve got no feelings and no thoughts.” I asked him to check inside again to see if his “gut” told him to increase or stop the medication. He was somewhat surprised by the answer that welled up. “I think it makes more sense to stop the medication,” he said. “I’ve actually been feeling worse ever since I started it.”

It was at that moment that I realized I hadn’t been sufficiently curious about why Dan wanted to begin retaking medication, and I didn’t take the time to explore what was going on for him at the time. In exploring what had precipitated his desire to start taking meds again, he told me that he’d just learned that his sister’s cancer had come back and that the prognosis was grim. What he’d misinterpreted as depression was really an attempt to numb out and avoid feelings of fear and grief. It turned out that we were medicating a psychologically protective response in him, not a biologically based depression. Dan’s parts that didn’t want to feel, and my parts that wanted to be liked, got in the way of effective treatment, and lead to me prescribing an unwarranted medication.

Bridging the Gap

Too often therapists don’t talk about meds with either clients or prescribers because they fear treading into areas that are beyond their field of expertise. An important part of therapy with clients taking medications is regularly asking them about their responses—both mind and body—to the full impact of medication, before, during, and after the time they’re taking them. Ongoing discussion about clients’ relationships with their meds should be as integral to therapy as other important dimensions of their lives, such as their family situation, troubles with work, personal triumphs or failings, or any other issues that generate intense feelings and shape their day-to-day existence.

Asking and listening are essential to making sure that psychotherapy supports the work of psychopharmacology. Asking means inquiring about clients’ thoughts and feelings around taking medications, and listening means helping them check in with their internal reactions, exploring any conflicts that arise. For the therapist, there’s also listening to your own reactions and feelings about medications. All are part of the all-too-often shadowy world that lies at the interface of psychotherapy and psychopharmacology. By acknowledging this territory, as with other charged issues, psychotherapists can help clients give voice to their complex emotional responses to taking meds, even if they feel the neuroscience and biochemistry of medication lie beyond their expertise. After all, even without a medical degree, therapists know quite a bit about how to handle a troubled relationship when they see one.

This post is based on an article originally brought to life by our partner, Psychotherapy Networker.

The full article, “Beyond Chemistry,” written by Frank Anderson, M.D., appeared in the Jul/Aug 2014 issue of Psychotherapy Networker magazine.

Psychotherapy deal4

When a Child’s Fever Turns Into a Nightmare

You expect a child to experience bumps, bruises, cuts, sore throats, runny noses, ear infections and fevers. But what happens when a child goes from a mild fever to convulsions, loss of consciousness, and foaming at the mouth?

Watch this 53-second video, and see if you diagnose this case study correctly…

If you guessed febrile seizure, you’re correct.

PESI speaker Maria Broadstreet, R.N., MSN, CPNP, has over 20 years of experience working with children. Her son and daughter have both experienced febrile seizures, and while they’re typically harmless, they can be alarming and terrifying—even for a mother with years of experience in the health care field. Here’s what you need to know…

What is a febrile seizure?

Febrile seizure are convulsions brought on by a fever in infants or small children. During a febrile seizure, a child often loses consciousness and shakes, moving their limbs on both sides of the body. These seizures typically last a minute or two, but can be as brief as a few seconds and as long as 15 minutes.

How often do febrile seizures happen?

One in every 25 children will have at least one febrile seizure, typically between the ages of 6 months and 5 years. The older a child is when they experience their first febrile seizure, the less likely that child is to have more.

What are the risk factors for febrile seizures?

Children who are younger than 15 months, have frequent fevers, and have family members with a history of febrile seizures are more likely to experience febrile seizures.

Are febrile seizures harmful?

Most febrile seizures are short and harmless, and there is no evidence that short febrile seizures cause brain damage. There is a small chance that a child may be injured by falling or choking from food or saliva in the mouth.

How is a febrile seizure treated?

Learn more about pediatric problems, emergencies and lab interpretation. SAVE 40% when you use code H16J19. Offer expires 1-22-2016 at 11:59 p.m. (CST).

There is no treatment for a true febrile seizure. Fever-lowering drugs such as acetaminophen or ibuprofen should be given at the appropriate dosage for the child. If the seizure lasts 10 minutes, the child should be taken immediately to the nearest medical facility. Once the seizure has ended, the child should be taken to his or her doctor to investigate the source of the fever.

Children that are especially prone to febrile seizures may be treated with the drug diazepam, either orally or rectally, whenever they have a fever.

What does the American Academy of Pediatrics recommend?

Clinicians evaluating infants or young children after a simple febrile seizure should direct their attention toward identifying the cause of the child’s fever. In general, a simple febrile seizure does not usually require further evaluation, specifically electroencephalography, blood studies, or neuroimaging.

Have you experienced a febrile seizure?
Tell us about it in the comments below.

A friendly reminder… Always call 911 in an emergency.