A Clarion Call to Compassion: Healing Embodied Trauma with Therapeutic Touch®

By Catherine Jirak Monetti

This book is about hope. Past trauma, an ubiquitous human experience need not be "prologue." The body tells its story to a compassionate "silent witness." Through the Therapeutic Touch (TT) process, embodied trauma, alchemized by bodily stored positive lived experiences, transmutes to the existential life layer. This reintegration process accounts for feelings of rejuvenation and wonder experienced by TT practitioners (TTrx) and healing partners (HPs) alike and their posttraumatic growth. Shared are the author's, students', and professionals' profound and sacred TT experiences of over twenty years. All are true.

• Language: English
• Publisher: Page Publishing, Inc.
• Release date: Oct 10, 2019
• ISBN: 9781684564170

Book preview

CHAPTER 1

Introduction

Trauma

Trauma is a ubiquitous human experience that affects the health or well-being of an individual. Catastrophic events, notwithstanding, are examples. Others are accidents, illness, bereavement, or loss of an interpersonal relationship. The same energetic, physical, emotional, mental, and spiritual disruption occurs in people. The damage does not disappear spontaneously over time (Slater 2004).

Though single incident traumas account for those diagnosed with post-traumatic stress disorder (PTSD), most adults who seek psychotherapy have had numerous traumatic events (Van der Kolk 1994). Patients with trauma histories are therefore widespread in clinical practice (Van der Kolk et al. 2007).

Intergenerational Trauma and Embodiment

Intergenerational trauma may have a greater effect on descendant survivors if both parents were exposed to an event. Research has demonstrated pervasive and enduring effects of stress exposure on the health of offspring generations (Brand et al. 2010; Yehuda and Bierer 2009). Walters, Beltran, Huh, and Evans-Campbell (2011) noted Scholars point to the amassing of evidence at the cellular level that powerful stressful environmental conditions can leave an imprint or ‘mark’ on the epigenomic (cellular genetic material) that can be carried into future generations with devastating consequences (p. 11). The trauma can literally become embodied, manifesting as poor mental and physical health outcomes, such as higher stress vulnerability to contemporary traumatic stressors (Kuzawa and Sweet 2009; Yehuda 1999).

Trauma Therapy

Psychological exposure is a component of established PTSD treatments, including Cognitive Behavior Therapy (CBT), Virtual Reality Exposure (VRE), and Eye Movement Desensitization and Reprocessing (EMDR) (Shapiro 2001). In exposure protocols, anxiety-or fear-producing memories are provoked as a form of information processing (Feinstein 2010). For traumatized individuals, fully reexperiencing symptoms may be disconcerting or even frightening (Ogden and Minton 2000). Confronting memories is not universally effective and can deter patients from treatment (Lewis 2003).

To mitigate retraumatization, some alternative therapies use brief psychological exposure. Collectively referred to as energy psychology (Gallo 2002), these approaches include Thought Field Therapy (TFT), Tapas Acupressure Technique (TAT), and the Emotional Freedom Technique (EFT) (Feinstein 2010).

Many experts have expressed strong interest in fostering the evidence base for energy healing approaches in PTSD (Strauss et al. 2011). Non-exposure-based complementary and alternative medicine (CAM) modalities (such as TT) have been posited as a welcome treatment alternative (Bleiberg and Markowitz 2005). A non-exposure-based therapy, such as TT, can also potentially offset the heavy reliance on psychopharmacology.

Van der Kolk (1994) recommends that trauma treatments integrate cognitive-based narrative therapy (psychotherapy/counseling) with somatic body memory treatment. Despite the fact that many symptoms of traumatized clients are somatically based, traditional psychotherapy lacks techniques that work with these physiological elements (Ogden and Minton 2000). Integration of TT is one solution.

Gestalt Therapy

Gestalt Therapy was developed by Frederick S. (Fritz) Perls in New York City in the late 1940s. After meeting Freud in 1936 and experiencing a severe disappointment, he became skeptical of psychoanalysis and turned to Zen, then to existentialism (i.e., one must take personal responsibility for one’s own existence). His work was primarily influenced by five traditions: psychoanalysis, Reichian character analysis, existential philosophy, Gestalt psychology, and Eastern religion. Among others, he was also influenced by the philosopher Husserl.

In Gestalt psychology, the phenomenal world is organized by the needs of the individual. Its goal is to add needs and bodily awareness to the gestalt-forming process (i.e., shape or form) through existential work in the here and now. Gestalt psychotherapy facilitates the change process through four stages: the games layer, the impasse layer, the implosive or death layer; and the explosive or life layer. The contact cycle entails the process of making contact, either with something/someone in the external environment and/or with something within the inner environment. Interruptions in healthy functioning, or creative adjustments to surviving childhood with less than good-enough parenting, is highly respected (Perls 1969).

CHAPTER 2

What is Therapeutic Touch® (TT)?

Introduction

As explained by Peper (1986/1987), TT is a method which involves the concept of energy fields in regard to health (p. 14). Regarding energy field theory used by Krieger, Hogan (1993) cited the work of Kunz and Peper (1985) to explain that the concept of field not only involves physical energies but also every human function, including emotion, thought, and intuition (p. 6). Peper (1986/1987) continued:

many health professionals have adapted the process of TT to offer their patients a high level of caring, which is so often missing in technological medicine. The concept of TT is based upon an appreciation of energetic systems in which the practitioner, who has learned this technique, appears to transform and transmit a healing energy to the patient. Without actually touching, the practitioner can often use his hands to sense, balance, and reenergize the field of the patient. This field surrounds and penetrates the person, and continuously interacts with the field of others. (p. 14)

Peper (1986/1987) added, During the TT process, there are metacommunications which underlie the remarkably successful diagnostic healing skills exhibited by Dora Kunz (p. 14).

Therapeutic Touch® (TT) Energy Medicine

To provide context for TT, energy medicine is recognized by the healthcare system as a subspecialty of complementary and alternative medicine (CAM). The National Center for Complementary and Alternative Medicine (NCCAM) defines energy healing therapy as the channeling of healing energy through the hands of a practitioner into the client’s body to restore a normal energy balance and, therefore, health. Energy healing therapy has been used to treat a wide variety of ailments and health problems and is often used in conjunction with other alternative and conventional medical treatments. NCCAM was renamed the National Center for Complementary and Integrative Health (NCCIH) to address changes in the use of CAM therapies (NCCIH 2015).

The premise behind energy healing is that (1) a disruption occurs in a person’s holistic harmony when energy paths of the body are blocked or disturbed; (2) illness, disease, weakness, pain, and/or psychospiritual issues may ensue from this disruption; and (3) realignment of the energy paths during energy healing can alleviate these ensuing issues (Fazzino, Griffin, McNulty, and Fitzpatrick 2010). The energy-based therapies commonly combine physical touch and nonphysical contact to stimulate healing (Hammerschlag, Marx, Yamamoto, and Aickin 2012).

While energy medicine has long been accepted by many clinicians in the nursing and allied health care professions, it is increasingly accepted as an important healing practice in the medical community. Of note, as part of their training in integrative medicine, some medical residents are being taught about energy medicine, and physicians are writing orders for it in many hospitals (Hart 2012).

Energy medicine therapies, such as Therapeutic Touch (TT), are among the most common complementary therapies offered in hospital and community-care settings (Hart 2012). TT is practiced in a variety of medical settings, including rehabilitation, hospice, palliative care, preoperative, postoperative, oncology, and home care. It is administered to people of all ages (Hart 2012). Parish nurses routinely administer TT. Veterans are among those benefiting from it too.

In Europe and the United States, these therapies are generally used to complement rather than replace biomedical therapy (Engebretson 1999).

Therapeutic Touch® (TT)

First, as a rule, Therapeutic Touch (TT) is an exceptionally safe treatment.

To introduce TT, human touch or laying-on of hands for the purpose of healing has been used for centuries. TT was developed in the early 1970s by Dolores Krieger (PhD, RN, professor of nursing emerita at New York University) and Dora Kunz (a clairvoyant). Founded within nursing science in 1972, TT was described by Krieger in 1975 as an act of healing or helping that is akin to the ancient practice of laying-on of hands. Krieger and Kunz envisioned TT as a noninvasive intervention that would be acceptable in the medical setting and build on the nursing tradition of compassionate, hands-on caring (Rhodes 2012).

Krieger (1979) describes TT as utilizing the hands to direct human energies to heal illness (p. 1) that results in a modification of the human energy field. Krieger (1979) believes that TT can be practiced by anyone willing to learn and aspiring to help another (Smyth 1995). Conceptualized as a secular modality, it can be practiced by people of any or no religious faith (Hemsley 2003). An extension of professional nursing skills, TT is analogous to autonomous nursing interventions, such as touch, massage, stress management, counseling, the provision of comfort measures, and the teaching of coping activities (Engebretson 1999; Fazzino et al. 2010). It is used to complement medical, nursing, and psychotherapy skills—not replace them (Smyth 1995).

TT is currently defined by the official organization of TT, Therapeutic Touch International Association (TTIA), as Therapeutic Touch is a holistic, evidence-based therapy that incorporates the intentional and compassionate use of universal energy to promote balance and well-being (TTIA 2013). TTIA reports that TT is now taught in more than 104 countries around the world in educational institutions, health care facilities, and community-based agencies and groups. More than 80 universities in North America include TT training in their curricula.

Research on Therapeutic Touch®

Overall, TT is the most extensively researched CAM modality in that over 1,000 research reports have been published. TT was the first holistic healing method to be taught at the doctoral level, with over 50 doctoral dissertations completed.

TT has been shown through research to help recipients in promotion of sleep; decreasing pain perception; creating a sense of well-being and comfort; acceleration of the healing process in wounds, second-degree burns, and bone; activation of the immunological system; acceleration of the relaxation response; decrease of agitation in elderly clients suffering from dementia; and comfort for the dying. Studies have also been conducted to explore its effectiveness in facilitating the grieving experience (Robinson 1995), lessening mood disturbances in women (LaFreniere et al. 1999), and helping to prolong periods of abstinence for people with alcoholism (Hagemaster 2000). Research continues in major medical centers (TTIA 2013).

However, few studies have explored the subjective experiences of TT on the part of nurse healers (TTrx) and adult recipients (HPs). Samarel (1992) acknowledged the difference between a linear versus a multidimensional perspective. She conjectured that while the experience of TT is nonlinear, the expression of it and the nature and memory of human experience is limited by language.

Nursing Diagnosis

A concern had arisen that there is a lack of evidence to support the concept of the human energy field (HEF) as a phenomenon of interest to professional nurses and nursing practice (NANDA-I 2014). In response, Shields, Fuller, Resnicoff, Butcher, and Frisch (2017) conducted a concept analysis on the term, using Chinn and Kramer’s (2015) method. They conceptually defined the HEF thus:

Luminous field of energy that comprises a person, extends beyond the physical body, and is in a continuous mutual process with the environmental energy field. It is a vital energy that is a continuous whole and is recognized by its unique pattern. It is dynamic, creative, nonlinear, unpredictable, and flows in lower and higher frequencies. The balanced HEF is characterized by flow, rhythm, symmetry, and gentle vibration." (Shields et al. 2017 [Abstract], p. 1)

Concomitantly, in their February 14, 2017, press release, the American Holistic Nurses Association (AHNA) announced that the North American Nursing Diagnosis Association-International (NANDA-I) approved a revised nursing diagnosis. The diagnosis was changed from disrupted energy field to imbalanced energy field.

Therapeutic Touch® Credentialing

A formal credentialing process for TT is available through the Therapeutic Touch International Association (TTIA 2017). Nurse Healers-Professional Associates International (NH-PAI) is the credentialing body of Therapeutic Touch International Association (TTIA 2017).

Credentialing is offered for qualified therapeutic touch practitioner (QTTP) and qualified therapeutic touch teacher (QTTT). Recognition as a QTTT is specific to the level of TT for which one is applying—e.g., foundations of TT (basic), transpersonal nature of TT (intermediate), and/or application of inner processes of TT (advanced). Initial and renewal applications can be accessed online, as well as one for those practicing prior to 2000 (TTIA 2014, 2017).

A formal documentation process is required utilizing approved TT CARER Notes©. The acronym stands for the following:

C—call to compassion

A—assessment

R—rebalancing and reassessment

E—end and evaluation

R—reflections/recall

A Single Case Study Table & Human Energy Field Cue Form is used for class, mentoring, and the QTTP application. The Longitudinal Case Study & Human Energy Field Cue Form is used for mentoring and the QTTP application only (TTIA 2014, 2017).

Along with the forms, Instructions with TT Process Questions and the Personal TT Human Energy Field Cue & Symbol Reference Chart© are also available on TTIA’s website (see above) (TTIA 2014, 2017).

Therapeutic Touch® in Mental Health Practice

With acceptance of TT now widespread, it has been integrated with mental health nursing approaches. Psychotherapists are also incorporating it into their practices (Macecevic 2008). Some psychologists use TT at the beginning or end of counseling sessions (Wager 1996). They have found that clients treated with TT at the beginning of a session report feeling more connected to the therapist and talk about their difficulties more openly (Wager 1996). It is apparent that a TT practitioner can become aware of the patient’s problems in an intuitive way without the need for conversation (Wager 1996). After all, quoting Macrae (2010), TT is a mode of communication in its own right (p. 5).

Veterans are among those receiving benefit for common conditions, such as fatigue, headaches, insomnia, depression, anxiety, sleep disturbances, and relationship problems (Eisenberg et al. 1998). Patient-centered health care systems, such as Planetree™ facilities, now offer TT training to their employees. For example, the Veterans Administration (VA) hospital in New Jersey is currently in the process of training its health care providers to become TT practitioners (Hart 2012). Many journey up to the Pumpkin Hollow retreat center in New York State to obtain their training.

Research has demonstrated TT’s usefulness in the psychiatric mental health arena. Schwab, Rader, and Doan (1985) found a decrease in the use of psychotropic medication and noisy behavior in persons with dementia, but they did not assess the efficacy of TT alone.

Hill and Oliver (1993) found teaching patients to use a combination of visualization and TT on themselves to be an effective strategy in mental health recovery. Their nursing students had begun dialogue about the potential use of TT for patients with problems of alcoholism, anger, grief, anxiety, and other problems. They emphasized how clients maintained their behavior change and experienced a found sense of peace and healing in their ability to use and transfer their new TT skills to other aspects of their lives.

Nursing students benefited too. Hill and Oliver (1993) exemplified:

In workshops over the past 8 years where I have taught TT, one student became tearful during a TT practice session and felt that ‘…the energy exchange was moving material in a new way for me…although I had worked on these feelings in traditional psychotherapy for some time, this TT experience opened up a whole new aspect of my pain and healing potential.’ (p. 19)

A significant reduction in anxiety was found in thirty-one inpatients of a VA psychiatric facility who received TT (Gagne and Toye 1994). The researchers concluded that since patients may lack the abilities needed to benefit from extensive visual imagery techniques, and anxiety is a key component of many disorders, especially those which are trauma related, development of a passive anxiety reduction technique such as TT would be invaluable for clinical mental health.

Hughes, Meize-Grochowski, and Duncan Harris (1996) concluded that as a nursing intervention, TT offered a holistic approach to care. Specifically, the term body/mind connection emerged as one of two themes to describe seven hospitalized adolescent psychiatric patients’ experience of receiving TT.

Hagemaster (2000) examined the efficacy of TT as a complementary therapy in prolonging periods of abstinence in people who abuse alcohol and other drugs. Woods and Dimond (2002) investigated the effect of TT on agitated behavior (i.e., vocalization and pacing) and cortisol in persons with Alzheimer’s disease. Woods Smith, Arnstein, Cowen Rosa, and Wells-Federman (2002) found that TT lowers emotional distress and may be a useful adjunct to CBT for people with chronic pain.

Larden, Palmer, and Janssen (2004) found that TT promoted lower levels of anxiety in pregnant inpatients with a chemical dependency compared to nursing presence alone or standard care. They concluded TT is a holistic, simple, and inexpensive way to improve compliance with chemical dependency treatment protocols.

MacNeil’s (2006) qualitative descriptive study indicated that TT is an effective nursing intervention to treat adult tension headache pain. She emphasized that students need to be introduced to complementary methods of pain control other than narcotics.

All clients need to understand that clinicians will not intrude on their energy field without their permission and that they can stop the TT process at any time (Hill and Oliver 1993). This is especially relevant for all clients in the psychiatric mental health arena. In general, the TT process requires the unconscious, implicit permission of the healing partner (HP).

Therapeutic Touch® and Compassion

Dolores Krieger (2017) herself emphasizes:

To clearly make the point, without compassion, whatever else one is doing with the technique, it is not TT… In using the TT method, it is compassion, one of the higher human functions, that is the constant companion of the transpersonal-sensitive psychodynamic background of the TT therapist’s (TTrx) healing style… (p. 10)

CHAPTER 3

What are the Phases of Therapeutic Touch® (TT)?

ATT treatment is a process that is always individualized and usually does not exceed twenty minutes in length. Although the exact method may vary among practitioners, generally their hands are passed over the body from head to toe, front and back, holding them between two to six inches from the skin. A person is seated or lying down. Physical touch may or may not be used by the practitioner. Disrobing is not required. What is required is an openness to change.

The TT process involves five dynamic and interactive phases: centering, assessing, intervention (unruffling), rebalancing/reassessment, evaluation, and reflective practice.

Centering. During centering, the TT practitioner’s body, mind, and emotions are brought to a quiet, focused state of consciousness. The breath, imagery, meditation, and/or visualizations are used to open one self to find an inner sense of equilibrium.

Assessment. The purpose is assessment of the condition, or quality, of the human energy field. The hands are held between two to six inches from the individual’s body. During the assessment phase, sensory cues—such as warmth, coolness, static, blockage, pulling, and tingling—are described by some practitioners. Rhythmical, sweeping motions are then done with the hands as if they are smoothing out wrinkles in the energy field.

Intervention/unruffling. Intervention (unruffling) involves facilitating the symmetrical flow of energy through the field. Unruffling is achieved by using hand movements from the midline while continuing to move in a rhythmical and symmetrical manner from the head to the feet.

Rebalancing/reassessment. During the rebalancing phase, energy is projected, directed, and modulated based on the nature of the living field. The client’s energy field is repatterned with the hands, creating energy transfer. The goal of rebalancing, or realignment, is to assist in the reestablishment of order to the system.

Evaluation or closure. This consists of the use of professional, informed, and intuitive judgement as cues to determine when to end the session

Reflective practice. This involves self-awareness, insight gained, and formalized documentation of the TT experience. TTrx signifies the TT practitioner; HP the healing partner (Krieger 1979, as cited in Smyth 1995, p. 15; TTIA 2017).

The Updated Phases of Therapeutic Touch®

In 2016 at the Montana Therapeutic Touch Dialogues in Columbia, MT the basic phases of TT were updated as follows:

Call of compassion

The approach (psychodynamic corridor)

The outreach

The search

The rebalancing

Done

The recall

CHAPTER 4

Author’s Integration of Therapeutic Touch®withGestalt Field

& Layers Theories©

The following delineates the author’s practice of Therapeutic Touch (TT) integrated with Gestalt Therapy. Alignment of TT phases with Gestalt Layers© is designated in italics.

Intentionality. This involves caring, compassion, empathy.

Relaxation, deep breathing, meditation. This involves contact with self/pure intelligence.

Chakra alignment. See below.

Centering. This involves centering oneself physically, psychologically, and psychodynamically. This involves intentionality, motivation, the ability to confront oneself, and the willingness to do so. (Gestalt games layer: pre-TT self; ego defenses operating.)

Assessment. This involves exercising the natural sensitivity of the hands to assess the energy field of the healing partner (HP) for cues to differences in the quality of energy flow (Gestalt games layer), mobilizing areas in the HP’s energy field that the TTrx may perceive as being nonflowing—that is, sluggish, congested, or static (Gestalt impasse layer: a sterile or fertile void).

Grounding. This is the HP’s energy field (Gestalt impasse layer and Gestalt death layer: revelation of HP’s embodied trauma/emotional pain).

Unruffling/realignment. Conscious direction by the TTrx of the HP’s excess body energies to assist the HP to repattern their own (Gestalt impasse layer, the transmutation and releasing unresolved emotional trauma, and Gestalt life layer, accessing the HP’s positive lived experiences from somatic memory, facilitation of the HP’s own innate healing potential, intrapsychic shift).

Final grounding. Gestalt life layer: transmutation of energy trauma, reintegration, transformation; The release is signified by TTrx’s visual imagery from the HP.

Seventh crown chakra opening. This involves the chakra opening to pure light (Gestalt life layer: release, transcendence, rejuvenation, awe).

Final expression of pure intentionality. This involves bestowing a blessing.

Analysis. This involves the analysis of release and processing via Gestalt Therapy techniques (e.g., empty chair work) (Perls 1969; Krieger 1979; Macrae 1990; Monetti 2007).

These can also summarized as the following:

TT centering phase ~ games layer (pre-TT self; ego defenses operating)

↓↓↑

TT assessment phase ~ games layer (pre-TT self) and impasse layer (fertile or sterile void, momentary blankness, felt sense of I don’t know, transient sense of confusion)

↓↓↑

TT initial grounding phase ~ impasse layer and implosive or death layer (revelation of embodied trauma/emotional pain)

↓↓↑

TT unruffling/realignment phase ~ impasse layer (transmutation and release of emotional trauma) and explosive or life layer (revelation of HP’s positive lived experiences from somatic memory)

↓↓↑

TT final grounding phase ~ life layer (transmutation of energy trauma, reintegration, transformation, visual imagery)

↓↓↑

TT seventh crown chakra opening ~ life layer (release; relief, joy, humor, or awe; rejuvenation; transcendence)

Conceptualization of Therapeutic Touch (TT) phases and the Gestalt Layers©

CHAPTER 5

Alignment of the Chakras

Ah, the rainbow…

For the first (or kundalini) chakra, chant Lom on exhalation.

Red (root chakra). This involves basic survival, primal sex drive, and bodily life energy. It lies at the base of the spine and acts as the physical energy regulator for the endocrine system (expressive).

For the second (or hara) chakra, chant Vom on exhalation.

Orange. It sits just below the navel in the center of the body and is the center of emotions, musculature, and gender identity (receptive).

For the third (or solar plexus) chakra, chant Rom on exhalation.

Yellow. It sits right in the center of the solar plexus, directly between the navel and the sternum and is involved in thought and intellect and the effect of thought on the body. It is associated with the adrenals and the pancreas and is also the center of the psychic immune system (expressive).

For the fourth (or heart) chakra, chant Yom on exhalation.

Emerald green. It resides in the center of the chest, behind the sternum and is associated with the thymus gland. It contains the ability to love and feel compassion, both for oneself and the world outside (receptive).

For the fifth (or throat) chakra, chant Hum on exhalation.

Sapphire blue. It sits right above the hollow at the base of the neck, where it processes communication from the spirit and the body and transmits it to the world. It is associated with the thyroid and the parathyroid glands (expressive).

For the sixth (or third eye) chakra, chant Ohm on exhalation.

Indigo. It sits right in the center of the forehead, between the eyebrows and the hairline. It is associated with the pituitary gland. It is the center of clairvoyance or the ability to receive energy vibrations visually (receptive).

For the seventh (or crown) chakra, one should have silence on exhalation.

Purple/violet. It sits above the very top of the head, almost floating over the body. It is the only central chakra that is outside of the body. It is the center of our bodily connection to pure spiritual energy and information. It is associated with the pineal gland. It contains absolute certainty and absolute purpose.

Last is beyond the crown chakra.

White light. This is the opening to the universal healing energy; it extends outside the body and beyond to infinity (McLaren 1998).

CHAPTER 6

Distance Healing with Therapeutic Touch® (TT)

by Tamara Lynn Wardell, PhD, MSN, RN

Larry Dossey (1993) brought distant (nonlocal) healing into the forefront of scrutiny with his work on intercessory prayer. Dossey (1993) included mention of Krieger and the use of TT