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Reflection of a Therapeutic Touch experience: Case Study 2 Christine A. Green

The purpose of this case study was to explore the experience of both giving and receiving Therapeutic Touch. A subjective account of the Therapeutic Touch experience is given in an attempt to throw light on its unique creative and therapeutic qualities. In most instances it was shown that the experience of both giving and receiving Therapeutic Touch was a parallel experience. This case study explores the effects of Therapeutic Touch on a client experiencing pain and associated anxiety. Whilst a response to treatment was observed, the need for further case studies and research studies in this area was identified.

Christine A. Green RGN, BSc(Hon) Nursing, Senior lecturer, University of Luton, Faculty of Health Care and Social Studies, Barracks Road, Wycombe General Hospital, High Wycombe, Bucks HPI I 2"1-I", UK. Tel: 01494 $226161 ext. 5135.

(Requests for offprints to CAG)

For this case study I have decided to focus in depth on the unique subjective experiences of giving and receiving Therapeutic Touch.

My chosen client was experiencing anxiety and pain and I decided to explore the possible benefits that Therapeutic Touch may have for her. Relevant related literature which will provide a basis for understanding this client's experiences, and responses to Therapeutic Touch treatment will be discussed. I will attempt to capture the unique quali- fies and richness of the moment by providing a sub- jective account of the Therapeutic Touch experience through the eyes of the therapist and the recipient. It will be shown that in most instances it was a parallel experience.

Rogers' (1994) Science of Unitary Human Beings conceptual framework provides a basis for understanding the underlying concepts of Therapeutic Touch. Reference to Rogers will be made in an attempt to conceptualize the experience and explain the phenomenon.

The client's name has been changed in order to ensure confidentiality and anonymity. Sarah is a student nurse on the project 2000 course and she will soon be approaching the end of her education. Sarah has only a limited knowledge of Therapeutic Touch which she gained through an introductory session held at her college. She approached me and asked for treatment after hearing that I was a student on a Therapeutic Touch practitioners course. She expressed a great deal of interest in the subject, and was keen to commence treatment.

Sarah is 38 years old. She leads a busy and fulfill- ing life both socially and professionally. Her main

area of physical concern is of a gynaecological nature. Since the age of 15 years, Sarah has suffered from dysmenorrhoea and menorrhagia. By the time Sarah had reached the age of 34 years, she was aware that she was experiencing pain not only at the time of menstruation but at other times in her cycle. This continued to increase and pain occurred 'most of the time'. A laparoscopy confirmed the presence of endometriosis which is 'the proliferation of endome- trial tissue outside the uterine cavity' (Gould 1990).

Sarah was offered Danazol hormonal therapy, a synthetic sex steroid chemically related to testos- terone (Gould 1990) that works by inhibiting gonadotrophin release from the pituitary and opposes the effect of oestrogen. Danazol would be given for a 9-week period, followed by laser treat- ment. Sarah considered the possible side-effects of drug therapy (which were weight gain, amenor- rhoea, and loss of libido) to be unacceptable and so she refused treatment. She experienced pain most of the time, finding it necessary to take analgesics regu- larly. She has observed that the nature of her pain can be affected by stressful situations. Pressures of work have on occasions enhanced the severity and/or duration of her pain. Sarah is concerned that this condition is affecting her quality of living. She now experiences fluctuating feelings of anxiety about her situation.

T H E R A P E U T I C T O U C H

Several authors have defined Therapeutic Touch (Krieger et al 1979, Heidt 1990, Meehan 1993). For

Complementary Therapies in Nursing & Midwifery (1998) 4, 17-21 �9 1998 Harcourt Brace & Co. Ltd

18 Complementary Therapies in Nursing & Midwifery

It is thought that treatment by Therapeutic Touch may relax the patient enough to break the pain cycle (Wright 1987).

... both Therapeutic Touch and relaxation therapy are

effective palliatives to experienced anxiety.

this case study, Meehan's definition was considered to be the most appropriate:

a knowledgeable and purposive patterning of patient-environmental energy field process in which the nurse assumes a meditative form of awareness and uses his/her hands as a focus for the patterning of the mutual patient environmen- tal energy field process.

This definition not only provides an insight into the process of Therapeutic Touch, it also begins to address some of Rogers' conceptual perspectives.

Rogers (1994) views the universe as an open sys- tem with an individual and their environment con- stantly exchanging energy. Although the human energy field and environmental energy field are dif- ferent and unique, they are integral and inseparable. Energy field is perceived by Rogers (1994) as a pat- tern. Manifestation of pattern refers to behaviours, qualities, and characteristics of a field, which is unique and constantly changing. Pattern manifesta- tion appreciation plays an important role in the pro- cess of Therapeutic Touch, as will be demonstrated within this case study.

Pandimensionality is a concept described by Rogers (1991) as a non-linear domain without spacial or temporal attributes. This term describes an infinite domain without limits or tight boundaries. Unitary thinking encapsulates pandimensionality as an intrinsic aspect of reality. A pandimensional experience cannot be successfully rationalized from a three-dimensional world perspective, other than to assume a supernatural link. Some examples of pandimensional experiences will be discussed within this study.

RELATED RESEARCH

Pain

Several research studies have explored the effects of Therapeutic Touch on the experience of pain (Keller & Bzdek1986, Meehan 1985). Keller and Bzdek (1986) investigated the effects of Therapeutic Touch on tension headache pain. They found that those subjects who had received Therapeutic Touch expe- rienced greater headache relief than those subjects who had received mimic Therapeutic Touch. The study indicates that Therapeutic Touch may have potential beyond a placebo effect in the treatment of tension headaches.

Meehan (1985) found that Therapeutic Touch could be marginally effective in helping to reduce post-operative pain, and that patients waited signifi- cantly longer before requesting more analgesia. It is thought that treatment by Therapeutic Touch may relax the patient enough to break the pain cycle (Wright 1987). Our knowledge of pain theories may contribute to our understanding of why Therapeutic Touch is effective in relieving pain. The Gate

Control theory, as proposed by Melzach and Wall (1982), suggests that pain impulses can be regu- lated, modified, or blocked by certain cells within the central nervous system. The activity of the gating mechanism can be affected by emotion. As Therapeutic Touch can evoke a relaxation response (Meehan 1992), it could be surmised that this in turn may activate the gating mechanisms in descending tracts and thereby lessen pain.

Case studies have also reported alteration of pain following treatment with Therapeutic Touch (Bulbrook 1984, Heidt 1991, Newshan 1989, Raucheison 1984). The research studies demonstrate that Therapeutic Touch can be effective in relieving pain. However, because of the many complexities associated with pain, further studies are needed.

Anxiety

Observations reported by Kreiger et al (1979) suggested that Therapeutic Touch has the potential for eliciting a state of physiological relaxation in patients. Several quasi-experimental studies have been undertaken to investigate the effects of Therapeutic Touch on anxiety (Heidt 1981, Quinn 1982). Heidt (1981) studied the effect of Therapeutic Touch on the reported anxiety of hospi- talized cardiovascular patients. Those patients receiving Therapeutic Touch showed a significant reduction in subjective anxiety after treatment. Quinn (1982) replicated and tightened up the control procedures of Heidt's study. She also reported sig- nificant reduction of anxiety after Therapeutic Touch.

Olson et al (1992) tested the effectiveness of Therapeutic Touch for the reduction of stress in individuals involved in a natural disaster. It was demonstrated that stressed people report themselves to be less stressed following Therapeutic Touch. Olson and Sneed (1995) demonstrated that pro- fessional caregivers who had a high level of anxiety had a greater reduction in anxiety after receiving Therapeutic Touch than caregivers who had low levels of anxiety.

A recent study by Gagne and Toye (1994) com- pared the effects of reducing anxiety when receiving either Therapeutic Touch, relaxation therapy or mimic Therapeutic Touch for 31 psychiatric patients. It was demonstrated that both Therapeutic Touch and relaxation therapy are effective pallia- tives to experienced anxiety. The research demon- strates that Therapeutic Touch can be effective in reducing anxiety for people with dysfunctional health or those people wishing to enhance the quality of everyday living.

Case study

For the purpose of this case study, Sarah has agreed to share with me her reflective experiences of Therapeutic Touch. An account of the Therapeutic

Reflection of a Therapeutic Touch experience: Case Study 2 19

... it f e l t as i f there

w a s a connec t ion

o f s o m e k ind

b e t w e e n us.

Touch interaction from Sarah's perspective will be given. It is hoped that the narratives will provide insight into this unique subjective experience.

Sarah's experience

I really did not know what to expect. I have an open mind but I did not expect much to happen. I have had a stressful week, rushing around a lot as I have not got a car at present. I had to walk here today. I was in pain when I arrived, it is not sur- prising really because at the moment I am in the pre-menstrual stage of my cycle, it 's always worse at this time. I was going to take some Neurofen but instead I decided to test Therapeutic Touch and see if it really works. I experienced a weird sensation when you placed your hands over the back of my head. I felt something happen. I know that your hands were not touching me, but it felt as if there was a connection of some kind between us. I felt a weird pulling sensation.

Sarah appeared to be sensing the interconnectedness between human energy fields and environmental energy fields. She found it difficult however to explain this sensation through language. She described it as a 'weird' or 'something was happen- ing' sensation. She did use the word 'connected' but she found it difficult to elaborate on this. Samarel (1992) suggests that the expression of a pandimen- sional experience through language, may reduce it to a linear description.

Sarah did not experience the sensation of heat and warmth:

. . . I did not experience any sensation of heat and warmth, I was expecting to, that really surprised me.

Several authors have documented the sensations of heat and warmth as felt by the recipients (Keller & Bzdek 1986, Kreiger 1993, Rancheison 1984, Samarel 1992). The fact that Sarah did not experi- ence this sensation may highlight the differences in the individual nature and pattern of each Therapeutic Touch interaction.

Sarah experienced a feeling of relaxation:

. . . I started to feel relaxed and drowsy, I enjoyed the sensation. I tried to keep my eyes closed, but it was not always possible to guess where your hands were. From my arms down to my legs I experienced a deadweight feeling. It was a com- forting sensation something good was happening.

Sarah felt more relaxed as a result of receiving Therapeutic Touch. This is consistent with the litera- ture (Kreiger et al 1979, Heidt 1981, Quinn 1982). It is interesting to note that Sarah felt the relaxation response for the rest of the day and well into the next. The lasting effect of the relaxation response has not been addressed by researchers, and this could be an area for further study.

Sarah experienced a level of awareness from within:

. . . at one stage I became aware of my reproduc- tive organs, I sensed a movement, a fluttering feeling from within. Something seemed to be happening in the region of my right ovary, it 's difficult to explain. I have never experienced that level of awareness from within my body before.

Sarah was slowly beginning to expand her con- sciousness of reality. She was drawn to areas within her body, but she perceived these areas as energy rather than solid parts. The sensation was not a static one. She sensed movement, the continuous inter- change of energy between fields (Biley 1995). The sensation of a unified whole was becoming more of a reality to Sarah (Rogers 1994). She was more aware than ever before of her total being.

Sarah observed an alteration in the level of pain she was experiencing:

. . . I t 's interesting the pain has almost disap- peared now. I certainly won't have to take Neurofen now. I have a busy day ahead of me but somehow I feel more in control to deal with it.

Sarah did obtain pain relief, and this supports the literature (Keller & Bzdek 1986, Meehan 1985). Her generalized relaxation response to treatment may have been an influencing factor in reducing her pain. Miller (1987) suggests that a genuine relaxation response produces a measurable physiological bene- fit and a decrease in the sympathetic nervous system. Sarah obtained pain relief for the rest of the day and well into the next. She also gained a sense of total well-being after the session lasting for several days. This she explained had a good 'knock-on' effect within her life generally.

The therapist's experience

Our Therapeutic Touch interaction began as soon as Sarah had entered the room. I achieved a cen- tred state almost immediately. I felt calm, relaxed, alert, open and in harmony with all around me (Sayre-Adams 1994). Sarah started to talk to me whilst she was getting into a comfort- able position. I sensed the openness of our inter- action and the flow of energy within and around us. I was aware of a mist surrounding Sarah from her shoulders down to her legs. I was already beginning to know Sarah's pattern of energy'.

Each individual has a unique pattern of energy and it is this that gives everyone their identity, and it also reflects their innovative wholeness (Biley 1995).

The close intimate nature of our interaction meant that our energy fields were mutually and continuously interchanging energy. I sensed the interconnectedness between energy fields (Rogers 1994). Using Rogers' methodology known as pattern manifestation appreciation

20 Complementary Therapies in Nursing & Midwifery

In most instances the experience of both giving and receiving Therapeutic Touch was a very parallel experience.

(Cowling 1990), I proceeded to assess Sarah's unique pattern. I observed for subtle differences in energy field. Like listening to music, I was open and receptive to vibrations around me. As I moved my hands over her lower abdomen, I was aware of a 'congested' feeling. I sensed the imbalance of her field and was drawn to the region of her right ovary. The area seemed 'hot' and 'red' . I reflected on this. The different fre- quencies of light are what the human eye sees as colour, with the lower frequencies appearing at the red end of the spectrum (Hawking 1988). I used my thoughts to direct rays of high frequency blue light to oppose the effect of red and bring about a change. I reflected on the principle of inte- grality (Rogers 1994). As a human field, I am integral with my environmental field. I sensed a 'cooling down' sensation.

Blue lightwaves have been related to a reduction in pain (McDonald 1986, cited by Biley 1995).

I was also aware of what seemed like movement of energy in the area of Sarah's lower abdomen. At the same time as sensing this, I also sensed a tree in full bloom with its branches gently sway- ing in the breeze. This can only be explained in pandimensional terms. I was sensing the ultimate wholeness of Sarah. I perceived this to encapsu- late the ever-changing present and future condi- tions. I conceptualized that time is a non-linear experience (Hawking 1988). Then ! used intuitive judgement to determine if repatteming was com- plete. The energy field felt more balanced now, I did not sense any extremes of temperature. The mist had lifted. I was satisfied that this session was complete.

Several authors have described the process of giving Therapeutic Touch in various stages (Bulbrook 1984, Macrae 1994). I decided not to use this approach. I considered that it would not be possible to capture the qualities of the moment or maintain the wholeness of the experience by describing the interaction in stages; this would have restricted it to tight boundaries.

It is interesting to note that during our interaction there appeared to be few differences of experience. Sarah and I both experienced a powerful force that radiated inner peace harmony and tranquillity. In most instances the experience of both giving and receiving Therapeutic Touch was a very parallel experience. A qualitative study by Heidt (1990) pro- duced similar findings. However generalisations should not be made on these findings. Our qualita- tive knowledge of Therapeutic Touch experiences is limited, further case studies and research studies are needed.

Sarah did feel more relaxed as a result of receiv- ing Therapeutic Touch. She also obtained pain relief. This supports the literature already docu- mented. Although Sarah still experiences some pain, this is becoming less frequent and less intense. This

case study has identified the need for further research in this area. It is necessary to extend our body of objective and subjective knowledge on the possible short and long-term benefits of receiving Therapeutic Touch for people who are anxious or in pain.

This study has highlighted some of the therapeu- tic qualities of a Therapeutic Touch interaction. It was demonstrated that there are positive benefits to be gained for both the person giving Therapeutic Touch and the person receiving it. It is an effective method of communicating. Elements of reciprocity within the communication can only enhance com- munication levels (McMahon & Pearson 1992). However, there is a need for further investigation in this area.

In summary, this study throws light on the unique subjective experiences of both giving and receiving Therapeutic Touch. It has been a learning experi- ence for both Sarah and I. Through the process of Therapeutic Touch, Sarah has been able to reach new and deeper meanings, not only about her condi- tion, but of her total being. This has led to an improvement in her quality of living overall. I, in turn, have also been able to reach new and deeper meanings. I recognize the unique dynamic and cre- ative qualities of Therapeutic Touch as a therapeutic vehicle. Therapeutic Touch is not just a process, it is a total concept of 'being'. Through my experiences of giving Therapeutic Touch, I have realized its potential in facilitating a truly holistic framework for nursing. So it can be seen that both Sarah and I have reached new levels of consciousness.

It is hoped that this case study will add to a grow- ing body of nursing knowledge on the phenomena of Therapeutic Touch. This, in turn, may play a small part in expanding consciousness within the nursing profession.

We ourselves feel that what we are doing is just a drop in the ocean. But if that drop was not in the ocean I think that the ocean will be less because of that missing drop.

(Mother Teresa)

ACKNOWLEDGEMENT

Work undertaken whilst a student on the Therapeutic Touch Practitioners course, Didsbury Trust.

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