Throughout history, physicians, nurses, and other healers have used their hands to assess patients' problems and deliver relief. Clinicians greet new patients with handshakes, hold and rock newborns to comfort them during routine exams, and pat babies to help them burp after eating. Through touch, clinicians palpate joints and percuss the abdomen to aid in physical diagnosis, and offer non-verbal reassurance by patting patients on the back or shoulder. Every child knows the healing power of mothers' kisses.
Therapeutic touch (TT) and healing touch (HT) were developed by sensitive and observant clinicians to provide additional information and therapeutic value to the types of touch offered in routine practice. TT was first defined and taught in the 1970s by Dora Kunz and Dolores Krieger, RN, PhD.1 The practice is simple, yet demands rigorous attention to the practitioner's own intentions and emotional selfregulation (Sidebar 1, see page 250). Preparation for treatment includes centering the mind and emotions and having a clear, explicit intention to be helpful or of service to the patient.
During the practice, the clinician assesses the patient's energy field, searching for areas of congestion, imbalance, deficit, excess, or disturbance. The clinician then uses the hands to lightly stroke the patient to help generate a sense of calm and reassurance. Next, the practitioner attempts to re-balance, harmonize, or restore the patient's energy field, transferring energy to (he patient if needed, and then re-evaluates the patient's field. Finally, the practitioner releases or detaches from the patient and returns to an inner, peaceful focus, empowering the patient to continue his or her own healing work.
HT also has its roots in the nursing profession. Janet Mengten, RN, BSN, developed the practice in the early 1980s after studying TT and other biofield healing techniques. HT touch includes a number of techniques for specific problems such as headaches, congestion, and pain, as well as general techniques for promoting relaxation, reducing anxiety, and enhancing a general sense of well-being.
Training in HT became formalized as a credentialed, continuing education program for nurses through the American Holistic Nurses Association in 1990. Certificates of attendance with approved Continuing Education credits in nursing and massage are issued at completion of each level. The 120-contact-hour curriculum is taught by certified instructors, and includes a 1-year minimum mentorship with a certified practitioner. Certification in HT requires a minimum of 100 supervised sessions with feedback from a certified instructor.
There is currently a lack of consensus on the scientific mechanism to explain these therapies, but most therapists who provide TT or HT believe the mechanism for clinical effects involves a subtle energy, vibration field, non-linear electromagnetic energy, or spirit or vital force.2"5 Other techniques that are based on beliefs in spiritual or vital energy include the Christian practice of "laying on of hands," the Chinese practice of QiGong, and the Japanese practice of Reiki. J?rofessional associations provide additional resources on training requirements for both TT and HT and maintain lists of active practitioners (Sidebar 2).
Although widely practiced by nurses, TT and HT were generally dismissed by physicians following the negative publicity in 1998 surrounding an article by a group of investigators skeptical of TT.5 In this study, 21 TT practitioners who were blinded to conditions were asked to state whether the investigator's hand hovered above their right or left hand. Because practitioners were correct less often than would be expected by chance, the investigators concluded that practitioners could not detect, and therefore could not affect, the human energy field.
This study and its conclusions have been refuted by numerous researchers on the basis that the study did not test a hypothesis consistent with the key practices of TT (Sidebar 1). The study was conducted by highly biased, inexperienced researchers under artificial circumstances because TT practitioners typically are not blinded to their patients under clinical condirions. In addition, it did not examine clinical effectiveness of TT and, therefore, could not be used to make conclusions concerning the practice's effectiveness.7-9
EPIDEMIOLOGY AND AVAILABILITY
Patients seek therapies that are consistent with their values and choose therapists who respect, empower, and care for them. TT and HT are usually sought as adjunctive or complementary therapies to decrease dependence on technical solutions and to enhance patients' resilience in the face of challenges. Relief of symptoms, peace of mind, feelings of connection and meaning, and assurance that they have tried every reasonable, safe option to assist their children are other reasons parents choose these therapies for their children.
Similar therapies have been used by an increasing number of patients during the past 5 decades; in fact, between 1990 and 1997, the use of "energy healing" tripled.10 Use is most common in patients with chronic or incurable conditions or those with anxiety or depression. Reported rates may underestimate the true use of TT and HT because such therapies are not fully described among the therapies listed in many US surveys.
In a survey of patients with acute lymphocytic leukemia seen in a pediatrie oncology clinic, the first choice for a complementary therapy patients would most like to see offered was "laying on of hand." Healing touch was second, followed by music, massage, biofeedback, meditation, acupuncture, and other complementary and alternative medicine therapies." No studies have specifically assessed the prevalence of use of TT and HT in pediatrie populations.
TT and HT were initially designed specifically to be provided by health professionals. TT is taught in more than 70 nursing schools in the United States and 80 foreign countries. Since the 1970s, more than 100,000 nurses and a smaller number of other health professionals have been trained to provide TT. Many hospitals, including Children's Hospital and Medical Center in Seattle, WA, and Children's Hospital in Boston, MA, have policy and procedure statements describing the provision of TT within the institution.
There are 175 certified instructors and 2,200 certified practitioners for HT, and 75,000 people in the United States have completed the first level of training. More than 25 US hospitals offer HT services, including Queen's Medical Center in Queens, NY, Good Samaritan and Bethesda Hospitals in Cincinnati, OH, Scripps Hospital in San Diego, CA, and Mercy Hospital hi Grayling, MI.
BENEFFTS TO PATIENTS
The primary clinical benefits attributed to TT and HT are increased relaxation, diminished anxiety, diminished pain, and enhanced sense of well-being (Sidebar 3).12-14 Stress reduction and enhanced sleep are commonly reported benefits, even among hospitalized children.15 Several studies have suggested TT reduces patients* anxiety, including one study conducted in pediatrie HTV patients.16 Several studies have also suggested TT can help relieve pain, including chronic recurrent headaches,17 arthritis pain,18,19 burn pain and anxiety,20 phantom-limb pain,21 post-operative pain,22 and pain experienced by patients in me intensive care unit.23
Physiologically, TT appears primarily to affect the autonomie nervous system,24 enhancing recipients' parasympathetic tones while decreasing sympathetic activation.25 Treatments are generally perceived as pleasant, and repeated treatments are often requested by children who received TT or HT in the hospital.26
BENEFITS FOR PRACTTTIONERS
A variety of positive effects for clinicians practicing HT and TT have been described. Most of these are attributed to the practice of centering, which is inherent in both techniques. Centering turns the conscious mind inward toward calmness and self-awareness. It also focuses the clinician's mind on the present moment. It is often described as a meditative state, involving a sense of wholeness and a balance between engagement and disengagement in caregiving. Many practitioners report that they experience great senses of calm, relaxation, stress relief, and emotional well-being.27-29
Other benefits reported to be associated with practicing biofield therapies are personal healing, reduced muscle tension, reduced pain, increased energy, and improved immune function.30-32 Some practitioners note an altered sense of time in which things seem timeless or less rushed.33 A number of reports cite greater job or personal satisfaction, greater ability to serve patients, more humanistic caring, and enhanced personal growth, insight, or spirituality.30,31,33 In addition, practitioners frequently report an enhanced sense of connection or empathy with patients.28,30
LIMITATIONS OF PREVIOUS RESEARCH
Methodologic reviews suggest substantial problems with previous research on TT and HT, such as inadequate sample size, poor attention to control groups, inclusion of patients with diverse conditions, and poor specification of study design. Much of the data is in unpublished studies in bibliographies maintained by the respective TT and HT professional associations. Healing Touch International and Nurse Healters-Professional Associates maintain bibliographies of unpublished studies such as projects conducted by students, presentations at nursing meetings, and other unpublished works. To our knowledge, no published research has assessed the duration of effect for TT and HT or specifically evaluated factors predicting which patients are most likely to respond to treatment. In the authors' clinical experience, however, treatment effects such as relaxation and pain relief appeared strongest during the treatment and for 15 to 45 minutes following each treatment. The duration of effect varied from hours to days. The limitations of current research underscore the need for standarized, peerreviewed research into the mechanisms and potential role for these therapies in conjunction with standard therapies.
TT and HT are extremely safe. The major concern about such therapies is that they could be used in place of effective medical care for serious conditions, but we are unable to find any documented cases where this had occurred with TT or HT. Similarly, we were unable to find any reports of adverse effects of either therapy in the published medical or nursing literature, but have noted that some patients are extremely sensitive to these therapies. For example, newboms may cry or squirm if an inexperienced practitioner treats the child for more than 5 to 10 minutes or too intensely. Similarly, we have occasionally seen patients in the intensive care unit experience temporary drops in their oxygen saturation when the initial treatment was excessive; oxygen saturation quickly returned to baseline levels within seconds once TT treatment was interrupted. Patients prone to headaches may experience increased pain or a feeling of being "spacey" or "dizzy" if treatments are focused on the head for too long.
For these reasons, practitioners who are accustomed to treating adults should exercise caution and offer briefer, less intense treatments to patients who are extremely young, medically unstable or very sensitive to such treatments. Therapists should also discontinue treatments immediately if any adverse effects are noted. Such adverse effects are rare and generally abate within minutes of interrupting the treatment.
HT and TT are unique touch techniques with origins in the nursing profession. They are widely available in pediatrie hospitals and often are used as adjunct therapies to decrease stress, anxiety, and pain. Practitioners, as well as patients, may notice improved sense of well-being during and after treatments. Additional research is needed to determine the mechanisms by which these effects occur, the optimal duration and frequency of treatments, factors predictive of treatment response, and the overall costs and benefits of including TT and HT in treatment in addition to traditional therapies. These therapies are safe and readily available.
1 . Krieger D. Therapeutic Touch: How to Use Your Hands to Help or Heal. Englewood Cliffs, NJ: Prentice Hall; 1979.
2. Jonas WB, Crawford CC. Science and spiritual healing: a critical review of spiritual healing, "energy" medicine, and intentionality. Altem Ther Health Med. 2003;9(2):56-61.
3. Oschman JL. Energy Medicine: The Scientific Basis. New York, NY: Churchill Livingstone; 2000.
4. Warber Sl, Gordon A, Gillespie BW, Olson M, Assefi N. Standards for conducting clinical biofield energy healing research. Altern Ther Health Med. 2003; 9(Suppl 3):A54-64.
5. Rubik B. The biofield hypothesis: its biophysical basis and role in medicine. J Altern Complement Med. 2002;8(6):703-7I7.
6. Rosa L, Rosa E, Samer L, Barren S. A close look at therapeutic touch. JAMA. 1998;279(13):1005-1010.
7. Cox T. A nurse-statistician reanalyzes data from the Rosa therapeutic touch study. Altem Ther HealthMed. 2003;9(l):58-64.
8. Dossey L. Therapeutic touch at the crossroads: observations on the Rosa study. Altem Ther Health Med, 2003; 9(l):38-39.
9. Leskowitz ED. Un-debunking therapeutic touch. Altern Ther Health Med. 1998;4(4):101-102.
10. Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990-1997: results ofafollow-up national survey. JAMA. 1998280( 18): 1569- 1575.
11. McCurdy EA. Spangler JG, Wofford MM, Chauvenet AR, McLean TW. Religiosity is associated with the use of complementary medical therapies by pediatrie oncology patients. J Pediatr Hematol Oncol 2003^5(2): 125- 129.
12. Giasson M, Bouchard L. Effect of therapeutic touch on the well-being of persons with terminal cancer. J Holist Nus. 1998;16(3):383-398.
13. WilkinsonDS, Knox PL, Chatman JE, et al. The clinical effectiveness of healing touch. J Altem Complement Med. 2002:8(1):33-47.
14. Lafreniere KD, Mutus B, Cameron S, et al. Effects of therapeutic touch on biochemical and mood indicators in women. J Altem Complement Med. 1999;5(4):367-370.
15. Kramer NA. Comparison of therapeutic touch and casual touch in stress reduction of hospitalLied children. Pediatr Nurs. 1990;16(5):483485.
16. Ireland M. Therapeutic touch with HIV-infected children: a pilot study. J Assoc Nurses AIDS Care. 1998;9(4):68-77.
17. Keller E, Bzdek VM. Effects of therapeutic touch on tension headache pain. Nurs Res. 1986;35(2):101-106.
18. Eckes Peck SD. The effectiveness of therapeutic touch for decreasing pain in elders with degenerative arthritis. J Holist Nurs. June 1997; 15(2): 176- 198.
19. Gordon A, Merenstein JH, D'Amico F, Hudgens D. The effects of therapeutic touch on patients with osteoarthritis of the knee. J Fam Pract. 1998;47(4):271-277.
20. Turner JG, Clark AJ, Gauthier DK, Williams M. The effect of therapeutic touch on pain and anxiety in bum patients. J Adv Nurs. 1998;28(1):1020.
21. Leskowitz ED. Phantom limb pain treated with therapeutic touch: a case report. Arch Phys Med Rehabil. 2000;81(4):522-524.
22. Meehan TC. Therapeutic touch and postoperative pain: a Rogerian research study. Nurs Sd Q. 1993;6(2):69-78.
23. Apostle-Mitchell M, MacDonald G. An innovative approach to pain management in critical care: therapeutic touch. Off J Can Assoc Crii Care Nurs. 1997;8(3):19-22.
24. Krieger D. Dolores Krieger, RN, PhD, healing with therapeutic touch. Interview by Bonnie Horrigan. Altern Ther Health Med. Jan 1998;4(l):86-92.
25. Sneed NV, Olson M. Bubolz B, Finch N. Influences of a relaxation intervention on perceived stress and power spectral analysis of heart rate variability. Prog Cardiovasc Nurs. 2001;16(2):57-64,79.
26. Hughes PP, Meize-Grochowski R, Hairis CN. Therapeutic touch with adolescent psychiatric patients. J Holist Nurs. 1996;14(1):6-23.
27. Brown CK. Methodological problems of clinical research into spiritual healing: the healer's perspective. J Altern Complement Med. 2000;6(2):171-176.
28. Kieman J. The experience of therapeutic touch in the lives of five postpartum women. MCNAm J Matern Child Nurs. 2002;27(l):47-53.
29. Whelan KM, Wishnia GS. Reiki therapy: the benefits to a nurse/Reiki practitioner. Holist Nurs Pract 2003;17(4):209-2I7.
30. Lewis D. A survey of therapeutic touch practitioners. Nurs Stand. 1999; 13(30):33-37.
31. Mentgen JL. Healing touch. Nurs Clin North Am. 2001;36(I):143-158.
32. Hayes J. Cox C. The experience of therapeutic touch from a nursing perspective. Br J Nurs. 1999;8(18):1249-1254.
33. Quinn JF, Strelkauskas AJ. Psychoimmunologic effects of therapeutic touch on practitioners and recently bereaved recipients: a pilot study. ANS Adv Nurs Sci. 1993;15(4):13-26.
34. Waidell DW. Spirituality of healing touch participants. J Holis Nurs. 2001;19(1);71-86.