An underlying premise for TT is that individuals extend beyond their skin (Krieger, 1979). It is this space, the energy field, that is the focus of the assessment and rebalancing techniques used in TT. In discussing the energy field theory used by Krieger, Macrae (1988) cites the work of Kunz and Peper to explain that the concept of field not only involves physical energies but also "every human function, including emotion, thought, and intuition." Field imbalances, blockages, or changes may be related to individuals' physical, emotional, or cognitive states.
From the perspective of the Science of Unitary Human Beings, energy field change facilitated by TT is explained as change that:
Occurs in the human-environmental energy field patterning as the nurse assumes a meditative state of awareness, recognizes his or her own unitary nature and integrality with the environmental field, and focuses his or her intent to help the patient (Meehan, 1990).
The technique of TT involves assessing the client's energy field from head to toe by holding one's hands 3 to 5 inches from the skin's surface and slowly moving the hands around and through the entire client field. This is done while the nurse is centered and is intentionally focused on helping the patient. It is during the assessment phase that imbalances are detected. These imbalances are manifestations of all dimensions of the individual. From a Unitary Human Being perspective, the imbalance is not causally related to physiological changes, but rather is a manifestation of imbalance in the energy field. For example, local imbalances around the head may reflect constricted arteries or may be associated with compulsive thoughts about a gambling trip. The energy field changes are manifestations of the client's mental as well as physical state that connects TT to mental health nursing practice.
We have expanded the original TT technique described by Krieger (1979) and teach clients to assess their own energy fields. When the "problem area" or "problem energy" (where the feeling is different from the rest of the field) is located, it is balanced, changed, or moved by the client. For example, if there is a problem area located around the head, the person is instructed to collect the area in a hand and gently throw it out or move it away; or if the area around the right knee feels warm or cold, then gentle movement around the area is encouraged with a healing energy directed to the area through the person's own hands.
The clients are taught to center and to channel the energy from the environment through their hands to or from the areas involved for themselves just as they would use TT on another. These techniques are taught to clients based on their needs, abilities, and health status.
Therapeutic Touch in Practice
"Clinical investigation indicates that therapeutic touch is a nursing intervention that has the potential for eliciting a state of physiological relaxation in patients and for decreasing patient anxiety" (Heidt, 1991). Nurse researchers have studied the efficacy of TT with patients in a wide variety of clinical situations, as evidenced by Quinn's (1989) compilation of studies from 1974 to 1986. Since that time, the research on TT continues to expand and includes, for example, studies involving nurses' and clients' experiences (Heidt, 1990), rest (Heidt, 1991), and energy exchanges (Quinn, 1989). No authors have addressed the use of TT with clients who complain of issues more traditionally related to emotional health. In workshops over the past 8 years that have taught TT, we have found that this issue has repeatedly come up. For example, one student became tearful during a TT practice session and related it to memories and feelings about past molestation. She felt that:
... the energy exchange was moving this 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.
Other students have begun dialogue about the potential use of TT with problems of alcoholism, anger, grief, anxiety, and so forth. A series of case examples demonstrating application of TT with clients seeking mental health care follow.
Clinical Issues: Discussion
This article is offered, in part, as an invitation for dialogue with interested clinicians. A number of treatment issues have occurred to us and we encourage a sharing of ideas and approaches used by other holistic nurse clinicians. For example, the client responses described in these clinical presentations could be seen as external and superficial "flights into health" or transference cures (Greenson, 1968). We find this unlikely in view of how these and other clients have maintained their behavior change and found a sense of peace and healing in how they have been able to use and transfer their new TT skills to other aspects of their lives.
Rossman and Bressler (1990) have explored many of the legal and ethical issues related to introducing guided imagery in clinical psychotherapy practice. There has been little discussion about this in relation to TT Many TT practitioners automatically incorporate guided imagery into their daily work with clients. Issues regarding billing are somewhat cloudy. It is unclear, for example, if a session to teach TT or guided imagery can or should be billed to insurance companies in the same way that a session of psychotherapy would be.
Record keeping is also important. Given the frequency with which records are subpoenaed for malpractice litigation, it is prudent for holistic nurses to think and talk with each other about the content and process of record keeping. Specific documentation of TT and guided imagery approaches are important. Documentation of the client's understanding of and reaction to TT is also crucial.
Another important issue is related to concerns about informed consent. There is a need for nurse clinicians to develop policies and guidelines regarding informed consent for TT and guided imagery interventions. Explanations about this approach offered to clients and their families need to be sensitive and comprehensive. Work with victims of molestation requires particular sensitivity to issues of boundaries and privacy. All clients need to understand that clinicians will not "intrude" on their energy field without their permission and that they can stop the process at any time.
Engaging in theory-based nursing practice is challenging. The Science of Unitary Human Beings transcends clinical specialty boundaries and is appropriate to guide nursing practice, education, and research. Therefore, as a theorybased nursing intervention, TT has the potential for facilitating and maintaining mental and physical health in an ever-changing environment.
- Draucker, CB. The healing process of female adult incest survivors: Constructing a personal residence, image: Journal of Nursing Scholarship 1992; 24(l):4-8.
- Greenson, R.R. The technique and practice of psychoanalysis, vol. I. New York: International Universities Press, Inc. 1967.
- Heidt, RR. Openness: A qualitative analysis of nurses' and patients' experiences of therapeutic touch. Image: Journal of Nursing Scholarship 1990; 22(3): 180-186.
- Heidt. RR. Helping patients to rest: Clinical studies in therapeutic touch. Holistic Nursing Practice 1991; 5(4):57-66.
- Krieger, D. Relationship of touch, with intent to help and to heal to subjects in-vivo hemoglobin values: A study in personalized interaction. In Proceedings of Ninth Nursing Research Conference. San Antonio: American Nurses Association, 1973.
- Krieger, D. The therapeutic touch. Englewood Cliffs. NJ: Prentice-Hall, 1979.
- Macrae, J. Therapeutic touch: A practical guide. New York: Knopf. 1988.
- Meehan, TC. The science of unitary human beings and theory-based practice: Therapeutic touch. In M.A.N. Barrett (Ed.), Visions of Rogers' science-based nursing. New York: National League for Nursing, 1 990. pp. 678l.
- Quinti, J.F. Therapeutic touch as energy exchange: Replication and extension. Nursing Science Quarterly 1989;2:79-87.
- Rogers, M. H. Science of unitary human beings. In V.M. Malinski (Ed.). Explorations of Martha Rogers' Science of Unitary Human Beings, Norwalk, CT: Applelon-Century Crofts, 1986, p. 5-12.
- Rossman, M. L., Bresler. D.E. Guided imagery: An intensive training program for clinicians. 3rd ed. Mill Valley, CA: Academy for Guided Imagery, 1990.