Therapeutic touch: the view from Rogerian nursing science.
|Article Type:||Clinical report|
Client-centered psychotherapy (Research)
Touch (Health aspects)
|Author:||Malinski, Violet M.|
|Publication:||Name: Visions: The Journal of Rogerian Nursing Science Publisher: Society of Rogerian Scholars Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 1993 Society of Rogerian Scholars ISSN: 1072-4532|
|Issue:||Date: Annual, 1993 Source Volume: 1 Source Issue: 1|
|Topic:||Event Code: 310 Science & research|
Therapeutic Touch has long been recognized as a health patterning modality consistent with Rogerian nursing science. However, theoretical explanations have not always been consistent with that science. Particularly problematic is the concept of energy transfer or energy exchange. In this article, the author provides overviews of the way Therapeutic Touch was originally introduced by Krieger and Kunz and how it is seen from the perspective of Rogers' Science of Unitary Human Beings. A theoretical rationale, developed from this nursing science, is then presented for consideration.
Key words Rogerian nursing science, energy field, Therapeutic Touch, health patterning
Therapeutic Touch was one of the earliest examples cited by Rogers of a noninvasive nursing modality congruent with the new world view presented in the Science of Unitary Human Beings. Therapeutic Touch practitioners usually reference this nursing science as one, if not the, theoretical basis for Therapeutic Touch. However, Rogers' earlier work, particularly her 1970 book, is often cited rather than her most current writings. For example, a frequently quoted statement from Rogers' (1970) An Introduction to the Theoretical Basis of Nursing is one she offered at that time as the second assumption of nursing science: "Man and environment are continuously exchanging matter and energy with one another" (p. 54). Rogers' 1970 definition of the principle of resonancy specified that change is "propagated by waves"; "Between man (sic) and environment there is a rhythmic flow of energy waves" (p. 101). Thus, Therapeutic Touch has been conceptualized and described in the literature as an exchange or transfer of energy between practitioner and client.
The five assumptions described by Rogers in 1970 have not been repeated in her publications dated from 1980 to the present. Instead, Rogers (1980) identified the building blocks for this nursing science as energy fields, a universe of open systems, four dimensionality, and pattern and organization. In her latest writings, these four are more frequently referred to as postulates and appear as energy fields, a universe of open systems, pandimensionality and pattern or patterning (Rogers, 1990, 1992).
Rogers has gradually refined the principles of homeodynamics. In 1980 the definition of resonancy specified that human and environmental fields "are identified by wave pattern and organization manifesting continuous change from lower-frequency, longer wave patterns to higher-frequency, shorter wave patterns" (Rogers, 1980, p. 331). The idea of a "flowing between" was deleted. The wording of the principle of complementary (now integrality), however, retained this idea: "The interaction between (italics added) human and environmental fields is continuous, mutual, simultaneous" (Rogers, 1980, p. 331). This suggestion of a linear flow is gone from the latest definitions of the principles, clarified to reflect a unitary mutual process (Rogers, 1990). Resonancy reflects the flow or process of change as one of "continuous change from lower to higher frequency wave patterns in human and environmental fields" and integrality, the context of change, is the "continuous mutual human and environmental field process" (Rogers, 1990, p. 8). There is no sense of linear flow or passing between in the principle of helicy, either. Helicy characterizes the nature of change as "continuous, innovative, unpredictable, increasing diversity of human and environmental field patterns" (Rogers, 1990, p. 8). Human and environment, although different by definition, are described as integral and inseparable, not as two distinct fields. Thus, there is no exchange or transfer of energy within the continuous mutual process of human and environmental field patterning.
Energy exchange also follows Krieger's (1979, 1987) idea that the healthy person has an abundance of energy that can be mobilized in healing, whereas the ill person's energy is depleted. The practitioner directs and modulates the flow of energy to the client. From her studies of Eastern philosophies and systems of medicine, Krieger identified this energy as "prana," Sanskrit for what could be translated as "the organization of energy that underlies the life process" (Krieger, 1987, p. 7) and a "natural means of energizing all life processes" (Krieger, 1987, p. 9). Krieger (1979) acknowledged that, as yet, there is no mechanism for measuring this transfer of energy.
Meehan (1988, reprinted 1990) suggested that, when the Science of Unitary Human Beings is used as the theoretical framework for Therapeutic Touch, the concept of energy transfer must be replaced by the human-environment mutual process. In this mutual process, human and environment are integral and irreducible. Therefore, there is no "to-from" exchange or interaction between practitioner and client. What occurs does so within the context of this mutual process. The advantage to conceptualizing Therapeutic Touch within Rogerian nursing science is to acknowledge it as a nursing health patterning modality not, as it is often described, as an alternative medical intervention or a technique of holistic medicine. In this article, overviews of the traditional and the Rogerian perspectives on Therapeutic Touch are presented. A theoretical conceptualization derived from the Science of Unitary Human Beings is offered next for consideration.
Traditional Perspective on Therapeutic Touch
What has come to be known as Therapeutic Touch (capital T's to distinguish it from other forms of therapeutic touch such as massage, stroking, and hand holding) was developed by Dolores Krieger and Dora Kunz in the early 1970's. A discussion of this development can be found in Krieger's (1979) The Therapeutic Touch: How to Use Your Hands to Help or to Heal. At New York University, Krieger introduced and taught the first graduate level course in nursing to incorporate Therapeutic Touch. Over the years, Krieger and Kunz have taught Therapeutic Touch to countless numbers of health professionals across the world, including this writer.
Kunz (Karagulla & Kunz, 1989; Kunz, 1991), well-known and highly respected for her clairvoyant and healing abilities (pandimensional awareness in Rogerian nursing science), sees and works with the aura and the chakras. The aura is a "luminous cloud of color" (Kunz, 1991, p. 11) that many believe surrounds each person and reflects the emotions, past and present, of that person. Kunz (1991) describes the chakras as energy centers within the aura that synchronize the flow of energy to the physical body from the various fields surrounding it. The energy perspective she presents is based on the idea that the human being is a complex system of interpenetrating fields: the etheric or vital field, the astral or emotional, and the mental, each with its own particular energy patterns. Every living organism is in constant interaction with the environment.
Krieger (19911 suggested the principle of resonancy as providing a possible explanation for what occurs during Thera peutic Touch. She also emphasized the participatory nature of the process, suggesting that "mutual bondings" (Krieger, 1991, p. 3) be explored from the perspective of Rogerian science. However, in the context of words and descriptions such as conscious, knowledgeable use of the chakras, guiding and modulating, and intentional directing (Krieger, 1991), it seems that she is using the earlier definition of resonancy and a theoretical framework that mixes elements from Kunz's and Rogers' views.
Looking at Rogers' second assumption of nursing science as formulated in 1970, it is easy to see how many Therapeutic Touch practitioners could assume that Rogers, Krieger (once a student of Rogers', then a member of her faculty at New York University), and Kunz were talking about the same phenomenon. This is especially true for the early students who had the privilege of working with all three women, albeit in different settings, and who went on to conduct research and teach Therapeutic Touch to others.
One of the early research studies was conducted by Heidt (1981), a former student of Rogers, Krieger, and Kunz, in 1979. For the purpose of this article, the important factor was Heidt's incorporation of physical touch (contact Therapeutic Touch) into the procedure for Therapeutic Touch, which is usually done two to six inches away from the physical body. Toward the end of the procedure the practitioner placed her hands on the patient's solar plexus and directed energy for 90 seconds.
Following up on this research Quinn (1984), another early student of Krieger, Kunz, and Rogers and a pioneer in Therapeutic Touch research, demonstrated that non-contact Therapeutic Touch is as effective as contact Therapeutic Touch. Instead of placing her hands on the solar plexus, the practitioner held her hands four to six inches away from t he solar plexus and directed energy for 120 seconds. Quinn interpreted the effect of non-contact Therapeutic Touch as support for the idea of energy exchange as a field phenomenon independent of physical touch or contact between practitioner and client. When Quinn (1989a) later replicated and extended her research she did not obtain consistent support for her hypotheses. In a discussion of future directions for Therapeutic Touch research, Quinn (1989b) identified three key areas for study, one being the development of a model or theory that could be validated and refined through research. She reiterated Krieger's (1979) earlier statement that no published studies have actually measured energy exchange, concluding that the sending/receiving of energy and the impact of such energy transfer on the recipient's health need further exploration.
Quinn's view of Therapeutic Touch, incorporating ideas from Rogers' Science of Unitary Human Beings, has been influential. This is apparent in the identification of a theoretical basis that some Therapeutic Touch researchers are calling the Rogerian-Quinn framework (Olson, Sneed, Bonadonna, Ratliff, & Dias, 1992). In addition to her research and writing, Quinn has worked with the National League for Nursing to develop a three-part video on Therapeutic Touch and its clinical applications.
Heidt (1990, 1991) recently published the results of a qualitative study exploring Therapeutic Touch from the perspective of both nurses and their patients. She cited Rogers' 1970 work, specifically the assumption that person and environment exchange matter and energy. Heidt found that the experiences of the patient during Therapeutic Touch often paralleled those of the nurse. She interpreted this as support for a "transfer of energy ... on both a physical and a psychological level...." (1990, p. 186).
The key variable that emerged in this research as descriptive of the experiences of both nurses and patients was openness, identified as
1. opening intent (affirming, quieting, intending)
2. opening sensitivity (attuning, planning)
3. opening communication (unblocking, engaging, enlivening) (Heidt, 1990).
This supports another key idea often cited from Rogers' work: person and environment are open systems.
Macrae (1987), another early student of Krieger, Kunz, and Rogers, identified the energy field as a key concept underlying Therapeutic Touch. However, she did not cite Rogers but followed the formulation of Kunz and Peper (1985), describing the person as a localization of a system of energy fields (vital, emotional, mental, and intuitional). Citing the works of Krieger and Kunz, Macrae described the transfer of energy between practitioner and client. Rather than drawing on one's own reserves of energy, the practitioner is drawing on the "universal field," an "inexhaustible source" (Macrae, 1987, p. 17).
Energy transfer or exchange has long been part of the language used to describe and explain Therapeutic Touch. Now it has been incorporated officially into its definition. The Nurse Healers-Professional Associates, Inc. (1992) published the first set of guidelines for teaching the beginners' level of Therapeutic Touch, Krieger/Kunz Method. Their definition of Therapeutic Touch contains the phrase, "...a consciously directed process of energy exchange...." (p. 1). They identify Rogers' Science of Unitary Human Beings as one of the frameworks supporting Therapeutic Touch, the others being Kunz's Human Energy Field Model, Relativity Theory, and Quantum Mechanics.
The work done to date on Therapeutic Touch represents a seminal achievement in nursing. The effort to re-conceptualize this process within nursing science does not represent criticism of the work done so far. However, it is time to identify Therapeutic Touch as a nursing health patterning modality underwritten by a nursing framework. Description and explanation should be consistent with that framework. In this author's opinion, the most appropriate nursing framework is Rogers' nursing science, the Science of Unitary Human Beings. Energy exchange as a linear transfer from practitioner to client, the implied causality in the language of altering and impacting, and the separation of nurse and client into two interacting human fields is not consistent with Rogerian science.
Furthermore, the idea of energy exchange or transfer has apparently led to some of the concerns voiced by some groups, both within and outside nursing, that Therapeutic Touch is a "heathen" activity. The fear seems to be of opening oneself to some outside force (possession?). A recent issue of Omni (Antimatter, 1992) described a similar outcry against yoga classes in a Georgia community where fundamentalist Christians charged that yoga was a form of devil worship. During meditation the injunction to allow the mind to go blank was seen as an invitation to invasion by demonic spirits.
Therapeutic Touch has also been labelled a hoax. Quinn (personal communication, 1992) has exchanged letters on Therapeutic Touch with William Jarvis, Ph.D., President of the National Council Against Health Fraud, Inc., who singled out the theory of energy exchange as cause to remove Therapeutic Touch from "the realm of responsible health care." Quinn (1992) suggested that, although one can neither demonstrate nor measure any energy transfer currently, energy transfer can still be used "as a working hypothesis" (p. 12). Further, in a discussion of the pros and cons surrounding possible certification in Therapeutic Touch, she questions how one could evaluate "the quality or quantity of such an energy exchange" (Quinn, 1992, p. 12). The problems surrounding the idea of energy exchange, i.e., conceptual, measurement, and as a potential evaluation mechanism for how one could differentiate between "effective" and "ineffective" treatments, supports the need to reconceptualize Therapeutic Touch within nursing science.
Rogerian Perspective on Therapeutic Touch
Meehan (1988, reprinted 1990) is one Therapeutic Touch practitioner and researcher who initiated discussion in the literature of the differences when Therapeutic Touch is viewed from the Science of Unitary Human Beings compared to the way Krieger introduced it. She selected a funded study she had already developed and juxtaposed the original theoretical rationale with a revision consistent with the current formulation of the Science of Unitary Human Beings, explaining the changes she proposed. As noted earlier, one of the key changes involved energy exchange and transfer. "'Energy transfer' should be changed to 'mutual process,' and 'energy exchange' should be changed to 'energy process'" (Meehan, 1988, p. 6). She re-defined Therapeutic Touch "as a knowledgeable and purposive patterning of patient-environmental energy field process in which the nurse assumes a meditative form of awareness and uses her (sic) hands as a focus for the patterning of the mutual patient-environmental energy field process" (p. 6).
In a subsequent article Meehan (1990) noted additional differences in theoretical rationale when Therapeutic Touch is viewed from the Science of Unitary Human Beings.
1. Therapeutic Touch is not seen as derived from laying-on of hands.
"Instead, the nurse is viewed as being integral with the patient's environmental energy field patterning, and therapeutic touch treatment is viewed as a purposive patterning of energy field mutual process...." (Meehan, 1990, p.74).
2. Change is not mediated by the flow of "prana."
Other differences have emerged in discussions with Rogers (personal communication, 1988) about Therapeutic Touch. First, Rogerian science does not include the concept of nurse-client interaction. Rogers maintains there is no one-to-one relationship between people as this leaves out the environment, which is integral in the mutual process of human and environmental fields. The nurse is integral with the client's environmental field; the client is integral with the nurse's environmental field. Therefore, the phenomenon of concern is the person-environment mutual process, not the nurseclient interaction. "We ourselves are integral with the totality of the client's environment ... And it is this totality that is engaged" (Rogers, personal communication, 1988).
Second, Rogers prefers "participation" or "participatory" over words such as "motivation" and "intentionality." For her, the last two connote the sense of will, as in willing something to occur. One can participate knowingly in the flow of life but one cannot direct that flow or will a particular change to come about.
Third, change is continuous; one does not initiate or direct it. The nature of the change in Therapeutic Touch or any other unitary process cannot be predicted. Therapeutic Touch involves patterning that is most commensurate with the wellbeing of the individual, whatever that may be for the individual.
Fourth, the Therapeutic Touch practitioner is neither an instrument of nor a conduit for a higher healing power that passes through the person. Rogers sees this as a yielding or giving over in the sense of non-participation. According to Rogerian science, one can never not participate. Both nurse and client, not just the client, are experiencing continuous patterning within the mutual human-environmental field process.
Finally, Rogers sees Therapeutic Touch as a technique not, in and of itself, a body of knowledge. It is one among many health patterning modalities that nurses can incorporate in their practice. These health patterning modalities represent the use of knowledge from Rogerian science in nursing practice. For this reason, rather than developing a theory of Therapeutic Touch per se to be followed by theories of the other health patterning modalities such as meditation and imagery, this author proposes that the theoretical rationale for Therapeutic Touch as a health patterning modality can be derived from extant nursing science.
Theoretical Derivation from the Science of Unitary Human Beings
The postulates of the Science of Unitary Human Beings are energy fields, openness, pattern, and pandimensionality (Rogers, 1990, 1992). In their irreducible unity they form reality as experienced in the Rogerian world view. Person and environment are irreducible, indivisible, pandimensional energy fields identified by pattern. The person does not "have" a field that can be identified as an aura. Rather, the aura and the chakras could be seen as manifestations of field patterning just as the physical body is a manifestation of the human field. The energy field is in continuous motion (Rogers, 1990) and is, therefore, continuously changing. The nature of this change is captured in the principles of homeodynamics (Rogers, 1990). Resonancy specifies the process of change, flowing in lower and higher frequencies. Helicy identifies the nature of change as innovative and unpredictable increasing diversity. Integrality describes the context for this change as the human/ environment mutual process. Thus, applying the abstract system of Rogerian nursing science to Therapeutic Touch, it occurs in a universe that is totally open, unbounded and infinite; within the context of energy fields, human and environment, that are characterized by patterning; and in a pandimensional domain where time and space have no meaning and, therefore, place no constraints on the process. The principles of homeodynamics suggest that the mutual patterning process of human and environmental fields changes continuously, innovatively, and unpredictably flowing in higher and lower frequencies.
The first theory that supports Therapeutic Touch is the theory of the emergence of paranormal phenomena (Rogers, 1980). This theory suggests that experiences ordinarily labelled paranormal are manifestations of the changing diversity and innovation of field patterning. They are pandimensional forms of awareness. With the refinements in the Science of Unitary Human Beings since 1980, this theory might, perhaps, now more accurately be named the theory of pandimensional awareness. Therapeutic Touch is one example of such pandimensional awareness. Centering, common to Therapeutic Touch as well as other health patterning modalities such as imagery and meditation, reflects higher frequency awareness that transcends time and space (Malinski, 1991). Practitioner and client often have similar experiences during the process of Therapeutic Touch, for example, a visualization that shares common features and evolves spontaneously for both. This highlights the mutuality of the process; the experience cannot be "claimed" by either nurse or client. It is a reflection of the totality of that experience. Therapeutic Touch seems to be one way to focus awareness of integrality which, although ever-present, is not always fully experienced.
The second theory that underwrites Therapeutic Touch is Barrett's (1986, 1990) theory of power as knowing participation in change. Knowing participation has long been an assumption in Rogerian science. Although one cannot stop or start the change process itself, one can change the nature of her/his participation in that process. Health patterning is providing knowledgeable caring to assist clients in actualizing potentials for wellbeing through knowing participation in change (Malinski, 1992). Therapeutic Touch is one such health patterning modality. There may or may not be a change in the physical manifestations of the field, e.g., symptoms. The change may occur in the experience or the meaning of such physical manifestations for the person. In this sense, Rogers has described Therapeutic Touch as a "neutral process of change" where "the whole is going to be better" (Rogers, personal communication, 1988).
Barrett (1986, 1990) has conceptualized power as a higher and lower frequency phenomenon, not good-bad, less more. Higher frequency power, higher frequency knowing participation, may be part of the acceleration in change theorized by Rogers. Diversity accelerates with higher frequency phenomena. This may be the basis for the assertion that, although one cannot predict a specific outcome with Therapeutic Touch, the experience is likely to be beneficial for the client.
Therapeutic Touch needs to be defined in a way that is consistent with Rogerian nursing science. The definition provided by the Nurse-Healers-Professional Associates, Inc., Cooperative (1992) is consistent with what commonly appears in the literature but not with the Science of Unitary Human Beings: "Therapeutic Touch, a contemporary interpretation of several ancient healing practices, is a consciously directed process of energy exchange during which the practitioner uses the hands as a focus to facilitate healing" (p. 11. It is consistent with Kunz's Human Energy Field Model, cited as the first supporting framework. Meehan's (1988) definition is consistent with Rogerian nursing science: "a knowledgeable and purposive patterning of patient-environmental energy field process in which the nurse assumes a meditative form of awareness and uses her hands as a focus for the patterning of the mutual patient-environmental energy field process" (p. 6). A potential problem with this definition is the phrase "purposive patterning," which seems to suggest that the nurse is directing the flow of the patterning process. "Knowing participation in the patterning" might be more appropriate.
Another definition, which retains some of Meehan's wording, is offered here for consideration. Therapeutic Touch is a health patterning modality whereby nurse and client participate knowingly in the changing human-environmental field process. The nurse:
1. experiences her/his integrality with the environmental field by assuming a meditative, pandimensional form of awareness and
2. uses the hands as a focus for knowing participation in the patterning of the mutual energy field process.
The client may or may not experience pandimensional awareness but does participate knowingly in the process, whether this participation is characterized by lower or higher frequency power.
Both nurse and client are identified in this definition to preserve the mutuality of the process. From the perspective of the client, the nurse is integral with the environmental field. From the perspective of the nurse, the client is integral with the environmental field. Both participate in the field patterning process. There are numerous anecdotal reports of enhanced wellbeing for practitioner as well as client, which parallels such findings as Heidt's (1990, 1991) of similarities in the experience reported by both practitioner and client. In this sense, it is difficult to designate one as "healer" and one as "healee." Indeed, given the nature of unitary field processes, each can be both, with the "healee" mobilizing her/his own innate healing abilities and the "healer" experiencing enhanced well-being. This reflects the totality of the process.
This view of Therapeutic Touch, the proposed definition and theoretical rationale derived from Rogerian nursing science, has yet to be tested. Clearly, there are differences in the way Therapeutic Touch is viewed from the perspectives of Krieger and Kunz, practitioners and teachers of the process, and Rogers, a nurse scientist who has experienced Therapeutic Touch. The ideas presented here resonate with this practitioner's experience of Therapeutic Touch and are offered in the hope that they will elicit critique and further discussion.
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Violet M. Malinski, RN; PhD
Associate Professor and Graduate Specialization Coordinator, Psychiatric-Mental Health Nursing Hunter-Bellevue School
Hunter College/City University of New York 425 E. 25th Street
New York, New York 10010
Accepted January, 1993
Received September, 1992
... there is a continuous energy exchange (italics added) between the individual and the environment which every living system (whether human, animal, vegetable, or even chemical) regulates in terms of its own self-organization. This energy exchange is so constant and so indispensable for all living organisms that it can be regarded as a universal field effect. (Karagulla & Kunz, 1989, p. 12)
During a treatment we try to make the vital energy more accessible to the patient by consciously serving as an energy conductor and trans former. When transferring energy (italics added), it is essential that we establish the intent to become a conduit for a universal force. (Macrae, 1987, p. 47).
Instead, it is viewed as change which occurs in the human-environ mental 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, p. 74).
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