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Tactile Defensiveness

 
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Tactile Defensiveness - May 6, 2005 4:39:00 PM   
Barrett

 

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I'm thinking about writing something about tactile defensiveness but need a little information first.

My question: Out of a hundred patients seen in a typical outpatient orthopedic setting how many do you find it difficult to touch without considerable care and preparation? I'm talking about the whole variety seen and I'm not talking about going after their painful part-just touching them.

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Re: Tactile Defensiveness - May 6, 2005 4:51:00 PM   
Jon Newman

 

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I've already admitted to this in myself but I'm much much better at this now. I don't think I would qualify for the "diagnosis". Still I'm sure people can pick up on the fact that I needed to work on this in ways that would be difficult to measure.

As far as my patients are concerned, I don't know. I'd say about 5%.

jon

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Re: Tactile Defensiveness - May 6, 2005 6:20:00 PM   
nari

 

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Barrett

This depends on the clientele. At the pain clinic 80% have tactile defensiveness, and part of this is their unhappy history of abuse and humiliation, and part is what other PTs have done to them in the past.
For the off the street patients in a health centre, probably around jon's 5%, maybe up to 10%.

Generally I avoid the painful part in all of them-that comes last in Ax. When I have an idea of the person before me and what their language is telling me - then I look at where their pain is being experienced.

I have more problems with patients wanting to be touched - massage is the message from them!!

Nari

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Re: Tactile Defensiveness - May 6, 2005 8:28:00 PM   
jma

 

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Yes, I think it is dificult to touch without preparation. Modalities usually help out before hands on comes in.

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Re: Tactile Defensiveness - May 6, 2005 8:29:00 PM   
Jon Newman

 

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Putting the 'diagnosis' aside, I would say that a much higher percentage of people who come to PT display the behavior you are speaking of on their intitial visit. I find that after our first session that the number that remains persistently that way drops down significantly to my guestimate of 5% or so.

jon

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Re: Tactile Defensiveness - May 6, 2005 10:00:00 PM   
Diane

 

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[QUOTE]Out of a hundred patients seen in a typical outpatient orthopedic setting how many do you find it difficult to touch without considerable care and preparation? I'm talking about the whole variety seen and I'm not talking about going after their painful part-just touching them.[/QUOTE]Well, apart from an initial handshake,... probably a hundred out of a hundred. I sit and we talk for a good 10 or 15 minutes before I touch them. I wouldn't dream of touching someone until I feel a good click with them, relationally.

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Re: Tactile Defensiveness - May 7, 2005 2:21:00 AM   
Randy Dixon

 

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I think that is an interesting dynamic. It is going to vary by the therapist as well as by the patient. My wife seems able to be able to immediately touch people and have them be with comfortable with that almost always. Most therapists I've seen have differing abilities/comfort levels with it themselves, some of them seem able to do it when it is cleary "clinical touching" but unable to do it when there is comforting or warmth to it.

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Re: Tactile Defensiveness - May 7, 2005 3:21:00 AM   
avalon

 

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Hi All,

I share a same behaviour as Diane. I takes around 10 minutes before touching people. The talking phase helping to find the way to ?touch? them.
The percentage of untouchable remains low and around 2/3%.

Touching people is a way to sense/feel what happens in their body/mind. It was our first sense of communication but replaced unfortunately by artificial means.

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Re: Tactile Defensiveness - May 7, 2005 10:00:00 AM   
ericm

 

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I have found that when confronted with someone whom my snap judgement tells me to 'hold back a while,' that if I ask for permission to touch rather than assuming it is implied, any barriers, real or imagined are either defined or cleared away. On the whole however, this is rare, probalby less than 5%.
eric

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Re: Tactile Defensiveness - May 7, 2005 10:43:00 AM   
Diane

 

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I think there are "layers" of permission and ideally all will be given prior to treatment.

1. There is the permission implicit in the "treatment contract", i.e., the patient is coming to see you, the therapist, so they already expect to be touched.

2. There is verbal permission, as Eric mentioned. Very wise to obtain, (especially given the way the human world has been set up, for guys to obtain first.)

3. There is the permission from the nervous system itself. I really think it can't give its full permission to be touched until it has had a chance to process you, the therapist, a little; smell you, see you, experience your non-threatening presence for a short while.

I treat all nervous systems as though they are babies who are easily threatened by strangers and who must make up their own minds if they are going to respond to you or not. It's a short process really, but I don't want my patients to be at odds with their own nervous systems.

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Re: Tactile Defensiveness - May 8, 2005 12:12:00 AM   
nari

 

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In Australia, written permission must be obtained for any intervention, or change in treatment approach.

A worthwile comment to remember, and one which I seem to constantly recall is: When you assess and treat what you think is the patient's CNS,
-remember, the patient's CNS is testing YOU, every minute of time spent in session.

Sobering thought.


Nari

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Re: Tactile Defensiveness - May 8, 2005 7:48:00 AM   
Jon Newman

 

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I think Bevis Nathan would have something to contribute here. In his book Touch and Emotion in Manual Therapy he states (among many many other things worth reading)

[QUOTE] In the West and particularly in the UK, where it is an assault to touch another intentionally without permission, the considerable degree of touching taboo which exists serves to emphasise the psychologically signficant nature of initmate contact....Whilst it is obvious that intimacy very often has a sexual component, it by no means always has. The difference between compassion and passion allows for 'fraternal' or simple affiliative intimacy, and not necessarily sexual intimacy. [/QUOTE]Patients are necessarily going to bring with them their past experience and cultural conception of touch.

But I have to say, I don't sense a decrease in 'tactile defensiveness' until I actually touch the patient. The longer I wait, it seems, the longer I sense an uneasiness about being touched. Then again, it could just be me. Also, this reduction in tension is observable and palpable. I'm willing my patients can feel the decrease in my tension as much as I can feel theirs decrease though I've never asked.

jon

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Re: Tactile Defensiveness - May 8, 2005 8:18:00 AM   
Barrett

 

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?I actually find it is the touching that decreases a person?s defensiveness and until I do that, all the talking just makes things worse. I try to do my talking while touching. This seems to make things go much smoother for the both the patient and me.?

Jon Newman

Jon,

I hope you don?t mind my quoting your recent email this way, but I was pretty sure you wouldn?t-especially since I agree entirely and couldn?t have said it better. I see your last post contains this also.

I?m reading a new book, ?Why We Lie-The Evolutionary Roots of Deception and the Unconscious Mind? by David Livingston Smith. Great stuff and sure to generate an essay, but for the purposes of this discussion I will focus on Smith?s explanation of how deception, both from and of ourselves, is required to simply get through the day, and that we evolved as creatures inherently adept at both deceiving and detecting deception. The ?social poker? we play all day long is acutely amplified on a verbal and non-verbal level throughout the course of history taking. Our personal ability to sense and perform on this spectrum varies wildly and can change even within us from moment to moment depending upon our focus, bias, intention and a host of other factors. Every clinician recognizes this dance.

But actually touching another takes this aspect of communication to another level. Every time I teach I walk up to a student seated on the aisle and touch them somewhere about the head and neck while I am speaking and within three seconds they begin to display their own movement toward a reduction in mechanical deformation. I have never, never encountered any ?tactile defensiveness? in response, and, this has been my response in the clinic with virtually every patient for many years. If verbal and social preparation is so crucial to its avoidance, how is this possible?

My answer (today anyway) is that people aren?t afraid of touch. In fact, I think they crave it. What they are afraid of and what they sense quite distinctly is coercion. If this is the therapist?s intent, no matter how gentle, the patient will sense this and quite appropriately resist, defend against it and, in turn, become more physically defensive themselves. They are born with the instinct to do so.

But if your touch contains no intention to coerce, test or judge then another instinct emerges. And defensive activity disappears.

Guess what that is.

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Barrett L. Dorko P.T.
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Re: Tactile Defensiveness - May 8, 2005 8:20:00 AM   
Diane

 

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[QUOTE]I don't sense a decrease in 'tactile defensiveness' until I actually touch the patient. The longer I wait, it seems, the longer I sense an uneasiness about being touched. Then again, it could just be me. Also, this reduction in tension is observable and palpable. I'm willing my patients can feel the decrease in my tension as much as I can feel theirs decrease though I've never asked. [/QUOTE]The patient's nervous system, sampling yours, as Nari mentioned.

I think there's a continuum involved. There's definitely (imo) a "right time" to start touching, sort of like there's a "right time" to jump into a whirling skipping rope (deja vu from childhood). For me it's a feeling I get, that the patient is as ready as they'll ever be. It's almost visible, something opens up in them and comes out to meet me. Hard to explain, I can see them relax by a certain degree and I know they are going to be more receptive to being touched.

And I agree that the decrease in tension continues on (and on and on) after contact has been made (otherwise there would be no point in touching in the first place.)

I've read and very much liked Nathan's book on touch.

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