A constructivist grounded theory of counselling psychologists’ in-the-moment decision-making process about touching their clients

Abstract

Clinician-client touch is controversial, and seemingly widespread. However, talking therapists report little-to-no training on it and major accrediting bodies offer no explicit guidance. Consequently, some clinicians feel a lack confidence and competence around touch and fear accusations of bad practice. There is no research on counselling psychologists’ (CoPs’) ‘in-the-moment’ (in-session) decision-making process about touching their clients. Hence, this study aimed to develop a constructivist grounded theory (CGT) of this process to facilitate best practice by identifying issues and evaluating and recommending changes to existing models, guidelines, and training.Following a CGT methodology, cycles of semi-structured interviews were conducted with nine CoPs, one clinical psychologist and two body psychotherapists about their process. The interview transcripts were analysed following Charmaz’s (2014) three-stage CGT coding process.A dual process model of touch-decision-making was produced, with the core category ‘weighing the predicted balance of appropriateness’: participants use an embodied sense of ‘felt appropriateness’ and a cognitive process of ‘considering the appropriateness’ to assess whether a ‘touch-related action’ is likely to be experienced as minimising harm and maximising therapeutic benefit to the client.The findings indicate a need for a CoP ‘professional stance’ towards touch-decision-making and talking about and upholding touch-boundaries in clinical practice.