Therapeutic Touch Healing Hospice Clients and Their Families

Maggie was a vivacious 47-year-old single nurse who, as an integral part of a nonrelational extended family, lived a full and rich life. So it came as a great shock when she was diagnosed with advanced carcinoma of the lung. Chemotherapy provided her with a period of time to get her affairs in order. However, Maggie's shortness of breath, weight loss, extreme fatigue, and nausea debilitated her quickly. Her extended family agreed to keep her at home as long as they could manage with support from home nursing and homemakers. As a Holistic nurse practitioner, I began to visit her three months after the diagnosis, Maggie wanted me to visit because her friends could not talk about her inevitable death. She felt that their own fear and pain were so great they had withdrawn from her spiritually. With Maggie's permission, I began to do therapeutic touch to ease her discomforts. She reported feeling more relaxed, which aided her breathing and sleeping, and commented that she felt more connected to her "inner core; more like a whole person." After several weeks of doing therapeutic touch with Maggie, several of her friends approached me to ask if they could learn therapeutic touch because it seemed to provide peace and comfort for Maggie. We began then and there. Over the next three months before Maggie's death, her friends did therapeutic touch almost daily. During this time Maggie said to me: "I feel like I have my friends back."

How do we facilitate an experience of healing into death for the dying and their families? In this culture, our relationship with death is so foreign that we need to create something that spans the terrain between life and death. We need a crucible, a vessel or container that withstands and contains the pressures that dying demands yet preserves the integrity of the "contents." The contents-fear, pain, anger, and vulnerability-call into question everything we believe in. We are face to face with our own mortality. Or as Levine expressed it, "illness causes us to confront our most assiduous doubts about the nature of the universe and the existence of God. It tears us open. It teaches us to keep our hearts open in Hell."

Maggie and her friends needed a new way of being with each other during the dying process. Bolen discussed how life threatening illness changes relationships, often for better or worse. On the one hand, such illness can provide an opportunity for growth in depth and understanding or, on the other, the possibility of abandonment-physically, emotionally, or both. Maggie and her friends used therapeutic touch as the crucible that held their fear and pain, allowing them to connect at a deeper body, mind, and spirit level. Healing, for them, was being able to communicate their love and understanding non-verbally with therapeutic touch. This trying time became an opportunity for their relationships to strengthen and grow. They gave each other the gift of being present in their suffering together.

HOW IT STARTED

Therapeutic touch as a healing modality was developed in the early 1970's by Dolores Krieger, Ph.D., R.N., professor emerita of nursing at New York University, New York City, and Dora Kunz, a healer and former president of the Theosophical Society in America. Therapeutic touch arose out of their observations and research on several famous healers in the United States. Ms. Kunz explained how it began, describing the goal she and Dr. Krieger had set for themselves: "If we could devise a technique, based on our observation of healers, and teach it to health professionals, many people could be helped." After developing the technique, they started teaching it to nursing students at New York University. Harpur noted: "There are now estimated to be approximately 30,000 nurses in the United States and Canada using therapeutic touch in hospitals and clinics." Therapeutic touch is used not only by health care professionals but also by a growing number of lay people who are committed to serving others in need. Dr. Krieger believes that anyone with the intent to help and the interest can learn therapeutic touch. As she put it: "You can do it; everyone who is willing to undertake the discipline to learn Therapeutic Touch can do it."

Therapeutic touch is defined as "a contemporary interpretation of several ancient healing practices. These practices consist of learned skills for consciously directing or sensitively modulating human energies." The basic assumptions that guide the practice of therapeutic touch are that (1) a human being is an open energy system in which energy transfer between people is effortless and happening all the time; (2) a human being is bilaterally symmetrical (which implies that this also occurs in the energy field); (3) illness is interpreted as an imbalance in the energy field that can be sensed and felt; and (4) human beings naturally transform their lives thus healing themselves.

HOW THERAPEUTIC TOUCH WORKS

The process for the practitioner of therapeutic touch, according to Dr. Krieger, includes four steps that are continuous and repeatable. They are: (1) centering-creating a calm focused state of being that is attained through breathing, visualization, etc.; (2) assessment-scanning the client's energy field with the hands 3-5 inches off the body from head to toe; (3) direction and modulation of the energy-using the process of "unruffling," which is done by making flowing sweeps with the hands over the client's body, especially in areas where imbalances are noted; and (4) balancing the energy field-reassessment by repeating the above procedures as needed until the energy field is balanced.

The laying on of hands was first studied by Grad, Smith, and Krieger. These studies showed acceleration in the growth of plants, wound healing in mice, and an increase in hemoglobin in humans. These findings became the foundation for the therapeutic touch research to follow. This research has shown the possibilities inherent in the practice of therapeutic touch, such as decreases in pain, anxiety, diastolic blood pressure, and stress in hospitalized children and accelerations in wound healing and relaxation

Widely reported effects of therapeutic touch include relaxation (usually within 2-4 minutes), pain reduction, accelerated healing (because of enhanced immune system function), and alleviation of stress induced illness. A plausible explanation for these effects emerges from recent research on psychoneuroimmunology, which provides fresh insight into mind-body relationships. This research identifies a biologic web of inter-connectedness among various systems, such as the central nervous system, autonomic nervous system, immune system, and endocrine system. The cells of these systems carry information receptors on their surfaces that allow communication between and among them. In other words, these cells have the potential to alter their internal states in response to the information they receive. This information enhances credibility for the reported benefits of therapeutic touch for the dying and their families. For example, if a person with a terminal illness is experiencing pain and fear, this message would trigger a response in the brain causing a biochemical reaction, i.e., a release of adrenaline.9 This biochemical response would be relayed via the information receptors among the other systems in the body causing a stress reaction. In this circumstance, therapeutic touch, done by a family member with loving intent and presence, has the potential to transform these negative cell messages to positive ones of relaxation and reduced pain.

THE DYING HAVE SPECIAL NEEDS

When using therapeutic touch with the dying there are special considerations to be observed. Generally, the dying are increasingly sensitive to their environment, so light and noise need to be minimized. Anxiety and stress are easily sensed so people around the dying need to be calm and focused. Energy is at low ebb with the dying, so they experience increasing fatigue and decreasing concentration. This means that the person giving therapeutic touch needs to stay centered so that the treatment will be effective. Energy is absorbed slowly by a dying person so therapeutic touch needs to be done with focused loving intent, slowly and gently. Wager suggests that during the therapeutic touch treatment, the therapist should hold the hand of the patient or place a hand over the patient's heart to impart feelings of peace, love, and acceptance of the inevitable death, freeing the patient to let go. The overall benefit of therapeutic touch for a dying patient and the family is to create a calm, peaceful environment that relaxes the patient enough to diminish physical discomforts allowing him or her to be in touch with the inner world. At the end, it eases the transition into death. It would be erroneous to think that therapeutic touch only benefits the recipient. Therapeutic touch makes a profound difference to both the giver and the receiver. The practitioner derives a satisfaction because of the ability to help the patient. Therapeutic touch provides a concrete way for the family to participate. As Wager stated, therapeutic touch "allows the family to take an active role in caring for the dying and gives [it] a way to relate which doesn't involve talking."

Jane and Marie were mother and daughter. They were also best friends. They enjoyed an intellectual and openly affectionate relationship. Jane was living with Marie, her husband, and granddaughter, when Jane had a recurrence of breast cancer. Her first thought was to move out so that her daughter and family would not have to "watch her waste away." Marie and her family insisted that Jane stay so that they could look after her. As their holistic nurse practitioner, I started doing therapeutic touch for Jane at the family's request. They had had a positive experience with it previously. After a few months with this family, one-day, Marie took me aside. She did not know how she would ever be able to separate from her another. Even now, with her mother's ebbing physical health, Marie was feeling an incredible sense of loss. The sharing and connectedness that had been integral to their relationship was occurring less and less as Jane became more introspective and less verbal. Marie wanted to know what she could do to let her mother feel loved and cared for at this time. She also wanted to let her mother know that it was okay to let go when she felt the need. Marie did not want Jane lingering on account of her. I suggested therapeutic touch as a concrete way of staying connected and helping both of them let go. Marie learned therapeutic touch and started using it daily with her mother.

How can we create environments that support clients' and families' healing into death? In the situation with Marie and Jane, the contents of the crucible love, support, and connectedness-were nurtured and deepened by the practice of therapeutic touch. It allowed them to move past the physical changes and withdrawal that signaled inevitable separation from each other. They were able to move into the psychospiritual realm, an environment that created a knowing and acceptance between mother and daughter. They knew and expressed that their separation was momentary in the larger scheme of life and death. As Marie said to me, "Therapeutic touch helped soften the sharp edges of letting go. It was a healing process for the both of us." Halifax referred to this process as "bearing witness ... a practice that allows us to be present for whatever is happening. In being present for whatever was happening, Marie and Jane experienced a letting go that transcended their fear of separation, creating space for healing.

CONCLUSION

Healing comes from the Middle English word "hele," to make whole, a phenomenon that concerns itself with opening to all aspects of life. Wholeness is a natural state present in wellness, disease, and dying, and it is a crucial aspect of healing into death. As Levine said about dying patients, "they were more healed, more whole at the moment of their dying than at any time in their [lives]. This paradox of healing into death is a difficult concept to grasp, given the values of our Western culture. Dying is set apart from living. Generally, death is something to be feared; a failure of sorts. A similar message accompanies our "technocure" model of health care, with its focus on overcoming illness and death.

Subsequently it is difficult for terminally ill clients and their families to have an experience of healing and wholeness. In fact their experience often reflects the opposite. They feel abandoned and isolated with their own fear, pain, and suffering. They are unable to make meaning of their lives as they confront death; are unable to piece together a cohesive whole. Bolen cited the shame and guilt engendered by a recurrence of illness or an inability to respond to treatment. Halifax stated that "what the dying person frequently experiences is marginalization, the experience of being pushed aside." These daily experiences of indignity, frustration, and invalidation only serve to compound the sense of separation and brokenness felt by the dying and their families.

Yet we know better! In 1970 Kubler Ross, in her seminal work, On Death and Dying, was one of the first people to write about the stages necessary in healing into death. She opened the way for further investigation and dialogue by others. Halifax talked about the need to explore feelings about death openly, including loss, pain, anger, and the experience of letting go. These create awareness and a beginning acceptance of death. Wager looked at the importance of connection and relationship with a view to resolving past hurts and wrongs. Jones emphasized the essential component of making meaning of life in the face of inevitable loss and death. Rinpoche supported the introduction of spiritual values and care based on the needs of the dying and their families. Therefore, as caregivers of the dying and their families, we have a beginning, a place to start. In the larger world, our role is to introduce our culture to the idea of conscious living and dying. We need to talk openly about the work we do with the dying and their families. We need to talk about the power and wonder of the lessons they have to teach. In our day-to-day work with the dying and their families, we need to acknowledge their feelings of isolation and brokenness. We need to create a crucible where these patients can be safely held with love, attention, and presence, thereby laying the groundwork for healing into wholeness.

Where is healing to be found? Often, as the stories of these families reveal, healing is found in rather unexpected places. Some of the most difficult and trying situations cultivate fertile ground for healing to take hold. These families extended their boundaries into unknown territory, the land of the dying. There are hard choices to be made by the dying and their families. They can stay within the landscape of the familiar or set out to explore new land. As Bolen succinctly noted: "we lose an innocence, we know a vulnerability, we are no longer who we were before this event, and we will never be the same." These families and their dying loved ones chose the new land; a new way to be in relationship with one another. Their use of therapeutic touch as a crucible was one way to cultivate wholeness in the face of death. These families, like the alchemists of old, turned base metal into pure gold. They transformed the dying journey into the stuff of life that heals.

Article references available upon request.

Yaterie MacKay-Greer, R.N., B.S.N., M.Ed. is the founder of Stillpoint Holistic Nursing Practice, Kamloops, British Columbia, Canada, where she pratices holistic nursing.

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