Haptotherapy from an ethical perspective

Introduction

In regular healthcare, psychology and psychiatry, increasing attention is being paid to working in the human relationship between the therapist and client, and to including the physical body with its related feelings and emotions (Os, van, 2022, Klabbers, 2024, Egan, 2012). This is a basic principle in which haptotherapy has conversations that provide insight and understanding, experiential skills exercises, and affective contact-oriented therapeutic touch (Klabbers, 2024, Rijsselberg, van, 2017).

Frans Veldman, the founder of haptonomy, discovered that different kinds of touch each produce their own effect. The person-oriented touch – in haptotherapy also known as affective touch – demonstrably produces both physical and psychological relaxation and vitality, which then reactivates the client’s own natural development . In this contact of person-oriented touch, the haptotherapist is eminently specialised in recognising feelings in themselves and in the client (Boot, 2004). Working in the relationship in a therapeutical context requires a great deal of care. Veldman states in this regard: “May haptonomy in its very nature provide in a simple and transparent manner, the means to open up/expand and be open in affectivity, so that these means are effective and useful solely in good – haptonomic – hands. And whoever has not yet found the certainty of these <good hands>, must refrain or cease, but learn and experience ….” (Veldman, 1988).

In this quotation, Veldman emphasizes the importance of ethical awareness. Working in the relationship can raise ethical dilemmas; how does one act in the proper way? Sometimes an unambiguous answer can be given that can be set out in legal or other guidelines. More often when working with unique people, grey areas arise. A precarious balance must be kept in these grey areas, between maximum closeness versus inappropriate conduct, or good example versus influencing. It begs the question: When are haptonomical hands appropriate (good, effective and useful)? How can a haptotherapist in this day and age ethically and responsibly treat their client in practice? Based on a final thesis at the Institute of Haptonomy (Lanen, van, 2023)[1], the author gives a first answer to these questions in this article.

Method

A literature and practice-based study explored whether the intuitive (unconscious) application of the haptonomic principle can be made conscious, using a set of standards (rules of conduct), on which basis the haptotherapist can ethically offer treatment (“the appropriate hand”). To this end, the following sub-questions were tested:

1. What are the theoretical perspectives that determine the appropriate hand?
2. What are the basic principles of haptotherapeutic treatment?

iii.  What meaning do haptotherapists attach to the appropriate hand in their daily practice?

1. In their daily practice, do (some) haptotherapists consciously apply standards, which can be identified and which would provide direction for the ethically correct application of the appropriate hand?

Results

Theoretical basis:

Veldman describes haptonomy as an existential science (ontic), which lies at the foundation of human behaviour. In interpersonal contact (such as with the haptotherapist) a person’s way of being becomes evident. Veldman initially asserted that haptonomy cannot be captured in a method, technique or educational model. In the development of haptonomy, the educational institutes later developed educational models: the Triptych[2]   ( Veldman, 1988) and the Development Framework (Hoendervangers, 2010). These models offer haptotherapists a framework for professional treatment.  Both frameworks are the base on which the haptotherapists can decide on appropriate interventions in therapy sessions.

In reactivating the natural development of those seeking help. Veldman distinguishes three phases in this natural development:

• the unlimited existence: WE (symbiosis). The first stage of life of a child knows no boundaries or standards. The child develops a secure foundation in the relationship with its parents.
• the limited existence: YOU + I > I + YOU. The young child is developing and the ego forms, the identity, autonomy and the discovery of boundaries develop.
• the opened/expanded existence: I & YOU are equal and capable of WE (being together in human solidarity). The authentic person is created. Psychological maturity is characteristic of this last phase. The person is capable of regulating themself in their environment. Simply put, they can be fully themselves in togetherness with others, without losing themselves, being dependent upon or separated from others.

The guidance of human development requires a great deal of psychological maturity from the haptotherapist. From their opened/expanded existence, haptotherapists can offer clear, non-judgmental conversation, genuine, affirming experiences and touch. Veldman shared the Johari Window Model as a framework for interpersonal guidance (Veldman, 2010). This model shows that haptotherapeutic work takes place on the border, just outside the comfort zone, of what is possible and what isn’t. This requires that the haptotherapist continually assesses whether the next intervention is in the interests of the client’s developmental process, based on the on the Triptych or the Development Framework

The choices the haptotherapist makes within this framework should be based on morality, determined by values and standards. Values can be described as ideals, qualities or situations which one strives to achieve. Many values and standards are unconscious, which calls for acting on intuition, within the framework of the client’s interests.

Which are the values for ethically responsible haptotherapeutic treatment, for the appropriate hand? Veldman gives two basic principles, which can also be interpreted as values:

1. Taking personal responsibility.

This applies to both the person asking for help and to the person providing care, for the interaction of their individual feeling and reason. This necessitates that the haptotherapist knows their own personal moral compass and reflective capabilities, while treatment is ongoing.

2. Making yourself fully available.

By being fully present yourself (presence), with undaunting openness (transparency) while correctly aligning to the client (prudence). Veldman talks here about the P.T.P. principle. This triad (presence, transparency and prudence) requires that the haptotherapist make themselves fully available in the connection with the client, whilst maintaining their own autonomy. This making themselves available implies walking alongside, neither ahead of nor behind the client. The strength and effect of this is elaborated on in the Presence theory (Baart, 2011). The haptotherapist must continue to discover the essence of the unique person before them. This requires a high degree of sensitivity and integrity of the haptotherapist.

Translating theory into practice – in search of standards

The values described above give direction to defining appropriate haptotherapeutic hands. However, these remain hollow concepts without the significance of the practice, the standards. The practical study (Lanen, van, 2023) showed that haptotherapists share a number of common distinguishable themes in responsible treatment, to which each therapist attaches their own personal meaning. It is the same as with a good dancer; you’re not dancing a role, you are the dancer, with your own body, individual movement and performance.

The following concrete themes were discovered as the basis for professional haptotherapeutic conduct, together forming a connective line from beginning to end, in each session and throughout the entire treatment process (Lanen, van, 2023).

• The point of departure in a therapeutic setting is unequal, the affective relationship is equal in a professional setting.
• You demonstrate authenticity in your being, which is expressed in full, non-judgmental availability for the person seeking help.
• You are WITH-AND-BESIDE-THE-OTHER, maintaining the professional distance necessary to carry out your professional duties.
• You invite the client to reciprocity, opening themselves up and discovering and developing their own momentum.
• You walk with them, the autonomy of the client is central, both in substance and duration of the process.
• You allow them to affectively and affirmatively experience how the client represents themselves in contact with others.
• You confirm and affirm affectively the natural growth towards the opened/expanded human being.
• You guide the conclusion of the process, including detachment, so that the client can independently continue on their own path.

These theme’s for professional haptotherapeutic conduct are not sequential (with the exception of the conclusion) but are conditional.

Discussion

Nuance is necessary when discussing standards. These standards cannot be prescriptively and cognitively imposed, externally, but are shaped by the personal interpretation of each haptotherapist, and find their expression in the interaction with each unique person seeking help. This influences the contribution of the haptotherapist in the relationship with their client.

Recommendation

It is noteworthy that so little contemporary literature on haptonomic ethics can be found. Each new spirit of the times brings new values and standards regarding what is correct, which then requires a contemporary interpretation of haptonomic ethics, for both haptotherapists themselves and for healthcare providers from other disciplines.

It is advised that every haptotherapist regularly take time to reflect on the values and standards that guide their work practices. It is precisely the dilemmas encountered in the daily professional practice that allow you to access your unconscious standards, and through professional or peer supervision, make them conscious. This allows you to choose if and how you will continue to apply these in your professional treatments. Rather than being stuck with your dilemmas, share them and dissect them, so that we continue to develop ourselves in professional collectivity.

Conclusion

The study (Lanen, van, 2023) shows that a theoretical framework and its interpretation exist in the haptotherapy practice, with common themes for ethically responsible treatment as haptotherapist: the aforementioned appropriate hands. In this practical study (Lanen, van 2023) it becomes clear that the spirit of the times has changed. The prescriptive words in the haptonomic ethics of Veldman, are seen less in the contemporary practices of today. The more static idea of good or appropriate, regarding the haptonomic hands Veldman speaks of, can better be replaced with the idea of dynamic alignment. These are the moments in which the moral dilemma arises, the extent of movement: inviting, addressing and affectively affirming. Feeling and movement are inextricably intertwined. A static approach that prescriptively seeks what is appropriate or not, does not fit in the theory of feelings and emotion. It’s about the alignment, continually seeking the balance between what is possible and what is not.

[1] The final thesis is a theory and practical based study carried out in 2022 and 2023. The scope of the study is not enough to qualify as scientific research. A Dutch version of the thesis is available on www.laanvoorgroei.nl/inspiratie

[2] Based on Veldman F. (1988) Haptonomie, wetenschap van de affectiviteit. Uitgeverij Bijleveld. Chapter 3: De mens en zijn lichaam (pp. 39-62); chapter 9: Haptonomische vermogens (pp. 291-310); chapter 15: De representatie tonus (pp. 311-335).