One day several years ago, I spontaneously hugged a patient of mine, Gretchen. It was during a moment in which her despair and distress were so intense that it seemed cruel on a human level not to reach out my arms to her, in the event that she might derive some relief or comfort from an embrace. She hugged me for dear life.
Months later, Gretchen reported to me that the hug had changed her. “The motherly embrace you gave me that day,” she said, “lifted the depression I have had all my life.”
Could a hug really have such an effect? The notion has stayed with me ever since.
I started thinking about hugs during my psychoanalytic training. Every so often I was assigned a patient who would hug me without warning, either at the beginning or the end of a session. When I talked about this with my supervisors, some suggested that I stop the hug and instead analyze the meaning of it with the patient. Other supervisors suggested the opposite: that I allow it and accept it as part of a cultural or familial custom. Bringing it up, they suggested, could shame the patient.
I remember consulting the ethical guidelines from the National Association of Social Workers and the American Psychological Association. I assumed “do not touch” was overtly spelled out. I was surprised to discover that those organizations, while expressly prohibiting sexual boundary-crossings, did not expressly prohibit touch.
Today, neuroscientists have learned that when humans get emotionally upset, our bodies react to manage the increased energy. These physical reactions bring discomfort at best, and at worst are unbearable.
What can we do to obtain immediate help when we are distressed so that we don’t have to resort to superficial balms like drugs or psychological mechanisms like repression?
What kind of relief is affordable, efficient, effective, and nontoxic?
The answer is touch. Hugs and other forms of non-sexual physical soothing, such as hand-holding and head-stroking, intervene at the physical level to help the brain and the body calm down from overwhelming states of anxiety, panic and shame.
I encourage my patients to learn to ask for hugs from their loved ones. A therapeutic hug, one designed to calm the nervous system, requires some instruction. A good hug must be wholehearted. You can’t do it halfway. Two people, the hugger and the “huggee,” face each other and embrace each other with their full chests touching. Yes, it is intimate. The hugger should be focused on the huggee with purposeful intention to offer comfort. It is literally a heart-to-heart experience: The heartbeat of the hugger can regulate the heartbeat of the huggee. Lastly and very importantly, the hugger must embrace the huggee until the huggee is ready to let go and not a moment before.
The paradox of hugs is that though they are quintessentially physical, they can also be enacted mentally. I often invite my patients, if it feels right for them, to imagine someone they feel safe with, including me, holding them. This works because in many ways the brain does not know the difference between reality and fantasy.
Gretchen, for example, sometimes feels small and scared. I know her well, so I can tell just by looking when she is being triggered into shame. To help her feel better, I intervene using fantasy. “Gretchen,” I say, “can you try to move that part of you that’s feeling shame right now to the chair over there?” I point to a chair in my office. “Try to separate from that part of you,” I continue, “so you can see it from the eyes of your present-day calm and confident self.”
I gesture with my hands to convey a part of her coming out of her body and joining the two of us on the chair a few feet away. Gretchen visualizes in the chair the shame-filled part of her — in her case, her 6-year-old self. In this fantasy, Gretchen hugs and soothes the 6-year-old.
But sometimes, as in Gretchen’s case, actual touch changes something deep. It seems, at those times, that there is no substitute for the real thing.