To hug or not to hug a client — that is the question that can haunt therapists. When a client is so distraught and you have no more words to offer, is physical contact a good idea?

Glen O. Gabbard, M.D., Brown Foundation Chair of Psychoanalysis and professor of psychiatry at the Baylor College of Medicine in Houston, doesn’t seem to think so. In an April 2008 Psychiatric Times article, he talked about the trouble therapists can find themselves in if they do not follow American Psychological Association (APA) ethical and legal guidelines. Transference, in which therapy clients transfer feelings—positive or negative—for someone in their past to someone, such as a therapist, in their present—can help small transgressions, such as physical contact (including hugs) or indiscriminate phone calls turn into sexual violations.

In The Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, Autumn 2008, Richard Brockman, M.D., takes a different viewpoint. Brockman believes that sometimes a one-off hug, when mutually integrated through the proper processes, can have therapeutic benefits for clients with borderline personality disorder, and does not necessarily lead to rampant couch-sex.

Most therapists will ask clients if hugs or other touch, even something as small as a pat on the shoulder, would help or upset them. Nancy McWilliams, author of Psychoanalytic Psychotherapy, A Practitioner’s Guide, writes that “[T]hese clients can fill the therapist with dread that a refusal will devastate or retraumatize them or provoke a flight from therapy … when clients feel the overwhelming wish to be held, the yearning may be sincere, but they are also frequently trying to avoid some negative feelings.”

I have a friend who works with special needs children. She is used to giving and receiving spontaneous hugs from them, but when she impulsively asked her male therapist for a hug, he backed away and refused with much horror. She was mortified and humiliated and for a while felt her therapy was compromised. Although she has been unable to bring it up with him in therapy since, she is emotionally stable enough to realize the issues over the non-hug were more about him and not her and she is still seeing him.

My middle-aged therapist does allow me to hug her; and I have — several times. What does it mean to me? It’s easy to intellectualize, rationalize and imbue touch with rich, infantilizing transference issues rather than just let it be experienced as a spontaneous, innate need for the warmth of another human being you have just shared some deep powerful, ingrained secret with. Regressively, it’s a maternal, comforting, preverbal, raw body sensation from my “mother figure” that I’ve internalized and can viscerally draw upon when I am lost, lonely, hungry, angry, emotional or tired. I can let myself sink into the memory of that soothing, consoling and invigorating hug and it grounds and focuses me in my current situation with stability, strength and mindfulness. It gives me the ability to carry on with my life, with my head held high in the knowledge that I’m cared for by someone whom I care dearly about. It makes me glow inside.

I always assumed my tall, slim, elegant, long-black-skirted, middle-class therapist would be bony, sharp and angular; and smell of Tweed perfume or something similar. I was astonished to find she was soft, warm and rather marshmallowy; and there was a surprisingly frail, delicate, almost ethereal and translucent quality about her, like she would be easy to bowl over if I wasn’t careful. She also smelled of fresh air and sunshine. However, this did not blindside me to the fact that she actually is steel-belted when it comes to her most capable and effective therapy and her many other iron-clad, non-negotiable boundaries.

Most clients do not want to hug their therapists any more than they would want to wrap their arms around their doctor, accountant, lawyer, postman or local policeman. While a small percentage of therapists and clients do slide down that slippery slope to sexual violations, I believe the healing power of touch from someone you have feelings for can be a transformational and restorative life-giving force which gets under your skin and into your heart in a way that sometimes mere words cannot.