The Ambush Hug

The session ends. You and your client rise and you move holding the door open……………………………………

………………….at that moment of passing through she suddenly turns, slides her arms around you, buries her head on your shoulder and says “Doctor I am just so grateful for all you have done” and begins to cry, her tears staining your new Zegna silk tie.

Welcome to the ambush hug. As we are fond of saying in Australia, “bugger”.

So do you

1. Quickly turn to the side gently breaking her grip with your well honed martial art skills and push her hands to her side and say, “This behaviour is inappropriate. Please do not do this again”, all the while thinking how I will get those tear stains out of my silk tie.
2. Do the half hug.  Hands usually go somewhat awkwardly around the shoulders with the hips pushed away (to avoid any hint of sexualising).  The muscles usually somewhat tensed in case the client attempts to move closer saying,” I not sure this is appropriate and thinking what if somebody sees us.”
3. Give into the hug. Briefly holding the client in a true relaxed hug before moving away and saying, ”It is important we talk about what has just happened at our next session.”

The ambush hug makes for an interesting tension between boundary issues and relationships issues.

Option A gives primacy to the boundary issue, resetting the boundary as quickly as possible and warning against future infringements. However there may be a significant breaching of the therapeutic alliance as the client feels rejected. This may be difficult to repair as often these hugs come out of session where the client has been feeling particularly vulnerable.

Option B is a compromise between still keeping a boundary while maintaining the relationship. Everybody usually feels awkward and tense with this option.

Option C The clinician gives the relationship paramountcy. Recognising that the boundary has already been breached the therapist responds briefly as any person might before moving away.

In choosing any of the options what has occurred must be processed with the client at the next session.The vast majority of clients know that touching is inappropriate So the processing of the hug needs to deal as much with the patients need or impulse as it does with the guilt they may feel for having transgressed a boundary. In choosing the option to return the hug a number of follow on behaviours should occur. It should be recorded in the notes and it should be raised in supervision.

Comments

[Phoebe]

I laughed and laughed at the post.
I am preparing for USMLE and our ethics questions actually sound like that!!!

Great blog!

Phoebe

[Tony]

Alas it seems what you write is true.

I remember receiving a document from the APS on touch in the psychologist's practice. It was 30 pages long!

Human touch, one of the most therapeutic things seems to have been sexualized out of existence.

I liked your description of option B, in the humorous way it was presented. Sometimes we call that the "A frame" hug.

I look forward to reading your blog

[Adiemus]

This reminded me of a wee book I had once called the 'Little book of hugs'. One of the hugs was called 'the grabber-squeezer' hug - designed for hug-by-stealth or 'ambush'!!
Good to see you're posting again! Look forward to more, you have a heap of good stuff on here.

[Lisa]

The vast majority of clients know that touching is inappropriate so the processing of the hug needs to deal as much with the patients need or impulse as it does with the guilt they may feel for having transgressed a boundary.

[phd in yogurtry]

I'm here by way of Cog-Beh Therapy Arena. The post is so necessary to talk about, often. I love the tear-stained tie bit. Yes, we therapists have a shallow side, too.

Looking forward to checking in regularly.

[Therapy]

This was a really humorous one but very true!!! My wife is a therapist and this happens to her always. She tells me that all advice fails when caught in an awkward situation especially with very delicate cases.

[Shrinklady]

That was too funny. It's such a taboo subject. Glad you brought it up.

I think our own anxieties about boundaries and touch in psychotherapy figures strongly in our established "rules" about appropriate distance with clients. In an effort to "do no harm" I wonder if we've taken too much of the natural healing right out of therapy.

I was at a worshop with Allan Schore who was talking about right brain processes and I remember someone in the audience asking if therapists should be learning the use of "touch" in therapy. I believe he said it was a good question to explore.

[Ellie]

Ha, this is excellent! As much as I want to hug my therapist I cannot imagine doing the ambush hug without getting a football block followed by termination/referral the following week. Also, since we have talked about the hug topic, and what a hug would mean to me, he is careful to stay about 5 steps away at the end of a session!
Just a reminder to the therapists out there, the right response to the client who says "I am just so grateful for all you have done" is "You are welcome and I am glad you feel this was helpful". Manners, please!

[tfb]

Ellie,

Excellent! i agree with so much of what you said! Very well written. i cannot imagine hugging my psychiatrist, much as i wish h e would hug me! Thanks for the "manners" part.

[Rachel]

You had me laughing!

Although I don't (at present) work with touch with my clients, my own therapist has been trained in 'touch work'. I find it incredibly powerful (obviously within appropriate boundaries) as a lot of attachment issues are touch-related, and it can be a healing process. I think we have probably gone too far in avoiding touch of any kind.

[John Manteria]

This is a great post this is so true, you know how you avoid all of this and its for free, go to, www.therapycounseling.com

[WTCI]

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[Christine Bonsmann]

Funny and insightful. Complex topic. I wonder if it matters more if the genders of therapist and client are different? What do others think?

[David]

My wife is a counsellor and psychotherapist.

I all the years she has been counselling I don't think this has happened to her.

Perhaps it is because her training is to let her client's see themselves out and thus avoiding the situation occuring.

I will be sure to ask her.

This is a thought provoking blog

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[Alison Phillips]

"The vast majority of clients know that touching is inappropriate"

wow! How black and white is THAT!

While I acknowledge that touch in therapy is a tricky issue, there are alot of good therapists who use safe touch in their sessions with their clients ... and this touch can be very healing and comforting for these clients.

My own therapist - who is CBT trained - has offered to hold my hand during the processing of past traumatic memories. And this safe touch from my therapist not only provides me with needed comfort during a very difficult time, but it is also very helpful to keep grounded in the present.

While saying this, I would stress the importance of approaching the use of touch in therapy very carefully, and that it is vital that both the client and the therapist are completely comfortable with the type of touch to be used. I also think that the client's and therapist's intentions and perceived benefits behind the use of touch would need to be explored, so that it can be ascertained that the touch is going to be helpful for the client and not harmful (both short and long term).

But I believe that making a statement saying that touching in therapy is "inappropriate", is simplistic and incorrect, as under the right conditions (and in compliance with professional standards and ethics) safe touch can be very beneficial for some clients.

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[UnmotheredChild]

Oh yes it is hugly important to discuss it in supervision and try to bring it back into the room with the client too, keeping in mind the deep shame and humiliation this could evoke.

[Networking solutions]

Wow, Great postNice work, I would like to read your blog every day Thanks

[Melbourne Psychotherapist]

Wow, if this scenario doesn't evoke intense countertransference I don't know what will! They should use the scenario for an "In Treatment" episode.

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[Fan of good therapy]

I love this blog. I was in therapy (for the first time), with the experience of being married to a clinical psychologist for 20+ years... Anyway, I had become very attached to my therapist, and was in the fantasy phase - she would give me all the love and acceptance I had missed from my mother, and I would be "cured". I was trying to be respectful of boundaries, and asked her for a hug. She hesitated then gave me a half-way pat-on-the-back-hug. It was perfect. Had she outright said "no", I would have felt rejected and the therapeutic relationship damaged (perhaps irrevocably). Had she given me a full-fledged heartfelt hug, she would have been reinforcing my unhealthy fantasy. It was good that it was awkward as it provoked me into thinking about why I wanted the hug, about whether or not my request was reasonable (it wasn't), and I became acutely aware of how she has to walk a fine line between providing me traditional support and confronting my defenses and unhealthy patterns...

[Russische Frauen]

I searched for this theme! The vast majority of clients know that touching is inappropriate so the processing of the hug needs to deal as much with the patients need or impulse as it does with the guilt they may feel for having transgressed a boundary.