Christine GreenSenior Lecturer andComplementaryTherapyPractitioner,University ofLuton, Faculty of Healthand Social Science, Depart-ment of Public Health andPrimary Care EducationCentre, HighWycombeHP111QW,UK.

LynneNicoll Comple-mentaryTherapy HealthCare Consultant, For AllSeasons, 8 West Street,Marlow, Bucks SL7 2NB,UK.

Correspondence to:Christine GreenTel.: +44(0) 1494 425135

Therapeutic caring: alearning disability experienceChristine Green and LynneNicoll

This paper is a reflective account of our experiences of giving Therapeutic Touch (TT), forthe f|rst timewithin a learning disability setting, to a client who has profound learningdisabilities.Using a case study approach, we share our story of this pathf|nder journey ofdiscovery and showhow the process of reflectionwas instrumental in enabling us to gaininsight on the unfolding therapeutic and caring relationshipwhichwe developedwith thisclient. Issues relating to informed consent were addressed, however thesewere complexand needed special consideration. As client consent could not be achieved through verbalmeanswe needed to drawon our senses and use intuitive skills together with teaminvolvement.IntroducingTTinto a learningdisability settingwasbreakingnewground, andas this case study has shown it does appear to have the potential to enhance therapeuticcaring.r 2001Harcourt Publishers Ltd

Christine Green Lynne Nicoll

INTRODUCTION

Oscar is 25 years old. He lives in a Mencap home

for residents who have profound learning dis-

abilities. Oscar is severely epileptic, has no

speech, and a very limited cognitive ability. It

Complementary Therapies in Nursing &Midwifery (2001) 7,180^187 # 2001Harcourt Pdoi:10.1054/ctnm.2001.0563, available online at http://www.idealibrary.com on 1

seems his hearing and sight is intact. He wears a

helmet at all times, except in bed, to protect

himself in case he has a seizure. He can walk, he

weighs about 45 pounds and is approximately 4

feet in height. He suffers from severe and

progressive scoliosis. Oscar chooses whether to

ublishers Ltd

Therapeutic caring: a learning disability experience 181

eat or drink or take his medication. He is not

forced in any way, as he is still able to make very

clear choices. His hold on life appears to be quite

tenuous.

We are both Therapeutic Touch (TT) practi-

tioners, and wish to share our story in working

with Oscar using TT. Whilst wishing to help

Oscar we would acknowledge that our therapeu-

tic relationship provided us with an opportunity

to extend our TT practice into working with

people with learning disabilities. In other words

this is a story about our journey of reflection and

discovery.

THERAPEUTICTOUCH

We define TT as a healing art, used to promote a

therapeutic and caring environment. It has been

found to be of benefit in reducing anxiety,

promoting relaxation and altering the perception

of pain. TT has the potential to place the patient

in the best possible position so that their own

self-healing processes can be activated.

In constructing this description of TT, we

draw on multiple existing definitions. For

example, Kreiger (1975), first named and de-

scribed TT as consisting ‘of the simple placing of

the hands for about 10 to 15 minutes on or close

to the body of an ill person by somebody who

intends to heal that person’ [p. 784].

Kreiger highlighted the significance of the

therapist’s intent to heal. This is referred to as

‘intentionality’. Martha Rogers’ Science of Uni-

tary Human Beings (1970) offers a nursing

theory to understand TT (Madrid 1994, Mills

& Biley 1994). In particular, Rogers identified

four inter-related concepts that help explain the

healing phenomena of TT:

K Energy fields

K Open systems

K Pattern

K Pandimensionality.

The energy field concept is based on the belief

that energy rather than atoms form the basic

structure of humans. The energy field consists of

a human energy field that is integral with

environmental energy fields. These fields are

open, enabling continuous changes of energy to

take place between them. Each energy field is

unique, and this can be read as a pattern that is

constantly evolving. The pattern is a reflection of

the physical body, which the TT practitioner

reads with her hands in order to note the energy

flow. Disruption of the energy flow reflects

bodily dysfunction. The TT practitioner,

through the use of her hands, smoothes out the

disruption to the energy flow helping to harmo-

nize and heal the body. Pandimensionality

relates to the body being connected to a greater

cosmic consciousness where there are no bound-

aries between energy fields, which are reflected in

such phenomena as deja vu and altered states of

consciousness.

Whilst we acknowledge that this description of

TT is limited, we hope Oscar’s story will

stimulate you to explore TT in greater depth.

We ask you to have an open mind to counter

prevailing prejudice within nursing and society

about such therapies. For example, Rayner

(1999) states that ‘Gobbledygook about this sort

of new age stuff is appearing all over the place

nowadays . . . (p. 220)’.

As such we are conscious about demonstrating

the therapeutic impact of TT. By sharing and

reflecting on Oscar’s story we aim to contribute

though a single case study the profound impact

of TT on Oscar’s life.

OSCAR

The Macmillan nurse, who was in contact with

the home carers referred Oscar to us. She felt that

Oscar’s condition had deteriorated and that TT

might be a useful therapy to enhance his quality

of care. Our first appointment at the home was to

meet the manager. She spent time with us and

explained Oscar’s medical and social history, and

she also tried to psychologically prepare us for

our first visit with him. She did this by explaining

his physical appearance in detail so that we could

create a mental image of him. She told us that

others have been ‘taken aback’ when first meeting

Oscar. At this point neither of us felt unduly

concerned as we thought our maturity and

professional skills would be transferable and

would equip us to deal with this new situation.

In fact we were feeling quietly confident. However

our quiet confidence was to be challenged.

When we first met Oscar we were consciously

aware of his fragility; his arms were like sticks,

so fragile, yet so whole. His blue helmet

appeared out of place on a body so small. He

appeared just like a little boy rather than a man

of 25 years. We both felt shock and disbelief.

Something we had not imagined. Nothing could

have prepared us for this moment. Even if the

manager had shown us a photograph of Oscar

we believe that this would not have conveyed

the true picture. We wrote in our reflective

diaries:

I experienced dual emotions – that of excitementand concern of doing any damage.

I felt awkward in his presence. I felt out of mydepth.

We found ourselves addressing our own inade-

quacies when communicating with people

who have learning disabilities. Suddenly com-

munication did not come naturally; we were

182 ComplementaryTherapies in Nursing &Midwifery

momentarily lost for words and when we spoke,

the words seemed superficial and seemed to echo

politeness rather than the relaxed and comfor-

table interaction we had hoped for.

We were only with him for a few minutes but

the impact was enormous. At this point we

realised our limitations. Our previous experience

had not fully prepared us for what we had

encountered. We felt the responsibility of making

a choice – to proceed with Oscar’s treatments or

not? In many ways we felt it would have been

easier to have said ‘no’. But is ‘saying ‘‘no’’ . . .

playing safe? Or is saying ‘‘no’’ . . . opting out?’

There was a lot at stake. We felt that we would

be letting a lot of people down – ourselves, the

manager and Oscar.

From our perspective we were hungry for this

knowledge and new experience. We were look-

ing to extend the use of TT in different specialist

areas of practice. This would therefore be an

important learning curve for us as TT thera-

pists. We felt strongly that if we did not follow

this through we would be giving up an

opportunity to discover new understanding of

TT. Consequently the need to treat Oscar

became a challenge.

There was also the issue of letting the manager

down. We had informally agreed on our first

meeting with the manager, to offer Oscar 10

treatments. In a way we did feel a sense of

obligation, especially as the manager had gone to

great lengths to seek our services through the

Macmillan nurse.

Lastly, would we be letting Oscar down? At

this point we have to admit Oscar was not our

prime concern, as we had not as yet built up a

therapeutic relationship with him. The relation-

ship could be described as ‘I – It’ rather than ‘I –

thou’ (Paterson & Zderad 1976). This describes

the movement from an objective relationship to a

more subjective caring interactive relationship.

However, we also considered whether it was right

from a humanistic point of view to deprive Oscar

of this treatment.

We reflected that saying ‘yes’ might involve an

element of risk for us, as we felt inadequate in

this foreign setting. We were not apprehensive of

giving the treatment. We believed that as it was

our intention to help and heal, he would not be

at any risk.

However, we felt as if we were walking new

pathways. We were testing new ground. We were

pathfinders, and whilst this offered excitement

and challenge, it also evoked a certain amount of

fear and apprehension from deep within. Nicoll

(1996) describes the feelings pathfinders may

experience. She uses the words ‘apprehension’

‘fear’ and ‘loneliness’ and clearly states that

pathfinding is not an easy route. Reflecting back,

the feelings we were experiencing were to be

expected.

We knew we had many boundaries to over-

come. Initially the following questions were

uppermost in our minds. How would we know

whether he wanted the treatment and would his

non-verbal communication tell us his needs?

On that first day we did not treat Oscar. We

told him who we were and explained TT to him.

We touched him only in a social manner. Oscar

was sitting in his favourite chair in the kitchen.

He was entertaining himself by moving the

coloured objects on his ‘activity centre’. His

hands were constantly moving. We were later to

discover that this constant hand movement was a

characteristic of his which sometimes ceased

when he was in a more relaxed state during

treatment.

Despite our identified concerns and anxieties,

we both felt comforted that we had each other to

support and share with. This first day encounter

highlighted the depth of our emotions, the ethics

and delicacy of the situation and the need for us

to work closely together. We would find this to

be our safety net.

We decided not to treat Oscar on our first visit

because we wanted to get to know him and gain

some form of consent from him. We felt we

gained this as he did not move away from us

while we were talking to him, or as we slowly

began to move closer towards him, or when we

socially touched him. The manager also felt that

Oscar had given us his consent as he stayed with

us. She stated that if he had been unhappy or felt

uncomfortable with any person, he would get up

and leave the room. We were learning about

Oscar’s unique way of giving us his consent. On

the second visit and on most other visits, Oscar

clearly gave us his consent by walking with us

into the lounge. The staff expressed that they

were surprised at his action. They also stated that

Oscar would not go anywhere he did not want

to go.

The following comments, from our reflective

diaries, demonstrate the depth of our commu-

nication with Oscar:

The first time I treated Oscar, I held his hand andlooked into his eyes. He spoke to me with his eyesand body gestures that it was okay to give thetreatment.

Oscar had a way with him that made you veryaware of what he wanted and did not want.

We found it difficult to express this inner

knowledge we were developing about Oscar’s

ways. He was almost charismatic in the way he

drew us to him. He used assertiveness in all body

gestures to ensure the outcome he wanted.

Sometimes at the end of treatment Oscar didn’t likehis helmet being replaced. Was he trying to tell usthat he didn’t want his treatment to end?

Putting his helmet on against his will made us

feel awkward and uncomfortable but we feared

Therapeutic caring: a learning disability experience 183

for his safety. He sometimes grunted but at

no time did he demonstrate any physical

resistance. We called Oscar’s expression of his

feelings ‘speaking without speaking’. It high-

lights the powerful nature of the way we

developed our non-verbal communications

with him.

The staff were also aware of his special form of

communication. They commented:

He has a unique form of communication andmanages to get across so well what he is feeling.

Everyone who meets him develops a close bondwith him.

He pulls himself into you, and you go into the backof his eyes, he is an amazing young man with afighting spirit.

Over the period we treated Oscar we began

to perceive his eyes as windows. We felt that he

used his eyes as his special form of commu-

nication. His eyes broke down barriers – they

were naked, knowing eyes. They sometimes

spoke with softness and sometimes agitation.

The eyes have been called the windows to the

soul (Dass & Gorman 1985). These words

reflected what we were sharing – the very being

of Oscar.

We reflected on Quinn’s (1996) definition of

TT when we were treating Oscar. She simply

states that ‘it’s the use of the hands on or near

the body with the intent to help and heal’

(p. 69).

Our intention to help and heal Oscar extended

beyond the physical; it was healing of the soul.

This we felt was through the greater cosmic

consciousness where there are no boundaries

between energy fields.

We noted in our reflective diaries:

When I commenced treatment with Oscar, I startedby using contact touch. This was useful to establishand connect with each other. I remember one of thefirst times I treated him, I gently caressed his hands.As I did, I noticed how smooth his skin was, yetpale. I remember feeling how privileged I was tohave made contact with this remarkable youngman. Although he could not speak to me, he spokein other ways. He told me he was pleased to see me.He also told me with his eyes and whole bodygestures.

This illuminates Rogers’ (1986) notion of ‘open

systems’, where two human energy fields were

interacting and interconnecting, in an integral

way. This allows for a continuous interchange of

energy to take place where energy is considered

to be the basic structure of humans.

On one occasion, whilst treating Oscar, thetelephone rang. Oscar was obviously disturbed bythis. His body moved in an erratic way. I spoke tohim in quiet, reassuring way telling him that thiswould not interfere with our interaction. Heseemed to know what I was saying. He wasresponsive to me.

This again illuminates Rogers’ ‘open systems’

(1986) demonstrating our special way of

connecting.

At the end of the session Oscar and I had developedan understanding of each other that was beyondspeech. It was a mutual understanding of a richnessthat is hard to describe. The strength of ourinteraction crossed physical boundaries. Itenlightened my soul in a meaningful way.

This illuminates Rogers’ (1986) notion of ‘pan-

dimensionality’, where there are no boundaries

between different energy fields. It felt as if we had

expanded into a greater consciousness of self-

realisation.

We learned so much from our encounters with

Oscar. When working with people with learning

disabilities it is important to be sensitive to their

every need. This was highlighted on Oscar’s

ninth treatment. Oscar had suffered a severe

grand mal seizure about half an hour before we

arrived. After discussion with a staff member we

decided not to treat him as he was heavily

sedated, and would not have been able to give us

his consent.

Prior to this encounter with Oscar we had

always gained his consent by walking with him

into the lounge and then by observing any

subtleties which occurred between us. These

subtleties we read as his unique pattern (Rogers

1986). Pattern recognition can be equated with

the inner voice that some people consider their

intuition (Newman 1986). It was these interac-

tions that made the consent unique and moved

us to a greater understanding of the diverse

means by which consent can be gained.

On this occasion Oscar was heavily sedated

and would have been unable to express himself in

a meaningful way, therefore we felt we would

have to consider consent in a different form. To

our knowledge there has not been any studies

undertaken on TT within a learning disability

setting, so the issue of consent has not been

addressed in this context. However Cox and

Hayes (1998) gave TT to an unconscious patient

in an ITU setting. They gained consent from the

next of kin. Oscar’s sister, his only surviving

relative, was aware that he was receiving TT.

However she relied on the staff, at the home, for

day-to-day decision making regarding her broth-

er. As the staff at the home took responsibility

for his care, we followed their advice and did not

treat Oscar on this occasion.

A week later we revisited him. Once again he

was in his own bedroom, as he had had another

fit the day before. The staff explained that they

sometimes, depending on the severity of the

seizure, let him rest in his room for at least a day

following a fit. They felt he was well enough to

receive treatment that day. We did not challenge

their advice but believed at that time that they

were acting in Oscar’s best interest.

184 ComplementaryTherapies in Nursing &Midwifery

We had not been in his room before. A carer at

the home asked if she could observe the TT

session. We said she could; at this point we did

not know that she was planning to use her

observation of TT for her college assignment.

He was lying in his bed in the dark as if he had

just woken up. Looking back it seemed that he

was not prepared for his treatment and was

maybe caught off guard. We greeted him and

told him we had come to give him his treatment.

Usually he is the one to greet us. At first he

looked at us and then after we commenced his

treatment he became very restless. He even

climbed in and out of bed. We had no option

but to stop our treatment.

Reflecting back, we felt we had violated his

space. We had not asked his permission to give

treatment, or for someone to observe, or if we

could enter his room. The only way he could

express his displeasure was by being restless.

Could his restlessness be because he had nowhere

to run? We felt we had failed to appreciate the

sensitivity of the moment and, more importantly,

his uniqueness. It was almost as if we were so

involved with our need to treat him that we

forgot the purpose of why we were there.

We the therapists and the staff were healthy,

strong and powerful, and we encompassed his

space and rocked the scales off balance. Ful-

brook (1994) has highlighted that it is possible to

insensitively override the patients’ rights when a

person is more powerful than another. The

understanding of power can take the form of a

hidden agenda, as seen by our intention, which

was focused on achieving our outcomes and the

carer’s intention to complete her assignment.

As Oscar has limited ability to express himself

verbally, he could be seen to be in the weaker

position. However this was not to be the case as

Oscar used his unique way of communicating

with us, and he knowingly rejected our treatment

by preventing us from continuing.

Uniqueness is related to Rogers’ (1986) con-

cepts of ‘pattern’ and ‘open systems’. Oscar’s

pattern is unique to him, and he has the right to

withdraw or open his energy field. On this day he

exercised his right to choose not to have the

treatment. The UKCC (1992) state clearly that

the patient has the right to choose freely the care

they receive. Oscar’s perseverance not to be

treated and his determination to make clear

choices for himself resulted in him achieving his

outcome in directing his own life and maintain-

ing his autonomy (Seedhouse 1991).

This incident highlighted Oscar as a great

teacher and us as the pupils. It was not an easy

lesson. We remember feeling embarrassed and

humbled. We felt a little disappointed too, that

this was our last negotiated visit with Oscar, but

felt pleased that the staff had asked us to teach

them TT so that they could use it on all their

clients. At least there may be some continuity to

the treatment Oscar received.

WORKINGWITHOSCAR

The room Oscar chose to have treatment in was

inviting, warm, quiet and relaxing, with colours

that smoothed the mind. Such a therapeutic

environment was important not only for Oscar

to relax and receive TT, but it also provided us

with the medium for centering our conscious-

ness.

Centring, according to Sayre Adams and

Wright (1995), is ‘achieved by shifting awareness

from an external to an internal focus, becoming

relaxed and calm and making a mental intention

to assist the patient’ [p. 84].

The importance of centring cannot be under-

estimated. We feel that the key to a successful

outcome in treating a client with TT rests on the

frame of mind of the therapist. Calmness and

tranquillity facilitate the whole process of the

therapeutic experience. Consider a situation

where you have been with someone who is angry

and you leave feel negative yourself. In the

same vein the reverse must be true. Peace and

tranquillity have the potential to result in similar

feelings in your client. This puts them in a

position where they can heal themselves.

Over the 10 weeks we saw Oscar, he developed

his own routine. He always went and lay on the

sofa, and we supported him with pillows. He

showed no resistance to the treatment. We just

removed his helmet and he waited for us to

commence. He seemed to know when the session

was over and on several occasions he indepen-

dently got up and walked into the kitchen, causing

us to scurry behind him with helmet in hand.

It is worth mentioning that on some occasions

we, the therapists, worked together and at other

times we worked separately. Whether working

together or not, we always felt excessive warmth

around his head during the therapy. It could be

argued that this could have been because Oscar

has to wear his helmet all of the time, except when

lying down. However, the sensations of heat and

warmth in association with TT have been well-

documented (Green & Nicoll 1996, Bulbrook

1984, Macrae 1994, Keller & Bzdek 1986,

Raucheison 1984). But what was interesting in

Oscar’s case was the depletion, coldness and

emptiness felt from his neck downward:

I felt the energy field in the region of his headexpanded and hot. This was in stark contrast to therest of his body.

I felt excessive heat in the head region and adepleted coolness from head to toes.

During Oscar’s treatment we repatterned the

imbalances using our hands, smoothing his

Therapeutic caring: a learning disability experience 185

energy field is a rhythmic fashion. Repatterning

involves, firstly, identifying the imbalances with-

in the energy field, and these may be perceived as

hot, cold, empty and depleted. The therapist then

mentally visualizes the wholeness of the indivi-

dual with the intention towards well-being.

Sayre-Adams (1994) defines repatterning as ‘the

process of projecting, directing and modulating

energy . . . assisting to re-establish the order in

the system’ [p. 27].

As Oscar’s imbalances were perceived to be

extreme, additional modalities such as colours

were used to rebalance his energies. Green (1998)

published a case study in which she used the

visualization of colour to gain a therapeutic

outcome. We used this medium to achieve a

similar effect.

I visualized the colour blue as my hands movedaround his head. I sensed that blue may act as acooling energy. This in turn may help rebalance theenergy field. I then noticed how quickly his energyfield was repatterned. The head now felt cooler.

At times his body was often motionless except

for his hands – they stroked each other in a slow

and caressing movement. Although he opened

and closed his eyes for equal amounts of time

before treatment, we noticed that during the

sessions his eyes were closed for longer periods.

Even when his eyes were open and focused,

they appeared relaxed, gentle and trusting. The

relaxation response associated with receiving TT

has been well documented (Green & Nicoll 1996,

Kreiger 1979, Heidt 1981, Quinn 1982, Olson et

al. 1992, Gagne & Toye 1994).

After we had given Oscar treatment we wrote

down our experiences. We did this as a means to

evaluate the treatment and to share the moment

and depth of the interaction with each other. We

were often surprised at how similar our observa-

tions and experiences were. Examples of these

are:

We both saw the energy like rays of light.

We both experienced the energy as a force pushingour hands further and further away from his head.

These energy manifestations may be considered

to be a pandimensional, especially as on occa-

sions we were not working together and neither

of us had verbally exchanged our experiences at

the time of treatment. Through our reflections

we were able to conceptualize non-linear ways of

being. This became rich and meaningful to us as

therapists and educationalists.

SHARINGOSCAR

Developing relationships with Oscar’s carers at

the home began on our first visit where we were

introduced to the home manager and the

members of staff who were on duty that day.

However we noticed that when we went on

subsequent visits there were often new faces,

some of whom did not seem to be aware of the

full purpose of our visit. It was only during the

treatments, when we were constantly interrupted,

that we realised that there was a flaw in the

communication links.

Our reflective notes identified the following

interruption during the first treatment:

She came in with his tea. She sat him up andproceeded to feed him. He was not happy. Heresisted and grunted. However drank his tea.Afterwards she remarked that – ‘he obviouslyenjoyed the treatment he was receiving because hedid not want to be moved, not even for his tea’.

We were aware that this was a learning

experience for the carer as well as ourselves.

Consequently we did not see the need to pursue

the issue further, other than taking the precau-

tionary measure of requesting that he had his tea

before commencing subsequent treatments.

However, as the following reflections high-

light, the interruptions continued:

Ten minutes into the treatment I was disturbed by amale care assistant who asked me what I was doing.I tried to explain but it wasn’t easy to break in themiddle of treatment. Interestingly he told me thathe was trained in holistic massage. I felt annoyedby this interruption as I felt it was unnecessary andit was difficult to recommence treatment.

A further 10 minutes into treatment I was disturbedby a female care assistant. Oscar’s eyes met hersand he cried out loudly. He seemed disturbed. Shetold me that she didn’t know Oscar well as she wasnewly employed. She informed me that Oscar hadsuffered a seizure earlier that afternoon and shegave this as her reason for disturbing me. I silentlyquestioned the wisdom of her action.

The constant interruptions affected the sensitiv-

ity of the moment and the connections were

often lost. This can be understood and related to

everyday reality when a person is disturbed

whilst in deep concentration. It is hard to

recapture that level of consciousness again.

During TT treatment we attain a level of

centredness which when disturbed can easily be

lost and can be difficult to regain. Consequently

the potential of the treatment may be compro-

mised and this could be even more marked if

there is rationing of treatment time available.

It wasn’t enough to assume that all members

of staff would not disturb us. Before each session

we explained to the staff members we would be

commencing the treatment and would be closing

the door. We asked not to be disturbed.

Reflecting back, it may also have been relevant

to have approached the home manager and

discussed this issue with her as she was in a prime

position to communicate with her staff.

We considered other possible reasons why we

were interrupted. Was it because of their lack of

186 ComplementaryTherapies in Nursing &Midwifery

knowledge of the nature of the treatment? If this

was the case, we needed to have spent time

informing them and perhaps allowing them to

experience the treatment for themselves before

commencing Oscar’s treatment.

Another possible reason could be because

they were in the protective parent role. To us, it

seemed like they were parents wanting the best

for their child – yet not always knowing when to

let go. Sharing of Oscar may have been difficult

for them as they were the key carers and we

were the invited guests. They may have per-

ceived us to be encroaching on their caring role,

especially if they were ill informed as to our

intentions.

Despite a slow start we developed a good

working relationship with the carers. We

achieved this by sharing at a more personal level

and using day-to-day conversations. We noticed

that this helped to break down many of the

barriers. The evaluation that follows demon-

strates that the carers had also acknowledged the

value of TT in the caring of people with learning

disabilities. Over the 10 weeks we felt that we had

developed a partnership based on mutual trust,

value and respect. We were pleased with the

outcome and the way we had finally dealt with

the situation.

SHARINGWITHTHESTAFF

We were invited to attend the staff meeting to

evaluate Oscar’s treatment. This was a valuable

experience as it enabled us to gain the percep-

tions of the staff and to gather objective and

subjective data. The staff made the following

comments:

K Improvement in diet. ‘It was noted that

during the period he was receiving regular

treatment, he began eating three meals a day’

K Relaxation. ‘He was very relaxed afterwards

and did not want to move from the sofa’

‘It relaxed him so much’

‘It was a pleasure to see him looking so

relaxed’

K Increase in sensory awareness. ‘Over

Christmas he selected some Christmas cards,

he chose the bold and colourful ones’

K Time and Space. ‘He responded so well to the

treatment and there is not a lot of things he

can do and be involved in, it gave him his own

quality time and space’

K Communication needs. ‘Therapeutic Touch

gave Oscar the quietness he likes and the

one to one close contact he desires’

‘Oscar enjoys a quiet and calm atmosphere and

chooses to sit by himself quite often, he does not

always respond favourably to close contact, but

his choice is quite clear’.

REFLECTINGONREFLECTION

Throughout our time with Oscar we have been

able to develop our reflective skills. At the onset

we decided to share our reflective experiences

with each other and this allowed us to grow

together. We took every available opportunity to

jot down our thoughts. Often we did this on

scrap pieces of paper. We would then piece these

together, so that we could capture the moment in

time spent with Oscar.

In no time at all our reflective diaries had

grown, and they enabled us to gather both

objective and subjective data from a variety of

rich sources. Reflective writing is a powerful

means of exploring practice as it can make

possible new ways of theorising, reflecting on

and coming to know oneself and ones profession

(Holly 1989). Initially we reflected after the

event. Schon (1983) refers to this activity as

reflection-on-action. It involves looking back on

an experience and drawing from it meaning and

understanding.

As we have mentioned earlier, within this

placement setting, we were novices, eager to

learn, and reflection provided us with the scope

to do so. A structured reflection-on-action,

enabled us to look critically at both our strengths

and our weaknesses, and take action where

necessary by using a problem solving approach.

However as we became more confident and

comfortable with Oscar in his home setting, we

were able to develop and strengthen our reflective

skills even further. We moved from a structured

to a less structured reflection-in-action.

Schon (1983) described reflection-in-action as

‘our knowing is in our action’ [p. 49]. It is a process

undertaken in the midst of action, which draws on

the innumerable judgements of quality made by

competent practitioners, within their day to day

practice. Such action is governed by intuitive or

spontaneous thinking, which guides further action.

Certainly during our TT sessions with Oscar,

intuitive thinking was seen to be a dominant

feature, which enhanced practice. The profound

nature of our journal writing highlights this.

Reflection enabled us to enhance our depth

and breadth of knowledge of TT phenomena and

the underlying unitary theory and research

underpinning both TT and therapeutic caring

in context of a learning disability.

CONCLUSION

We acknowledge that TT was of great value to

the total well-being of Oscar. It was clear that

there was never going to be a physical cure for

him. This was never our intention. However TT

treatment improved his quality of living at that

moment in time in his life.

Therapeutic caring: a learning disability experience 187

TT has been criticised strongly by Rosa et al.

(1998). They state that the claims of TT are

groundless and that further professional use is

unjustified. Their article reviewed some of the

published literature and tested 21 practitioners

with TT experience under blinded conditions to

determine whether they could correctly identify

which of their hands was closest to the investi-

gators hands. The findings of this study indicated

that the results were slightly worse than would

have been predicted by chance.

On reviewing our work with Oscar, Rosa

et al.’s (1998) research loses its relevance of what

TT is all about. The richness of the experience,

the perceived outcome and the sharing of new

knowledge cannot be compared to the clinical

outcome of the distancing of hands. In other

words, quality is much more important than

prediction. Especially when dealing with people

in palliative care.

Quality in our eyes was achieving a holistic

outcome. An analogy can be drawn with

McCaffery’s (1979) work on pain. She states

that ‘Pain is whatever the experiencing patient

says it is, existing whenever he says it does’

[p. 14].

This takes into account ‘pain as an experience’

rather than dividing the pain into subgroups.

Working with Oscar was also a lived experience

where he was the focus of our treatment. Not

whether we were dealing with his physical, social,

psychological or spiritual well-being. The whole

made the experience more than the sum of the

parts.

Reflection too, was part of the process of

achieving a holistic outcome. It was a useful tool

for enhancing our growth and development as

well as for problem solving. We feel reflection

enabled us to appreciate the therapeutic caring of

the total situation. It has been shown that we

worked closely together in order to look with

critical eyes at our practice. Dass and Gorman

(1985) offer the following appropriate quote; ‘We

work on ourselves, then, in order to help others.

And we help others as a vehicle for working on

ourselves’ [p. 227].

Breaking new ground is both exciting and

daunting. However we believe that we could not

have anticipated the outcomes we experienced

and shared. So many times we have used the

words unitary in our teaching but now we feel we

have experienced it.

REFERENCES

Bulbrook M 1984 Bulbrook’s model of Therapeutic

Touch. One form of health and healing in the future.

Canadian Nurse 80: 30–34

Cox C, Hayes J 1998 Experiences of administering and

receiving Therapeutic Touch in intensive care. Com-

plementary Therapies in Nursing and Midwifery

4: 128–133

Dass R, Gorman P 1985 How can I help. Rider, London

Fullbrook P 1994 Assessing mental competence of

patients and relatives. Journal of Advanced Nursing

20: 457–461

Gagne D, Toye R 1994 The effects of Therapeutic Touch

and relaxation therapy in reducing anxiety. Archives

of Psychiatric Nursing 8 (3): 184–189

Green CA 1998 Reflection of a Therapeutic Touch

experience: case study 2. Complementary Therapies in

Nursing and Midwifery 4: 17–21

Green C, Nicoll L 1996 An exploration of student nurses’

perception of the experience of receiving therapeutic

touch. European Nurse 1 (2): 111–123

Heidt P 1981 Effects of Therapeutic Touch on anxiety of

hospitalised patients. Nursing Research 30: 32–37

Holly ML 1989 Reflective writing and the spirit of inquiry.

Cambridge Journal of Education 19 (1): 71–80

Keller E, Bzdek VM 1986 Effects of Therapeutic Touch on

tension headache pain. Nursing Research 35: 101–106

Kreiger D 1975 Therapeutic Touch. The imprimatur of

nursing. American Journal of Nursing 75: 784–787

Kreiger D, Peper E, Ancoli S 1979 Physiologic indices of

Therapeutic Touch. American Journal of Nursing

4: 660–665

Macrae J 1994 Therapeutic Touch: a practical guide.

Alfred A Knopf, New York

Madrid M 1994 Participating in the process of dying. In:

Madrid M, Barrett EAM Rogers’ scientific art of

nursing practice. National League for Nursing Press,

New York

McCaffery M 1979 Nursing the patient in pain: Lippincott

Nursing Series. Harper and Row, London

Mills A, Biley F 1994 A case study in Rogerian nursing.

Nursing Standard 9 (7): 31–35

Newman MA 1986 Health as expanding consciousness.

Mosby, St. Louis

Nicoll L 1996 Pathfinders in Therapeutic Touch. Com-

plementary Therapies in Medicine 4: 264–267

Olson M, Sneed N, Bonadonna R, Ratliff J, Dias J 1992

Therapeutic Touch and post hurricane Hugo stress.

Journal of Holistic Nursing 10 (2): 120–136

Paterson J, Zderad L 1976 Humanistic Nursing. John

Wiley and Sons, London

Quinn J 1982 An investigation of the effects of Ther-

apeutic Touch done without physical contact on state

anxiety of hospitalised cardio-vascular patients.

Doctoral dissertation. New York University. Disser-

tation Abstracts International 46 (6): 1797B

Quinn J 1996 Therapeutic Touch and a healing way.

Alternative Therapies July, 2 (4): 69–75

Raucheison MI 1984 Therapeutic Touch: maybe there is

something in it after all. RN 47: 49–51

Rayner C 1999 Stuff and nonsense. Nursing Standard 13

(39): 22–23

Rogers M 1970 An introduction to the theoretical basis of

nursing. FA Davies, Philadelphia

Rogers M 1986 Science of Unitary Human Beings. In:

Malinski VM (ed.) Explorations on Martha Rogers’

science of unitary human beings. National League for

Nursing, New York

Rosa L, Rosa E, Sarner L, Barrett S 1998 A Close Look at

Therapeutic Touch. JAMA, 279 (13), 1005–1010

Sayre-Adams J 1994 Therapeutic touch: a nursing

function. Nursing Standard 8 (17): 25–28

Sayre-Adams J, Wright S 1995 The theory and practice of

Therapeutic Touch. Churchill Livingstone, Edinburgh

Schon D 1983 The reflective practitioner. Basic Books,

New York

Seedhouse D 1991 Ethics: the heart of health care. Alden

Press, Oxford

UKCC 1992 Code of Professional Conduct. United King-

dom Central Council for Nursing, Midwifery and

Health Visiting, London