Therapeutic touch and wound healing
By Dónal P. O'Mathúna, PhD
Therapeutic touch (TT) is an alternative healing therapy that has garnered widespread interest among nurses and, increasingly, physicians and medical researchers.1 It is taught at 75 schools and universities in the United States and Canada and practiced at 95 health facilities.2 Most national nursing organizations in the United States promote TT through courses and teaching materials. Dolores Krieger, co-founder of TT, has personally taught the technique to more than 48,000 health care professionals in 75 countries.3
Practitioners are seeking to expand TT's use in clinical settings and often deem it unnecessary to inform clinicians when their patients receive TT.4 A recent study published in the Journal of the American Medical Association found no basis for the theory behind therapeutic touch. Your patients are likely to have heard the media furor over this article and may ask more questions about this therapy.
Touch has always been an integral part of healing and is the basis of numerous ancient healing practices. TT is a modern interpretation of these practices. However, TT does not involve physical touch but instead is "the conscious use of the hands to direct or modulate, for therapeutic purposes, selected nonphysical human energies that activate the physical body."5 It is based on the belief in the existence of a "life energy" (also called prana, qi, or chi) which gives rise to the human energy field or 'aura.' Wiccan and older theosophical sources describe an identical practice called "pranic healing." Theosophy is an eclectic mix of esoteric belief systems, many of which are associated with Eastern religions and Western mystical traditions, such as Wicca (or "white witchcraft").
Krieger and Dora Kunz, a prominent clairvoyant and theosophist, developed TT in the early 1970s. Krieger's research and writing at New York University's School of Nursing led to much of TT's current popularity. Also influential in this development was the University of Colorado's nursing school, particularly through the work of TT researcher Janet Quinn and of Jean Watson, a prominent nurse-theorist and past president of the National League for Nursing.
Mechanism of Action
TT is based on the assumption that health and healing depend on the balanced flow of life energy between the environment and the body. The practice corrects imbalances and removes blockages in the patient's energy field. Many proponents admit there is no scientific evidence for the existence of life energy. They attribute this lack of evidence to the limitations of science, and insist that life energy does exist and that they can manipulate it. However, the JAMA study found that TT practitioners could not detect human energy fields with statistical reliability.4
Practitioners must enter an altered state of consciousness to develop sensitivity to life energy. Imbalances are then detected as various "cues," such as "vague hunches, passing impressions, flights of fancy, or, in precious moments, true insights or intuitions."5 Problems in the flow of life energy can be corrected by the practitioner's intention to bring about healing. Five stages are usually recognized in TT:
1. Centering, a form of meditation during which practitioners quiet their thoughts and become attuned to the energy field. Practitioners must remain centered throughout the therapy.
2. Assessment, where practitioners pass their hands 2-4 inches above the patient's body, gathering information about the patient's energy field.
3. Unruffling, which involves practitioners sweeping their hands along the length of the patient's body. This removes congestion from the energy field in preparation for treatment.
4. Treatment, during which practitioners send life energy to correct energy field imbalances. For example, practitioners may visualize warmth while sending energy to areas assessed as cold.
5. Conclusion, when practitioners receive a cue that treatment should stop, the energy field is re-assessed, and the patient encouraged to relax before concluding the session.
TT is usually given for about 20 minutes. Training is offered in many nursing schools and through continuing education programs. Certification and credentialing do not exist and are opposed by the official organization of TT practitioners (the Nurse Healers-Professional Associates, Inc.) because life energy cannot be quantified and responses to treatment are individualized.
The clinical effects attributed to TT include relaxation, pain relief, and healing of wounds and bone fractures. Independent reviews of TT research have revealed methodological problems, inadequate controls, and inconsistent results.6
TT's effect on wound healing is widely cited in support of its efficacy. Daniel Wirth, Director of Healing Sciences Research International in Orinda, CA, has published five studies in this area. Physicians using standard skin biopsy instruments made 4 mm full-thickness dermal wounds to subjects' lateral deltoids (except in the first study when wounds were 8 mm). Subjects were randomly assigned to test or control groups. Studies were conducted for 10 days (16 in the first) with test subjects given TT for five minutes each day (alternate days in the fourth study). Wounds were examined for re-epithelialization by independent physicians and reported as fully healed or not.
Subjects were blinded to the treatment given by passing their arms through a modified door or by using one-way mirrors. In the first study, the average wound size was significantly smaller in the treated group (n = 44; P < 0.001).7 After 16 days, complete healing occurred with 13 treated wounds and none of the controls. The second study had seven completely healed wounds in the TT group after five days and none in the control.8 After 10 days, 10 treated wounds were completely healed compared to four in the control group (n = 24; P < 0.041).
Wirth's third study placed a clear plastic sheet over the one-way mirror through which treatment was given, with practitioners one foot away from patients (a greater distance than is customary for TT).9 No differences in numbers of fully healed wounds were found between test and control groups (measurements were not reported, and statistical analysis was not conducted). The fourth study removed these variables and administered TT in the usual way (subjects were not blinded).10 After 10 days, the treatment group had one fully healed wound, while the control had seven (n = 15; P < 0.01). Wirth's fifth study used the same protocol as his second.11 After 10 days, the treated group had no fully healed wounds and the control group had four (n = 38; P < 0.05). Wirth's results reveal the problem of drawing firm conclusions from unreplicated studies. A search of Medline and CINAHL revealed no additional studies (using "therapeutic touch" and "touch and wound" as the search terms).
Anecdotal reports exist of TT causing pain, nausea, or anxiety.5 Practitioners caution that it can exacerbate fevers and inflammation and should be used sparingly over burns and tumors.5,12 Practitioners urge giving very short treatments (if any) to children, elderly patients, and debilitated patients.13 No controlled studies of adverse effects have been reported.14
Clinicians should be concerned that well-meaning practitioners may expose their patients to TT without informing them of its unproven nature. TT should be viewed as experimental until research shows that it is effective and safe.14 Anecdotal reports of patients benefiting from TT may better reflect the importance of meaningful interactions between clinicians and patients, and the value patients place on caring, interpersonal relationships.
1. Goldman EL. New Age therapies are put to the test. Intern Med News 1995; 28:1, 33.
2. Krieger D. Therapeutic Touch Inner Workbook: Ventures in Transpersonal Healing. Santa Fe, NM: Bear & Co.; 1997.
3. Horrigan B, Krieger D. Healing with therapeutic touch. Alt Ther 1998; 4:87-92.
4. Rosa L, Rosa E, Sarner L, et al. A close look at therapeutic touch. JAMA 1998; 279:1005-1010.
5. Krieger D. Accepting Your Power to Heal: The Personal Practice of Therapeutic Touch. Santa Fe, NM: Bear & Co.; 1993.
6. Claman HN. Report of the Chancellor's Committee on Therapeutic Touch. Denver: University of Colorado Health Sciences Center; 1994.
7. Wirth DP. The effect of non-contact therapeutic touch on the healing rate of full-thickness dermal wounds. Subtle Energies 1990; 1:1-20.
8. Wirth DP, Richardson JT, Eidelman WS, et al. Full-thickness dermal wounds treated with therapeutic touch: A replication and extension. Complementary Ther Med 1993; 1:127-132.
9. Wirth DP, Barrett MJ, Eidelman WS. Non-contact therapeutic touch and wound re-epithelialization: An extension of previous research. Complementary Ther Med 1994; 2:187-192.
10. Wirth DP, Barrett MJ. Complementary healing therapies. Int J Psychosom 1994; 41:61-67.
11. Wirth DP, Richardson JT, Martinez RD, et al. Non-contact therapeutic touch intervention and full-thickness cutaneous wounds: A replication. Complementary Ther Med 1996; 4:237-240.
12. Cowens D. A Gift for Healing: How You Can Use Therapeutic Touch. New York, NY: Crown Trade Paperbacks; 1996.
13. Wytias CA. Therapeutic touch in primary care. Nurs Pract Forum 1994; 5:91-97.
14. O'Mathúna DP. Therapeutic touch: What could be the harm? Sci Rev Alt Med 1998; 2:57-63.
Dónal P. O'Mathúna, PhD, is Professor of Bioethics and Chemistry, Mount Carmel College of Nursing, Columbus, OH.