Therapeutic Touch (TT) and Healing Touch (HT), which encompasses TT as well as other techniques (Slater 1996), are forms of healing that seek to balance the energy fields of an individual patient through the process of "laying-on of hands" (Ledwith 2000). The energy fields, although not detected to date, are thought by TT proponents to direct physiologic processes (O'Mathúna 1999). The exchange of energies between the practitioner and the patient is meant to facilitate physical and spiritual healing in a positive way (Ledwith 2000). The energy of TT practice is not unlike forms of energy described in other healing modes, such as qi (pronounced "chee") in Traditional Chinese Medicine (TCM) and prana in Ayurvedic medicine. (Please see the monographs on those specific health systems for more details.) One of the developers of TT, Dora Kunz (see Historical Background section), distinguishes the energy of TT and HT from other modalities as "hand-mediated energetic healing" (HMEH) (Slater 1996). The word "touch" is somewhat misleading because there is generally no physical touch involved. Central to the treatment is the conscious intent on the part of the practitioner to heal the patient (Ledwith 2000).

TT was developed in the early 1970s by Dolores Krieger, a nursing professor at New York University, together with Dora Kunz, a natural healer who served as mentor to Krieger. Krieger's professional research and writing increased the popularity of the technique, particularly among nurses (O'Mathúna 1999; Slater 1996), and the practice grew primarily through a grassroots effort of nurses throughout the United States. Janet Mentgen, a Colorado nurse, developed HT as an outgrowth of TT. She blended the Krieger-Kunz technique with other HMEH approaches as well as Native American medical practices and, at times, hypnotherapy, biofeedback, counseling, meditation, and guided imagery. HT practitioners tend to choose particular techniques based on their perception of the needs of the particular patient (Slater 1996). Today, many national nursing organizations promote the modalities of both TT and HT (O'Mathúna 1999), and many hospitals include them as part of standard nursing protocols (Slater 1996). These modalities are practiced at more than 100 hospitals and health centers in North America (Ledwith 2000). However, some experts caution that, due to the lack of scientifically verifiable research, the practices should be viewed as experimental treatment methods (O'Mathúna 1999).

TT is based on the idea that optimal health requires a balanced flow of life energy (O'Mathúna 1999). TT practitioners, by their own description, sense the patient's energy through their hands and then send healthy energy back to the patient who subjectively reports feelings such as warmth, relaxation, and/or pain relief. The practitioner describes the patient's energy as hot or cold, active or passive, blocked or free. There are eight general regions of the body above which energy is sensed – head, throat, heart, stomach, lower abdomen, sacral region, knees, and feet (Ledwith 2000). HT holds that the patient is the ultimate healer by allowing the body's own healing mechanisms to emerge. The role of the practitioner is to facilitate this process (Slater 1996).

One explanation for the way TT works involves understanding the interaction between the mind and the body as well as cell biology. According to this theory, the brain stores memories of a physically or emotionally traumatic experience such as an infection, an injury, or a difficult, painful relationship. The pain associated with any one of these experiences manifests in the body, not in the brain. The manifestation on a cellular level blocks gap junctions and gap junction complexes, preventing communication between cells, which thereby interrupts normal function of organs and tissue. TT is thought to restore cellular communication by opening gap junctions through the exchange of healthy energy (Ledwith 2000).

Another theory of how TT works uses quantum physics to try to explain this healing method. According to quantum physics, human beings are "electrical devices that produce magnetism, heat (body temperature), and phosphorescence." Blood circulates in a person, with the iron in hemoglobin producing an electromagnetic field that may be sensed by the TT or HT practitioner. The "aura" that some describe may be phosphorescence produced from electrical properties of the human body; the belief, in terms of quantum physics, is that through the process of evolution most of us lost the ability to see radiant electromagnetic energy surrounding other people, but some individuals develop the ability to sense this light (Slater 1996).

Despite the belief in TT by many practitioners as well as documented beneficial clinical outcomes (see Clinical Applications section), the mechanism of action remains controversial (Redwood 1999). Two studies to date have not been able to demonstrate detectable human energy fields on the part of the TT practitioners. But, as Mehmet Oz, MD, an expert in complementary and alternative medicine (CAM), explains, "just because...a phenomenon [cannot be explained] does not mean that it does not exist" (Tanne 1998).

TT is used in a wide variety of clinical settings, including hospitals, nursing homes, hospice centers, psychiatric wards, childbirth preparation classes, neonatal intensive care units, and labor, surgical, and recovery rooms (Slater 1996). TT sessions last about 20 minutes (O'Mathúna 1999), while HT sessions can last from five minutes to much longer, depending on the clinical circumstance (Slater 1996). In order to detect the flow of life energy, the practitioner enters an altered state of consciousness, a process known as centering (O'Mathúna 1999). The practitioner then assesses the patient's energy fields by passing his or her hands two to four inches above the patient's body. In a procedure known as unruffling, the practitioner sweeps his or her hands along the patient's body to remove congested energy. Next, the practitioner visualizes and transmits life energy to specific areas of the patient's body to correct energy imbalances. Near the end of the session, the practitioner reassesses the patient's energy fields and then facilitates further relaxation as the session comes to a close (O'Mathúna 1999).

Studies indicate that TT significantly improves anxiety in oncology and cardiovascular patients (Slater 1996), as well as institutionalized elderly (Astin et al. 2000; Abbot 2000). There is also evidence that TT significantly reduces pain and increases function in those with osteoarthritis of the knee (Astin et al. 2000; Abbot 2000), relieves tension headaches (Abbot 2000), and has the tendency to reduce post-operative pain and decrease the need for analgesics. TT may also accelerate healing in puncture wounds, reduce pain and anxiety associated with burns (Astin et al. 2000), and help psychiatric patients behave more calmly and cooperatively (Slater 1996).

TT induces deep relaxation, as evidenced by an increase in alpha brain waves. As a result, patients may experience reduced stress, lowered blood pressure, and enhanced respiration. Deep relaxation may also be associated with lower cholesterol as well as improved hormonal balance, bowel function, and immune response (Ledwith 2000).

Potential side effects include light-headedness, thirst, and increased urination; while the lightheadedness generally only lasts 15 minutes after a TT session, thirst may continue for a number of days (Ledwith 2000). Although it has not been documented, some practitioners speculate that TT may have negative effects on patients by "flooding" them with too much energy, resulting, theoretically, in increased pain, irritability, restlessness, anxiety (Astin et al. 2000), or even nausea (O'Mathúna 1999). This inundation is described as an "overdose" for which, again, there is no demonstrable evidence (Astin et al. 2000). TT may exacerbate fevers and acute inflammation (O'Mathúna 1999).

There are no specific contraindications to TT known at this time; caution should be exercised in the case of fever or acute inflammation (see section on Risks, Side Effects, Adverse Events). Some practitioners recommend that treatments be brief for children, the elderly, and debilitated patients (O'Mathúna 1999). Although not a contraindication, tremendous care and caution must be exercised when a patient has a history of physical or sexual abuse, which is not uncommon for those seeking TT as a healing modality (Ledwith 2000).

There are many conditions for which TT may be used adjunctively, in addition to those mentioned in more detail in the Clinical Applications section, such as chronic pain, chronic fatigue syndrome, fibromyalgia, weight loss, hypertension, premenstrual syndrome, menstrual cramps, menopausal symptoms, ovarian cysts, stress, addictions, symptoms of lupus, fibrocystic breast disease, difficult pregnancies, allergies, bronchitis, diverticulitis, endometriosis, irritable bowel syndrome, periodic and restless leg movement syndromes, sleep apnea (Ledwith 2000), edema, hives, injuries, and HIV-related symptoms (Slater 1996). TT may also result in emotional and spiritual rewards, such as increased self-confidence, self-control, and self-understanding (Ledwith 2000).

A meta-analysis of current studies on TT concludes that the existing trials contain methodological flaws, such as small sample sizes, lack of control groups, and inadequate explanation of techniques applied (Winstead-Fry and Kijek 1999). Despite problems with methodology, many clinical trials have shown intriguing results, particularly for the chronically ill, indicating a need for continued research with improved study designs and expanded outcome measures (Abbot 2000; Winstead-Fry and Kijek 1999).

According to the Nurse Healers-Professional Associates International (NH-PAI), TT is taught at more than 90 colleges and universities worldwide; TT is also taught in continuing education programs as part of graduate nursing education, and via intensive summer workshops. However, training is not yet fully standardized (Ledwith 2000), and there is no formal credentialing and certification. By report, such measures are opposed by the NH-PAI because they consider the practice subjective and non-quantifiable (O'Mathúna 1999). A TT practitioner is generally a licensed nurse, massage therapist, physical therapist, or a person who carries another medical associate degree (Ledwith 2000). HT is a certificate course taught by the American Holistic Nurses' Association (AHNA) (Slater 1996).

For more information, contact the Nurse Healers-Professional Associates International (NH-PAI) at 703-234-4149 or on the web at www.therapeutic-touch.org, or the American Holistic Nurses' Association (AHNA), P.O. Box 2130, Flagstaff AZ, 86003-2103, 800-278-AHNA or on the web at www.ahna.org.

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Astin JA, Harkness E, Ernst E. The efficacy of "distant healing": a systematic review of randomized trials. Ann Intern Med. 2000;132:903-910.

Ledwith S. Therapeutic Touch. In: Novey DW, ed. Clinician's Complete Reference to Complementary and Alternative Medicine. St. Louis, Mo: Mosby; 2000:462-471.

O'Mathúna DP. Therapeutic Touch and Wound Healing. In: Micozzi MS, Bacchus AN, eds. The Physician's Guide to Alternative Medicine. Atlanta, Ga: American Health Consultants; 1999:273-276.

Redwood D. Therapeutic Touch. In: Micozzi MS, Bacchus AN, eds. The Physician's Guide to Alternative Medicine. Atlanta, Ga: American Health Consultants; 1999:261-264.

Slater VE. Healing Touch. In: Micozzi MS, ed. Fundamentals of Complementary and Alternative Medicine. New York, NY: Churchill Livingstone Inc.; 1996:121-136.

Tanne JH. Therapeutic touch fails text. BMJ. 1998;316:1037.

Winstead-Fry P, Kijek J. An integrative review and meta-analysis of therapeutic touch research. Alternative Therapies. 1999;5(6):58-67.