The Handshake

Being of Austrian-Jewish extraction, I grew up in a family in which everyone hugs and kisses when we meet. Indeed, in my private life, I would regard myself as a rather physically affectionate person. But in the consulting room, during my working day, I adopt a very different stance. Although I endeavor to be at ease within my body during analytic sessions, I do maintain a certain physical distance from my patients, and I keep myself seated in my leather chair, perched behind the couch. I do so for the obvious reasons. I regard psychotherapy and psychoanalysis as cognitive-affective relationships in which one provides healing through compassion, reliability, and understanding—not through cuddles. Furthermore, I know only too well that the vast majority of my patients, if not all of my patients, will have experienced noxious physical contact during infancy and childhood, and many of them maintain a phobic reaction to actual touch; therefore, like most psychoanalytically inclined mental health professionals, I adopt a hands-off policy in order to refrain from retraumatizing the men and women who come to work with me.

In fact, in more than twenty-five years of practice, I can recall only one instance when I had to touch a patient. Some fifteen years ago, while working in the mental handicap field with clients who had suffered from brain damage, and who would, therefore, often manifest various forms of “challenging behavior,” I received a referral request from a psychiatric colleague to assess a woman afflicted with compulsive head-banging—a most distressing presenting symptom. This lady—also suffering