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 Feeling the Flow
The Energetic Language of Therapeutic Touch
by Shirley Spear Begley, R.N., H.N.C., N.C.T.M.B.
Cover Story Massage Magazine,
 Jan/Feb 1999 

Back To The Roots Of Nursing: The Holistic Approach

by Shirley Spear Begley, R.N., H.N.C., N.C.T.M.B.
Vital Signs Magazine, 1998

A Rich and Varied Journey
by Shirley Spear Begley, R.N., H.N.C., N.C.T.M.B.
Vital Signs Magazine, 1998

Intrepid Explorer
Nurse tours the Galapagos Islands, discovers beauty and realizes a dream
by Shirley Spear Begley, RN, BFA, HNB-BC, NCTMB, CCHT, QTTT  
Advance for Nurses

Therapeutic Touch

Therapeutic Touch - the intentionally directed process of energy exchange that utilizes the hands to facilitate healing - brings together the art & science of nursing
by Shirley Spear Begley, BFA, RN, HNC, NCTMB
Advance for Nurses, 2002

Galapagos Island Adventure
by Shirley & Tom Begley

For Other Publications by Shirley Spear Begley, please contact the author or go to:  "Therapeutic Touch," Advance for Nurse Practitioners, 2002
"Tibetan Buddhist Medicine: A Transcultural Nursing Experience," The Journal of Holistic Nursing, 1994






Feeling the Flow
The Energetic Language of Therapeutic Touch
by Shirley Spear Begley, R.N., H.N.C., N.C.T.M.B.
Cover Story Massage Magazine, Jan/Feb 1999 



In the summer of 1982, when I wasn’t yet doing the work I love, I found myself up against one of those continuing education deadlines for license renewal. I was living in Nevada City, a small town in northeastern California, where my options for interesting continuing education courses were limited. But one day I saw a flyer for a course that had to do with the power of touch. Feeling adventurous, I registered for it.

On the morning of the course I joined 20 other inquisitive people at the local hospital. I actually thought the course was going to be about a form of acupressure with "touch" in its name, a technique I had heard about from a friend who was a massage therapist in another state. But when the instructor, an operating room nurse, began her presentation, I quickly realized my confusion. This course was not what I had expected, but was on a method called Therapeutic Touch.

When a volunteer for demonstration purposes was asked for, I was unprepared for what I was about to observe. The nurse began to move her hands gently in the air a couple of inches above the man’s body. I was intrigued, and wondered, "What could she possibly do without touching him?" I felt skeptical, yet as I watched I saw a perceptible shift in the man’s breathing. His color brightened slightly and he sighed a deep breath of relaxation. The nurse continued with her assessment, slowly scanning his body in the energy field around him, and before long stated that she felt energy imbalances in certain areas of his body. Asking if he could confirm this in any way, he answered that he definitely had minor medical problems in all of the areas she had noted. An audible murmur rippled through the room as we onlookers marveled at the nurse’s accuracy. As the volunteer moved to sit down, seeming very much at ease, he spoke to me, perhaps in response to my quizzical look, saying, "It’s so relaxing, you ought to try it!"

I continued to listen as the instructor spoke of the human energy system and our ability to consciously direct energy flows within people to help them heal themselves. The instructor was a gentle spirit, yet spoke clearly and directly as she told us how the use of Therapeutic Touch, often called "TT," had grown in their hospital. It had gained popularity when the backaches that surgeons developed after long hours in surgery were alleviated by her use of Therapeutic Touch. When she was consistently able to relieve their pain and discomfort, the physicians began to recognize the potential benefits of this method for their patients, and suggested she visit patients during their hospital stays to offer Therapeutic Touch both before and after surgery.

The teacher reminded us that the purpose of Therapeutic Touch is to help others, and that this positive intention and an attitude of caring and compassion are important keys to the inner workings of Therapeutic Touch’s effectiveness. The class continued with more instruction and theory as we made initial attempts in the exploration of this method. We attempted to sense the cues that the instructor told us guided her in knowing where the man’s discomforts originated. She assured us that this was only an introduction to this remarkable form of healing, and that our skills would improve with practice.

On the way home I stopped at one of my favorite spots, where a beautiful stream feeds a deep, clear pool. I sat in thought, watching the water’s flow and absorbing the day’s events. Therapeutic Touch completely fascinated yet mystified me. Although I had witnessed its effects, still it was challenging to understand. "Keep your skeptical nature," our teacher had instructed. "Don’t believe it until you see evidence of its usefulness. Just keep practicing, and in time you may become convinced."

When I arrived home, I shared the day’s events with my sister-in-law, who listened intently. She had a backache, she said, and wanted me to show her what I’d learned. Although a novice and very unsure of myself, I tentatively began working on her back as she lay fully clothed on the bed. Setting all thoughts aside as best I could, I centered my awareness on the memory of the beautiful stream, seeking a sense of peacefulness within. Focusing on the sensations I perceived in the palms of my hands, I attempted to determine the energy imbalances that could account for her backache. I wasn’t sure I knew how to interpret what I was feeling. Nevertheless, before long I noticed her breathing had changed and she seemed to be asleep. I continued working quietly from her head down.

When I reached her feet, I felt a strong sensation in the palm of my right hand each time I passed it over her left heel. I couldn’t examine her foot, because she had socks on—and I didn’t want to disturb her rest. Yet each time I moved my hand over that area a sharp sensation seemed to come from the center of the palm of my hand. Remembering my instructions earlier in the day, I took a deep breath and recentered myself, thinking peaceful thoughts and re-establishing my intention to help my sister-in-law feel better. I kept returning to the area, moving my hand over it in the way I had been instructed earlier in the day. Soon the sensation subsided. I continued to balance the energy around her entire body. Remembering the teacher’s admonition that "less is more," I continued the session only until I felt evenness in the energy field. The session lasted about 20 minutes.

Puzzled by my experience, I sat quietly in the dim light, thinking about this incredibly different day. It didn’t fit within my framework or the information I knew about health care, nursing or bodywork. Yet I felt oddly at peace and simultaneously excited by the implications of what I’d experienced. My sister-in-law stirred and stretched. "Gee, that must be pretty amazing stuff," she said to me. "My back seems to feel better already."

"I’m glad," I said. Then, almost at a loss for words, I continued. "But the strangest thing was happening with your foot." I related my experience. She looked at me sheepishly and said, "Well I wasn’t going to tell you because I knew you’d get after me, but I cut my foot a few days ago and didn’t clean it out right away … and now it’s infected." She peeled off her sock and I saw that an area on her heel was indeed cut and reddened with infection. The next day, to both of our surprise, it was decidedly better, paler in color with the edges of the skin more intact. That must have been the hook for me, for Therapeutic Touch has since become a major part of my work as a holistic practitioner, nursing consultant, educator, massage therapist and bodyworker.

Since those days almost 17 years ago, Therapeutic Touch has continued to fascinate me with its incredible breadth of clinical application and benefit to others. After many years of practicing this method as an adjunctive therapy in both nursing and bodywork, I am thoroughly convinced of its usefulness. When other types of care are contraindicated or simply aren’t providing the necessary relief, energetic forms of healing, like Therapeutic Touch, can be wonderfully advantageous.

Exploring the human energy field

For centuries various cultures have referred to human energy as chi (Chinese), prana (Hindu), ka (Egyptian), lung (Tibetan), and mana (Hawaiian). Further, many Asian movement theories like qi gong, tai chi, yoga and meditation work with life-force energy. Many cultures have very detailed and exacting methods for the promotion of healing utilizing this energy.

Therapeutic Touch is considered a contemporary interpretation of ancient energy-based healing practices. It is an intentionally directed process of energy exchange that utilizes the hands to facilitate healing. Therapeutic Touch was developed specifically for use by health care professionals as an extension of their professional skills. It grew out of the observations of Dolores Krieger, Ph.D., R.N., professor emeritus from New York University (NYU), and her mentor, Dora Van Gelder Kunz, a natural healer, while they explored the relationship between laying-on of hands and the healing process. In 1972, at the same time they began to realize that bioenergetic healing was a natural potential that can be learned and actualized under appropriate circumstances, Krieger began teaching Therapeutic Touch to nurses in the master’s program at NYU, in a class called "Frontiers in Nursing."

Now, 27 years later, Therapeutic Touch is taught in hundreds of settings, including medical centers, universities and schools of massage therapy, and in more than 75 countries abroad. Renee Weber, the renowned philosophy professor at Rutgers University, has stated that this phenomenon of TT is the first time in recorded history that healing has been taught consistently within formal academic settings. Therapeutic Touch has been called the clinical application of The Science of Unitary Human Beings, the nursing theory of Martha Rogers, Ph.D., R.N. Highly regarded as one of the foremost nursing theorists of our time, Rogers was the former dean of the Division of Nursing at NYU. Rogers’ work expands upon the ideas that each man is a unified whole, possesses his own integrity and is an energy field in constant exchange with his environment. Quantum Mechanics, a branch of physics; Einstein’s Theory of Relativity; as well as Kunz’s Human Energy Field Model are all theoretical frameworks supporting Therapeutic Touch. Richard Gerber, M.D., in his book Vibrational Medicine, New Choices for Healing Ourselves, states, "We are in the midst of a massive paradigm shift from the older mechanistic world view of Newtonian pragmatists to the new perspective of an interconnected holistic universe as envisioned by the Einsteinian thinkers." The Einsteinian paradigm as seen in energetic healing views human beings as networks of complex energy fields that interface with physical systems. Gerber continues, "The recognition that all matter is energy forms the foundation for the understanding how human beings can be considered dynamic energetic systems."

The effects of Therapeutic Touch

Therapeutic Touch is considered a scientifically based intervention, primarily because of the large body of research credited with verifying its effectiveness. Research has validated the benefits of Therapeutic Touch in pain management, dermal wound healing, increases in hemoglobin levels, decreases in anxiety and stress levels in several different populations, childbirth, spousal relationships, psychoimmunologic effects on practitioners and those who are bereaved, to name a few. Studies recently completed at the University of Alabama’s (UAB) Center for Nursing Research indicate the positive effect of Therapeutic Touch on stress reduction1 and immune function in persons with AIDS.2 Another UAB study funded by the U.S. Department of Defense has shown the positive benefits of Therapeutic Touch on pain and anxiety in burn patients.3 Yet another recent study completed at UAB suggests that Therapeutic Touch is also beneficial to those experiencing grief over the loss of a loved one.4 Therapeutic Touch is regularly used along the entire life continuum, from premature newborns in hospitals to people receiving hospice care. In the view of holism, caring and healing are different from curing and even a person facing terminal illness or death may come to a state of wholeness.

As it is known that newborn infants, anesthetized patients and persons in comas can be benefited by TT, belief in it is not a prerequisite to its success. Although one’s belief system and the placebo effect are important factors that can contribute to the process of healing, these cannot be solely responsible for the benefits of TT. Therapeutic Touch seems to mobilize the individual’s own healing energies to restore health, balance and order and creates a feeling of integration and equilibrium.

The theory behind the technique

Therapeutic Touch relies on four basic assumptions as working hypotheses5: 1) Humans are open, complex and pandimensional energy systems (Rogers); 2) In a state of health, life energy flows freely through the organism in a balanced, symmetrical manner (Kunz); 3) Human beings are capable of both transformation and transcendence (Krieger); and 4) Healing is an intrinsic movement toward order that occurs in living organisms and can be facilitated by practitioners. Life energy follows the intent to heal (Kunz).

The first assumption—that humans are open, complex and pandimensional energy systems—can most easily be understood by the simple expression, "We (energy systems) do not stop at our skin." Just as the bioelectricity of the heart’s activity can be measured with electrocardiograms (EKGs) by placing nodes on the skin, and electroencephalograms (EEGs) measure brain waves, the body’s electrical activity, or energetic field, is not solely contained within the confines of our physical body (as yet, however, an accurate method of measurement of the human energetic field that radiates outside the body has not been found6).

The second assumption—that in a state of health, life energy flows freely through the organism in a balanced, symmetrical manner—relates to Kunz’s model of the human energy field: Just as the body is anatomically bilaterally symmetrical, the energy field in health can also be assumed to be bilaterally symmetrical. In a healthy state the field is often perceived as rhythmical, flowing and ordered. In a diseased state the energy field can be perceived as imbalanced, disharmonious or disordered, which the practitioner feels as a variety of cues and changes in the field’s pattern. The most common cues sensed by students of Therapeutic Touch are heat, coolness, tingling, and pulling or drawing sensations, although cues seem to vary widely with individual perception.

Experienced practitioners begin to build a repertoire of understanding what specific cues mean.

The third assumption is based on Krieger’s hypothesis that human beings are capable of both transformation and transcendence, with the natural ability to transcend their ordinary conditions of living—the awareness of which leads one to the opportunity for personal growth, which in turn leads to healing and wholeness.

The fourth assumption—that healing is an intrinsic movement toward order that occurs in living organisms and can be facilitated by practitioners, is based, Kunz explains, on the concepts that the universe is organized, orderly and whole, and healing is an intrinsic movement toward that order. Healing can be seen as an innate capacity to become whole7 that implies order and integrity. Thus, the Therapeutic Touch practitioner learns to guide the energy flow in support of the universal order that is considered an innate force in all energy fields, in a movement toward wholeness.

In her latest book, Therapeutic Touch Inner Workbook, published in 1997, Krieger states that the practitioner can be viewed as "a human support system guiding and repatterning the recipient’s weakened and disrupted vital energy flow to increase their immunological system. TT seems to stimulate the system so that recovery is strengthened and reinforced." With experience, a practitioner can begin to access the client’s energetically distinct patterns that are not only physical, but psychological and behavioral in nature.

Centering, compassion and intent

Healing through Therapeutic Touch has been called, by Krieger, a "humanization of energy" as well as a form of sensitivity training to perceive the patterns embedded in the vital energy field. Further, living systems are self-organizing, dynamic wholes in continuous interchange with the environment; therefore, the principles of holism must be considered when discussing Therapeutic Touch. In Therapeutic Touch practice, one adopts a holographic attitude that views the client as a doorway to the whole of humanity. One’s intention, then, is key to the proper attitude and outcome of this practice.

Recently, a student of mine asked what differentiates Therapeutic Touch from other types of bodywork. She said that as a massage therapist she works in the client’s energy field all the time—so what was different about Therapeutic Touch? The answer to that question is based in one of the foundational concepts of Therapeutic Touch: the practitioner’s ability to center, place his or her intention in the compassionate interest of another and remain on center throughout the Therapeutic Touch interaction.

Consciousness itself can be viewed as a form of energy, integrally involved with all life processes. The power of the Therapeutic Touch interaction comes from the practice of centering one’s consciousness and having the strong intention of helping or healing the person in need. Without these two components, the ability to balance the energy field is limited. Intentionality is considered by Krieger to be the "necessary mindfield factor" of Therapeutic Touch. In the Therapeutic Touch Inner Workbook, she states, "Logic suggests that TT is being done as a conscious, mindful act based on a person’s knowledge of the therapeutic functions of the human vital energy field. It is the mind that directs the flow of energy, dynamically driven by intentionality." The Therapeutic Touch practitioner consciously directs the process toward health for the recipient.

It is here we see the interplay of centering—maintaining one’s mind in a state of peace—with intentionality and resonancy. Resonancy is one aspect of Rogers’ theory, The Science of Unitary Human Beings. When individuals are in resonance, it is suggested that the healer’s inner self speaks to the higher orders of the client’s inner self. Rogers has suggested that our interactions with others depend on our interactions within ourselves; therefore, the process of centering one’s mind in a place of peace and calmness not only benefits one’s perception of patterns, but sends messages that encourage the relaxation response8 within another as well.

"Therapeutic Touch creates a sacred space in which I practice massage," said Lucy Klein-Gebbinck, L.M.T., former coordinator of the St. Petersburg Free Clinics’ Wellness Program. "The more experienced I become in Therapeutic Touch, the more I utilize it in my [massage] work because it’s so effective.

"Also, I seem to benefit enormously," Klein-Gebbinck continued. "I don’t seem to get so tired in my work. I guess that’s because the energy moves through me too, balancing my system."

Therapeutic Touch practitioners note a mutual process of healing that seems to occur from working out of this larger context of universal order. Many practitioners state they have never been healthier than since they incorporated Therapeutic Touch into their practices. And the very act of centering can lead one to an inner awareness and growth.

The four phases of Therapeutic Touch

There are four phases to the Therapeutic Touch process: centering, assessment, balancing and reassessment. Once centered, the Therapeutic Touch practitioner scans the client’s energetic field to assess it by perceiving cues. Knowing how to work with the cues to bring about balance within the field is the art and science of Therapeutic Touch.

Modulating (tempering energy outflow to meet the needs of the client), directing (transferring energy between the therapist and client, or from one area of the client’s body to another), unruffling (clearing the energy field so that it flows smoothly), the law of opposites (rebalancing the energy field by projecting the opposite of the cues perceived) and a number of other skills are utilized to bring harmony and order into the client’s energy field. The use of color, sound and other modalities like visualization or guided imagery can be combined with Therapeutic Touch to enhance relaxation and the mind-body connection, and lead one toward wholeness. The final phase of reassessing the field assists one in determining if the work has brought about the desired result. The phases are not always practiced in a linear fashion, but become part of weaving a web of centering, assessing and balancing. Although one can learn the phases of Therapeutic Touch quite readily, most practitioners recognize that one’s ability to effect a consistently beneficial outcome is developed over years of practice.

It is generally easier for beginning Thera-peutic Touch practitioners to assess the energy field without contacting the skin, thereby avoiding the confounding factors of skin temperature and the sensation of physical touch that can interfere with the ability to perceive the more subtle energy field cues. Some students who are also seasoned massage therapists report, however, that they are able to touch the body and feel the energy field at the same time, thereby assessing the muscles and energetic cues simultaneously. As one’s ability to remain centered deepens, cues in the form of intuitive hunches and insights become more common, allowing the therapist to begin to have more awareness of the factors that are causative in the person’s illness.

Incorporating Therapeutic Touch into a massage session

The benefits of Therapeutic Touch are numerous. Benefits most readily experienced by recipients are the promotion of relaxation and lessening of anxiety and stress-related illnesses. Blood pressure and heart rate are lowered. Therapeutic Touch can also significantly ameliorate or eradicate the perception of pain. Even if this were all that Therapeutic Touch offered, it would be a beneficial, additional skill for massage therapists.

Several years ago I was discussing Therapeutic Touch with the owner of a massage therapy school where I was to teach a continuing education course. I asked where she had learned about Therapeutic Touch. "Seven years ago I was in a serious car accident," she began. "I was hospitalized for quite some time. I was so bruised and tender, no one could get near me to do massage. A nurse offered Therapeutic Touch and it provided me with such relief that I’ve never forgotten how much it helped me. It’s quite amazing, isn’t it? That’s why I want to offer it here."

Over the last 11 years of teaching Therapeutic Touch, many of my students have been licensed massage therapists. After a two-day beginning course in Therapeutic Touch, they are eligible to begin a series of classes to deepen their understanding and practice of the technique. In ongoing group classes they meet biweekly over a four-month period, in a forum designed for mentoring, supervised practices and an extension of their professional education. Many students continue on for several series, deepening their understanding of this remarkable method.

Many massage therapists have found Therapeutic Touch to be a method that helps them address their clients’ needs without deep-tissue work. Course participants say that massage therapists often begin their careers thinking that the only thing that re-educates muscles is the use of the therapist’s muscles—and participants also said it was wonderful to learn a subtle method to incorporate into their work to provide relief. Students have related many experiences that validate the efficacy of energetic healing through Therapeutic Touch principles either alone or in combination with various massage therapy techniques.

Robert Burgess, L.M.T., of Largo, Florida, has studied Therapeutic Touch extensively and says that it is easily integrated with massage.

"I often use Therapeutic Touch with conditions that might go beyond the realm of massage," Burgess said. "Arthritic hands and knees seem to respond, and clients find good pain relief. Therapeutic Touch regularly helps clients with sinus conditions, headaches, and necks in pain from stress. Conditions like fibromyalgia, injuries from accidents, and scalene groups that are very sore or hard and knotty with spasms are frequently too painful to massage. Therapeutic Touch seems to facilitate a calmness in the area and a diminishment of pain.

"It may sound funny," Burgess continued, "but it seems to help the area become peaceful so that it is finally receptive to massage. As I begin to work I have patients pay attention to their bodies, and as the session ends [I have them] reassess how they feel. People see a difference before and after, even when Therapeutic Touch is used by itself."

Shari Hinkle, a Therapeutic Touch practitioner and massage therapist in Oldsmar, Florida, always assesses a client’s energy using Therapeutic Touch before she starts a massage.

"If I pick up strong cues, I’ll specifically ask the client about the area," Hinkle said. "Often they will be unaware of any problems in the area, yet later when I get back to that place to massage they’ll say, ‘Hey, that is sore. How did you know that?’ Some clients respond so well to it, I use half massage and half Therapeutic Touch in their sessions. I’ve found patients with chronic back pain get relief with Therapeutic Touch not found with massage. Therapeutic Touch helps me treat the person as a whole, incorporating everything into their sessions and working beyond the physical."

When asked why she utilizes energetic modalities including Therapeutic Touch in conjunction with massage, Mary Thornton, L.M.T., who is in private practice in Hartville, Ohio, explained her choice by using a metaphor understandable to bodyworkers: "For me, using primarily soft-tissue manipulation is similar to working only with a client’s problem area, rather than with them as a whole person."

For example, Thornton said, "Clients often come in wanting massage on only the area where their pain is, let’s say, only [on] their necks. Not realizing the neck works in conjunction with many other aspects of the body, I educate them of the need to massage the whole body. In the same way, by breathing and centering myself and helping my clients do the same, I feel I am better able to help them bring balance to their minds and spirits, as well as their bodies. In balancing the client’s energy field, I am helping them to become more whole."

Thornton believes that helping clients learn of the mind-body connection as an important piece of attaining wellness is one of her roles. "Energy work through Therapeutic Touch helps me remember my innate wholeness and that of my clients, setting the stage for the accomplishment of our goal—total wellness."

The evolution of medicine

This view of holism is in direct contrast to the one reinforced until recently in our current health care settings. Holism can be seen as a way of viewing patterns and processes that combine to form wholes, instead of seeing things as parts or fragments. For centuries, Western culture’s primary approach to illness and disease has been based on the views of 17th-century French philosopher and mathematician René Descartes, whose view was that human beings are composed of mind and body, two separate entities that for the most part do not interact.

This mind-body split, known as Cartesian dualism, was given as evidence that disease was to be relegated to bodily processes. This is the primary basis of current scientific and medical approaches that segment people into systems—muscular, cardiac, orthopedic, etc.—rather than viewing a person as a unified whole, including not only the interplay of all physical systems, but also mind and spirit.

Western medicine is also based on the Newtonian model of reality, which views the world and all in it as intricate mechanisms. In contrast to this reductionistic model, a holistic hypothesis postulates that the primary cause of disease is disconnection from the flow and rhythm of the whole. Proponents of holistic thought state that true healing cannot occur within Sir Isaac Newton’s reductionistic framework.

In his book Healing Words, author Larry Dossey, M.D., delineates three eras of medicine. Briefly stated, the above tendency to separate mind and body falls into the category of Era I, or physical medicine. Era II medicine, or mind-body medicine, allows for the mind as a major factor in healing and includes therapies that effect consciousness within a person. Era III medicine is considered transpersonal medicine, where mind is a factor both within and between persons. Dossey suggests that noncontact Therapeutic Touch, utilizing interactions within the energy field, may fall within the realm of transpersonal medicine.

In recent years more physicians have become interested in Therapeutic Touch. Two years ago I was contacted by a board-certified psychiatrist, Renee Haney, M.D., who had been in a serious automobile accident that had shattered bones in her wrist. Although successful surgery to stabilize her wrist had been followed by two months of physical therapy, she still had minimal use of one hand and considerable pain. A mutual colleague who knew of my work with Therapeutic Touch referred her to me. After one session of Therapeutic Touch Haney returned for her usual physical therapy. Her physical therapist found that her range of motion had increased significantly in all six ranges of flexion and extension, pronation and supination, and ulnar and radial deviation. Resistance and number of repetitions were also measured by computer and showed a definite increase in work output from her previous physical therapy session.

Haney said her therapist asked, "‘What have you been doing differently?’

"Only Therapeutic Touch," she told him.

Intrigued by Therapeutic Touch, Haney continued with twice-weekly sessions. She made remarkable progress and now has a fully functional wrist and hand. Haney said she had also felt an emotional impact from the trauma of the accident and found Therapeutic Touch helped her move beyond the upsetting feelings of her accident and injury.

"Even after the pain diminished, I kept coming for Therapeutic Touch, as I found it exceedingly relaxing," she said. So convinced of its benefits, she added, "I continue to refer patients to [Therapeutic Touch] regularly. We have seen consistently beneficial results with patients having a variety of conditions, both physical and emotional in origin."

Becoming a Therapeutic Touch practitioner

To become a practitioner of Therapeutic Touch, "self-discipline and having a strong intention to help the person [are] very important," according to Dora Kunz, co-creator of Therapeutic Touch. (Kunz is now in her 90s and still practices and teaches the technique.)

"Many people want to be healers without studying," Kunz continued. "Therapeutic Touch is like many other things ... one must study and practice to become adept."

Other optimal attributes of a Therapeutic Touch practitioner are compassionate nonattachment, a sense of well-being and nonjudgment.

"What we must do is help the ill person move beyond resistance and resentment," Kunz stated. "I think you ... can do that with Therapeutic Touch. Remember though, the outcome is not in our hands. We do the best we can, then that’s enough."

Learning the basics of Therapeutic Touch can be done in about 12 hours. During this time, one learns the foundational concepts underlying the practice, as well as the philosophy and phases of the method at a beginner’s level of competence. There are also intermediate, transitional and advanced courses offered. Most effective to deepening the practice of Therapeutic Touch is to be mentored by an advanced practitioner/educator. As personal knowledge comes with experience, and experience with practice, it is useful in one’s development as a Therapeutic Touch practitioner to have a mentor. Confidence and experience gained through supervision, demonstrations and feedback encourages a deeper understanding of this work.

Nurse Healers-Professional Associates International, Inc., The Official Organization of Therapeutic Touchsm (NH-PAI) is an international network for those interested in Therapeutic Touch and healing, established by Dolores Krieger in 1977. Contrary to the first word in its name, one does not have to be a nurse to join NH-PAI. The network is a voluntary, not-for-profit organization and the principle clearinghouse for information about Therapeutic Touch. Facilitating the exchange of research findings, teaching strategies and new developments in healing, its mission is "to lead, inspire and advance Therapeutic Touch, other healing modalities and healing lifeways for the world community." Besides developing the curriculum for Therapeutic Touch courses, NH-PAI educators provide ongoing groups, practicum sessions, intensive retreats, satellite chapter meetings and support groups, as well as annual and international conferences.

Qualified Therapeutic Touch practitioners have completed specific courses and an approximately one-year mentorship. Educational guidelines, curricula, position statements, the scope of practice statement, and policies and procedures are available to members of NH-PAI. The organization’s Therapeutic Touch Teacher’s Cooperative maintains excellence in teaching, and recognizes and refers qualified educators.

The wave of the present

As we come to a fuller understanding of human functions in terms of complex energetic models, Therapeutic Touch seems to be not only the wave of the future but of the present. National radio and television, as well as many forms of print media, continue to report on the widespread effects of Therapeutic Touch and its utilization in numerous well-respected institutions.9

The number of grants and research on Therapeutic Touch are growing, and Therapeutic Touch is being taught in many schools of massage therapy. And as many types of complementary therapies are integrated into mainstream health care, we are seeing an attendant growing awareness of looking not only at the symptoms of disease but also at causative factors.

The keys to health are often found in the patterns of one’s personality, behavior and lifestyle. Therapeutic Touch helps us more readily recognize these interconnected patterns, assisting in their illumination in a movement toward wholeness.

In 1988 Richard Gerber stated, "Subtle energy medicine does contain solutions to many of the problems that orthodox treatment methods cannot hope to correct. Vibrational medicine is revolutionary in both its theory and its methods of application. It is a healing system whose time has finally come." Now, 11 years later as the new millennium approaches, an opportunity to enhance the growth of wisdom within the world community becomes imperative to the betterment of ourselves, our interactions with others and our cultures. Therapeutic Touch, like a clear stream, gently encourages us to flow in understanding toward the deepening pool of consciousness. With this expansive, holistic view, the effects of Therapeutic Touch may well be felt far beyond the surface of the human skin.


1. Gerrard, Claire. Doctoral dissertation, 1995, University of Alabama, Birmingham, Alabama.

2. ibid.

3. Turner, Clark; Gauthier, Williams. "The Effect of Therapeutic Touch on Pain and Anxiety in Burn Patients," July 1998, Journal of Advanced Nursing, Vol. 28-1, p. 10-20. (See Massage Magazine, Table Talk, Issue #74, July/Aug. 1998).

4. Robinson, Sue. Doctoral dissertation, 1996, University of Alabama, Birmingham, Alabama.

5. As outlined in the Nurse Healers-Professional Associates, Inc.’s (NH-PAI) Therapeutic Touch Teaching Guidelines.

6. Early research in field theory postulated that all living systems are fields of vibrating energy, and that the field exchanges information with the universe, stated by Patricia Rose Heidt, Ph.D., R.N., (Burr, 1972; Margenau, 1962; Tiller, 1977) in "Openness: A Qualitative Analysis of Nurses’ and Patients’ Experiences with Therapeutic Touch," 1990, Image: Journal of Nursing Scholarship.

7. The root of the word healing is the Anglo-Saxon haelen, meaning whole.

8. The term "relaxation response" was coined by Herbert Benson, M.D., a Harvard cardiologist and founder of the Mind/Body Medical Institute at Beth Israel Deaconess Medical Center and Harvard Medical School. The relaxation response is the opposite of the fight-or-flight response, the body’s reaction to stress. Benson’s work, detailed in his book, The Relaxation Response (William Morrow, 1975), found correlations between the relaxation response and lowered rates of metabolism, lowered blood pressure, breathing and heart rates, the body’s oxygen consumption, brain wave patterns and various chemical changes. Therapeutic Touch is known from research to quickly (usually within two to four minutes) elicit the relaxation response.

9. In its April 1, 1998, issue, the Journal of the American Medical Association published an abstract of research titled "A Close Look at Therapeutic Touch," in which researchers (including the 9-year-old who was the research designer) concluded that the human energy field does not exist. The research has been publicly refuted by Krieger and others as flawed (see Massage Magazine, Table Talk, "AMA-published study claims to debunk Therapeutic Touch," Issue #74, July/August 1998; and Public Policy Issues, "Research Methodology Challenged: AMA Journal Claims to Discredit Therapeutic Touch," Issue #75, Sept./Oct. 1998).


Clark, Ann, Ph.D., R.N., Interview with the author, September 1997, Center for Nursing Research, University of Alabama at Birmingham, Birmingham, Alabama.

Dossey, Larry, M.D. Healing Words: The Power of Prayer and the Practice of Medicine, 1993, Harper San Francisco, San Francisco, California.

Gerber, Richard, M.D. Vibrational Medicine: New Choices for Healing Ourselves, 1988, Bear and Company, Santa Fe, New Mexico.

Krieger, Dolores, Ph.D., R.N. Therapeutic Touch Inner Workbook, 1997, Bear and Company, Santa Fe, New Mexico.

Krieger, Dolores. Accepting Your Power to Heal—The Personal Practice of Therapeutic Touch, 1993, Bear & Company, Santa Fe, New Mexico.

Macrae, Janet. Therapeutic Touch: A Practical Guide, 1987, Alfred Knopf Publishing, New York, New York.

NH-PAI. Therapeutic Touch Teacher’s Guidelines: Beginner’s Level, Krieger/Kunz Method, 1992, NH-PAI, Allison Park, Pennsylvania.

For more information about Therapeutic Touch or NH-PAI membership, contact Nurse HealersProfessional Associates International, Inc., The Official Organization of Therapeutic Touchsm, 1211 Locust St., Philadelphia, PA 19107 (215) 545-8079.

Shirley Spear Begley, R.N., H.N.C., N.C.T.M.B., is an international speaker and advanced educator of Therapeutic Touch and other complementary health care methods. She holds national certification in holistic nursing, therapeutic massage and bodywork, education and clinical hypnotherapy, among others. Having been mentored by Dolores Krieger and Dora Kunz, she is recognized by the NH-PAI Therapeutic Touch Teachers Cooperative. She has practiced and taught Therapeutic Touch for 17 years. She lives in St. Petersburg, Florida, and may be contacted at (727) 367-3063, or via e-mail:



More Resources

These are just a few of the research studies and articles written about the effects of Therapeutic Touch:

•"Application of Nonpharmacologic Methods of Managing Chronic Pain." Owens, M.; Ehrenreich, D. Holistic Nursing Practice, 6(1) 32-40, 1991.

•"The Use of Therapeutic Touch in the Management of Pain." Wright, S. Nursing Clinics of North America, 22(3), 705-714, 1987.

•"Effects of Therapeutic Touch on Tension Headache Pain." Keller, E.; Bzdek, V.M. Nursing Research, 35(2), 101-106, 1986.

•"Cancer Patients Receiving Narcotic Agents." Ayers, L.L. Thesis (M.S.), Virginia Commonwealth University, School of Nursing, 1983.

• "Full Thickness Dermal Wounds Treated with Non-Contact Therapeutic Touch: A Replication and Extension." Wirth, D.P.; Richardson, J.T.; Eidelman, W.S.; O’Malley, A.C. Complementary Therapies in Medicine, 1(3), 127-132, 1993.

• "Therapeutic Touch with Adolescent Psychiatric Patients." Hughes, P.P.; Meize-Grochowski, R.; Harris, C.N.D. Journal of Holistic Nursing, 14(1), 6-23, 1996.

• "Effects of Therapeutic Touch on Anxiety Level of Hospitalized Patients." Heidt, P., Nursing Research, 30(1) 32-37, 1981.

• "Effectiveness of Therapeutic Touch on the Quality of Sleep in Elderly Residents in Assisted Living Facility." Brockman, J.A. Thesis (M.S. in Nursing), Gerontological Nurse Practitioner, University of Wisconsin-Oshkosh, 1996.

• "The Effectiveness of Therapeutic Touch in Elders with Degenerative Arthritis." Peck, S.D.E. Journal of Holistic Nursing, 15(2), 176-198, 1997.

• "Therapeutic Touch and Mastectomy: A Case Study." Ledwith, S.P. R.N., 58(7), 51-53, 1995.

• "Therapeutic Touch and the Terminally Ill: Healing Power Through the Hands." Snyder, J.R. American Journal of Hospice & Palliative Care, 14(2), 83-87, 1997.

• "Psychoimmunologic Effects of Therapeutic Touch on Practitioners and Recently Bereaved Recipients: A Pilot Study." Quinn, J.F.; Strelkauskas, A.J. Advances in Nursing Science, 15(4), 13-26, 1993.

• "The Effect of Therapeutic Touch on Stress Reduction and Immune Function in Persons with AIDS." Garrard, C.T. Doctoral dissertation, University of Alabama at Birmingham, 1995.

• "Therapeutic Touch—Case Study: The Application, Documentation and Outcome." Mills, A. Complementary Therapies in Medicine. 4(2), 127-132, April 1996.

• "Nurses’ Perceptions of Energy Field Patterns During the Assessment Phase of Therapeutic Touch." Lavoie-Vaughan, N. Thesis (M.S.), Florida State University, 1996.

• "Solid Objects are Not Solid: And Other Ruminiations on Atoms, Energy, and Therapeutic Presence." Davis, C.M., P.T. Magazine of Physical Therapy, 2(9), 61-65, 1994.

• "Rogerian Science, Phantoms, and Therapeutic Touch: Exploring Potentials." Bily, F.C. Nursing Science Quarterly, 9(4), 165-169, 1995.

• "Therapeutic Touch: Two Decades of Research, Teaching and Clinical Practice." Krieger, D. Inprint, 37(3), 83, 86-8, Sept.-Oct., 1990.

• "Searching for Evidence of Physiological Change." Krieger, D.; Peper, E.; Ancoli, S. American Journal of Nursing, 79(4), 660-662, 1979.

• "The State of Research on the Effects of Therapeutic Touch." Easter, A. Journal of Holistic Nursing, 15(2), 158-175, 1997.

Source: Nurse Healers-Professional Associates International, Inc.,

The Official Organization of Therapeutic Touchsm

This article originally appeared in Massage Magazine (Issue #77, Jan/Feb 1999)

Not for Resale. To be used for Educational Purposes Only. Author's permission required for multiple duplications of the article. Reprinted by permission of Massage Magazine.



Back To The Roots Of Nursing: The Holistic Approach
By Shirley Spear Begley, R.N.
Vital Signs Magazine, 1998

In 1859, Florence Nightingale advised: "Nature alone cures … and what nursing has to do is put the patient in the best condition for nature to act upon him."

Nightingale’s directive was to nurse the person, not the disease. With that wisdom in hand, holistic nurses today are returning to the roots of nursing.

Nowhere is this advice better heeded and necessary than in the critical care setting. These demanding and busy units are where highly technological care, often by necessity, takes priority over the needs of the person. The danger is that we, as knowledgeable and skilled nursing professionals, can become so involved with the high-tech needs of the patient, that other needs become secondary and are often overlooked, to the detriment of both nurse and patient.

A fundamental theory of holistic nursing is that when all aspects of a person are considered, the healing process is faster and more complete. The conceptual model of practice includes minimal intervention with appropriate technology complemented by a range of non-invasive techniques. Yet the real key in this area of specialization is the development of the practitioner. The field has become so popular that qualified nurses can now apply for national certification.

Holistic nursing theory views people as whole beings. One definition of holism is "a way of viewing patterns and processes that combine to form wholes, instead of seeing fragments or parts." This person—a unified, whole being—encompasses not only the physical component, but the emotional, psychological and spiritual aspects as well. Often non-physical needs are relegated to the social worker, psychologist, psychiatrist or pastoral counselor. But in the context of holistic nursing, spirituality relates to one’s meaning and purpose in life and is viewed as the "unifying force in one’s life."

Historically, in most hospital settings, nurses have been reluctant to address the spiritual needs of a patient. Primary caregivers—especially in the CCU—well might ask:

"How can we as nurses not participate in this aspect of our patients’ healing processes?" This question is ripe for the asking, and for three years Harvard Medical School has held conferences in spirituality and healing to show health care professionals how these two elements work together.

Holistic nursing also emphasizes human values. Understanding a patient’s personal philosophy beyond the religion listed on the chart allows a nurse to assist the patient more readily in restoring the integrity of his or her view of the world. Furthermore, nurses can touch patients in a way that assists them in remembering and recognizing their innate wholeness—an integral view for healing.

"We are to befriend life…we are gardeners of men’s souls," says Rachel Naomi Remens, M.D., assistant clinical professor at the University of California San Francisco School of Medicine. "Nurturing, supporting, being fully present to and for them," is how to do it, she says.

Nurses have a foundation already for this type of care in Jean Watson’s well-known theory of human caring in nursing. Her 10 carative factors encourage an attitude of caring as opposed to one of only curing. 

In holistic nursing, caring is seen as a necessary component of healing. This means our job as nurses is to combine our scientific knowledge with the art of nursing to meet all the needs of the person through curative measures.

How do we do this? Many aspects of care indeed are common sense and not new to our philosophy of nursing. But in the heat of battle, with too many patients and too many demands as CCU nurses, many of us have a tendency to disregard or forget about them.

"Nature alone cures . . . and what nursing has to do is put the patient in the best condition for nature to act upon him."
-Florence Nightengale, 1859


A Rich and Varied Journey
By Shirley Spear Begley

Vital Signs Magazine, 1998

As a registered nurse with an integrated nursing practice that incorporates conventional nursing and complementary therapies within the framework of holistic nursing concepts, I am often asked how I came to this work. During the years between 1975-1978, I had the opportunity to spend extensive time in numerous Third World countries in the southern hemisphere. During these travels, I was exposed to the health care practices of various cultures. In southwestern India I personally spent four days hospitalized for an illness where I was diagnosed and treated by both western trained medical doctors and ayurvedic doctors, who practice the traditional medicine of India. This exposure awakened me to the often ancient and enduring wisdom of cultures much older than our own.

Since that time, more than 20 years ago, my own work as a nurse has expanded from that of a critical care nurse in a large university hospital in the north to Director of Nurses and Director of Community Education in home health care agencies in the west.

Throughout these years, as an adjunct to my work, I continued to study psychology, adult education and group facilitation. Earlier in my career, a personal injury sustained while working as a nurse prompted me to seek help with pain that would curtail the use of pain medications that kept me from being as effective at my work. The only choice given by the doctor was to have surgery. Very reluctantly, I ventured into the world of chiropractic, massage therapy and acupuncture. In time, these methods afforded me an ability to begin recovery. Incorporating yogic postures, imagery and strengthening exercises added to my healing. In addition, learning to pace myself in a very measured manner, rather than going "flat out" as most nurses are prone to do, proved to be enormously beneficial during this time as part of pain management and recovery.

As years passed, many people asked about my travel experiences. What became fascinating to discuss was the idea of benefiting our patients by combining multi-cultural practices and then-called "alternative" methods as a complement to conventional nursing and medicine. In early 1982, I began designing courses that explored the integration of safe, adjunctive methods that could be used in our clinical nursing care. Because they were methods that were to be used "in addition to" (complementary) rather than "instead of" (alternative), continuing education courses in complementary health care for nurses were created. Wanting to emphasize, I didn't intend to "throw the baby out with the bath water!" a seminar series called "Toward an Integrated Approach to Nursing" and my educational organization, Integrated Health Care Systems, was born.

Shortly thereafter, I took a class taught by a nurse in what I thought was a form of acupressure called Touch for Health which was originated by a chiropractor. As the class unfolded, I realized my mistake. I was in an introductory course on Therapeutic Touch (TT), a nursing intervention started at New York University in 1972 by Dolores Krieger, Ph.D., R.N.. I had confused the similar names. The class I attended fascinated me. It was taught by an operating room nurse and endorsed in her hospital because of the physicians whose own aching bodies had benefited by her Therapeutic Touch during and after surgery. The concepts of an energetic system did not seem too foreign to me after my Asian travels, yet that it was incorporated as a western nursing method was new and puzzling. The evening after the Therapeutic Touch class, while exploring TT with a family member, I had an undeniable experience of perceiving the energy field that shocked me into believing there was something to this method. My sister-in-law had asked me to show her what I'd learned and see if it would help her back pain.

While doing the TT assessment and rebalancing phases, each time I passed my hand over her stockinged foot, I felt a strong sensation between the palm of my hand and her foot. As she appeared to be sleeping, I didn't speak about it, yet by the end of the TT session, the sensation had finally dissipated. I was mystified. When she awakened I told her of my discovery and she sheepishly confessed she had cut her foot some days previously and had not taken care of the cut. Peeling off her sock, it appeared reddened and infected. By the next day, however, much to our surprise, the foot appeared to be in a significant stage of healing!

My exploration of Therapeutic Touch continued and now, 15 years later, includes years of direct mentoring by Dr. Dolores Krieger and the inclusion of TT as an important intervention in the work I do in a full time private practice in holistic nursing consultation and education. What began as a foray into my interest in exploring multi-cultural health care practices, has grown into a passion for helping others by incorporating these methods into a nursing framework that includes the caring philosophies of some of the foremost nursing theorists of our time, especially those of Dr. Martha Rogers, Dr. Jean Watson and Dr. Margaret Newman.

During and after my travels, one component of exploration for me was meditation and eastern philosophies and its relationship to contemporary western psychology. The foundation philosophies of eastern thought that recognize that an expansion of consciousness can lead to improved health and wellbeing are seen in the work of the above theorists, especially Newman's theory of Health as Expanding Consciousness.

Advanced education and state certification in clinical hypnotherapy enhanced my awareness of the benefits of guided imagery practices that support, among other conditions, preparation for and recovery from surgery. (Current reports from Columbia Presbyterian Medical Center's "Center for Complementary Medicine," in New York City, where research is being done on including TT, guided imagery, yogic breathing and other methods for many people undergoing cardiac surgery, reveal that patients feel more involved, in control and benefited by the inclusion of these methods.) Board certifications in Holistic Nursing and Therapeutic Massage and Bodywork with a concentration in energetic systems, rounded out my education. Drawing from approaches based on Watson's Science of Human Caring and from Roger's Science of Unitary Human Beings, "the humanitarian concern for the well-being of our patients" is woven throughout the foundation of my holistic nursing practice. In holistic nursing, the integration of mind, body and spirit are seen as necessary components of attaining and maintaining health, or assisting in the healing process of those with disease and illness. The patient's relationship to the environment is also considered significant for health and healing to occur. A holistic-minded nurse is also aware of his or her contribution to the shared mutual process that supports the patient in healing. Complementary nursing methods that relate to the further development of one's physical, mental and spiritual growth are seen, for example, in breathing exercises for stress management and improved health, progressive relaxation techniques and guided imagery where the patient uses the power of imagination to attain the desired positive outcome. In private practice, these methods are combined with Therapeutic Touch and our conventional nursing care of assessment, patient education and counseling.

Currently, my work includes teaching the benefits of combining methods, as well as faculty and faculty advisor positions with the National Certification Program in Holistic Nursing.

Because of nursing research, outcomes that verify the effectiveness of Therapeutic Touch (TT) in stress and pain management, enhanced burn and wound healing, pre- and post-operative care, an ability to diminish the side effects of chemotherapy and radiation, as well as its benefits in many acute, chronic and life-threatening illnesses, TT is growing as an extension of professional nursing skills. It is taught in well over 100 universities and medical centers across the United States and in more than 73 countries abroad. Through the international Nurse Healers-Professional Associates, Inc. policies, procedures, standards of care and the exchange of information on Therapeutic Touch and other healing modalities occur. As a holistic nurse educator and consultant, teaching and lecturing nationally and internationally on TT and other

Complementary methods, I have observed in recent years an enormous increase in interest, awareness and participation in seminars among professionals across the health care spectrum.

My growing practice reveals that the public is seeking methods to learn about preventive care and taking more responsibility for their own health through active participation in the healing process. Working in conjunction with and cross-referring to other qualified health care practitioners, my clients range from those with auto-immune disorders and chronic illnesses, including, for example, lupus, arthritis, fibromyalgia, depression and cancer, to those seeking relief from stress and pain from multiple causative factors. My patients range in age from premature neonates to those facing end of life issues. The measurable outcomes exhibited regularly by my patients confirm the value of this type of complementary nursing care.

This work is the fruition of years of explorations that came from asking myself "What if I studied this for a while?" It has lead me to the recognition that if we as nurses are to assist multifaceted people with complex issues and concerns on their journey toward health and healing, we also need to expand our consciousness to include broad philosophies, foundational concepts and complementary methods that meet the needs of our patients with sensitivity, compassion and care. This work has grown out of the many creative endeavors that life has brought my way and I am so grateful for this rich and varied journey.


Intrepid Explorer
Nurse tours the Galapagos Islands, discovers beauty and realizes a dream
By Shirley Spear Begley,
Advance for Nurses


Growing up on a 100-acre farm in northeastern Ohio, I always believed I had ridden up the sidewalk of our family home on the back of a giant land tortoise. This might sound outlandish, but our farm had once hosted a small circus — complete with a big-top tent, elephants, and a finale of a pony express ride and wagon train — to help celebrate the 150th anniversary of our little country village.

I also was a vivid dreamer and the memory of that tortoise ride remains as clear as the circus had been. As I grew older and asked my parents where that giant land tortoise came from, they laughed and said I must have dreamed it, for no giant tortoise had ever graced our farm.

In 1975, my husband and I began plans to visit South America and the Galapagos Islands. We learned they were 600 miles off the west coast of Ecuador, and were only one of two places in the world where those giant land tortoises still roam. Unfortunately, circumstances prevented our trip, and we put our plans on hold.

Thirty years later, that long-awaited dream trip became a reality. Although we wouldn’t be able to ride them, we finally would have the chance to visit those wondrous creatures that live in the wilds of the Galapagos National Park and at the Darwin Research Center, where the Tortoise Dynasty Restoration Program is under way. 

Wildlife & More

We made this amazing journey through an ecology adventure travel company that provides education and passage through the Galapagos on 20-passenger yachts. The nine-member Ecuadorian crew and two knowledgeable naturalists made every effort to provide a comfortable and professional journey of 524 miles between the islands over 7 days, crossing the equator six times. We disembarked from the yacht into “pangas” (12 passenger dinghies) and were ferried to and from the islands.

The archipelago of 13 islands in the Pacific Ocean is renowned for its conservation efforts and ecological measures to preserve the endemic species uniquely found there. Its efforts have been rewarded with a stunning array of wildlife that appears completely unafraid of humans. On walks through the islands, we observed within mere feet of us giant frigate birds in full mating display; red-footed and blue-footed boobies (birds with gorgeous aqua blue and red webbed feet) sitting on eggs or guarding fluffy white chicks; prehistoric land iguanas, giant albatrosses and some of the 13 different finch subspecies, each with a different beak, that scientists learned have adapted to differing foods and conditions on each island.1

While snorkeling, we played games with sea lions, looked in the eyes of giant sea turtles, watched marine iguanas swim (this is the only place in the world where they do), and saw tiny penguins dart through the water or scramble onto rocks. Aquamarine waters and reefs teeming with marine life, hikes to dormant volcanoes with breathtaking views, sunny days, refreshing breezes, and gentle activities on land and sea all added to the natural beauty and wonder of this incredible place, aptly called the “Enchanted Islands.”  


Each day brought a new, amazing adventure. Yet the added wonder of this place is the enormous effort to conserve and protect this outdoor scientific laboratory, while showing the world the need to save the species found there.

The Galapagos National Park covers 97 percent of the islands and is a world model for environmentalism and ecology of both land and sea (a 40-mile perimeter around the islands also is a marine preserve). The Galapagaons have embraced the eco-tourism model of development, and the numbers of boats and visitors are strictly controlled to support ecological integrity and the indigenous people’s rights to control their resources.

The islands’ history reminds us, however, that the Galapagos has faced challenges. Pirates, explorers and whalers discovered the islands and over 4 centuries exploited their rich resources: tortoise meat and oil, fresh water, fur seals, marine and plant life. They also brought non-native plants and animals that grew wild, became serious pests — rats, goats, dogs, etc. — and have led to the extinction of many endemic species. Some of these animals eat tortoise eggs, contributing to the tortoise population’s decimation from 250,000 to its current number of 20,000.2

In 1959, the park was formed to protect the islands, “so the world can delight in the life, beauty and magic that is the Galapagos.”2 The Darwin Research Station was created in 1964 to increase the study and protection of endemic species, and scientific research of its flora and fauna continue to help us understand the mysteries of life on Earth. Eco-tourism is assisting to educate us all with the hopes that it will make a difference in preserving our environment, not only in the Galapagos but worldwide. 

Healthy Environment

Ecopsychology, the concept that restoring the earth’s health is intimately tied to not only our physical but also emotional and mental health, takes us a step closer to creating this deeper awareness.3

Nurse travelers I spoke with said eco-travel has increased their personal sense of well-being and joy, and also raised their awareness of the importance of connecting with others, caring for the Earth and how each of us has a significant part to play in it all.

Barbara Zingg, MSN, RN, CNOR, a clinical nurse specialist at All Children’s Hospital in St Petersburg, describes herself as an “animal and environmental extremist.”

“I am alarmed at the lack of concern for the disappearance of natural habitats and natural resources that is contributing to the decline of animal populations,” Zingg said. “We are all connected and gain strength, health, wellness and comfort from those natural surroundings and inhabitants that continue to disappear.” 

Fresh Perspective

Eco-tourism to the Amazon, Peru and the Galapagos has given Teresa Hoover, BSN, RN, an ARNP candidate at the University of South Florida, in Tampa, a fresh perspective on life and people in general.

“This feeling comes from being immersed in the society of different cultures, rather than locked away in a resort. It has helped me to become a better nurse and more culturally sensitive to all my patients,” Hoover said. “Flying in a small plane over the Amazon forest — reminded me that the very air we breathe comes from the oxygen of the rain forests. The relationship between our ecology and our economy became very clear.”

Respecting the fragile ecosystem that encompasses our world is the overall message of ecologically based adventure travel. The Galapagos reminds us the Earth is a living organism and we are integral with it.4 For every cause there is an effect, as in all feedback loops. This also is the message of environmental determinism, that physical environment determines culture and human evolution.

The experience of those involved with the Galapagos Islands may be seen as providing an importance message for our world community: the necessity to enhance and accelerate our efforts to preserve and encourage the balance of our environment for the continued health of all beings.

As we left the Galapagos, my heart was happy and full with all we’d experienced, especially seeing the land tortoises of my dream.  


1. Weiner, J. (1994). The beak of the finch. New York: Alfred A. Knopf.

2. Galapagos National Park Interpretation Center.

3. Kanner, A., Roszak, T., & Gomes, M. (1995). Ecopsychology: Restoring the earth, healing the mind. New York: Crown Publishing & Sierra Club Books.

4. Lovelock, J. (1979). Gaia: A new look at life on earth. New York: Oxford University Press.

Advance for Nurses 2005


Therapeutic Touch

Therapeutic Touch - the intentionally directed process of energy exchange that utilizes the hands to facilitate healing - brings together the art & science of nursing By Shirley Spear Begley, BFA, RN, HNC, NCTMB
Advance for Nurses, 2002

 "I am open-minded. Just now, however, my mind is closed for repairs."

- Anonymous

As an educator and lecturer on Therapeutic Touch (TT), I often encourage my audience to maintain a healthy skepticism about TT until they have direct evidence of benefits. As with anything unfamiliar, or ideas that do not fit readily within our cultural framework or “world view,” TT, although widely practiced, is still looked upon with skepticism by many health care professionals. Yet imagine being able to remain skeptical and use your critical mind in an open and interesting manner to explore something new. What might you learn?

It is with this perception that you are invited to look at the world of Thera­peutic Touch, a scientific nursing in­tervention with a holistic foundation that has been practiced for nearly 30 years. It is a complementary nursing practice that blends readily with conventional care. TT draws on the strengths of nurses’ knowledge as well as their insights, yet calls upon the body’s in­nate wisdom to heal itself and seems to mobilize that healing ability. 

What is TT?

TT is considered a contemporary interpretation of ancient energy-based healing practices. It is an intentionally directed process of energy exchange that utilizes the hands to facilitate healing. Therapeutic Touch was developed specifically for use by health care professionals as an extension of their professional skills. It grew out of the observations of Dolores Krieger, PhD, RN, professor emeritus from New York University (NYU), and her mentor, Dora Van Gelder Kunz, a natural healer, while they explored the relationship between laying-on of hands and the healing process.

In 1972, at the same time they began to realize that bio-energetic healing was a natural potential that could be learned and actualized under appropriate circumstances, Dr. Krieger began teaching TT to nurses in the master’s program at NYU, in a class called “Frontiers of Nursing.” TT continues to be taught there and in more than 200 other settings, including medical centers, universities and massage therapy schools, and in more than 78 countries abroad. A national credential in TT is now available with policies and procedures, scope of practice and teacher/mentor/practitioner guidelines established by the Nurse Healers-Professional Asso­­ciates Inter­national Inc., (NH-PAI) the official or­ganization of TT.

The focus of TT is to assist in balancing the flow of human energies by specifically directing or sensitively modulating them. The TT practitioner seeks to re-pattern the recipient’s weak­ened vital energy flows, and stimulate the immunological system so that re­covery is strengthened and reinforced. With TT, comfort is more readily ex­perienced, harmony restored and health enhanced so the person with health challenges can strengthen and effect his own healing “from the inside out.”  

Four Phases of TT

There are four phases to the TT pro­cess: centering, assess­ment, balancing and reassessment. The act of centering is based on maintaining one’s mind in a state of peace. Once centered, the TT practitioner scans the client’s energy field to assess it by perceiving cues. Knowing how to work with the cues to bring about balance within the field is the art and science of TT.

Assessing the energy field is done without contacting the skin, thereby avoiding the confounding factors of skin temperature and the sensation of physical touch that can interfere with the ability to perceive the more subtle energy field cues. As one’s ability to remain centered deepens, cues in the form of intuitive hunches and insights become more common, allowing the therapist to begin to have more awareness of the factors that are causative in the person’s illness.

The third phase, balancing, utilizes several techniques, a few of which are listed below, to bring harmony and order into the client’s energy field:

* Modulating - tempering energy outflow to meet the needs of the client

* Directing - transferring energy between the therapist and client, or from one area of the client’s body to another

* Unruffling - clearing the energy field so that it flows smoothly

* The law of opposites - rebalancing the energy field by projecting the opposite of the cues perceived.

The use of color, sound and visualization or guided imagery, along with other modalities can be combined with TT to enhance relaxation and the mind-body connection, and leads one toward wholeness.

The final phase of reassessing the field assists one in determining if the work has brought about the desired result. The phases are not always practiced in a linear fashion, but become part of weaving a web of centering, assessing and balancing. Although one can learn the phases of TT quite readily, most practitioners recognize that one’s ability to effect a consistently beneficial outcome is developed over years of practice. 

Learning TT

The basic process of learning TT consists of obtaining a minimum of 12 hours of education with a qualified TT educator. Qualified, advanced TT educators who meet specific guidelines are recognized and endorsed by NH-PAI. Individual TT educators offer continuing education credits and a national credential for qualified TT practitioners is now available. This includes a year-long mentorship in which the practitioners learn to hone their ability and confidence in working with the process under the direction of an ad­vanced practitioner, teacher and mentor.

There are basic, intermediate, integrative and advanced courses in TT, as well as on­going groups and practicum for supervision, further learning and support.  

The Growth of CAM

It is because of the expanded view of many clinicians and the outcomes that have been demonstrated to provide relief, that comple­mentary and alternative practices are currently taking the country by storm. A few statistics may prove to enhance this observation. David Eisenberg, MD, a Harvard physician, in a 1998 survey reported that $27 billion was spent that year on complementary and alternative medicine (CAM).

A Con­sumer Report survey spanning 2 years de­m­on­strated their readers spent up to $300 each on CAM. Further, a 1998 survey through Stanford Medical Center reported that two out of three people had used some form of CAM in the previous year.

The National Institutes of Health has created a National Center for Complementary and Alternative Medicine (NCCAM) to fund and support re­search in this area of health care. Thera­peutic Touch was the first in the area of human bio-energetic field therapies to re­ceive support for study through research and funding grants by NCCAM.  

A Scientific Nursing Intervention

Studies completed at the University of Alabama at Birmingham (UAB) Center for Nursing Research indicate the positive effect of Therapeutic Touch on stress reduction and immune function in people with AIDS.1 Another UAB study funded by the U.S. De­partment of Defense has shown the positive benefits of TT on pain and anxiety in burn patients.2 Yet another recent study completed at UAB suggests that TT is also beneficial to those experiencing grief over the loss of a loved one.3

TT is regularly used along the entire life continuum, from prema­ture newborns in hospitals to people receiving hospice care. In the view of holism, caring and healing are different from curing and even a person facing terminal illness or death may come to a state of wholeness and therefore benefit from heal­ing methods like TT.

As it is known that neonates, anesthetized or comatose patients can benefit from TT, belief in it is not a prerequisite to its success. Although one’s belief system and the placebo effect are important factors that can contribute to the process of healing, these cannot be solely responsible for the benefits of TT. Thera­peu­tic Touch seems to mobilize the individual’s own healing energies to restore health, balance and order and creates a feeling of integration and equilibrium.

If a new medication were able to show simi­lar multiple benefits, no doubt it would be widely touted for its abilities. Yet why not TT? Mostly one must assume it is because it does not yet fit within our traditional cultural per­spectives of conventional science. Yet what of the art and science of nursing?

At the end of a recent continuing medical education lecture on TT, a physician said, “It’s been interesting and fun to keep an open mind, and this lecture fills me with hope. I sometimes forget the mystery of medicine.”

Healing is one of the most humane of human endeavors, so I urge you to learn more about its outcomes and benefits, and experience TT, while keeping an open mind, and then judge its merits for yourself. 


1. Gerrard, C. (1995). Doctoral dissertation. Univer­sity of Alabama, Birmingham, AL.

2. Turner, C., & Gauthier, W. (1998). The effect of Thera­­peutic Touch on pain and anxiety in burn patients. Journal of Advanced Nursing, 28(1), 10-20.

3. Robinson, S. (1996). Doctoral dissertation. Univer­sity of Alabama, Birmingham, AL.




Shirley Spear Begley is executive director of Integrated Health Care Systems Inc., St Petersburg. She would like to take a group of nurses on an eco-tour to the Galapagos, and can be reached at or