Couple Therapy and Reiki

Abstract

Traditional psychotherapy currently tends to advocate for the exclusion of physical touch in the therapeutic context, as an attempt to address the issue of physical and emotional safety for the client and mitigate ethical and legal concerns. However, throughout human history touch has been an important factor in physical, psychological, and emotional healing processes. The authors of this article examine the current implementation of couple therapy modalities and discuss the benefits that Reiki, a biofield touch therapy, could offer in conjunction with traditional couple therapy.

Keywords

couple therapy Reiki alternative therapies holistic care

Psychotherapy and the various models of therapy have traditionally and historically excluded touch from the psychological and emotional healing processes (Casement, 2000; Durana, 1998; Goodman & Teicher, 1988; Gutheil & Gabbard, 1993; LaTorre, 2005; Phelan, 2009). The authors of this article examine the practice of couple therapy and discuss the potential for combining Reiki, a biofield touch therapy, with traditional psychotherapy and therapy modalities in order to enhance the couples’ therapeutic experience and outcomes. Historically, using touch has been considered to have an injurious effect on transference and countertransference, as well as confound ego boundaries for both the client and therapist (Gutheil & Gabbard, 1993). However, within the last 40 years the attitude toward the use of touch in psychotherapy has gradually changed. Recent research and clinical developments have shown the efficacy of touch in promoting, nurturing, and enhancing emotional expression in the client (Durana, 1998; Hunter & Struve, 1998a, 1998b; Totton, 2003; Zur & Nordmarken, 2004). The authors of this article will focus on the philosophical underpinnings of combining couple therapy and Reiki, couple therapy effectiveness, ethical considerations, and implications for training, clinical work, and future research.

Couple Therapy and Effectiveness

In several of the current couple therapy modalities such as emotionally focused therapy (EFT; Johnson, 2004), integrated behavioral couple therapy (IBCT; Jacobson & Christensen, 1997) or Gottman’s model (Gottman, 1999), verbal communication is the primary mechanism used by couple therapists to assist distressed couples to overcome “problems” that brought them into therapy. Traditional verbal couple therapy alone, however, may not always be the most effective way to assist distraught partners in overcoming their challenges. While the benefits of Reiki will be discussed in the following section, it is important to note that Reiki may be a desirable adjunct to couple therapy due to its healing properties. Some of the most powerful effects of Reiki are decreased levels of anxiety, stress, and depression (Miles & True, 2003), all of which would address several core issues that lead to relationship distress.

Couple and family therapy outcome research are often contradictory. Some researchers conclude that there are no discernable differences in outcome for different types of couple therapy modalities (Jacobson & Addis, 1993; Shadish, Ragsdale, Glaser, & Montgomery, 1995). Others have argued that couple therapy as a modality has demonstrated differential outcomes (Johnson & Greenberg, 1985; Leff et al., 2000). Despite the disparate differences in outcome research, one issue remains clear; traditional verbal couple therapy may be leaving a significant number of couples unchanged or still distressed by the end of treatment.

According to outcome research by Christensen and Heavey (1999) that included currently utilized couple therapy approaches such as behavioral couple therapy ([BCT] Jacobson & Margolin, 1979)and EFT (Johnson, 2004), all approaches showed statistically significant effects relative to control groups. However, there were no reliable differences between different theoretical models. One reason for this finding could be that most of the outcome research at that time was focused on BCT. There were over 24 published studies in at least 4 countries demonstrating the advantage of various versions of BCT to control groups at the time of this study (Hahlweg & Markman, 1988). Other couple therapy approaches received considerably less attention from investigators of treatment outcome in the late 1980s and early 1990s.

Couple therapy research from the late 1990s and early 2000s tended to conclude that therapies with an affective component such as insight-oriented marriage therapy (IOMT; Snyder & Wills, 1989), IBCT (Jacobson, Christensen, Prince, Cordova, & Eldridge, 2000), and EFT (Johnson, 2004) are often more effective than traditional behavioral-based therapies alone. In a comparative outcome study, EFT was found to be more effective than behavioral problem and communication training interventions (Johnson & Greenburg, 1985), and IOMT (Snyder & Wills, 1989) was found to be significantly more effective than behavioral interventions at a 4-year follow-up study (Snyder, Wills, & Grady-Fletcher, 1991), as only 3% of IOMT couples versus 38% of BCT couples were divorced.

In a preliminary study of IBCT (Jacobson et al., 2000), which enhances BCT with aspects of acceptance and change, IBCT showed a greater efficacy rate than BMT (Johnson, 2003). At the end of treatment, 70% of IBCT couples achieved recovery, whereas only 55% of couples receiving BCT achieved the same outcome.

One analysis of EFT found that this modality was associated with a 70–73% recovery rate for relationship distress (Johnson, 2003). This result is better than the 35% recovery rate estimated for couples receiving behavioral interventions (Jacobson et al., 1984) and the 42% recovery rate for couples receiving a combined cognitive behavioral intervention (Baucom, Shoham, Mueser, Daiuto, & Stickle, 1998).

While the results from couple therapies with an affective component have been shown to be more effective than behavioral-based couple therapies alone, several studies conclude that considerable numbers of couples who receive traditional verbal couple therapy remain unimproved or at least still somewhat troubled (Gottman, 1999). When researchers ask the question, “what percentage of treated couples are happily in a committed relationship by the end of treatment?” the majority of tested treatments report no better than a 50% success. There is extraordinary consistency both across studies and across different treatment modalities in the success rate (Jacobson & Addis, 1993). For example, according to Gottman (1999), “a pervasive problem exists for almost all marital therapies that have been systematically evaluated using long-term follow-up (and this is a minority of studies): a ubiquitous relapse effect” (p. 5). Jacobson and Addis (1993) strengthen Gottman’s claim with their findings that of the couples who do have some initial success with therapy, a large percentage of these couples, about 30–50%, relapse within 2 years (p. 86).

According to the research, there is a void in the effectiveness of current techniques being used in couple therapy. Although researchers and practitioners have often viewed physical touch in the therapeutic context as a taboo subject, touch therapy, such as Reiki, may have the potential to offer spiritual, physical, and emotional healing that often endures after initial treatments (Heidt, 2000). Sneed, Olson, and Bonadonna (1997) identified categories of relaxation, physical sensations, cognitive activity, and emotional and spiritual experiences derived from therapeutic touch. The connection between Reiki, its healing properties, and its potential for use in conjunction with couple therapy, in particular EFT, will be discussed further in the following sections of this article.

What is Reiki?

The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health classifies Reiki as an energy medicine that originated in Japan (“Reiki: An Introduction”, 2009). NCCAM has classified energy medicine therapies into two categories: biofield therapies and bioelectromagnetic-based therapies. According to the NCCAM classifications, biofield modalities are defined as those healing practices intended to affect energy fields that surround the human body. These healing modalities, which include Reiki, Qigong, and Therapeutic Touch, entail the placement of the hands in or through biofields (Miles & True, 2003). Reiki practitioners place their hands lightly on or just above the person receiving treatment, with the goal of facilitating the person’s own healing response. Reiki can be received from a Reiki practitioner and may be offered in a variety of health care settings, including medical offices, hospitals, and clinics. It can be practiced on its own or along with other complementary and alternative medicine (CAM) therapies or conventional medical treatments (“Reiki: An Introduction,” 2009).

In a Reiki session, the client lies down or sits comfortably, fully clothed and a light touch is given. “A full treatment typically includes placing the hands in 12 positions on the head and on the front and back of the torso that correspond to the body’s endocrine and lymph systems” (Miles & True, 2003, p. 64). Each position is typically held for less than 10 min, or until the hands of the practitioner no longer radiate heat or have a sensation of “tingling.” Typically, the practitioner delivers at least four sessions of 30–90 min each (“Reiki: An Introduction,” 2009).

The number of Reiki sessions administered depends on the health needs of the client and is assessed through a discussion with the client. When the client feels a decrease in symptoms and an increase in general well-being, the Reiki treatments are no longer needed. However, it is important to note that Reiki is a rebalancing technique and is often self-administered. Therefore, some Reiki practitioners are dedicated to the practice of daily self-treatment. According to Dr. Pamela Miles (2003), there is no diagnosis with Reiki.

Because it is patient driven, there is no possibility of overtreating or of incorrect treatment. The person receiving treatment draws Reiki like a dry sponge drawing water. No matter how long you leave it in a pool of water, the sponge won’t draw any more than it can hold (Horrigan, 2003, p. 76).

Although Reiki, as practiced in the West, was first used among Reiki practitioners outside of hospital settings; it is increasingly used in a variety of medical settings. Such settings include (a) hospice care settings to assist patients through the physical and emotional affects of dying (Sadock & Sadock, 2003); (b) emergency rooms settings to assist clients who are experiencing pain and trauma (Eos, 1995); (c) psychiatric settings to assist patients who suffer from depression and anxiety (Nield-Anderson & Ameling, 2001); and (d) family practice centers to decrease patients’ anxiety and discomfort and to assist with complications from pregnancy (Starn, 1998). Reiki’s recognition among mainstream American society is evidenced by its mention in a wide variety of publications such as the New York Times in which 10 articles are dedicated to the description and practice of Reiki and Time where 6 articles are dedicated to Reiki and other complementary therapies (Miles & True, 2003).

Reiki has demonstrated effectiveness for clients who are anxious, stressed, depressed, or in chronic pain (Nield-Anderson & Ameling, 2001). For example, registered nurses have administered Reiki to patients who are stressed, anxious, fatigued, sedated, or unconscious, as well as during and following invasive, painful medical and surgical procedures. Reiki has been given and taught to both children and adults (Alandydy & Alandydy, 1999; Bullock, 1997; Nield-Anderson & Ameling, 2001). It has also shown to be an empowering complementary therapy in which clients may learn to treat themselves outside of the therapeutic session and emphasizes self-healing and health promotion (Miles & True, 2003).

Qualitative data collected by Wardell and Engebretson (2001) indicate that feelings of safety and calm enhance a sense of connectedness toward the Reiki practitioner. Thus a greater therapeutic alliance may be formed between the Reiki practitioner and client. Utilizing Reiki as a component of a therapy session might contribute to support the overall interpersonal work between the couple and therapist, as well as to help the partners in the relationship in their overall connection process. Providing a Reiki treatment can also serve as an example for the couple, a healing approach they can do for themselves at home, adding a sense of empowerment and expanding the treatment scope (LaTorre, 2005).

Reiki and Treatment Effectiveness

Reiki is a therapy that has not been well researched in general (Engebretson & Wardell, 2002; Miles, 2006; Miles & True, 2003; Nield-Anderson & Ameling, 2001), and only a small number of studies exist that discuss the potential for combining Reiki and couple therapy. Although some Reiki studies are in the biomedical literature, most were conducted with small, nonclinical samples of healthy volunteers (Nield-Anderson & Ameling, 2001).

Other researchers have studied the effects of Reiki on postoperative dental pain (Wirth, Brenlan, Levine, & Rodriguez, 1993), blood glucose and urea nitrogen (Wirth, Chang, Eidelman, & Paxton, 1996), and wound healing (Wirth, Richardson, & Eidelman, 1996). The results of these studies, although indicative of positive effects, were limited because effects could not be attributed directly to Reiki as it was combined with other treatments (Nield-Anderson & Ameling, 2001).

A small number of observational and descriptive research studies with more conclusive results have focused on the effects of Reiki in decreasing pain and increasing relaxation and a sense of well-being in patients (Chapman & Milton, 2002; Engebretson & Wardell, 2002; Miles & True, 2003; Olson & Hansen, 1997). Olson and Hansen (1997) reviewed the impact of Reiki on persistent pain using a pre- and posttest design and validated self-report measures. Participants experiencing chronic pain due to diverse etiologies, including cancer, reported a considerable decline in pain after receiving a single 75-min Reiki session. This study was imperfect in its design due to a number of potentially perplexing variables, but it does point to possible clinical applications of Reiki that should be studied further (Miles & True, 2003; Olson & Hansen, 1997).

The Windana Society in Melbourne, Australia, has operated a Reiki clinic for more than 15 years and provides holistic care to clients who are receiving treatment for withdrawal from drugs and alcohol (Chapman & Milton, 2002). The Windana staff analyzed clinical records and client surveys and found clients and staff ascribed a number of client successful outcomes to Reiki therapy, including decreased pain and improvements in clients’ sleep patterns, mood, and clarity of thinking. This research supports the hypothesis that Reiki encourages a greater sense of self-awareness and connectedness, and increased relaxation that enabled clients’ recovery and enhanced their therapy sessions (Miles & True, 2003).

The increased state of awareness and sense of inner peace and calm reported by clients at Windana were also recognized as a key theme in qualitative data collected by Engebretson and Wardell (2002). Clients articulated feelings of safety and a perceived trust in the relationship with the practitioner. Some also elucidated what Engerbretson and Wardell perceived as a luminal state of consciousness, a period of transition where normal limits to thought, self-understanding, and behavior are relaxed—a situation which can lead to new perspectives. The authors interpreted that such luminal states are often connected with spirituality and cross-cultural ritual healing practices (Engebretson & Wardell, 2002). Currently, additional studies on Reiki are being undertaken by NCCAM and other institutions and are focusing on the use of Reiki for patients with diabetic neuropathy, to improve quality of life and spiritual well-being for patients with advanced HIV/AIDS, for patients with fibromyalgia, the effects of Reiki on physiological consequences of acute stress, and the effects of energy healing on prostate cancer (“Found five studies,” 2009; Miles & True, 2003).

Ethical Considerations

The ethical consideration of the use of touch with both children and adults in psychotherapy has been researched (Aquino & Lee, 2000; Durana, 1998; Hunter & Struve, 1998a, 1998b). Although there is a taboo against touching in traditional psychotherapy treatment, codes of ethics of major mental health associations (e.g., The American Psychological Association; The American Counseling Association; The Association for Marriage and Family Therapy) neither forbid touch in psychotherapy nor highlight touch as a boundary violation (Phelan, 2009).

The National Association of Social Workers (NASW) Code of Ethics does not explicitly prohibit touch; however, it includes a cautionary statement for the use of physical contact and discusses that “social workers who engage in appropriate physical contact with clients are responsible for setting clear, appropriate, and culturally sensitive boundaries that govern such physical contact” (NASW Code of Ethics, 1996; Standard 1.10 Physical Contact).

The U.S. Association for Body Psychotherapy (USABP) is an organization of practitioners who use a wide variety of healing techniques including touch, movement, and breathing methods. USABP’s code of ethics highlights the use of touch and provides precise guidelines (USABP Ethics Guidelines, 2001; Standard VIII Ethics of Touch). The guidelines are explicit that the use of touch must have a justifiable and important role and be used with clear boundaries. The organization cautions that therapists should be sensitive to the potential for dependent, infantile, or erotic transference through the use of touch and that practitioners seek healthy restraint rather than therapeutically inappropriate interventions. Genital or other sexual touching by a therapist or client is always forbidden. USABP advocates that touch may never be used for the personal needs of the therapist. Further, a therapist should not allow his or her theoretical viewpoint to take precedence over the client’s needs or wishes (USABP Code of Ethics, 2001).

The authors of this article acknowledge that even with codes of ethics and such precautions, that a potential breach of ethics could possibly occur when combining Reiki and couple therapy. Therapists are charged to benefit those with whom they work with to do no harm (APA Code of Ethics, 2002). Therefore, it would be important to assess before, during, and after Reiki treatments the client/clients readiness, comfort, and willingness to continue treatment. If the client feels uncomfortable in anyway, the intervention should cease immediately.

Personal values and the worldview of the therapist and client are important considerations in discerning the fit of this treatment modality. In order to respect multicultural considerations, one would have to assess the appropriateness of a male therapist administering a Reiki treatment on a female client or vice versa. The couple therapist would want to evaluate whether Reiki would be an appropriate intervention based upon culture and gender. Finally, the couple therapist would want to consider his or her position of power when suggesting such an intervention.

Integration of Reiki With Couple Therapy

Pamela Miles is the founding director of the Institute for the Advancement of Complementary Therapies, a clinician, educationalist, author, and researcher in integrative medicine (Horrigan, 2003). She has developed complementary treatment programs for major New York city hospitals to address a wide variety of medical and surgical problems in adults and children using traditional healing practices, especially Reiki and meditation (Horrigan, 2003). As a result of her experience in working with Reiki clients and practitioners, she discovered that Reiki and psychotherapy complement each other well. In particular, she asserts that due to the self-awareness and inner safety that is created through Reiki treatments, it is an ideal adjunct to family and couple therapy.

Due to the heightened physiological arousal (Gottman, 1999) that distressed couples have more often than nondistressed couples, a therapist would see a couple enter therapy with a higher rate of negative exchanges (e.g., disagreements, criticism, and hostility), or higher levels of reciprocity in negative behavior, and lengthier chains of negative behavior once initiated (Weiss & Heyman, 1997). Often couples will enter therapy with feelings of depression, anger, sadness, and/or powerlessness.

Couple therapy interventions often involve talking about the problems that led the couple into therapy, which is a helpful component of assisting clients to process their own narratives. However, if the clients repeatedly discuss the cycle that led them to therapy (Johnson, 2004) or focus on the formulation of their polarity issues (Jacobson & Christensen, 1997), then both the practitioner and the client would have a greater chance of heightening the physiological response that further reinforces the negative feelings and emotions among partners. Perhaps the belief among many counselors and therapists that talk therapy alone can create a positive transformation in couples could account for Gottman’s (1999) concern: “I think that we must conclude that it is likely that we have an intervention methodology that nets relatively small effects, and we have a huge relapse problem” (p. 5).

While verbally discussing a couple’s communication history, behavioral patterns, emotions, and their own narrative is an important step on their path to healing, the combination of therapy and Reiki could create a powerful intervention, in which the couple may heal holistically—psychologically, physically, and socially. “In recent years students of psychology, anthropology, psychiatry, sociology, comparative religion, nursing, and other disciplines, have converged in recognizing health and disease as long term outcomes of a complex process of biopyschosocial actions” (Gielen, Fish, & Draguns, 2004, p. xi). The world’s first healers acted not only as healers but also as religious specialists and psychotherapists. They did not create a division between their clients’ mind, body, and spirit (Gielen et al., 2004). Reiki is an effective holistic healing tool that integrates the mind, body, and spirit. In addition, it has been shown to reduce pain, anxiety, depression, and to offer the client a general sense of balance and well-being (Miles, 2006). Further, when couples arrive at a place in which they have traditionally been stuck, they could use the Reiki technique on themselves to stabilize their heightened arousal state or increase intimacy in their relationship.

Implications for Training, Clinical Work, and Research

Although Reiki research is derived primarily from descriptive trials or randomized controlled studies with design limitations, support of the favorable effects of Reiki makes a persuasive case for the need for further research. Future research is needed to identify probable mechanisms that would build upon studies already completed and be informed by promising theories in the physical sciences. In addition, it is critical to create well-designed studies of explicit biological effects, as well as possible clinical benefits of Reiki (Miles & True, 2003).

Consulting practitioners who are educated regarding the theory and methodology of Reiki and familiar with the process and limits of scientific inquiry in the initial stages of research design may greatly increase the quality of the explorations (Miles & True, 2003). A greater integration of CAM research of qualitative methods and varied methodological design (where qualitative methods are used to expand upon and clarify findings from quantitative data) would be valuable in research on energy medicine (Hufford, 1995; O’Connor, 2002). Miles and True (2003) state the following:

Thus, for example, if qualitative and descriptive data described above tells us that recipients of Reiki report greater self-awareness, feelings of “centeredness,” and overall well-being, then these are important outcomes to try to measure, even if associations between these “patient-centered” outcomes and “clinically meaningful” outcomes, such as improvement in function or greater receptivity to therapeutic counseling, are difficult to measure. (p. 69)

At the core of Reiki training, and unique to this practice, is a series of initiations, also called empowerments or attunements, which are believed to connect the student to a “universal energy” that directs complex cellular processes (Miles & True, 2003). It is significant to note that no certificate communicates consistent information about quality of training. There are three ways in which Reiki is used: (a) individuals who use Reiki for themselves, family, and friends; (b) licensed or unlicensed health care professionals either offering full Reiki treatment or combining Reiki with others modalities (such as a psychotherapists starting/ending treatment with a few minutes of Reiki, or a physician using Reiki to ease the discomfort of an examination); and (c) hospital-affiliated and community-based programs offering Reiki treatment or training (Miles & True, 2003).

Due to the lack of regulations surrounding the practice of Reiki, the authors of this article suggest using the AAMFT, ACA, and APA code of ethics as guidelines, when combining Reiki and couple’s therapy. The standard of best practices should be followed for any client who is receiving Reiki in a clinical setting, including close monitoring of medications.

Conclusion

Clearly traditional couple psychotherapy has taken a hands-off approach during therapeutic sessions. However, the efficacy of couple therapy is lower than many researchers and practitioners in the field would like it to be. Since touch has been shown to be a healing factor across cultures throughout human history, perhaps the conceptualization that psychotherapy must preclude touch should be examined further. In particular, combining Reiki with traditional couple therapy techniques could enhance couples’ success rates both inside and outside of therapy sessions and bring greater intimacy to the relationship. In particular, Reiki could be a particularly synergistic adjunct to EFT, due to its experiential nature. Further, while more quality research on biotherapies must be conducted in order to gain greater awareness of their potential healing properties, the information derived from available Reiki studies point to many positive results. Decreased stress levels, greater feelings of self-awareness, connectedness, and relaxation are strong indicators of the benefits of Reiki. Since couples often enter therapy stressed, upset with one another, and in cyclical arguments of negativity, the above mentioned advantages of Reiki may offer couples another way in which they could heal in conjunction with couple’s therapy.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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