Therapeutic Touch

Krieger, Kunz and a nursing setting

Therapeutic Touch is attributed to Dolores Krieger, a professor of nursing at New York University, and Dora Kunz, who is described as a natural healer. The Therapeutic Touch International Association (TTIA), the practice's own professional body, places its development in the early 1970s and says it was first taught in a master's nursing course at New York University in 1972. A 1998 JAMA paper by critics of the practice also says it was conceived in the early 1970s, and a 2021 nursing review gives 1972. A 2017 trade-magazine profile of Krieger instead dates the work to the late 1960s, so published start dates differ by several years.

Accounts of the founding collaboration differ in emphasis. TTIA states that Kunz believed healing abilities could be taught to compassionate people, that Krieger was mentored by Kunz, and that the two ran experiments in 1971 comparing hemoglobin levels after laying-on of hands. The JAMA paper reports that Kunz was president of the Theosophical Society in America from 1975 to 1987 and claims to be a fifth-generation 'sensitive'; that characterization comes from the paper's authors, not from TTIA. The hemoglobin claim was not assessed in the sources reviewed here.

Intellectual influences

The JAMA paper says Krieger first linked the practice to prana, an Indian concept of life force, and that the vocabulary of energy fields owes much to the nursing theorist Martha Rogers, then dean of nursing at New York University. A 2021 review calls Therapeutic Touch a contemporary interpretation of spiritualism built on a hypothetical human bio-energy field. A 1998 article in the Journal of Professional Nursing argues that its ideas have religious sources tied to particular religious groups and that it should be treated as a religious practice. These are scholars' and critics' characterizations. TTIA describes the practice as holistic and evidence-informed, using a universal energy.

Spread through nursing and the NANDA diagnosis

Reported numbers of people trained vary by source and date. The 1998 JAMA paper cites more than 100,000 people trained worldwide, including at least 43,000 health professionals, teaching in more than 100 colleges and universities in 75 countries, and use in at least 80 North American hospitals. TTIA describes about 100,000 trained in roughly 90 countries. A 2017 magazine profile gives more than 250,000 in 107 countries. None was audited in the sources reviewed.

Within nursing classification, a diagnosis called Disturbed Energy Field was added to the NANDA list in 1994, and the JAMA paper noted that Therapeutic Touch was the only treatment recognized for it. A 2025 integrative review reports that the diagnosis was removed in 2011 for lack of evidence and for its similarity to the Nursing Interventions Classification entry for Therapeutic Touch, and that a revised Imbalanced Energy Field diagnosis entered the 2018-2020 edition and has not yet been validated for clinical use. Other secondary sources date the removal differently, and NANDA's own publications were not checked.

The name and its spellings

The name can mislead, because the practice as described by TTIA does not require physical contact, and a 2021 review likewise says it involves no physical contact. The JAMA paper says the label was adopted because the older phrase laying-on of hands was considered an obstacle to acceptance in nursing. Sources also differ on the first name of the founder, Delores in the 1998 JAMA paper and Dolores in later sources. A 1997 nursing article notes that early writing links the practice to laying-on of hands, and that calling it spiritual healing was contested within nursing. The abbreviation TT is common in the literature.

Energy-field vocabulary

Proponents speak of a human energy field, abbreviated HEF in the JAMA paper, and the 2021 review uses the term biofield for a proposed massless field said to extend beyond the body. The same review states that no anatomical structure or physiology for such a field has been identified. Practitioners also use the verbs center, assess, unruffle and rebalance for the steps of a session. These terms describe how practitioners understand what they do; they are not established biomedical constructs.

Neighboring practices: Healing Touch and Reiki

Healing Touch is a separate named program that a 2011 systematic review describes as a biofield therapy that arose in nursing in the late 1980s. The 1998 JAMA paper calls it a Therapeutic Touch variant offered through the American Holistic Nurses Association, which is the critics' framing; the sources reviewed here do not set out the Healing Touch curriculum. The National Center for Complementary and Integrative Health describes Reiki as a practice in which hands are placed lightly on or just above a person to direct energy. A 2021 Therapeutic Touch review excluded studies that were about Reiki or massage, so findings for those practices should not be carried over.

Steps as described

The JAMA paper summarizes Therapeutic Touch practice guides as three steps, none of which requires touching the body. In centering, the practitioner focuses attention and intent to help, a step the paper likens to meditation. In assessment, the hands pass from a distance of 5 to 10 cm over the body from head to feet, attuning to changes in sensory cues such as tingling or heat. In intervention, the practitioner removes perceived congestion, replenishes depleted areas and smooths the field, which is said to leave the person's body able to restore itself. A 2025 review gives a similar four-part definition ending with reassessment and closure.

Descriptions vary. A 2017 profile lists five steps, centering, assessing at about 2 to 6 inches from the body, unruffling, rebalancing and evaluation or closure. TTIA says physical touch is not required and that the hands act as a focus for directing energy exchange.

Sessions, training and professional standards

In clinical studies reviewed in 2021, sessions lasted from about 10 to 30 minutes, and courses ranged from a single 10-minute session to 15 sessions of 20 minutes over five weeks. A sham comparison was usually the practitioner holding the hands more than 6 inches away and not thinking positive intentional thoughts, a distinction the review calls unverified.

TTIA's own guidelines set a Foundations workshop of at least 12 hours, followed by mentored practice. Its credentials are Qualified Therapeutic Touch Practitioner and Qualified Therapeutic Touch Teacher, and its standards call for introducing the process, seeking consent where possible, and documenting sessions. They tell practitioners to check licensing rules in their state or province before accepting fees. No government licensing standard specific to Therapeutic Touch was identified in the sources reviewed.

Uses described by proponents

TTIA describes the practice as promoting balance and well-being and says research indicates effectiveness with cancer patients, premature infants and comatose patients; that statement is the association's, and it was not independently verified. The JAMA paper compiled claims from the Therapeutic Touch literature in a table, among them relieving pain, nausea and anxiety, promoting healing of wounds and bone and muscle injuries, decreasing inflammation, breaking fever and comforting the dying. The paper's authors present these as claims they found, not as established effects.

Settings and outcomes studied

A 2021 rapid review of trials published from 2009 to 2020 lists pain, anxiety, sleep, nausea and functional improvement as the main outcomes. The studies took place in postoperative care, cancer care, cardiac procedures, intensive care for newborns, nursing homes and burn care, among others. Study settings show where researchers tested the practice, not where it is advised.

A blinded test of the energy-field claim

In 1998 JAMA published a study by Linda Rosa, Emily Rosa, Larry Sarner and Stephen Barrett. Twenty-one practitioners with 1 to 27 years of experience sat with their hands on a table behind an opaque screen, and the investigator hovered a hand, chosen by coin flip, 8 to 10 cm above one of theirs. Practitioners named the correct hand in 123 of 280 trials, or 44 percent, against 50 percent expected by chance, with no significant link to years of experience. A first series in 1996 scored 47 percent and a follow-up in 1997 scored 41 percent. The authors concluded that the result was unrefuted evidence that the claims of Therapeutic Touch are groundless.

The paper states that Emily Rosa designed the test when she was nine and that the authors recruited volunteer practitioners, some of whom said afterward that conditions such as a television crew made concentration harder. The first author belonged to a task force of the National Council Against Health Fraud, and the paper says this test addresses one premise, perception of the field, rather than clinical effects. Replications and published rebuttals were not located in the sources reviewed.

Cochrane reviews on wounds and anxiety

A Cochrane review of Therapeutic Touch for acute wounds, updated through 2016, included four trials in people with experimental wounds. Two small trials, of 44 and 24 people, reported increased healing, one found significantly worse healing and one found no difference, and all four were at high risk of bias. The review concluded there was no robust evidence that Therapeutic Touch promotes healing of acute wounds. A further update was withdrawn on 23 August 2016 'due to serious concerns over the validity of included studies', and its author wrote that the planned revision would leave an empty review.

A 2007 Cochrane review of Therapeutic Touch for anxiety disorders, searching to January 2006, found no randomized or quasi-randomized controlled trials in people with a diagnosed anxiety disorder. It called for well-conducted trials. That finding concerns diagnosed disorders, not anxiety measured in other patient groups.

Later trial reviews

A 2021 rapid evidence assessment covered 21 studies from 2009 to 2020, including 15 randomized trials, with 1,302 patients in total. Most reported positive results, yet only four had a low risk of bias and the review found no high-quality evidence for any claimed benefit. Several higher-quality studies, including trials in burn care and preterm infant pain, found no difference. The reviewers are openly skeptical, and the text gives different counts of positive studies in its abstract and discussion.

A 2009 nursing review of five pain studies from 1997 to 2004 reported mostly significant positive results and recommended considering the practice. Its conclusions rest on a small, older set of studies, and the review does not report their risk of bias in the abstract. Healing Touch trials, summarized in a separate 2011 systematic review, are not evidence about Therapeutic Touch.

Direct effects reported

The 2021 review found that none of the studies reported an adverse effect and concluded that the practice appears to carry minimal risk, while noting that trials rarely monitor harms systematically. A 2009 nursing review likewise found no identified risks. The JAMA paper adds a practitioner-side caution that overly long sessions or too much energy in one area may cause hyperactivity, especially in infants; this belief has not been tested in the sources reviewed. The sources do not list contraindications, so none are given here.

Indirect concerns and care boundaries

The 2021 reviewers raise indirect concerns. They report that practitioners charged about 120 US dollars an hour, that this adds cost for a benefit they call dubious, and that patients may be given unrealistic expectations. They note that other relaxation methods can be practiced at no cost. The JAMA paper says nurses sometimes used the practice in hospitals without the permission or knowledge of attending physicians, and the 1998 nursing article argues it should be handled as a religious practice. Consent and open communication with a patient's care team are therefore part of the context.

TTIA's standards call for assent or consent where possible, and for practitioners to clarify their roles with the relevant licensing rules. Nothing in the sources reviewed shows Therapeutic Touch replacing assessment or treatment of any condition, and it should not delay or replace necessary medical care. This page is educational and is not individual medical advice.