Being able to balance communication about what is appropriate versus inappropriate social touch is important when working with individuals who are highly distressed and who have complex presentations related to their physical health needs. Individuals can often ‘hang’ off of their carers. Is this a form of communication or is this a high need for emotional support which needs to be processed within the long sequence of other messages that have been said before about a particular topic. Forcing someone to physically interact with you can be a source of protection when you need to pick them up to move them out of harms way. In other circumstances moving them physically is something that can cause significant distress. Individuals with seizure disorders may periods of time before a seizure starts where they feel like they need to remain still and as a result may refuse to interact with others or with the normal routine tasks that they are normally required to complete. Other individuals may use the body parts of their carers to fix things such as my arms are itchy could you please scratch them as I don’t have the coordination to use the right amount of pressure.