massage with survivors of abuse & trauma

Today’s topic is a very big one and a very sobering one. I will touch on just a few main points.

Massage therapists who are nationally certified or members of a professional organization like the American Massage Therapy Association, are required to complete a certain number of continuing education credits over a particular time frame. To meet these requirements, I took a course in 2009 that gave an overview of topics related to giving massage to survivors of abuse and trauma. The course did not intend to fully train someone in all aspects of such a big topic, but rather to acquaint the massage therapist with topics they should be aware of and to stimulate thinking about how best to serve clients with abuse or trauma in their past.

Statistics about abuse in the U.S. are very sobering. According to Shonen-Moe and Benjamin (The Ethics of Touch, 2004 p.216) “On the average, one of every five clients a practitioner sees has a history of some kind of trauma or abuse.”  Trauma is such a broad term, it can include extreme or prolonged instances of abuse, a medical trauma, an accident, and other experiences. When I meet with a client for the first time, I ask questions about his or her health. I include this question: “Have you experienced any injuries, surgeries, car accident or traumas?” This gives my client an opportunity to disclose any traumas or abuse he or she has experienced if he or she feels comfortable doing so. Some clients have disclosed incidents and experiences during this health intake; others have disclosed information at another time. Because we experience life through our bodies, it’s relevant to disclose this information in the context of a massage session if the client feels comfortable doing so.

Here are some major issues that might be present when a survivor of abuse and trauma receives a massage:

  • there might be a tendency to dissociate from the body during the session.
  • there might be an aversion or fear of a certain part or parts of the body being touched.
  • the client might feel as though he or she is back at the age or place of the abuse or trauma.
  • the client might feel a loss of control and be afraid, unwilling or unable to speak up about preferences relevant to the massage session (where touch occurs, depth of pressure, temperature, duration of session, wanting to end the session, etc.).
  • there might be strong feelings about an imbalance of power between the client and the massage therapist.

These are just some examples. I’m sure you can imagine others as well. Many clients who have not experienced abuse and trauma describe some nervousness or apprehension before getting a massage, especially with a new therapist or in a new context. Some clients don’t know what to expect and feel uncomfortable asking questions, perhaps because they feel they should know the answer or don’t want to appear to be a novice. If this is true for someone without a prior experience of abuse or trauma, imagine how intimidating the same situation might be for someone who has.

Here are some things I do with all clients to try my best to provide a comfortable context for massage:

  • ask an open-ended question (described above) so that if someone wants to disclose information about abuse or trauma, they have an invitation to do so.
  • provide a physical environment that is safe, private, and non-sexualized.
  • communicate in clear terms. This includes agreeing with my client what parts of the body will be massaged. The less that’s left to the imagination, the better. If during the session, another plan develops, we agree on this together or wait to implement that plan during another session. (For example, low back pain is a problem. We agree before the session to massage the back. After feeling the back I feel the hamstrings might be contributing to the tight low back muscles. I would state this opinion and ask if the client wishes me to massage the hamstrings also.)
  • orient the client to the massage table, describing that it is dressed like a bed, with a top sheet and bottom sheet. I state that the client will be in between the sheets, covered by the top sheet. I show the face cradle and describe how it can be adjusted to provide a comfortable fit for each person.
  • provide appropriate “draping.” Draping is a term that means covering the body with a sheet and possibly a blanket as well to keep private body parts covered. I make sure the sheet is opaque enough that it provides visual privacy. (I’ve received massage some places where the sheet was so thin, I felt uncovered even though technically I was.)
  • inform the client that communication is very important and invited during the session. If the client wishes a change in the massage technique, the music, lighting, temperature, all of these types of feedback are important and invited. I mention that reading minds was not covered in massage school, so I rely on people to communicate if they want a change. I also give an example like: “It’s simple and I’m not at all offended. You can just say, ‘Oh, I’d like that pressure a little lighter or a little deeper.’ I’d rather have you speak up so that I can modify the massage than you wait until the massage is over and feel disappointed.” I feel that stating some of these communication items up-front goes a long way to evening out the imbalance that is often felt between a client and therapist.
  • invite feedback after the session. Whatever was difficult to communicate during the session, might come out easier after the session.

If someone discloses prior abuse or trauma before the session begins, I also do the following:

  • ask what the client’s goals are regarding massage. If there are specific goals for addressing prior abuse and trauma, the conversation goes a different way than if there are more generic goals of relaxing or working on specific muscle tension. See more below.
  • explain that massage can take place while the client is fully dressed or undressed. It’s up to the client, not me, to decide what he or she is comfortable with.
  • invite feedback as described above, but also go into a bit more detail about how in prior experiences the client may not have felt or had control over what happened to the body, but that this is different. The client does have control and is invited to use that control to maintain a feeling of safety.
  • ask if there are places on the body he or she would not like me to massage. Of course it’s illegal for a massage therapist to massage any genitals, breasts or enter any orifices. I speak clearly about gluteal muscles and make sure permission is granted before massaging this area whether that’s on the skin or through the sheet and blanket.
  • suggest a non-verbal signal the client can use to let me know he or she wants the session to pause or end. This can be used if the client is having a difficult time speaking up.
  • keep the lights a bit brighter.

As I mentioned, these are just a few things I’ve developed over the years and insights gained from the course I took regarding working with survivors of abuse and trauma. There are many benefits a client can gain through massage if he or she has a specific goal of using massage to aid in healing and recovery from abuse and trauma. For example, receiving massage or touch therapy can help the survivor regain body control, redefine physical boundaries that feel safe, experience the pleasure of safe, non-sexual touch, and regain a sense of dignity and respect for his or her body. There are some prerequisites that both client and therapist would need to meet before launching into such an endeavor. At a minimum, the client would need to be in some kind of professional therapeutic relationship with someone with training on abuse and trauma (most likely a psychotherapist). The massage therapist would need advanced training in working with survivors of abuse and trauma. Again, I’ve just touched on very few of the aspects within this topic. If you have any questions you’d like to ask in the comments or through email, I welcome you to contact me. My email is susan (at) susanyoungmassagetherapy (dot) com. Thanks for reading.

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