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.


5 tips for getting the most from your massage

Here are some ideas for getting the most bang for your buck when getting a massage.

1. Arrive on time. I’m assuming you scheduled your massage for a time that’s convenient for you in the first place. Give yourself some wiggle room to account for traffic or finding parking. If the place you’re going to offers amenities like a whirlpool, sauna, or steam room, leave time to take advantage of these before and/or after your massage. Heating your body up in a whirlpool is an excellent way to prepare for a massage. The heat gets the process going to relax the muscle tissue and makes the massage that much more effective!

2. Get comfortable giving feedback. For some strange reason some people don’t feel welcome to give a therapist feedback during the session. I go out of my way to let my clients know that their feedback is welcome. I’d rather have a client speak up about wanting pressure lighter or deeper than wait until the end of the massage and feel dissatisfied. Sometimes clients feel that massage therapists can somehow read their minds or that they know better than the client how much pressure is appropriate. Mind-reading is generally not covered in massage school, so please get comfortable giving feedback. You’ll be getting more from your massage and your therapist will be better able to serve you.

3. Put your mind on screen saver. Allow your mind some fallow time. The time goes quickly enough, so embrace your massage time as a time to put your problems on hold and concentrate on your body or nothing at all. I believe my clients who are able to zone out mentally get more from their massage time. Here’s a trick – when you walk into the massage room think of that as step 1 to setting aside the thoughts that might be racing through your head; when you lay down on the table that’s step 2 of putting any anxieties on hold; when the therapist starts the massage, that’s step 3 and you have now entered a special time that can be protected from interfering thoughts. You’ve made this appointment for a reason and it’s most likely not a brainstorming session for all life’s problems.

4. Practice acceptance. Receiving massage brings our attention to our bodies. Not everyone is at peace with their body. Similar to allowing your mind some fallow time, allow your emotions and any negative self-talk to take a vacation. Negative attitudes towards your body will clutter your experience and detract from it. Your massage session can be a great step toward getting on the same team with your body.

5. Clear up questions before the session starts or when they arise. If you’re new to massage, ask your therapist to describe what the session will be like so that you can know in advance and not fret. Ask any question you have so that you’re comfortable. Perhaps you’re not sure if you should take your clothes off or if you can choose to leave them on. Just ask. Things like this are really up to you anyway. And, remember, if anything ever doesn’t feel right in the middle of a massage session you are completely free to stop the session, ask a question to clarify what’s going on and choose to continue or not.

I hope every massage you get is a great one! Let me know if you resonate with any of these tips or have a good one to share in the comments below. Thanks for reading!