I’m one of those people that nod and smile to the person next to me on the bus and 15 minutes later I have heard most of their life story. You might be nodding and thinking “mmmhmm” right about now. In fact, I think if there was a group of massage therapists gathered and a similar question was asked, many would raise their hand at being “that person”.
Massage therapists have an intimate connection with their clients. Many of us work on clients who are only one sheet away from being naked in front of us. That means we need to be exemplary in our treatment of someone on the table. It’s not only a body, but a mind with varying experiences we are working with everytime we touch a client.
Let’s go back to questioning a group of MTs. If the question asked was “How many of you are survivors of trauma” there would no doubt be hands in the air. A lot of MTs came to the profession because of their experience with massage during a traumatic recovery, or, seeing how it positively affected a loved one.
But for the hands that remained down, does this mean they have not experienced trauma?
Many people prefer not to share their stories, which is understandable and acceptable. Do not expect that your client will share their personal past or trauma with you. Do treat everyone with the knowledge they may well be in the middle of a traumatic event, or have past event(s) that continue to have an impact on their lives.
When we speak of treating a client with a past trauma we usually think of a physical injury or PTSD. PTSD often brings to mind those who served in the military, but in fact many situations may cause PTSD, as well as C-PTSD, Growing up in poverty, being adopted, survivor guilt, sexual abuse/rape, confinement of any sort (prison, residential treatment centers) repeated injury such as childhood physical and sexual abuse.
The person currently in the middle of a divorce or custody situation. The one who just found out they cannot birth their own children. The client who spent part of their life living with abuse-whether verbal, physical or both. The one who has been body shamed by loved ones. A person who may have spent time in confinement. A former or current member of the military or someone who has seen the effects of war firsthand.
The stories are different, sometimes similar, but affect every human in a very personal manner, consistent with their other life experiences.
Nurturing, Ethical Standards, And Trauma
A few years ago, a client of mine I thought I knew well opened up after a year of sessions.
The client told me they were glad that I worked through the sheets when doing gluteal work, as they had always felt uncomfortable having this type of work done, but enjoyed the benefits post massage.
They told me about being aggressively assaulted by a group of people earlier in their life. This news was of course stunning. All I could do was stutter “I am so sorry” and continue with the session. At the end of the session, the client thanked me for listening and not offering any advice, and again for providing the additional draping. This incident opened my eyes to the knowledge that as massage therapists we rarely know more than the basic details of a client’s history.
After working so closely with the public, I realized that most people have many hidden faces underneath.
I changed my outlook to try and recognize that when someone comes in and says they are ‘not doing great’, there is no need for me to ask why. I am here to provide bodywork. If the client decides to share information with me, it stays in the room. I will not bring it up in another session (unless it is health related to their treatment) and will acknowledge that sometimes people need an ear, but that isn’t a request for feedback.
What we do is nurturing, but we are not “healers”. We must hold high ethical standards that go well beyond not dating clients. All clients must be treated equally, and strict adherence to scope of practice is mandatory. With this in mind and the knowledge that we cannot know if someone currently is experiencing, or has been affected in the past by trauma, all clients should be treated as though trauma has affected their life in some way.
When clients do indicate “PTSD” on their health history, do not inquire about specifics.
Usually, boxes for anxiety, depression and insomnia are also checked as PTSD comes with a host of comorbidities. Some, such as depression and anxiety, have been shown to be alleviated by massage therapy to some degree. Other symptoms like sleep disturbances may also benefit from the use of massage.
A common side effect of PTSD are panic attacks. Some of us have already experienced a friend, family member or coworker have a panic attack. It is a scary and debilitating experience both for the person having the attack and the others present. I have personally witnessed several clients experience a panic attack during a session. I have found it is best to stop the bodywork, redrape the client and allow them the opportunity to end the session at that time. Every experience is different. Some clients need a few minutes, a sip of water, some need to have the therapist leave the room so they can regroup, or get dressed and end the session for that day.
Be sure to ask them if they are aware if this is a panic attack. If not, symptoms can be similar to cardiac events, so familiarize yourself with the symptoms of each, or call for emergency assistance if necessary.
While studies suggest that massage therapy may be beneficial for symptom management of PTSD, it is a priority to ask all clients about their comfort of level of undress, areas of the body to be worked or not touched- and informed consent. Remind each client this is their session, and as a therapist, you are willing to work within their boundaries.
As discussed, we cannot identify trauma in a client and many clients may not feel comfortable enough to discuss trauma, especially during early sessions, so we must do our best to avoid triggers which may result in panic attacks or other symptoms of distress. As your therapeutic relationship develops, it may be more appropriate to discuss things as the patient opens up to you, but when starting out, try to avoid those triggers.
Some suggestions are below.
Do’s And Dont’s
Do: Create and maintain boundaries in your practice
Don’t: Deviate from boundaries
Do: Allow time for a thorough intake
Don’t: Rush your client
Do: Ask for emergency contact
Don’t: Ask marital status
Do: Have a box to check for pregnancy
Don’t: Ask about children
Do: Ask for preferred name & pronoun
Don’t: Assume nicknames or gender
Do: Request current health information
Don’t: Ask about heritage, accents
Do: Ask for surgical/accident history
Don’t: Set time limits (ie: 10 yrs)
Do: Add a box for PTSD
Don’t: Expect full disclosure
Do: Discuss levels of undress
Don’t: Ever adjust bras/underwear
Do: Ask clients about working gluteal areas
Don’t: Ask when client on table
Do: Discuss Informed Consent
Don’t: Make assumptions
Do: Avoid negative words & phrases
Don’t: Talk down to clients
Do: Greet every client with a smile & nod
Don’t: Force a handshake
Do: Respect personal space
Don’t: Initiate a hug
Do: Give advance warning of animals in practice
Don’t: Assume a client likes animals
Do: Ask client about music preference or none
Don’t: Play what you want to hear
Do: Appreciate client’s religious preference
Don’t: Display religious emblems
Do: Treat a body with respect
Don’t: Ask about scars or tattoos
Do: Provide appropriate draping
Don’t: Discuss client weight/height
Do: Acknowledge each client is an individual
Don’t: Council/compare clients
Do: Work in scope of practice
Don’t: Offer nutrition advice or sell other services you provide
Remember, we do not need to walk on eggshells, just work within our scope of practice, treat each client as an individual and understand there are many context layers in each person’s life experience.
- Massage Therapy, Communication, And Helping Trauma Survivors - February 26, 2018