How Can Massage Therapy Help Clients with PTSD?
Research also indicates massage therapy may be effective for those clients who experience dissociation as a symptom of PTSD, allowing these clients to experience a more coherent sense of self, which for some is a primary reason they initially seek out a massage therapy.
Stress relief, decreasing anxiety, reducing depression1, and improving personal mood are all positive outcomes massage may provide clients. Additionally, a 2012 study focusing on how integrative therapies can help promote reintegration among veterans found that those participants who received massage therapy reported significant reductions in physical pain, tension, irritability, anxiety/worry, and depression.2
Another recent study of Somali women refugees with chronic pain—the majority of whom reported military and/or sexual trauma—found that massage therapy provided enormous relief for distressing physical and psychological symptoms largely attributed to the exposure to trauma, according to Cynthia Price, a research professor at the University of Washington and massage therapist.
Research also indicates massage therapy may be effective for those clients who experience dissociation as a symptom of PTSD,4 allowing these clients to experience a more coherent sense of self, which for some is a primary reason they initially seek out a massage therapy.
allowing these clients to experience a more coherent sense of self, which for some is a primary reason they initially seek out a massage therapy.
While almost all studies on the subject point to the positive effects of massage therapy, making sweeping generalizations about its effectiveness for PTSD would be unwise.
“Given that the studies to date have involved small samples, we do not know the magnitude of these effects, nor do we know how massage facilitates health in trauma recovery,” says Price. “However, research findings suggest that dissociation reduction, i.e., a more coherent sense of self, may play an important role in positive massage therapy effects.”
There are aspects of massage therapy, too, that appear to provide some unique benefits to clients with PTSD—mainly giving these clients a feeling of comfort, safety, and control they often can’t achieve on their own.
According to Fitch, some of the massage therapist’s most powerful tools come from how the massage therapy session itself is handled, from the informed consent and opportunity for a client to ask questions that start each session to the therapist’s ability to respond to the individual’s needs during a session, whether that’s stopping altogether, changing positioning or adapting levels of pressure. “All of these actions ensure that clients are safe and know they can stop the treatment at any time, providing them a safe environment to experience touch,” she explains.
Massage therapists can also provide clients with self-care strategies to help prolong the positive benefits achieved, not only in massage therapy sessions but with other integrative treatment approaches as well. “People who have been traumatized are no longer at home in their bodies,” Fitch says. “Massage therapists can teach clients safe and effective ways of self-soothing and stress management.”
What Massage Therapists Need to Know About Working WIth Clients with PTSD
Two words are going to be the focus of every massage therapy session you provide for clients with PTSD: trust and safety. “For a person to allow you to touch them, they must trust,” Fitch says. “People with PTSD have difficulty trusting, and that’s why it’s so essential that therapists work first on building trust and ensuring the client understands they can refuse treatment. Without client trust, there is no proceeding.”
Developing a professional relationship with clients who have PTSD often means more than simply explaining the benefits of massage therapy. Again, these clients are going to need to know they can trust you, and that may require spending more time talking before a massage therapy session begins, Fitch says, or in some cases, before they ever enter your practice space.
“Clients who have a history of trauma may ‘suss’ out the therapist, ask questions, call ahead and even interview the therapist prior to allowing themselves to become vulnerable in the treatment room,” she adds.
Working with clients with PTSD is best-suited for massage therapists who have some massage experience.
“Definitely, years in practice will help to ensure that the therapist does not try to do too much,” Fitch says. Price agrees, though adds that additional training specific to working with mental health issues and trauma, in particular, is a good idea, too. “This can include reading the literature as well as taking courses,” she explains. “There is a lot of training available for mental health practitioners that is an excellent background for massage therapists.” Here again, however, you need to be mindful of your scope of practice as a massage therapist.
Both Price and Fitch suggest having other health care professionals you can rely on should you need support. “Peer supervision and consultation with more experienced therapists allow massage therapists to support clients without taking the client experience too far,” Fitch says. Price echoes this recommendation: “Getting supervision from a clinician with expertise in mental health is helpful,” she explains.
Communicate, communicate, communicate
From the intake to the massage therapy session to the close of the session, communication is imperative for clients with PTSD. For the most part, intake with a client with PTSD will be very similar to all the other intakes you do, with one distinct difference: “The intake process can appear the same, but the therapist’s intention should be to ensure the client’s safety,” Fitch says. “This may require that the therapist asks about a client’s touch history.”
Colleen O’Connor, a massage therapist who has worked with veterans suffering from PTSD, believes the intake is incredibly important for these clients. “Setting the stage for what the veteran can expect during the session is key,” she explains. “We were very clear that the veteran was in control of everything, including how dark the room would be, how much pressure would be used, what areas of the body I could touch, and that they could stop the session at any time.” For veterans who are amputees, O’Connor says, how that area of the body will be addressed—if touched at all—is decided during intake as well.
During the massage therapy session, make sure the client is comfortable giving you feedback, as knowing if or when something is making the client feel uncomfortable or unsafe is key with clients with PTSD. “Ensure that the client feels safe enough to provide feedback,” Fitch says. “Encourage feedback, even if it’s negative.” And if, for some reason, massage therapy is making a client’s symptoms worse, then massage would be contraindicated, Fitch adds.
Julie Finn, a massage therapist who also works with veterans suffering from PTSD, says massage therapists must be aware of what might trigger a response from the client. “You need to understand the sounds, smells, loud noises or even touches that might trigger a flashback or response,” she explains.
Clients with PTSD are going to need you to work at their pace, whether that’s during intake or a massage therapy session. “The biggest challenges are to work slowly, conservatively, and try not to rush,” says Fitch. “Taking the time demonstrates to the client that the therapist appreciates their need for feeling safe and in control.”
Fitch also reminds massage therapists to think about their practice space. “People who have PTSD usually feel vulnerable when in a confined and intimate space,” she says. “It’s exactly the kind of environment that massage therapists work in.” Lying face down may make some clients with PTSD feel less in control, she adds, so be aware of positioning. Also, reiterate the fact that they should undress only to their comfort level so they understand they are in charge of the session.
As a massage therapist, you are in a good position to help clients with PTSD—but you need to know how massage sessions may differ with these clients.
“People living with trauma need compassion, care, and a willingness to work at their pace,” says Fitch. “The therapist’s job is to ensure safety and protect the client from experiencing intrusive symptoms of trauma. Breathe, settle, allow your own body to become still. With informed consent at the heart of the treatment, massage therapy is powerful medicine.
*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider.
Please consult your healthcare provider with any questions or concerns you may have regarding your condition.
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