A teacher told me a story in massage school that I haven’t forgotten:
A psychotherapist had contacted him about a patient who had experienced severe trauma. The doctor thought my teacher’s subtle massage work and gentle manner could be helpful for her patient. The three of them met and all agreed to try this approach.
At the first session, the he client lay on the table fully clothed, eyes open. She took a deep breath, then slowly let it go. “OK,” she said. “You can come to the doorway.”
The therapist took two steps forward. “I’m in the doorway,” he said, his voice calm. “I’ll stay right here unless you ask me to come further.”
At the second session, the client invited the therapist to enter the room.
At the third session, the client let the massage therapist stand next to the table.
This story is an example of how the simple act of holding a safe, sacred space for clients can be transformative. When I get to teach about communication, boundaries, and ethics, I always include this story.
Regardless of modality, massage therapists never only touch clients’ physical bodies—we are contacting every experience they have ever had. Chances are we have all worked with clients who have experienced some form of emotional trauma, such as that incurred through abuse or surviving a disaster, although we may never know who, or the nature of their experiences.
There are, however, those massage therapists who feel a pull toward working with people navigating trauma. If you are someone who is particularly adept at holding space, I encourage you to pursue training in this specialization. Additionally, there are some cautions and guidelines that could help you in this practice.
Color Inside the Lines
Observing good professional boundaries is essential to any massage practice, but it is especially important in working with clients dealing with trauma.
Many massage therapists do this work out of an abundance of empathy, but that empathy can also blur the lines that separate client and professional. In an appropriate therapeutic relationship, the massage therapist holds a figurative container around their client—a space where the client can, with the massage therapist’s cues and support, navigate their own healing.
No matter how much you feel for your client, maintain a neutral, professional space. Think about it—if your client was in a boat on a stormy sea, would it help her to have you jump into the boat with her? Better to be the lighthouse shining a steady beam from the shore.
A consistent self-care practice, especially one that includes some kind of self-reflection or meditation, will help you keep your thoughts and energy separate from your client’s.
Another critical boundary is scope of practice. Operating outside your scope can not only be detrimental to the client, damage your relationship with the referring therapist and hurt our profession as a whole—it is illegal for you to do so, and you could be the subject of a malpractice suit and loss of license if you do so.
Keep regular contact with the referring professional, especially if the therapy is ongoing. With client consent, report back on session work, and if something comes up in your work together that is beyond your scope—such as the client wanting to engage in what feels like talk therapy—guide him back to the professional responsible for their mental health care.
Opportunities in Trauma Therapy
In my experience, a growing number of psychotherapy practices are open to or actively seeking to have a massage therapist as part of their practice. Additionally, this kind of work, for a defined population, could be ideal for grant funding. Linking with a nonprofit could be helpful to obtain this kind of funding.
Also, some massage therapists choose to make working with trauma survivors the focus of volunteer or sliding scale work and keep their regular practice separate from this specialty.
Working with this clientele could be limited by geographical area, though. For instance, a smaller town will likely have fewer opportunities to practice specialized modalities or for specialized groups.
Are You Qualified?
It is always best to seek out specific training in a hands-on specialty that you want to explore adding to your practice. There are many training opportunities for massage therapists that guide students in working with this clientele.
To become more skilled in working with this client base you can also do research by looking up articles and case reports on massage and trauma, addiction, or other area you want to specialize in. Two great reads for this are Peter A. Levine, Ph.D.’s Waking the Tiger and Bessel van der Kolk, M.D.’s The Body Keeps the Score.
Some massage therapists go to social work or psychotherapy school so they can incorporate touch with approaches such as somatic experiencing, to focus on the nervous system. Rubenfeld Synergy is a long-established bodywork technique that combines touch and talk, and biodynamic craniosacral therapy is a useful modality to explore that examines how the body stores trauma. .
Network to Build a Practice
If you want to work with people who would like to use massage therapy as an adjunct to their mental health work, network with mental health professionals to tell them what you do and what qualifies you to work with their patients. Nonprofits serving the groups you’re interested in working with can also be a great resource.
Many nonprofit groups that organize bodywork for selected groups, such as victims of domestic violence. I volunteered for a group that did massage at the National Naval Medical Center on families of recently injured Marines, and sometimes the Marines, themselves. This can be a great way to get training and experience, and network.
If you don’t have any mental health professionals already in your sphere, begin networking with the mindfulness and meditation community. These communities tend to draw a lot of people in the wellness and wellbeing fields of work.
Explain that you have been training to work with trauma clients, and ask for informational interviews with mental health providers. Just 15 minutes of their time is enough to see if they are a good fit for you. It may be helpful to offer to come meet them, or invite them to receive work from you. But be careful, it’s best to charge your regular rate for this work so that subsequent referrals wouldn’t be construed as “kickbacks” for free or discounted massage.
My wife is a bodyworker and yoga therapist, and belonged to a local professional group that included psychotherapists and bodyworkers, for several years. They would meet monthly to discuss how their modalities overlapped and how they could support one another. Such a group can be a fertile source of referrals. If there isn’t a group in your area, consider starting one.
As for the client in the opening story, my teacher was eventually able to do standard massage sessions with her. As he recounted the experience for my class, he was visibly moved, as were we. “This,” he said, “is another way massage can be.”
About the Author
Kelly Huegel Madrone, L.M.T., is on faculty at Potomac Massage Training Institute and at Central Maryland School of Massage. She is based in Frederick, Maryland, and works with a wide variety of clients ranging from office workers and professional athletes to teens to retirees.