Many massage contraindications are born from a lack of skin integrity, significant cardiovascular issues, neuropathies and infectious disease. A large portion of these contraindicated massage clients are candidates to receive a different form of bodywork called a Sweet Session.

Sweet Sessions are easy to learn and can be practiced or modified by almost any massage therapist.

The Sweet Session is characterized as a holistic, full-body appointment that includes local massage, bone tracing, comforting holds, skin moisturizing, acupressure, anatomical brushing, joint mobilization, affirmations and more.

It was developed at CE Institute LLC, and has been made publicly available, free of charge, for all professional massage therapists to practice. (Sweet Session bodywork is regularly taught in CE Institute LLC’s oncology, geriatric, AIDS and advanced prenatal CE courses.)

Watch an instructional video on Sweet Sessions here.

Sweet Sessions can be provided as a regular appointment or as a treatment alternative for select clients who are contraindicated for traditional massage.

Most practitioners use Sweet Sessions for clients who are suffering:

  • acute organ failure
  • toxemia of pregnancy
  • severe osteoporosis
  • terminal frail cancer patients
  • some bedridden clients
  • clients who have issues with touch
  • some hospice situations
  • those who do not wish to undress
  • immediately after joint replacement surgeries
  • individuals with AIDS who have advanced past tolerating compressive or prolonged pressure of manual therapy, or have extensive and severe skin complications such as with Kaposi sarcoma
  • anyone who may benefit from bodywork but cannot or will not be a candidate for traditional full body massage.

Sweet Sessions are not appropriate for anyone with infectious conditions or disease that would be transmitted in massage practice.

Why is it Called a Sweet Session?

This bodywork was named a Sweet Session because it is usually provided to clients who are severely ill, and in some cases, terminal. These clients are regularly undergoing various medical procedures and treatments, some of which can be invasive or painful. Informing the client that they are going to receive a Sweet Session may feel a little bit more positive than another therapy.

Sweet Session Beneficial Practices

Massage therapists should exercise superior hand hygiene at all times, especially when working with medically compromised clients. This includes keeping fingernails short, trimmed, filed and dull.

Some clients who are indicated for Sweet Session bodywork could endure serious injuries with a tiny skin cut from a practitioner’s fingernail. While this would be unintentional, the health consequences of a skin cut can be profoundly difficult for some medically compromised clients. And it is the medically compromised clients who are the usual candidates for a Sweet Session appointment.

Applying a hot towel or cleansing cloth to the client’s hands or feet prior to service may also be indicated. Some medically compromised clients could be experiencing poor hygiene, especially if they are living independently. Practitioners should not work over any client area that is characterized as unreasonably unsanitary.

Use low-pH balanced creams when using any massage medium with a medically compromised client, to provide less disruption to the client’s protective acid mantle.

Optional service includes deep breathing and verbal affirmations with the client, especially when practicing the holding or comforting positions. An example of a verbal affirmation that is commonly practice with deep breathing would be on the inhale, you could say, “we inhale all positive,”and on the exhale you could say, “let’s let go and exhale any negative.”

Verbal Affirmations, Wishful Thinking and Mental Intentions beyond the Bodywork

There are eight comfort-holding positions executed during a Sweet Session. Practitioners can express verbal affirmations during these hand hold positions, or at the beginning or end of treatment, or all of the above. Affirmations can be expressed to oneself silently or aloud for the client to hear or repeat.

When affirmations are eligible to practice in the Sweet Session, practitioners should determine with the client how they will be executed prior to the start of service. This includes whether they will be shared silently or aloud with whatever intention is to be expressed with the affirmation.

Verbal affirmations could include any wishful thinking or mental intention for the client. For example, when working with a terminal client, you may wish them peace. When working with a client who is fighting cancer, you may wish them strength to fight. When working with a pregnant eclampsia, you may wish positive thoughts for the client and their baby.

Practitioners can also exercise stillness with silent peace during the holding and comforting bodywork steps. Verbal affirmations, mental intention and wishful thinking can be fully eliminated from Sweet Session practice. While some clients may memorize and repeat consistently practiced verbal affirmations, these are not a required element of the Sweet Session or any bodywork.

We provide preprinted generic verbal affirmations for different medical scenarios in our CE classes where we teach these Sweet Sessions. What we have found is that massage therapists usually start with our preprinted affirmations, and eventually modify away from our language to a more customized verbal approach once they become more familiar with the hands-on routine.

We suggest new practitioners to create their own general affirmation language for various client scenarios, if they would like to practice these. Having readily available generic affirmations may help the practitioner better focus on the client when this is a new practice.

Some regulating boards may prohibit massage therapists from sharing verbal affirmations. We simply advise massage therapists to skip verbal affirmation practice if this is not allowed within your licensed scope of practice.

How To Practice a Sweet Session

Sweet Sessions can be performed on a massage table, reclining chair or in a bed. It is best for the practitioner to have access to the top of the client’s head, from the side of the body and inferior to the client’s feet to comfortably complete the full treatment. Sweet Sessions can be modified to not include any body area that a practitioner cannot reach or should not touch for any reason.

The client remains dressed in supine position. A pillow or bolster should be placed under a client’s head and knees, or whatever would be appropriate positioning for the client’s individual situation.

Sweet Session Appointment Time Length and Treatment Modifications

Sweet Sessions can be provided in any time length, usually somewhere between 20 to 60-minute sessions with 30-minute treatments being the average.

The practitioner determines how much time will be provided with each Sweet Session step.

Practitioners will increase or decrease their massage and hold times to adjust for the scheduled appointment length. This is similar to how a massage therapist decides how long they will spend with effleurage or petrissage strokes in a full-body Swedish massage.

Practitioners should modify the Sweet Session to their individual client needs. Here are some modification examples:

  • Skip the finger combing of hair or scalp massage if a client is actively losing their hair due to chemotherapy. These clients should also be provided a silk pillowcase with their head bolster given cotton fabrics will tug harder on their remaining hair.
  • Shortly after the first trimester, a pregnant woman’s upper torso should be bolstered to a 30 to 45-degree angle in semi-recumbent position.
  • Avoid touching any places where there is broken or compromised skin.
  • Do not practice verbal affirmations aloud if the client does not wish for these or if it is beyond your licensed scope of practice.
  • Do not practice anything that could be harmful to the client. Simply skip the step and move onto the next until you would do no harm.

30-Step Sweet Session Bodywork Sequence Protocol

Watch a Sweet Session bodywork appointment on video here.

Operate within your scope of practice and use rudimentary massage training to execute a Sweet Session.

  1. Client intake process. Review and follow potential service precautions or contraindications. Inspect any skin concerns prior to the start of hands-on application.
  2. Sit at the top of the client, superior to the client’s head.
  3. Holding position: crown comforting. Place hands bilaterally over the client’s crown of their head. The practitioner’s carpals will meet at the top of the client’s head with their fingertips pointed inferiorly towards the client’s ears.
    • Exercise affirmation with hand hold over crown when appropriate.
  4. Holding position: head comforting. Move hands to bilateral hold under client’s head. The client’s head will be cupped in the practitioner’s hands with their fingers pointed towards the client’s occipital region.
    • Exercise affirmation with hand hold of client’s head when appropriate.
  5. Scalp treatment. When the client has hair, finger comb through the client’s hair if and when appropriate. Practitioners will insert a supinated hand next to the client’s scalp and allow the client’s hair to fall between their fingers. Gently comb the fingers through the client’s hair, outwards, to complete finger hair combining. Repeat with alternating finger combs, over and over again when possible.
    • Scalp massage can be practiced here in addition to finger hair combing, or as needed. For example, bald clients.
    • Some clients will have hair that will not be a good candidate for finger combing. Skip the entire scalp altogether when none of this work is desired or can be practiced.
  6. Ear massage. Lightly rub the client’s pinna or external ear cartilage between the practitioner’s opposing thumb and fingers. This can be practiced bilaterally, and provided on dry skin, or with a pH balanced massage lotion or cream. Start at the ear lobe and massage superiorly towards the top of the helix for one full pass, and repeat. Five to ten passes of ear massage is standardly practiced.
  7. Bridge of the nose massage: clearing the third eye. Practitioners position their bilateral pointer and middle fingertips inferiorly towards the client’s feet, above the client’s bridge of their nose. Individually and slowly flex the pointer and middle fingertips on the client’s skin over the bridge of their nose backwards towards you, to lightly massage the bridge with a fingertip crawl. 10 to 15 passes is standardly practiced.
  8. Temple massage. Practitioners can use their pointer and middle fingers, or any combination they chose to provide circular clockwise and counterclockwise light friction over the temple region bilaterally. Five to 10 circular passes in each direction are standardly practiced.
  9. Sinus point acupressure. With bilateral finger placement over sinuses, the practitioner will gently press for 10 to 20 seconds or longer. Three or more series of passes are applied over:
    • The bridge of the nose.
    • The middle nasal sidewall of the nose.
    • The lateral corners of the nostrils.
    • Practitioners can optionally apply facial acupressure to any additional place desired. OPTIONAL: Practitioners can cover the client’s eyes after this step, which is not standardly practiced, especially when providing this service for a client with dementia, Alzheimer’s or those who have issues with touch.
  10. Light bilateral jaw tracing. The practitioner will close their opposing thumb and pointer finger together to create a V-shaped position between these two digits. Starting at the midline of the chin, the practitioner will lightly trace the client’s mandible with their v-positioned thumb and pointer finger, posteriorly towards the client’s ears. five to 10 passes from the chin midline to the ears is standardly practiced.
  11. Holding position: shoulder comforting. Place one hand on each top of each shoulder with fingertips facing interiorly towards the client’s feet.
    • Exercise affirmation with hand hold of the shoulders when appropriate.
  12. Holding position: heart comforting. Place hands on, and just inferior to, the client’s clavicle with fingertips facing the midline. Avoid excessive contact with breast tissue.
    • Exercise affirmation with hand hold over the heart are when appropriate.
  13. Move chair to the side of the table and sit at the client’s side.
  14. Holding position: abdominal comforting. Place one hand over the abdomen and the second hand anywhere else on top of the client’s body to make physical contact.
    • Exercise affirmation with hand hold of tummy when appropriate.
  15. Hand moisturizing massage. Massage the client’s hands individually with low pH balanced lotion or cream. Each finger should be individually massaged with retrograde application. Wipe hands dry if a client is to move from their treatment area.
  16. Move chair to sit next to the client’s legs.
  17. Holding position: upper leg comforting. Hold bilateral hands over the midpoint of each quadricep.
    • Exercise affirmation with upper leg holding when appropriate.
  18. Holding position: lower leg comforting. Hold bilateral hands over the midpoint of each tibia.
    • Exercise affirmation with lower leg holding when appropriate.
  19. Move chair to the inferior end of the client to sit at their feet.
  20. Holding position: foot comforting. Use both hands to hold both client’s ankles or heels.
    • Exercise affirmation with foot holding when appropriate.
  21. Ankle rotation. Individually rotate each client’s ankle in both clockwise and counterclockwise direction. Three to 10 circles in each direction is standardly practiced.
  22. Foot moisturizing. Apply low pH balanced lotion or cream to the client’s foot or feet. Practitioners can massage one foot at a time, or they can alternate back and forth between feet with each step.
  23. Ankle tracing. Lightly trace the medial and lateral malleolus in both clockwise and counterclockwise direction. Three to 10 circles in each direction is standardly practiced.
  24. Foot massage: Aka the spinal twist in foot reflexology. Petrissage the medial arch of each individual foot with both hands. The petrissage can extend to the client’s medial big toe to their medial heel and everything in between.
  25. Ankle plantarflexion and dorsiflexion: inspired by the foot reflexology lung press. The practitioner will place their palm of one hand over the client’s dorsal foot. They will gently press a fist with their second hand into the client’s ball of the foot to dorsiflex the foot. After dorsiflexion, the practitioner will pull the dorsal foot towards them to plantarflex the foot. Press and pull repeatedly to create a gentle rocking motion, back and forth with the client’s ankle. Five to 10 ankle pumps in both directions are standardly practiced.
  26. Foot brushing. Gently brush each client’s foot inferiorly from the tarsals to the toes with hand over hand contact with the client’s foot. 10 to 30 passes of hands over each foot is standardly practiced.
  27. Treatment reflection: inspired by the foot reflexology solar plexus hold. Gently press thumbpads under the middle of the client’s balls of the feet bilaterally. Gently release this pressure, little by little, until you are no longer in contract with the client’s feet. This gradual letting go process usually lasts somewhere between 30 seconds to two minutes. Some clients may feel like the practitioner is still touching them even after touch has ended with this step.
  28. Wipe the client’s feet: safety first. Remove all massage medium from the client’s feet with a hot towel or other method, if the client will stand after the treatment. Never allow a client to dismount from their treatment area with greasy feet to prevent a slip and fall accident.
  29. Closing rituals. Practitioners can engage any closing ritual that they feel is appropriate for the session. This might include asking the client to take some deep breaths while thanking them for their time. Practitioners can also apply some gentle body brushing with sweeping hands strokes, down the outsides of the client’s body, from their shoulders to their toes. Repeat three to five brushes along the most lateral edges of the body from top to bottom.
  30. Conclusion of service. Remove the bolsters if needed and help the client to their feet if they are leaving the treatment area. Sometimes allowing a client to acclimate to their surroundings by sitting on the table first is best.

Clients Love Sweet Sessions

One of my first exposures with massage was in the Athens Olympic Stadium in Athens Greece in 1989 where I was competing for my first world championship in arm wrestling on Team USA. Our American athletes practiced vigorous sports massage on each other’s arms to enhance performance and it did help. I was a 18-year-old teenager competing in the adult category and I won the gold.

Because my massage career was born from this intensive and vigorous practice, it has felt onerous at times to transition to other bodywork that is still and calm. This created concern that other vigorous bodywork practitioners might feel the same about the Sweet Session, but it was just the opposite. Some of our most aggressive bodyworkers have appreciated the relaxing simplicity of this service.

I would never hesitate to offer a Sweet Session after experiencing this overwhelming positive response from both massage therapists and clients. Massage recipients from all styles have regularly found wellness and enjoyment with a Sweet Session appointment. Sweet Sessions encompass whole-body treatment from the crown of the head to the soles of the feet. This session provides an incredible journey for those who require an alternative massage or bodywork service.

Selena Belisle

About the Author

Selena Belisle is the founder of CE Institute LLC in Miami, Florida, where they teach massage, nursing and cosmetology industry CE courses. The school teaches a 12 hour CE course in Evidence Based Massage, among many other subjects. Selena is approved as a continuing education provider by many industry boards including the National Certification Board for Therapeutic Massage & Bodywork. She has been practicing massage therapy and bodywork for over 30 years.