Far away with thoughts. Happy and smiling senior woman sitting with crutch and looking straightListening is our bridge to the deeper wisdom in a massage session with a hospice client. All aspects of this field require listening skills, from the very first intake to our private processing of the session.

One of the most uncomfortable challenges for practitioners new to hospice massage can be the initial entering into the hospice client’s room or stepping up to a hospice client’s wheelchair.

Always connected. Cropped image of senior positive woman in wheelchair and doctor standing and holding tablet computer

First, Pause

Entering into a hospice client’s space requires the practitioner to integrate into the existing experience. This requires the practitioner to pause, listen and observe the activity already in motion. This pause involves observing the environment and noting any obvious changes to the client’s comfort care, such as bed positioning or positioning.

Notice. Is there any new equipment by the bedside? What is the client’s overall demeanor, skin tone and body animation? After a verbal intake from caregivers, this visual assessment, even before entering the client’s immediate space, gives the massage practitioner current information about what is happening in that moment.

There may also be other support team members in the space. This is a common occurrence in hospice massage. In hospice massage, the practitioner is a part of a greater support team. Although the massage practitioner may have an appointment, he must take a seat at the larger table and integrate his piece of support with the wider care plan.

The pause allows the practitioner to sense and feel the dynamics already present in the client’s space and assess how he might enter into the current dynamic without a sense of intrusion. This might include speaking softer than usual, moving slowly or saying hello to a number of other visitors or team members before saying hello to the client or introducing himself to a new client.

The practitioner may also need to sit while conversations or activities are completed or need to simply wait outside the room. In short, there may be several layers of activity happening in addition to the massage appointment.

Be Receptive

The pause also allows the practitioner a moment to adjust his level of receptivity to the physical pain and emotional stress that may be present in a dying person’s space.

There are many layers of pain involved with the dying process. The client may be experiencing physical pain as well as depression and unimaginable grief in regard to leaving loved ones, the loss of one’s personal identity, regrets and all that one might process in reflection of one’s life journey.

Others in the room, including professional caregivers, will all be in various stages of grief and grieving in their own unique ways. Everyone experiences grief differently. Feelings may vary from anger, fear, and resentment to deep sadness and withdrawal. Attitudes such as mistrust, defensiveness, aloofness, chaotic humor, or the inability to process any new information, including the practitioner’s name and why he is there, may be exhibited as byproducts of grief.

The room is already full. There may be no receptivity to input. To walk gently and slowly and speak softly is in honor of the unknown or the unseen and unspoken. This is the silent dialogue that requires a pause and a moment of deep listening.

The second level to this silent dialogue is that of the practitioner observing his responses to these dialogues and listening to one’s own dialogues that are triggered within oneself.

Both the physical and emotional dynamics of the client, the environment, those in the client’s space and one’s own personal responses require the practitioner to pause, observe and listen. To deeply listen requires a commitment to be fully present and available to the space in between the breaths; the silence. Listening deeply includes listening with one’s eyes, heart, and hands as well as with one’s ears.

Enter the Space

  • Begin entry with a pause. Be still.
  • Feel your feet on the earth.
  • Observe the moment and breathe.
  • Observe your client’s environment and body. What’s happening? What experience are you entering into? What is your experience? Observe yourself.
  • Breathe
  • Integrate the experience you are witnessing, both intellectually and through the senses.
  • Ask permission to enter into your client’s space. This may be a hello to other team members in the room and being asked to enter or with a lone client who is nonverbal, stating what you are going to do and observing the body language as to comfort or discomfort to your entry.
  • Integrate into the experience you are witnessing. Listen, sense, observe.
  • Breathe with exhale included.
  • Listen deeply, with your head, your heart and your body
  • Ask permission to step to the bedside or chair. In case of a nonverbal client, state what you are going to do and evaluate permission or lack of, through your client’s body animation. This requires a pause for observation and a quiet mind.
  • Breathe with exhale included.

Young care giver helping hands for the elderly woman

Approach the Hospice Client With Touch

  • At the bedside or chair, ask permission to touch or state exactly where you are going to touch if the client is nonverbal.
  • Observe your client’s body animation to assess permission or lack of permission.
  • Approach the body slowly, honoring the space around the body, to provide the hospice client care. The energy fields surrounding the physical body are scientifically the most sensitive of the bodies. Move slowly and gently, so as not to create anxiety.
  • Offer the hands as a point of regard for whatever your client’s body is expressing. This is the practice of witnessing, rather than the intention to fix or change.
  • Always feel your feet grounded with the earth.
  • Breathe with exhale included; rest and touch.
  • Observe your client’s body responses and facial animation.
  • Integrate the experience, intellectually and through the senses.
  • Listen to the silence. This requires a pause. Listen with your head, your hands, your whole body and with your heart.
  • Observe your responses and breathe with exhale included.
  • Continue to touch or massage with this pause—the breath—with observation and integration as your guide.
  • Always feel your feet grounded with the earth.
  • Always breathe. Always rest.
  • There is nothing to fix, nothing to change and nothing to heal. Your experience is already perfect.

Excerpted from Massage in Hospice Care, an interactive iBook by Irene Smith. For more information, read “Massage Therapy’s Role in the Growing Hospice Movement,” by Irene Smith.

About the Author

Irene Smith began her journey as a massage therapist in 1974. She founded and directs Everflowing, an educational outreach program dedicated to teaching mindful touching as an integral component to end-of-life care. Smith is a member of the National Association of Massage Therapists, Hospice Volunteer Association and the San Francisco Bay Area End of Life Coalition. She wrote “Advocate for Yourself in the Health Care Environment” and “Massage Therapy’s Role in the Growing Hospice Movement” for massagemag.com.