The Session Surrounding the Session

A recent commentary in the International Journal of Therapeutic Massage & Bodywork proposes a framework I think you’ll find both familiar and quietly unsettling, the way a good idea can be uncomfortable when it holds up a mirror. Shawn Maier, a certified massage therapist, calls it the “Somato-Relational Framework,” and while it’s a theoretical model rather than a clinical trial (Maier is candid about the need for empirical research to validate it), what it describes is something we’ve probably all felt happening in a session without having language for it.

Maier argues that massage therapy has untapped potential as a mental health-care intervention and that the gap between where we are and where we could be isn’t about technique but about three things he calls embodiment, relational dynamics, and integration. I want to spend our time together on that third one because integration is the place where I think we leave the most on the table. (Literally.)

I’m going to ask you a question, and I want you to carefully consider it and be honest with your answer. Do you do things, both internally and externally, to prepare for your work with clients before and after a session, or do you show up, massage, and move on?

If you’re wincing slightly, that’s OK. Wince-worthy observations are where the learning is.

Before the Work Begins

Maier describes what he calls “creating a therapeutic container.” It’s possible that phrase makes you roll your eyes a little. I get it. It sounds like a continuing education marketing brochure. But strip away any baggage about the words, and you might see that what he’s describing is something you already know matters: intention. Specifically, taking a few minutes at the start of a session to invite your client into a collaborative, purposeful process rather than just asking where it hurts.

In my most recent two columns, we’ve explored motivational interviewing and contextualizing care. Asking, “What do you most want to address today?” or “Is there anything going on in your life that’s showing up in your body?” isn’t therapy. It’s skilled inquiry coupled with curious listening. It’s within your scope, it takes 90 seconds, and it changes everything about what happens next. Maier calls this phase “identifying emotional states clients wish to address.” I’d call it being curious so you can be useful.

He also names something that may seem obvious to some massage therapists but that still, in my experience, is not well understood: the idea that creating a sense of safety and trust isn’t optional. It also won’t “just happen.” It isn’t a trait some therapists happen to have; it’s the result of specific clinical observation and related behavior. The power differential in our treatment rooms—in which one person is clothed, and one is not; in which one is standing, and one is lying down; in which one has expertise, and one is in need of it—is real. Navigating that reality skillfully is part of the job. It’s also part of the job to actively do something, or a variety of somethings, about it.

During the Work

What Maier describes as “relational attunement” is the part of this framework where most skilled massage therapists will nod and think, “I already do this.” Noticing a shift in breath, adjusting your pace in response to a change in muscle tension, sensing when a client has mentally left the room versus when they’re fully present. This is the language of a thoughtful practitioner. The research Maier cites suggests it also has measurable biological effects, including oxytocin release associated with the quality of connection that skilled, present care creates.

The transformative potential of massage therapy in mental health care is conditional. It only happens if we do the things Maier describes in this framework. It’s on us. It doesn’t just happen when we touch. It depends on whether we’re showing up as practitioners of a complex, psychosocial discipline or just performing techniques.

After the Session

After the session is where I think we have the most room to grow. Maier’s third pillar of integration asks us to help clients carry their experience beyond the session—simple things like a somatic check-in practice, a breathing anchor for a stressful week, or an invitation to notice what changes. The goal is to empower the client to become engaged and curious about their own process and wisdom. This sets the stage for sustainable benefit, rather than a return visit predicated on temporary relief. (Which, as I explored in the beneficence column, is both the ethical and clinical standard.) 

None of this is complicated. As a result of its seeming simplicity, it’s also easy to overdo. The framework isn’t asking you to become a talk therapist. It’s asking you to be a complete massage therapist who holds the time before the session and after the session as part of the session.

One final thought: Maier refers to massage therapy as a “modality.” I’ll give him the content and quibble with the word. We are a discipline, and the distinction matters precisely because frameworks like this one help make the case. When we bring this kind of consciousness to our work, we’re not adding something foreign. We’re finally naming what was always there, and how fundamentally it and we belong. 

Resource

Maier, S. “Reframing Massage Therapy: The Somato-Relational Framework for Mental Health and Healing.” International Journal of Therapeutic Massage & Bodywork 18, no. 3 (September 2025): 102–7.