Trauma fundamentally alters our sense of safety, overwhelms our normal coping mechanisms, causes us to feel helpless, and becomes an instant habit. Chris Smith is a trained professional in trauma touch and takes us through recognizing trauma in ourselves and in our clients, addressing long-term physical and emotional effects. Chris gives listeners advice for recognizing trauma on the massage table and the dos and don’ts of working with clients, all the while cognizant of scope of practice.
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0:01:55.1 Darren Buford: Welcome to The ABMP podcast. My name is Darren Buford, I'm Editor-in-Chief of Massage & Bodywork Magazine and Senior Director of Communications for ABMP.
0:02:03.4 KC: And I'm Kristin Coverly, licensed massage therapist and ABMP's Director of Professional Education.
0:02:09.2 DB: Our guest today is Chris Smith. Chris is a recognised leader in the field of massage therapy and trauma. She is a massage therapist and trauma touch therapist. She developed and has been teaching trauma touch therapy at the Colorado School of Healing Arts and to therapist worldwide since 1992. She has been with Colorado School of Healing Arts since 1988, where she serves as the School Director. For more information about Trauma touch therapy, visit the school's website at csha.net. Hello, Chris. Hello, Kristin.
0:02:39.0 Chris Smith: Hello, Darren. Hello, Kristin, it's so nice to see you all.
0:02:45.4 KC: Chris, it is so wonderful to have you here, and we're so grateful to have you here with us today to talk about trauma and trauma touch, because as we know more than ever, as we begin to understand and process how the COVID pandemic has impacted us emotionally and physically, the ability to recognise and address trauma and clients, but also ourselves, and let's talk about both all throughout this podcast, clients and ourselves, it's so important that we understand how to recognise and work with trauma, so before we go any further, let's start though with the general definition, Chris, what is trauma?
0:03:23.4 CS: Well, trauma is anything that overwhelms our normal coping mechanisms, and oftentimes, some of the hallmarks of trauma are that it was unexpected and the person was unprepared, there was nothing that they could do to prevent the event from happening. Very much like the pandemic, who knew that it was gonna be what it was, that it was gonna take so long, that it was gonna affect us so deeply worldwide, and sadly, none of us can escape traumatic events, whether it's personal or tangential. It's everywhere.
0:04:00.0 DB: So Chris, what's the difference between trauma and stress?
0:04:03.5 CS: Stress is really kind of a part of everyday life, and although the symptoms can be as severe as those of trauma, they can usually be mitigated or resolved by just simple lifestyle changes, eating less sugar, getting more sleep, talking to a friend. And also, if you add in the ability to experience social engagements such as talking with good friends, things can normalise in a relatively reasonable amount of time, but trauma is different and it creates a complete and very complicated dysregulation in our brains and our nervous systems. And so, it fundamentally alters our sense of safety, our ability to make meaning out of our experiences, it activates the autonomic nervous system and puts the individual in a constant and unrelenting state of hyper-arousal. It's very difficult, almost impossible really to mitigate by lifestyle changes, like we would with stress and common hallmarks of trauma, things like helplessness and isolation and hyper-vigilance, and insomnia, and so I think it's just much more unrelenting and difficult to shift gears. It really becomes, as I've heard many times said, it becomes an instant habit, all of a sudden our life completely changes and is turned upside down.
0:05:43.9 KC: Wow, everything you just said is so powerful. And if we really think like the words that struck me and really popped out to me where fundamentally changes, who we are and how we feel, that it's constant and unrelenting, just that word unrelenting really encapsulates how someone who's experiencing trauma and especially extended trauma will be feeling and that it's an instant habit. Instantly, we change who we are and how we move through the world because of this experience or whatever was the trigger for the trauma.
0:06:19.3 CS: Yeah, it does. It also changes in somebody that's experienced trauma, it changes our baseline of arousal and that base line of arousal becomes elevated and doesn't return back to normal, and so with each new trauma or stress, that baseline continues to elevate making it easier and easier for the person to become more and more traumatised with less and less stimulation, and so this is where people start to feel like, I never feel safe. This always happens to me. And it's just 24/7.
0:07:00.6 KC: And Chris, it's really hard for someone to heal from trauma, a lot of times you hear people say, "Oh, just get over it." "Are you still thinking about that thing that happened a week ago or a month ago?" Why is trauma is so hard to heal from?
0:07:13.9 CS: Well, I think, again, we have to recognise the fundamental changes that happen in the brain and in the autonomic nervous system. What happens in the brain is that you have... The moment we experience trauma, neuronal connections, maps are formed to basically hard-wire us to experience every new event, however normal that event might be, but every event through the lens of our hyper-arousal, through the lens of our already irritated limbic system. And then the thing that's even more challenging is that those neural connections receive more myelin, which is sort of the grease that makes the synapse go faster, and so it just increases the level of hyper-arousal. The other thing that I think though, that we have to look at too, and you sort of refer to that is, "Just get over it? That happened 10 years ago. Why can't you just get over it?" Is that a lot of the hallmarks that show up in an individual that's experienced trauma are actually mistaken for that person's personality, and they don't get a chance to come off of that easily, and then there's the shame piece. People are saying, "Why can't I get over it? Well, why can't I get over it? I must be a flawed human being." It just feels like failure at every turn.
0:08:49.7 DB: Chris it sounds like compounding factors, prolonged compounding factors, what are the long-term emotional effects of prolonged trauma?
0:09:01.8 CS: Well, I think the long-term emotional effects of trauma would be things like anxiety, depression, panic disorder, the other thing though that I think happens, which makes sense when you think about this level of hyper-arousal that happens in the nervous system is this... Again, and I'm gonna use the word unrelenting sense of numbing and we can numb really well, we can numb out everything, and so we just have a complete inability to sense aliveness and joy, 'cause numbingness isn't specific to, "I'm just gonna numb out the bad things," numbing happens overall. So you don't experience anything positive either.
0:09:52.8 DB: So Chris, when you mentioned that, it made me think of compartmentalising, you mentioned numb, and that made me think of people being able to separate feelings into multiple categories and to put it over there, just to put it over there, and I understand that they're gonna be re-triggers or re-triggers that are gonna make it resurface, but is compartmentalising something that people do to get past a traumatic event?
0:10:19.8 CS: Well, I think there's an attempt to compartmentalise that they can just put it over there, but because... Let me go into another thing there that what happens oftentimes is the pre-frontal cortex, which is that part of the brain that kind goes into executive functioning and so forth, it also is affected by the trauma, and so we usually operate out of that part of our brain, the pre-frontal cortex that tells us what has gone before, what's worked, what's not worked, and then we can kind of live our lives fairly well out of that place, but when it's disrupted by these neuronal maps and disconnects and hijacks and things that happen in the brain, even the ability to compartmentalise doesn't work, people just get into this place where they just feel so isolated, and it's almost like their body has become the enemy, their brain has become the enemy, how can I even isolate to the point where I'm even isolating from myself, and it's not even working, and that's where it becomes really crazy making on many levels, you don't even trust your own perceptions.
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0:12:32.5 DB: Now, let's get back to the podcast.
0:12:34.6 KC: Chris. Let's transition and start talking about how this affects the physical being, so how might sadness, grief and trauma manifest in the body?
0:12:44.5 CS: You can see generally a lot of tension, pain that seems to have no real origin, shallow breathing, sleeplessness, and I think overall feeling too much or feeling too little is something that happens, but the thing that I think is even more important to understand in terms of how it manifests in the body, is that trauma creates basically an inflammatory process, and that can be actually demonstrated by a simple blood test, when people who have experienced trauma, as they perhaps ask their physician to have a blood test, the test C-reactive protein, usually those levels of C-reactive protein in the blood stream are highly elevated in people that have experienced trauma. So when you have that, again, unrelenting level of information, and we're talking about sometimes people that are experiencing this for 10, 15, 20 years, you can also run into things that really are pretty severe, you can get esophageal spasms, you can get reflux, ulcers, migraine headaches, TMJ, vision, problems, colitis, bladder infections, reproductive issues, colitis. Just a whole host of disease processes that basically come from that high level of information in the body, in the bloodstream.
0:14:27.4 DB: Chris, how can we recognise trauma in a client?
0:14:30.5 CS: Well, I think what you're gonna see is oftentimes a sense of isolation, anxiety, panic, an inability to rest, sleep, they might report that they're having nightmares all the time, changing in their eating patterns, changing in their normal routines, they may get on the massage table and just literally freeze, that you may, as a massage therapist, feel just an overall sense of tension in the body, and another thing that I think is very, very important to notice as massage therapists and our clients is to make sure that they're not dissociating when they're on the table. Often times even well-meaning touch can still add more overwhelm to that already irritated and unstable limbic system, and so the client may dissociate and that means they basically check out, they go away. It's a really amazing coping mechanism, but it's a terminal level of coping where they just go. They're not feeling... They often may be re-living some aspect of their traumatic experience, and so to continue working with a client who's dissociated, it's very, very dangerous, 'cause you're usually escalating that traumatic moment for them.
0:16:04.5 KC: So Chris, if you recognise that, you say it's dangerous, is the best thing to not have the session or stop the session and then refer out? Or what would you suggest?
0:16:14.2 CS: I think the most important thing is to stop, but what we often see, and I've seen this in classrooms where the therapist will, hands fly off the client and, "Oh, I'm so sorry, I'm so sorry. What's going on? Are you still there? What are you thinking of right now? Where are you?" And those are all the questions that are just gonna further deepen that level of dissociation, so the most important thing is to have the client turnover, open their eyes, and you may have to encourage them, "Susie, open your eyes, come out and look at me. There you go." And if they're in the face cradle, have them turn their head, "Look at me, here I am, let's make eye contact, there, there, here you are," and just make sure that they're back. Now, sometimes clients can go in and out of that dissociative state and they may say, No, let's go ahead and try a little bit more contact. I think I'm gonna be okay. And so what I'll usually do is say, "Well, let's make an agreement. If you start to feel yourself going, raise your hand, and then we'll know, we'll stop, we'll reconnect, we'll open the eyes, and just go from there," but it's really important to always work with the body in the present moment.
0:17:37.8 KC: And Chris, let's talk about clients who aren't in that phase, so they're not experiencing disassociation, but they've either been forthcoming with you about trauma they've experienced, or you've recognised the physical signs you talked about, how can we as practitioners create a space for them, what are the dos and don'ts of working with clients experiencing trauma?
0:17:58.8 CS: I think the most important thing to do is don't see them as damaged, don't see them as broken, don't call them, "I'm gonna be working with my trauma client today," then you've put them in a box that they'll never get out of. I think it's important to see every client, regardless of whether they have trauma or not, as fundamentally whole, and you work towards that wholeness. You see a person as a fully realised human being and not their pathology. Carl Rogers had this great concept of bathing people in unconditional positive regard, and people can feel that, it's a tangible quality that you can bring to the relationship. I think the other thing that you have to watch for is, don't have an agenda. I've talked to massage therapists who in... [chuckle] They have the right space, they really wanna do their best job, but they've researched all this stuff about trauma, and so now they think they're gonna have this certain protocol that they have to do, and people don't fall into a protocol, they're all individual, they're all different. And so you have to just show up, be present, be authentic, and just be ready for whatever happens and be willing to have more of a conversation. I do quite a lengthy intake with my clients before they get on the table.
0:19:32.0 DB: Chris that's exactly what I was gonna ask you, because trauma isn't a check box on an intake form, like high blood pressure.
0:19:40.9 CS: It's not.
0:19:41.9 DB: Can you tell me about that? And somebody is probably obviously not gonna be forthcoming about trauma on an intake, right?
0:19:51.1 CS: So what I have is a little area that says, "Is there anything I need to know that would make this session more comfortable for you, 'cause clients, I don't assume that just because a client comes in for massage, they're ready to be touched, right? [chuckle] So I have to... And I certainly don't assume that they are going to be trusting me right away, that trust has to be developed over time, so that question kinda opens it up for them to share as much as they wanna share. I think sometimes we all have that sense that maybe there's something more going on, but I have to keep that to myself and not let that necessarily color how I'm, again, seeing this client, I have to see them as fundamentally whole, and I think if we work towards their wholeness instead of their pathology, the outcome is just 100 times better.
0:20:53.7 KC: I love that, work towards their wholeness and not their pathology. I also wonder, as we're talking about whether or not clients might be forthcoming, I wonder if because you are a trauma touch specialist, they do feel more confident and secure in telling you a bit more than they might another practitioner who doesn't list trauma touch as one of their specialties. What do you think about that?
0:21:15.5 CS: Kind of both. I have clients that I think probably do feel a bit more comfortable knowing that... But I'm hoping that's more coming from how I present myself rather than what my E-I-E-I-O is at the end of my name. But then I think there's also clients who might see that trauma touch therapy, and this is the other thing that I do and may be even more cautious about, "Oh my gosh, if I shift around the table or if I just kind of go to sleep is she thinking I'm gonna be dissociated," and then... So it can kind of work both ways.
0:21:52.1 KC: Chris, if we are working with a client who has experienced trauma, I think most people's instinct would be that when we're thinking about techniques to use with them, it's like, "Oh my gosh, lighten up. Don't do anything deep." What's true? I don't know, that's just what people's minds might go to, but what are some dos and don'ts with the actual techniques that we use?
0:22:12.6 CS: Thank you so much for asking that question because here's what you need to do, ask the client, [chuckle] ask the client rather than assuming one way or the other. I think rather than negotiating, sometimes the depth, it's more about going slow. It was funny, I was just talking to one of my classes the other day about a client that I had who came in and said, "I just need you to help me feel more whole, more integrated. I feel completely fragmented." And I thought, "Okay, well, what does that look like?" And she kind of stopped for a minute and said, "I think it means more pauses," and so I said, "Oh, okay, well, I definitely can do that, but how are we gonna know? Are you gonna tell me when I need to pause?" And we did the thing of, "Well, how about this? If you need me to pause, raise your hand," 'cause sometimes that ability to vocalise isn't always there, so just raise your hand. And the thing that was really remarkable about that was, one, how many times we paused in that massage, and then the other thing that I thought was interesting is that pauses, were not at all where I thought they were gonna be. So again, I'm trained... I feel I've been doing this for a long time, and I still have that little bit of, "Oh, I think it's gonna be here or here." It wasn't anything like I thought it was gonna be.
0:23:54.9 DB: Chris, that's amazing that you and the client had that conversation pre-session, but what about in the session, if somebody had a sudden emotional release?
0:24:04.5 CS: Yeah, the thing that happens is, I think it's really important to see that emotional release is just this wonderfully organic, normal [chuckle] response to touch. And again, we don't wanna take our hands away and start apologising thinking that is the therapist, we did something wrong. That emotion can be just a wonderful accompaniment to the work that we do and a normal response to just basic touch. So I think we have to just pause. Check in with the client, affirm that, "Listen, I'm here. What do you need?" And oftentimes, the client may, in my experience, say, "Just keep your hands there, I'm just gonna move through this for a moment, just give me a moment," and it can elevate into sometimes much more active crying and vocalising and maybe some movement in the body and so forth, and then what we might do is see if there's a different position they wanna be in, but I don't leave, and even if they asked me to take my hands away, I still continue to affirm, "I'm right here. Just let me know what you need."
0:25:40.3 KC: Simple but powerful, simple but effective.
0:25:43.6 CS: Yeah. You wanna be careful not to try and engage the client into, "What was going on and what were you thinking, and what were you experiencing?" Because really, that starts to go outside our role as a massage therapist. We're not psychotherapists, and even if we were, that would be happening in a different context. We're massage therapists, so we can do things like, "So what's happening in this place where I have my hands right now? What's happening in the body?" I think that's really important to reference back to the body.
0:26:18.8 KC: Chris, I'm curious, when you're teaching your trauma touch therapy courses, so we're in the classroom with practitioners, what are massage therapists learners most surprised by when they're learning trauma touch?
0:26:31.7 CS: I think, first of all, that the approach is really simple, in fact, the hardest thing I have to do when I'm teaching trauma touch therapy is to help people unlearn what they think they ought to do and need to do, and so it's simple, it's simple. But I think the other thing that is really surprising to everybody, and often to me too, it's just, sometimes humor comes in, we laugh, we get playful. Play is one of the hallmarks of trauma too, that lack of ability to play or be playful is often one of the first things that goes away when we've had trauma, and so to be able to so easily move back into that is very surprising, and I think another thing that I think is part of the work that surprises a lot of people is that they can sit with themselves when nothing is happening, because if you've been somebody that's had trauma in your history, there's a tendency to keep that arousal level elevated because that's what's comfortable? That's what we're used to. And so if it drops and nothing is happening, then what does that mean? That means that something bad might be happening, something bad is about to happen, and so they spiral back up into that hyper-arousal, and so to be able to learn how to just sit and nothing is happening and it's okay, is just a miraculous sort of moment.
0:28:16.7 DB: Wow, that's really powerful. Chris, let's bring it on home. If listeners recognise trauma is present in their own lives or bodies, what suggestions do you have for self-care?
0:28:27.9 CS: It's kind of a challenge, and I'll tell you why, in talking to a lot of people and myself as well, sometimes self-care can just be one more thing we have to do, and then we get all judgy and competitive about it. I had friends during this pandemic that decided, I've got this time off, I'm going to be the healthiest person during this pandemic ever, and so I'm running 10 miles a day, and then I wake up and I do this 20-minute yoga practice, and I had this wonderful Buddhist teacher that gave me this wonderful practice to do, and it's just so amazing, and I'm thinking, "You know, I'm lucky if I get to the kitchen in the morning without tripping over the dog." So it's like, "Holy smokes." So I think the thing about self-care is just pause, ask your body what it needs. Get out in nature, sometimes when you're in, like I often go, we have a park near our house, and I go out into the park and I see the clouds, and I think the world is so much bigger than what I'm experiencing right now, and to have that perspective is such good self-care, but I also have times when I lay on the floor, I stare out the window.
0:29:46.9 CS: I stop making it a thing, and I think what I found more helpful for me is to just have moments of pause and quiet throughout my day, rather than having this thing that I do that takes an hour or 20 minutes is some magnificent whatever, I just take more pause and I notice that my nervous system is much happier with that, much more balanced with that, and for me, that's the best kind of self-care.
0:30:22.9 DB: Wow, this has been a very powerful and amazing podcast. I wanna thank our guest today, Chris Smith, for more information about Trauma touch therapy, visit csha.net. Thanks Kristin and thanks, Chris.
0:30:35.7 CS: Thank you so much Darren.
0:30:37.7 KC: Chris, thank you so much for being with us and sharing all of that incredible content and your passion with us today, it's gonna help every listener and also everyone they interact with. Thank you so much.
0:30:49.3 CS: You are so welcome, thank you all too.
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