Ep 27 – Surfacing Hidden Suffering with Massage & Bodywork Columnist Cindy Williams

00:00 Kristin: Anatomy Trains and the Laboratories of Anatomical Enlightenment are excited to invite you to Dissection Livestream, a regional and layered journey through the human body with Tom Myers and Todd Garcia. September 11th through 14th. Student Jan Ball, who attended the last Dissection says, "The whole livestream Dissection course was truly a unique educational experience. It was profoundly moving, I gained so much from it. It was one of the most valuable educational opportunities that I've had. I'm truly grateful to Tom, Todd and the whole team of people involved who made this unique opportunity available." This experience will be delivered through Zoom webinar with high quality audio and video, multiple perspectives and time for questions, visit anatomytrains.com for dates and details.

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01:01 Darren Buford: Welcome to The ABMP Podcast. My name is Darren Buford. I'm Editor-in-Chief at Massage and Bodywork magazine and Senior Director of Communications for ABMP. I'm joined by my co-host, Kristin Coverly, licensed massage therapist and Director of Professional Education for ABMP. Our goal is to connect with luminaries and experts in and around the massage, bodywork and wellness profession in order to talk about the topics, trends and techniques that affect our listeners practices. Our guest today is Cindy Williams, after earning a degree in sociology from Indiana University in 1997, Cindy stumbled upon her calling as a massage therapist and bodyworker. She completed massage school in Boulder, Colorado in 2000, and has been actively involved in the massage profession since that time.

01:46 DB: She has spent the last 20 years in private practice as a school instructor and administrator, curriculum developer and mentor. In 2010, she joined the ABMP education team as a school liaison, they continued her work as a content writer and facilitator for ABMP's Instructor on the Front Lines program. Cindy writes the Classroom to Client column for Massage and Bodywork magazine, as well as various feature articles for Body Sense magazine. She currently works as a freelance educational content writer, combining her training in massage and polarity therapies with her extensive background as a yoga practitioner and instructor, she loves teaching how the body operates holistically and how each component of the individual must be addressed in order to create change. She is very passionate about her work. Hello, Cindy.

02:32 Cindy Williams: Hi, Darren. How are you doing?

02:33 DB: Good. Hello, Kristin.

02:35 Kristin: Welcome. Hi everybody. Hi, Cindy.

02:37 DB: Cindy, two-time guest on the pod, look at that. We brought you on this time because we wanna talk about your most recent column in the September-October issue of Massage and Bodywork magazine called Surfacing Hidden Suffering, because we know a lot of MTs might be facing hidden suffering as they go back to work with their clients. So I want to bring this up and ask you the first question is, as clients begin to return to tables, why might MTs see this increased stress or sadness or grief?

03:11 CW: Yeah, Darren, and it's because we have literally had our world turned upside down lately, our routines have been altered, our freedoms have been compromised, and fear of harm actually is at an all-time high. It's scary enough to deal with the fear of a virus, but when we begin stirring each other because of things in the world, like rioting, violence and division on a lot of different levels, feelings of stress and sadness and grief become very, very powerful. And on top of that, a lot of people are dealing with financial distress because of job loss, and we do what we can to process what we can, but in times like these emotions that become really too powerful or uncomfortable to feel, they tend to get tucked away from the surface. It just gets a little too hard to manage when the very basis of one's life security starts to get compromised, so whether a client is conscious of that or not, those experiences and emotions are held in the tissues of the body. So naturally, as we manipulate those tissues, the emotions have a good chance of rising up. Now, the bright side of this is we have a really unique and wonderful opportunity to assist our clients in becoming conscious of them and to shift and release them.

04:39 Kristin: Absolutely. And Cindy, I really love how you structured the information in the column. So you talk to therapists about what they might see, hear and feel with clients, and then ultimately then what we would do in those situations. So let's start with see. So in that section, you talk about sympathetic dominance, can you tell us a little bit more about that and what we might see with clients?

05:02 CW: Absolutely. Yeah, when people feel stressed or unsafe or overwhelmed, their autonomic nervous system typically goes into a state of sympathetic dominance, and what I mean by that is basically a perpetual state of fight-or-flight, so it's always on the ready. Always in preparation mode. And so signs of these could be things like dilated pupils, which the reason for that, by the way, is to prepare oneself to take in visual signs of danger. We have to remember the autonomic nervous system and fight-or-flight is all based off of really a sense of danger and I've gotta run from a lion type of thing, and while we are running from lions necessarily, fear is fear, so I think that's interesting that our pupils will become dilated, sometimes you might see shaky hands, excessive sweating, of course, elevated shoulders, we see those all the time anyway, but especially when things get really stressful, a clenched jaw.

06:04 CW: I know another one that I've started to really notice a lot is that people's hands will be clenched more into fist, they won't even really notice that necessarily, flushed skin. They might be gesturing really excitedly, and of course, they might have shallow or swift breathing. So again, clients might not even be aware that they're displaying these signs of sympathetic dominance or not realize they're in this perpetual state of feeling unsafe, but as bodywork practitioners, it's really valuable to learn to observe these finer details that the body offers to us when the client, especially when the client is not conscious of them.

06:45 DB: And Cindy, what signs my practitioners hear?

06:49 CW: Well, what I hear most often are stories, Daren, a client might not be equipped or even aware enough of the root of their suffering to say something as simple as, I'm scared. And let's think about that, being scared is perhaps the most vulnerable experience that a person can have. So instead, they commonly express their feelings in the format of anger or sadness, and especially anger, it seems. Anger somehow gives people a sense of control when they feel they have none. So how that comes out is they might complain of irritation or disappointment with people in their lives, they might complain about their kids or their spouse, or their co-worker or their boss. When really that's just an outlet for a deep sense of loss of security. You might hear clients swear a lot, speak loudly or rapidly, or they might sigh a lot, like that irritated kind of, "Oh, this is what's going on in my life." all of these are signs of suffering that we might hear.

08:00 Kristin: Perfect. So we've talked about what we might see, what we might hear, how about what we might feel once our session starts?

08:06 CW: Well, of course, we're definitely going to feel tension in their muscles, we're also possibly going to feel a sense of shaking or jitteriness, we might feel a rapid pulse. When we put our hands on the body, we might feel that pulse being elevated. And again, clammy skin because of sweating, lots of different things like that, but really one of the main things is we'll feel tension, we'll feel tension in their muscles, but shaking jitteriness are all very common as well.

08:43 DB: Once we've seen, we've heard, we've felt, how can we physically and verbally support clients whom we see are suffering or that we are aware now that are suffering?

08:52 CW: Well, the number one thing we can do is to be fully present with them. I once had a teacher say, "Treat each and every client like they are the single most important part of your day. And like every word they have to say is deeply important." And I thought that was really powerful, once I began applying that to my work, clients would tell me that something felt amazingly different, even though they couldn't quite put their finger on it, that same teacher also used to say, "To use your hands like mirrors." And what that means is that with each stroke, your intent is to help the body to see itself, to see its state of being that's lying beneath the surface. Even literally having a conversation with the body in your mind, saying, again, this is all in your mind, "I feel your tension. I see your shaking. I hear your frustration." The body is so wise, and amazingly enough, the nervous system will start to self-regulate as we reflect its state of being back to it.

10:01 Kristin: I am now in love with the phrase, "Hands as mirrors." I think that resonates on so many different levels. So thank you so much for sharing that, thanks to your regional instructor for bringing it to you and you bringing it to all of us. So moving forward, we're starting our session now, and you recommend that right now, maybe always, but definitely right now, that therapists start a session with a resting stroke. Can you tell us a little bit more about what that is?

10:26 CW: Essentially, it's stillness. So I always open my sessions with stillness, I always teach my students to do so as well. And the reason for that is that as a practitioner, it gives time to ground myself and to tune in with my clients to feel sensation under my hands, to be able to feel that potentially rapid pulse, that kind of more shaky, jittery energy or... I don't know, maybe I feel a sense of peace. I could feel a lot of different things, but to also open my intuitive mind and to welcome the body to tell me whatever it is I need to know. And when I talk about a resting stroke, and by the way, that can be applied anywhere, basically it means is I just hold my hands on the client, very gently and confidently, and how that might look, if a client is supine, I might cradle their head or hold their feet, and literally it's just a whole thing, you just hold their head or their feet in your hands, and then you go through this, "What do I feel? I'm opening my mind, I'm welcoming the body to talk to me."

11:37 CW: If a client is prone, I might put one hand on the occiput and one on the sacrum, and I hold for about a minute or really until it feels like time to start moving. And I know that that is somewhat of a skill that's developed over time, being able to listen and then hear the, "Okay, that's good. Let's move on." It's just really important to give yourself that time to be able to take in information so that you can then formulate the session in a finer detail. I will also sometimes guide the client to take two or three deep breaths and even add in a hefty sigh, like, "Ahh" [chuckle] I actually do that quite a bit throughout my day, it's amazing how replenishing that is and how releasing that is, of certain tensions, and it also triggers that parasympathetic restful side of the nervous system and that journey then towards balance begins.

12:36 Kristin: As I was reading your column in preparation for this recording with you, I did that out loud in that section of the call and Darren is raising his hand, he did too. And it really did make a difference, like I took a regular just deep breath without the verbalization, and then I did the actual verbal ahh, huge difference. Listeners give it a whirl. I would encourage you to press pause and do a deep breath with an ahh, right now.

13:01 DB: I am very fortunate to have received several bodywork sessions from you, Cindy, and I can attest that you may not have directed me to breathe, but you began the session with very deep breathing. And as a client, I was super dialed in, because it was an acknowledgement that the session had begun, and then I was also finding that I was matching my breathing patterns to yours as if we were working through the session together, and I just can't say how valuable that was.

13:33 CW: Good. Yeah, and it's amazing because that was the intent, and I didn't even communicate that to you, it's what our bodies do. We become energetically in tune with each other, and we also have to remember as practitioners that we are models to what we want our clients to be practicing. So when we bring in that deep breathing, we are doing it for ourselves to prepare, and like you said, signaling that the session started and then hope then that that encourages our clients to breathe with us, so that's really cool. I love hearing that feedback Darren.

14:07 DB: Well, something you also do is I remember you beginning and ending the session by holding the feet, can you describe why and how?

14:15 CW: Yes, absolutely, I can tell you about that. So first of all, holding the feet is so calming, and I do wanna take a little side bar here and say, "Of course, that we have to be mindful of clients who don't like their feet touched because there are some clients who don't. So always make sure that you ask that in an intake when you have a first-time client, because that's kind of a big one, you could take someone from relaxation to jumping off the table and a millisecond by touching their feet if they're uncomfortable with that. And if that is the case, you can also hold their ankles or their calves, the idea is that since the feet are the furthest point away from the head, holding them has an amazing effective slowing thoughts and bringing the client into a grounded state. So beginning and ending here brings the client into the here and now, it draws their attention into their body. And this can also be done, honestly, any time during the session, sometimes I'll do it if a client starts fidgeting or talking, or again, coming back to that, seeing their hands clenched in a session, I just take a graceful and connected detour to the feet, I hold them, maybe massage them a little bit, and then return to where I was.

15:33 CW: Of course, it's important always to maintain contacts either with a light gliding over the sheet or compressions from point A to B, if you just pick up your hands and go down to the feet, that could be jarring to the client, you have to remember their eyes are closed. So if you lift your hands, they don't know where they're gonna go back to, so you don't want them to be suddenly stun, make sure you always make that move if you're doing it mid-session with constant contact from wherever you are to the feet and then back.

16:02 Kristin: Yeah. Another way that we can sort of piggy back on that is once the session starts, you're saying that a lot of times we're seeing now a lot more talking during a session, even from clients that may be in the past were quiet during sessions and maybe it's the lack of social interaction, but also could be the fear and anxiety and grief that everyone's experiencing, it leads to a lot more conversation during the session. So one of the things you mentioned in the article is how we direct those stories back into the body. Can you tell us a little bit more about that?

16:35 CW: I sure can. If you find a client is talking a lot, I mean it's fine, of course, if they wanna talk a little bit, but if it continues on and seems to start distracting from them experiencing the session. I will say something like, "So as you talk about that, do you feel any sensations in your body, especially relating to what you're saying?" Now, I will say sometimes clients don't know how to do this naturally, or they're not sure what they might feel or what they're supposed to feel, so I might give them some options like, "You might feel tightness in your throat or your belly. Do you feel butterflies in your stomach? Do you feel like you're clenching your jaw? Does your heart space feel heavy? Do you have any dizziness?" And these are just ways to get them in tune with possibilities of what they might be feeling, and then from there, of course, they can feel their own way, but the idea is to take them out of the narrative in the head and to relate that to a sensation in the body, then they stop thinking and start feeling.

17:44 CW: And once we really start feeling those things, then clients have a lot more power to consciously release, once they've established and communicated to sensation, I will usually ask them to either direct their breathing to that area, or you know a lot of times I'll ask them to simply hold their attention on that sensation and not trying to do or change anything necessarily, because then that takes us into a place of effort. But simply giving awareness and acknowledgement to the fact that our thoughts are creating these sensations and experiences in our bodies, these super simple ways of directing work wonders. It is just amazing to me how then the body says, "Oh wow, you know, I see this connection." And it begins to self-regulate. It's really amazing.

18:37 DB: Another way you mentioned in the article too was changing pressure, either increasing your pressure or lessening the pressure, depending on where the client might be. Can you describe that a little bit?

18:48 CW: I can. And it comes down to the purpose of the stokes that you're using. First of all, an awareness that certain strokes create a more stimulating effects, whereas other strokes create a more calming effect. So it kinda is natural to come to the conclusion that if a client is really agitated, then likely a faster pace or lighter strokes is gonna add to the agitation, because faster pace and lighter or say like a tapotement or a faster friction, those are just gonna add to stimulation and our intent at that point is to try to dial things back a little bit. It would be much better in those cases to slow the pace down, to deepen the pressure a little bit. Of course, always asking your client if it feels good for them, on the other hand, I've talked a lot about clients who come in agitated and things that we would see in those cases, that you know, another response to this overwhelm of emotion can also be shut down where people who normally engage in life or really motivated, they will report to you that they're suddenly feeling really lethargic, they're struggling with motivation, they're struggling even with sleep, those kinds of things.

20:06 CW: When that is the case, you might want to instead use a lighter, faster paced more stimulating stroke to just sort of awaken things. We don't want to over agitation, we also don't want over depression, we wanna find a beautiful waving dynamic kind of in the middle of that, not a perfection, but a waving dynamic in the middle of that. And so we encourage the body, whichever direction, depending on that particular client and the situation and what sometimes can arise during the session. You know, I had a client just a couple of weeks ago, and I hit a spot and it was suddenly like, "Woo!" You know like zoom. He went from being really relaxed to, I guess agitated is the best word that I can use. He wasn't angry in any way that you could just sense that he was like, "Oh!" you know, I don't even know that was there. And in those cases, when you feel that change, you have to change and adapt with them, as long as your intent is loving, kind and supportive, you're probably not gonna go wrong, but when you add in those little elements of really paying attention and adjusting accordingly, then clients feel so seen, and so heard, and so valued, and they're much more receptive to the work that you're getting.

21:23 Kristin: Yeah, absolutely. And I think that phrase overwhelm of emotion is something that all of us can relate to right now, I think clients are experiencing it, we're experiencing it. And something then we really have to be cognizant of is when a client's on our table, there is that potential for energy transference. So you talk about in the article energetic boundaries, can you tell us a little bit more about what those are and what we might do? How do we build an energetic boundary? How do we put one in place? What does that mean for a therapist in this session?

21:55 CW: Yeah. And it can mean different things. I do wanna acknowledge that different therapists have different perspectives on this question. So I'm gonna give a couple of options. Now, some teachers I've heard recommend envisioning, literally envisioning an imaginary boundary or barrier around you. Almost like a protective shield, and that when big emotions come up, you hold that vision really clearly, and that way, that energy doesn't permeate you or you can deflect it or basically don't take it on. And that is definitely fine. I have personally found for myself, and again, I'm gonna attribute it back to this super amazing teacher, I've had a lot of amazing teachers, but this person specifically stood out as a very wise, wise soul. And I learned so much from him.

22:48 CW: He taught that you actually let the energy move through you and out of you, and when I do that, I definitely make sure that my feet are solidly on the earth so that I'm feeling grounded. And then as the emotions roll, I let that energy pass right on through me and into the earth. I might even say to myself, I am holding space for Susie's emotions, [chuckle] that way you identify them and name them as hers, not mine. Again, a couple of different ways you can do that, and I think either one is just fine, it really depends on what fits for you. I feel that I have an ability to sense energy enough to know if it's getting stuck in me, and that's why I feel okay letting that move through me, but especially for a new practitioner, you might not be ready to do that. So again, creating a vision, really just visualizing in your mind's eye that you have this protective shield around you, and again, naming this is hers, not mine, I'm here to facilitate.

23:52 DB: So what do you if while you're massaging or during this session, a client begins to cry?

24:02 CW: I just let it happen. [chuckle] In some cases, clients might have just a few tears, and in those cases, I don't say anything, I just let it pass as if it's a completely normal... Which it is, a completely normal thing, so I don't draw attention to it unless they do. But there are some cases in which a client might begin sobbing, and I have definitely experienced that before. And so, I think the best thing to do is either slow down and say something like, "This is so good, just let it flow." You know, encourage, "This is great, I love it. Beautiful." You know, [chuckle] "Let it all fly." [chuckle] Sometimes I'll apply a resting stroke for a moment. People that are really sobbing, they probably don't like the stimulation of you massaging them, and so I will sometimes just stop and have my hands on them and ask them what they need. You know, "Is there any way that I can support you right now? You are in good hands here, please feel free to feel at all." And then as we were talking about a little while ago, deep breathing, I also will begin deep breathing myself, and that supports them and encourages the client's rep to slow also.

25:22 Kristin: Yeah. And I think all of us who've been practicing for a good number of years know exactly what you're saying, it's through experience that you handle each situation as gracefully as you can and as uniquely to that client as you can, because everyone's different and even on different days, sometimes they wanna talk about it, sometimes they want you to just keep moving along as if you don't even notice it's happening. And so you have to really be in that moment, ready to respond, I think you gave some really great advice for a therapist, especially new therapists, right, there's a chance a client may cry on your table. And it's one thing to have that in your head, but it's another thing to experience that, so I think you gave some great advice, is there anything else, any other additional advice for new therapists you might share?

26:07 CW: Yeah, sure. Simply offering love and kindness is probably one of the best things that we can do, and to not get worked up about it or feel afraid of it. You don't need to be afraid that you're gonna do the wrong thing, or that you're not gonna know how to handle it, just trust yourself. And a few simple words of encouragement to your client and some soothing strokes will absolutely do the trick, so just think of it in very simple terms, instead of something that's like, "Oh my gosh, I hope this never happens to me." And if it does, it's a really good thing, it really is. And it can be very simply dealt with. Another piece of advice I sometimes get students, is to consider what they would need if they had an emotional response while on the table. Really put themselves in the position of their clients, the old, "Do unto others, [chuckle] as you would have them do unto you." What would you need? And how would a practitioner best be able to support you and offer you peace? I think is also a really great starting point.

27:13 DB: And Cindy, I wanted to ask, because I would imagine in some practitioners minds, they might be wondering about scope of practice here, and it could be sliding into psychotherapy, so can you just... How do you maintain that balance during a session? If... Especially if a client is seeking information from you?

27:31 CW: Yeah, certainly. Well, the most important thing is to not offer advice or fix anything. Simply say, it's so good that you are letting these emotions move through you. But, I know what it's like when they try to ask you for advice. The key to that is just to tell them that you're not qualified to offer that and to re-direct them to what you are capable of doing. Remind them that talking about things is just not something you're trained to do. But to recognize how these feelings occur in the body, so that you can address them with your hands and through the tissue, then I think it helps clients to understand, "Oh yeah. Okay, right, I see that this is what you can and cannot do." And then another key is to have... We should all have a referral list anyway for all kinds of different practitioners that do things that we do not do. So one of those things would be to have a qualified counsellor or psychotherapist on your list, and to be able to provide that to a client who starts asking you too many questions, or wants your advice, or things like that. Yeah, then you can have someone that you feel that you can trust to send them to. And then you're still providing for them without having to provide verbal assistance.

28:53 Kristin: Cindy, thank you so much, this is such great information for therapists on what they might see, hear, and feel right now with clients, what they can do when they do you see, hear, and feel an overwhelm of emotion from clients. And I think not only is it timely for the grief, anxiety, and stress everyone's feeling now, this will be information that really benefits everyone's practice going forward. I'd like to close with a phrase that you shared in the article as a suggestion that therapists might say to clients in the moment, but I wanna take this opportunity. It's a beautiful phrase, I absolutely love it, and I'd like to share it with everyone listening. Please feel free to feel. You are safe and supported here. Thank you so much, Cindy.

29:40 CW: It is absolutely my pleasure.

29:47 DB: This has been a production of Associated Bodywork & Massage Professionals. ABMP is the leading association for massage therapists and bodywork professionals in the United States and beyond. From liability insurance to professional advocacy, award-winning publications to the world's largest continuing education library for massage, to this podcast, no organization provides more for its members and the profession than ABMP. ABMP works for you.

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