Mind-Body Medicine for massage

Readying clients for healing

By Kathy Gruver

A client arrives for his massage, looking scattered and stressed. He rushes to get into the treatment room, anxious to get started because he doesn’t want to keep you waiting. By the time he gets on the table, he seems more stressed than when he came in. Sound familiar?

How much more work do you have to do to help him relax, when he is stressed to just be at the massage? What if you could learn a simple technique to help with relaxation before the massage even begins?

During their massage, clients often talk. Usually it’s about what hurts their bodies or what may be happening emotionally in their lives. Though most of us are not psychotherapists, many clients feel comfortable sharing their concerns and stresses with us. Sometimes it’s a stressful situation that is eating at them, keeping them awake at night and disturbing their thought process during the day. What if there was a way we could help them deal with their daily stresses and repetitive thoughts, as well as their physical concerns? 

The Stress Response

A few months ago, I was privileged to study at the Massachusetts General Benson-Henry Institute for Mind-Body Medicine in Boston (www.massgeneral.org/bhi/). There, I learned techniques that have not only helped my clients, but have given me relaxation and peace of mind when I need it most— techniques that anyone can immediately incorporate into their lives.

First, let’s examine the stress response and how it affects our bodies. The stress response is an important evolutionary process that evolved as our alarm to danger. This fight-or-flight response creates a cascade of hormones that affects brain function, digestion, heart function, muscle tone, and more. The opposite of that reaction is the relaxation response, which calms the stress response and releases feel-good hormones. The stress response was beneficial in warning us against immediate danger, like a saber-toothed tiger, but our modern-day stresses are not as dynamic. It’s not a saber-toothed tiger threatening our lives; it’s the economy, the Internal Revenue Service, job insecurities, family pressures, our boss, and other daily stresses that never seem to subside. When we don’t get a break from our reaction to that stress, it starts to manifest as problems in our bodies. Studies have shown that increasing the relaxation response not only slows heart rate, decreases blood pressure, and lowers cholesterol, it also slows the genetic expression of aging. That’s right—relax more, age slower.          

The Relaxation Response

So, what types of things invoke the relaxation response? Getting a massage, of course, but affirmations, breath work, meditation, qigong, tai chi, visualization, and yoga are some other things we can do for ourselves. So how could you incorporate that into the scenario in which the client arrived totally stressed out? An effective group of techniques taught at the Benson-Henry Institute are called “minis.” These are mini-meditations that take just a few minutes and can be done almost anywhere. There have been several times that I’ve taken a minute or two to do a mini with my clients to help them relax before the massage or consultation. I say, “You seem a little stressed today. Would it be OK if we just took a few minutes before the massage to help you relax?” If they say yes, have them sit comfortably in a chair and use one of the following scripts:

Mini #1: Countdown

Count very slowly to yourself from 10 down to zero, one number on each out breath. Breathe in deeply, and on your first out breath say, “10” to yourself. Repeat, and with the next out breath, say, “nine,” working your way down to zero. When you get to zero, notice how you feel.

Mini #2: Up and Down

As you breathe in, count slowly up to four; as you breathe out, count slowly back down to one. As you breathe in, say quietly to yourself, “One ... two ... three ... four,” and as you breathe out, say quietly to yourself, “Four ... three ... two ... one.” Do this several times.

Mini #3: Square Breathing

On the in breath, visualize a vertical line and then a horizontal line. On the out breath, visualize another vertical line and horizontal line, completing a square.


These are just a few versions of minis that I’m providing here, compliments of the Benson-Henry Institute for Mind-Body Medicine. Taking this short preliminary step to prep the client for the massage will relax them even more. You can do it during the first few minutes of the massage, which can be just as effective. For myself, I use this technique when in traffic, a few times a day when I feel like I need a little vacation, and sometimes even during a massage when the client is particularly quiet. I use that time to quiet my own mind by repeating, (inhale) “I am” (exhale) “pure health.”

Cognitive Restructuring

The next technique is a bit more complicated, and though I’ve explained it to clients on my table, it is important to show them face to face. The technique is called cognitive restructuring, and it helps change our minds and thoughts about our stress. Here’s how it works (see chart, above).

• Across the top of the page, list your stressor.

• The first column is for how the stressor makes you physically feel (Physical Signs).

• The second column is for emotions about the issue (Emotions).

• The third column is for the repetitive thoughts you have surrounding the stressor (Automatic Thoughts).

• The fourth column is for the distortions that those thoughts have (Cognitive Distortions, page 87).

• The fifth column is for how you would like to feel (Positive Thoughts).

• The sixth column is for action items that you can do to improve how you feel (Positive Emotions). 

If I were to make a sample chart, you’d see that one of my recent stresses about getting my condo rented made me feel queasy, sleepless, and made my heart race. From an emotional perspective, I felt anxious, angry, and humiliated. My repetitive thoughts were, “I’ll be broke,” “I’ll never get it rented,” and “We’re stupid for buying the place at all,” with the distortions listed next to it. As I reread all of what I had written, I realized how ridiculous it was. “I was going to be broke.” Really, all my money would be gone and I’d be living on the street? Is that really true? No, of course not, but my distorted thinking made it seem that way. Another one was, “We’ll never get it rented.” Really, it will sit empty until the day I die? No one, ever again, will rent that condo? Again, when you say it out loud and write it down, it seems ridiculous, and what I realized was that it had only been available for two weeks. Not several months, not years. Two weeks.

The next column of how I want to feel is pretty self-explanatory. It’s the action steps in the last column that are most important. I thought hard about what I could do to remedy the situation, and also added in the fact that it had only been open for two weeks and we had always been able to rent it before. What else could we do aside from taking a deep breath and doing a mini? We could hire a rental agency, we could lower the rent, we could advertise in different places, we could accept Section 8 (Housing Choice Voucher Program), and, if it really got that bad, we could try to sell the property. Just knowing that there were actionable things I could do decreased my stress about the situation. Also, seeing how distorted my thinking was about the situation relieved most of the stress. Was the condo still for rent after I finished this process? Yes. But I could handle the stress in a rational way and better deal with the situation. We can’t control our feelings, but we can control our thoughts about those feelings.

This process can help our clients deal with their stresses as well. Once they learn how to fill out the simple chart and identify their distortions, they can use the technique for almost any repeat offender of stress. And you can see how useful it would be for you in your own life. Once I started using the chart on a few issues, I now find that I don’t even need to fill it out—it comes naturally to me. I don’t have the immediate stressful knee-jerk reaction to situations that before would have put me in a tailspin.

Hopefully these two methods will help you handle the stress better in your own life and encourage your clients to handle theirs better as well. 

 Kathy Gruver, PhD, is a massage therapist, Reiki Master, and public speaker. She’s been involved in healing since 1990. Contact her at www.thealternativemedicinecabinet.com.


Cognitive Distortions

1. All or Nothing: Things are black or white.

2. Overgeneralization: You see a negative event as a never-ending pattern of defeat.

3. Mental Filter: You pick out a single negative detail and dwell on it exclusively.

4. Disqualifying the Positive: You reject positive experiences by insisting they don’t count.

5. Jumping to Conclusions: You automatically draw a negative conclusion even though there are no facts to support it.

6. Magnification: You exaggerate the importance of a negative event or mistake.

7. Emotional Reasoning: You assume your negative emotions affect situations.

8. “Should” Statements: Unproductive self-statements, usually containing the words should, ought, or must.

9. Labeling and Mislabeling: I’m a ... She’s a ... He’s a ...

10. Personalization: Even if something really isn’t your fault or responsibility, you own it.

11. Perfectionism: You and others must be perfect all the time.

12. Approval-Seeking: All the significant people in your life must love and approve of you all the time.

13. Self-Righteous: People should always do what you think is right.

14. Woe is Me: You regard yourself as a victim despite the ordinariness of a situation.

15. Reductionism: Failure to see the complex causes and potential benefits of a stressful experience by reducing it to one simple cause or consequence.

16. Fallacy of Fairness: You judge a negative event as unfair when it truly isn’t an issue of justice.

17. Comparison: You habitually compare yourself to others.

18. Sophism: The combination of two or more related notions which falsely appear to produce a logical conclusion.


Adapted in part from D. Burns, Feeling Good: The New Mood Therapy (New York: New American Library, 1990); A. Ellis and R. Grieger, Handbook of Rational-Emotive Therapy, vol. 2 (New York: Springer Publishing Co., 1986).