Through my years offering massage therapy to survivors of sexual and domestic violence, I’ve seen the tremendous emotional, physical, and spiritual impact of these interventions. Could this be an avenue of healing for others? Could the therapeutic experiences of these once bruised and battered women offer comfort or, better yet, a healing path to today’s victims? To answer those questions, I designed a research project to evaluate the role of massage therapy in the well-being of sexual abuse and domestic violence survivors. My hope was that this information could be shared to empower other survivors to make a more informed decision about receiving massage.
I started the project by spreading the word. Posters about the project were hung in the local community and a letter was also mailed to local massage therapists with a request for them to post information in their offices. Then it was time to wait and see if anyone would volunteer to be interviewed about his or her personal experiences. During the next few weeks, a few calls came in and while some women were comfortable meeting at a local coffee shop, others only wanted to talk over the phone. Based on the research guidelines, 10 women agreed to be interviewed.
Although they were not going to be interviewed about the specific experiences of abuse they endured, these women were courageous in volunteering to talk about the effects these experiences had on their lives. I was amazed at the resiliency they displayed in trying to survive and heal from the violence. What came out of these interviews was not only important for other survivors, but helpful for the practice of massage therapy in general.
Results in Narrative
As consumers of bodywork, the women interviewed for this research provided information about their personal experiences with massage therapy and therapists. The resulting information included subjective reports regarding the effects of sexual and domestic violence on the survivor, the methods used for healing from these effects, and the reasons that led each woman interviewed to turn to massage therapy as part of her healing journey. With regard to their personal experiences with massage therapy, the women provided information about the benefits of massage they had received, their emotional experiences during massage, and their feelings of safety during their interactions with the massage therapist.
Based on the responses, it is obvious that although the specific effects differ among individuals, the experience of being traumatized through sexual or domestic violence is a life-altering event. The multidimensional nature of traumatic experience produced emotional, physical, and spiritual challenges for the women interviewed. Issues reported by survivors range from self-esteem struggles and difficulty in trusting one’s perceptions, to an inability to feel safe when alone and with others. Interactions with other people are a source of stress for women who have been abused and this is not limited to their intimate or personal relationships.
The difficulties mentioned affect the ability of a survivor to reach out for assistance to any helping professional. This is especially true about the decision to contact a massage therapist. Despite these challenges, the women interviewed showed resilience in trying to heal from the experience of abuse and in taking calculated risks in reaching out for help in various ways.
Survivors have significant apprehension about initially contacting a massage therapist. A survivor of abuse is less likely to call a new therapist using the phone book, due to issues of hypervigilance about safety. Information from the subjects suggests that a face-to-face meeting would be helpful to establish a basic level of interpersonal comfort prior to the first massage session. It may be helpful for massage therapists who are interested in serving this population to volunteer their time at domestic violence shelters and rape crisis centers in order to connect with potential clients who might not otherwise seek the services of a massage therapist.
Connections with psychologists, social workers, and other professional counselors or advocates who commonly work with survivors are valuable resources with regard to client referrals. Because community support groups have been identified as a common part of the healing process from sexual and domestic violence, getting permission to provide a short presentation at a meeting would be another valuable way to connect with this population. The need to build trust with a client and network with other professionals is not unusual, but the level of hypervigilance or difficulty experienced by a survivor of abuse has implications for the level of outreach massage therapists use to advertise their practice.
Holistic Self-Care
Education about holistic self-care that benefits the body, mind, and spirit is another resource for the healing process of many individuals. The knowledge that psychological trauma and emotional issues connect profoundly to the body may give all massage clients a new perspective on wellness. The option of using healing modalities such as massage or bodywork as an adjunct to psychotherapy may also become more popular. When issues of healing the body through touch are considered to be important connections to trauma, just as intellectual-based aides such as books and support groups are, a more holistic approach may be applied to helping survivors of abuse. For survivors, this awareness may close the gap between understanding the emotional and physical nature of trauma recovery.
Chronic physical symptoms such as muscle tension and pain, digestive disorders, and migraine headaches are reported during the healing process from abuse, yet these physical symptoms are not necessarily attributed to the abuse unless the violence has been physical in nature. Most of the women interviewed reported receiving massage for relief from day-to-day stresses or chronic pain rather than as a specific part of trauma recovery; it is not uncommon for a survivor of abuse to be unfamiliar with the fact that receiving massage may tap into deeper emotional issues or that the treatment of her chronic physical issues may connect her with the aftermath of abuse.
Because a new massage client may not realize trauma can cause physical symptoms and that massage for the physical symptoms may bring up emotional reactions, it is essential for a professional massage therapist to not only be aware of this connection, but be able to explain this to clients. A client presenting for massage therapy who is carrying the trauma of abuse may look the same as any other client who comes in for a “stiff neck” caused by work stress. The survivor may not disclose that she has been abused, as she may not feel this is relevant. Massage therapists might consider a standard practice of explaining to all new massage clients this link between body and mind and how issues may come up during treatment. Having empathy for the person who feels she is taking a risk by trusting a massage therapist and remembering that the experience of safe touch and a caring presence by the therapist, can be a powerful healing force.
Gender Implications
While it might be challenging for a survivor of abuse to make initial contact with a massage therapist, it appears that the massage therapist’s gender is another serious concern. This topic, with regard to study participants’ willingness to receive massage therapy and their perceptions of safety during massage sessions, was discussed frequently. This bias toward employing female massage therapists clearly has implications for male massage therapists in the field. This is one example of the way that violence against women has implications for men as well. If, as a result, of her abuse experiences, the survivor has an inability to trust men or their ability to provide safe or caring touch, this is a major roadblock for a professional male massage therapist to overcome.
Because of the increased vigilance and safety concerns that survivors of abuse have with regard to receiving massage by a male therapist, sensitivity regarding client interactions, professional boundaries, and draping are heightened. It might be even more critical for a male therapist to educate himself about the issues surrounding sexual and domestic violence and about working with traumatized clients, than it is for women. Male therapists might also have to make a more concerted effort to engage with survivors of sexual and domestic violence through the resources that serve this population, if they are indeed interested in working with this clientele.
Heightened Awareness
Many of the women in the study reported a greater awareness after receiving massage. This may be due to the experience of touch providing deeper mind-body connections than the client initially expected. Some of the feedback from survivors who received massage included positive feedback about the benefits of experiencing safe touch, the positive experience of feeling connected with the body, and a decrease in the emotional numbing that survivors sometimes endure. These all aided the individual’s healing journey. It is important to note that these experiences were sometimes reported only after several bodywork experiences, never after the first massage session. Many survivors reported feeling ambivalent about continuing with massage when it began to touch on their emotional scars. This implies that benefiting from massage is a process for many individuals.
Some of the negative experiences that were mentioned included: being triggered during the massage; an inability to relax the body due to fear; and dissociating while being touched during treatment. It’s important for a massage therapist to provide standard pretreatment education for all clients about the effects of massage. For survivors, this is a crucial part of therapy, so they can reduce the fear and discomfort they may experience when their abuse issues unexpectedly come to the surface during treatment. The retraumatization of experiencing triggers on the massage table can detract from the overall massage experience, especially if the survivor is caught by surprise.
Setting Boundaries
In addition to highlighting the potential for emotional issues to be triggered during massage therapy sessions, the suggestions provided by study participants imply that it is important for massage therapists to ask clients about any areas of the body that they might not want to have worked on during treatment. If a survivor is uncomfortable with having her neck massaged for example, this would give her the opportunity to ask the therapist to avoid the neck during the session, rather than endure the discomfort or dissociate during that part of the session. The client may not feel confident enough to make this request on her own. Asking the question gives her the healing opportunity to be assertive about her wishes.
Besides asking about preference regarding body regions, letting the client know she can disrobe to her comfort level is another aspect of allowing the client to set limits. While many clients are nude or only wearing underwear under the drape, a massage therapist should not require this nor instruct the client to disrobe to this level without giving options. Survivors of abuse have reported difficulty in setting boundaries in a variety of situations. Although she may take off her clothes if requested, the perceived pressure to disrobe completely may feel unsafe. Without empathy for the potential struggles experienced by a survivor of abuse, it may not be apparent that this request would generate fear. Communication about these issues prior to the massage session is a powerful way to establish a comfort level for the client and improve the connection between client and therapist.
Crucial Communication
Comments by the women who participated in this study suggest that it is important to continue checking in with clients periodically as the massage session progresses. They reported feeling vulnerable in certain body positions and also mentioned that oftentimes pressure is too deep and the massage strokes are too fast. While these factors may decrease the ability of any massage client to fully relax during a session, the implications are more serious for a survivor of abuse, as she may be frightened or otherwise reminded of her victimization by this experience. When a survivor of abuse feels vulnerable on the table, she may not feel safe speaking up on her own about personal boundaries. This may result in an internal struggle that clearly detracts from the benefits of the massage. Only half of the women surveyed reported they felt safe and comfortable with the massage therapist at all times. Asking about clients’ comfort level gives them another opportunity to participate in the structure of the massage session and provides evidence that the massage therapist cares about their experience.
Instituting these ways of communicating with clients may make a massage therapist’s work more successful with all clients. If a client feels she has some control over what is happening to her body, she will feel safer and better able to experience the benefits of the treatment. On another level, the experience of setting limits with the help of a massage therapist is therapeutic. Although a survivor of abuse may not be able to state her needs on her own, being asked about them is a valuable opportunity in her healing.
Participants also said that, should a client become visibly uncomfortable or emotional during a massage session, appropriate support by the therapist is important. Giving the client the option of stopping the session temporarily or permanently may be helpful. Do not decide for the client that the session has ended because she is upset. Asking the client if she needs anything, such as a glass of water or tissues, may also be helpful. Beyond these gestures, it is important that the massage therapist stay professional and normalize the event as much as possible for the client. Practitioner education about the reactions of the body to touch and trauma, as well as the connections between the emotional and physical, is beneficial here.
It is not wise for the massage therapist to assume that the distressed client wants to be hugged or touched in any way, as this might feel unsafe to her during a time of emotional release. Validating the person’s experience and providing a caring presence are key roles for the massage therapist. Unless the client volunteers information, it is not the massage therapist’s role to ask for details of the abuse experiences. Listening to her if she wants to talk, and providing validation about her reactions, are appropriate and helpful responses. Recognize her courage in trying to heal from the experience.
If a client has experienced distress due to emotional issues during a massage, it is helpful for the therapist to have referral information available for community resources. Providing these options for the client and offering to support her as she makes those connections is a positive step. Ultimately, it is the client’s decision to utilize resources that are offered. The therapist should not apply any pressure to get the client to take action or reach out to a particular resource.
The Untold Trauma
Without an increased effort among massage professionals to modify their services for the survivors of abuse who are on the massage table, untold numbers of clients may be silently feeling traumatized during massage therapy sessions. This discomfort was frequent among the women surveyed for this research and in most cases it was not detected or acknowledged by the massage therapist. Clearly the benefits of massage cannot be maximized under these circumstances. Attention to the client’s emotional state, breathing, and relaxation positively affects the massage experience. A positive or safe experience with therapeutic touch seems to be the best way survivors of abuse can clearly connect the benefits of massage with their healing process.
The women interviewed for this study have offered many recommendations for professional massage therapists who work with trauma survivors. It is apparent that knowledge of the dynamics of the aftermath of abuse can facilitate massage therapists’ ability to effectively work with clients who have experienced sexual or domestic violence. Practitioners who work carefully to establish a caring and professional relationship with their clients have a unique opportunity to reduce the impact of sexual and domestic violence in our society. If massage therapists can in anyway reduce the effects of trauma, they will provide a great service to the many individuals affected by abuse, and their loved ones as well.
Audra Hixson has a doctorate in natural health and received training in massage at the Central Pennsylvania School of Massage. She works at Pennsylvania State University as a program coordinator, providing education, advocacy, and support on issues affecting the wellness of female students. She’s a certified massage therapist and speaks publicly on wellness issues such as stress reduction and self-care topics. Contact her at ALH145@sa.psu.edu.