Massage With
Survivors of Abuse
Excerpted from
Massage: A Career At Your Fingertips
by Martin Ashley
Childhood abuse has become a well-recognized problem in modern society. Whether abuse has increased, or we are just more open about discussing it, a great many adults find themselves dealing with the effects of having been abused when they were young. These men and women may or may not remember being abused. They may have been abused sexually or non-sexually. And they may or may not have begun the journey of healing the effects of that abuse.
As a massage practitioner, chances are you will come in contact with one or more clients who experienced childhood abuse. Some of these clients will have normal reactions to massage - they will appreciate your services, and will pose no difficulty to work with. Others may have extreme reactions that include terror, convulsions and withdrawal - and can have these reactions even to sensitive and compassionate touch. This article is about working with clients who have dramatic reactions to massage because of childhood abuse and the basic information you need to serve them to the best of your ability.
Since touch can directly re-activate childhood trauma, there are certain fundamental things you should understand in order to work with these clients without doing harm to them.
Most massage clients are women, so the female pronoun is used in this article. Be aware, however, that many men have also experienced childhood abuse, both sexual and non-sexual.
Children have natural mechanisms to deal with stress. However, extremely strong experiences can overwhelm these mechanisms. Sexual or physical abuse is too much for the child to deal with, and it can prevent the normal integration of the psyche as the child matures.
One aspect of this process is numbness, or dissociation. Minor dissociation is a natural part of life for most people, taking the form of spacing out, daydreaming, or similar behaviors. However, a person with more significant dissociation may be unaware of the physical sensations of the body; she is not consciously present in the experience of the body. In extreme cases, multiple personalities are created and the person lives a life as different personalities who may not even know each other.
Psychologically, childhood abuse destroys the child's sense of safety and trust, and drastically violates the child's boundaries. The child may grow into an adult who has difficulty trusting and is confused about boundaries. One who experienced childhood sexual abuse may have guilt about the sensations she had during the abuse, feel shame or responsibility for the abuse, and have terror buried in her body from these childhood experiences. As an adult, she may feel like "damaged goods." She may believe that sex is all she is good for or she may believe she is incapable of having sex.
While you should not attempt to diagnose someone psychologically, certain traits can clue you in that childhood abuse may be an issue in someone's life. Signs to look for include depression, lack of emotion, extreme changes in emotion, feelings of being different or defective, dysfunctional relationships, irresponsible sexuality, anorexia, bulimia, obesity, self-mutilation, childishness or excessive vulnerability, inability to take care of one's self, workaholism, compulsive rituals or other compulsive behaviors, and anxiety attacks.
You may also have a client who was abused as a child but exhibits none of these symptoms, and is not even aware of the childhood abuse. This person may have a strong reaction to your touch, and may not even understand why.
When initially interviewing a client, do not directly ask if she experienced childhood abuse. Asking this question violates the client's boundary; it requires her to either lie or disclose something she may not wish to share with a person she does not yet trust.
It is better to ask generally whether bodywork brings up feelings for her. You may tell her verbally or in your printed information that you invite her to let you know if she is in psychotherapy. However, avoid probing too deeply. It is better to listen carefully and watch for signs that may alert you to a history of abuse.
You may want to ask if this is her first massage, or her first massage by a male or a female. However, even if a client has had massages before without incident, you still need to be attentive, as your touch may evoke different reactions in her.
The abused child has been dis-empowered. When massaging this adult client, be careful to empower her and to operate with clear boundaries. Be scrupulous about giving control of the session to the client. You may want to make agreements about permission to touch in specific places or in specific ways. Check in often with your client to be sure she is comfortable with the session and is present in her body.
Even a client who is not an abuse survivor will appreciate being empowered, respected, and given control. Since you likely will not know that a particular client is a survivor, follow these guidelines with all clients.
It is especially important to check in often during the massage with a client who has a history of abuse. When your touch triggers an emotional response or a memory of abuse, this client may be unable to tell you what is happening. The abusive experience often includes training in "not telling," and when a memory of that experience is triggered, the training to be silent may prevent the client from letting you know what is happening.
If a client recalls a portion of the abusive treatment during a massage session, it can be extremely upsetting for the client and a difficult situation for the massage therapist. A "flashback" can feel to the client like a flood of terrifying feelings. She may dissociate from current time and reality and be completely immersed in an experience of the childhood events. She may shake with terror, convulse, go into tetany, curl up in a ball, or shout at the perpetrator.
If you as a therapist find yourself with a client having such an experience, remember that this person is re-experiencing a terrible event from her past. Consider the following suggestions for how to handle a flashback:
Because flashback experiences can be so unsettling, it is advisable to insure that a client with a history of childhood abuse has a psychotherapist if she is going to receive massages from you. Because of the likelihood that your work will bring up such an intense experience, the client should have the services of a professional who can help process such an event if it occurs.
As a massage practitioner, consider discussing with the psychotherapist whether massage is beneficial for this client, or whether it might bring up too much intense material for her to deal with at this point in her psychotherapy.
Massage has a key role to play in the recovery of some survivors of childhood abuse. To be touched without sexual intention and without violence can be a revelation - it may be the first time this client has experienced sensitive, non-threatening touch.
An alarming number of "normal" people have a history of sexual or physical abuse. Many are too afraid to come to a massage therapist, but some reach out. Once you understand the basic principles you need to know to work with these clients, you have the opportunity to help them learn that it can be safe to receive touch from another person. The strokes and modalities you use are not as important as your awareness and your presence. This work is not easy, but it can be very rewarding.
From: Massage: A Career At Your Fingertips, 4th Edition, by Martin Ashley, J.D., LMT. Copyright © 2003 by Enterprise Publishing. All rights reserved.