Summary: Trauma-informed massage therapy is an approach to practice and not a massage technique. It’s built upon four principles: trauma awareness, safety and trust, collaborative choice and connection, and strength-based skill-building. Registered Massage Therapists working in this area don’t have to be experts in trauma, but can respond appropriately to various situations that may arise and reduce the chances of causing additional harm. Strategies for healthcare practitioners to deepen their understanding of Trauma Informed Practice are shared in this article.

“I was in a car accident last year. I felt a bit anxious about going for a massage but I wanted to give it a try. Finding a Trauma Informed RMT made a world of difference. My RMT worked with me to find ways I could feel comfortable and relaxed. They asked me about my boundaries and preferences and told me it was okay if those changed from day to day. I came to really enjoy my massage appointments!” - Patient at Intent Health

What is a trauma-informed approach to massage therapy?

Trauma-informed massage therapy is an approach to practice and not a massage technique. It involves fostering trust, safety, clear communication and collaboration with patients and reduce the chances of inadvertently causing additional harm. Care provided in a trauma-informed manner is beneficial for all clients and should be applied as a universal standard of care, regardless of trauma history or disclosure.

“Utilizing a trauma-informed approach does not necessarily require disclosure of trauma. Rather, services are provided in ways that recognize the need for physical and emotional safety, as well as choice and control in decisions affecting one’s treatment. Trauma-informed practice is more about the overall essence of the approach, or way of being in the relationship, than a specific treatment strategy or method.”

— Trauma-Informed Practice Guide

Before we look at the principles of trauma-informed massage, let’s explore the question: what exactly is trauma?

According to the Trauma Informed Practice Toolkit, “(t)rauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional or spiritual well-being.”

Trauma may result from adverse events in childhood, and at any stage of life, through:

abuse (in all forms)
accidents
acts of violence
disrupted attachment and neglect in childhood
medical procedures
natural disasters
sudden unexpected loss, and
war

Trauma can be due to direct individual experience, and it can also be systemic, or intergenerational in nature.

“How people are affected by trauma they experience depends on many different factors including what their life and relationships were like before the trauma happened, how people responded to them during and after the trauma, their own personality, strengths and resources, their other life experiences and the cultural context in which they live their lives.” —Trauma-Informed Practice: A Toolkit for Scotland

Trauma is common

The experience of traumatic events in childhood and adulthood is all too common. About 76% of Canadian adults report having experienced a form of trauma; while an estimated 9.2% meet the criteria for diagnosis of post-traumatic stress disorder (PTSD) (Ameringen, 2008). People who have experienced trauma may develop chronic pain, headaches, stress, insomnia, anxiety, depression or PTSD. Research demonstrates a correlation between childhood abuse and chronic pain syndromes (The Handbook on Sensitive Practice for Health Care Practitioners).

Trauma hugely impacts the body and mind. From a person’s memory and brain development, sense of safety, ability to ask for help and voice preferences, to one’s capacity to regulate emotions and experience trust in relationships. Experiencing trauma can also affect a person’s comfort in interacting with healthcare providers.

Considering the prevalence of trauma and its wide-reaching impacts, we can understand how important it is for RMTs to apply the principles of trauma-informed practice in their role as healthcare providers.

If you’re an individual who is looking for support, please consult mental health professionals and organizations in your community who work with folks who’ve experienced trauma. Our Registered Massage Therapists have taken extra training to be able to provide trauma informed massage therapy which may be a part of your self-care plan.

The four principles of trauma-informed massage therapy

Trauma awareness
Safety and trust
Collaborative choice and connection
Strength-based skill-building

1. Trauma awareness

Trauma-informed RMTs are aware of the impacts of trauma, and how people may adapt their behaviour to cope and survive it. They use language that destigmatizes and normalizes an individual’s response to trauma and understand certain reactions as survival mechanisms triggered by a perceived threat. These can include:

anger
irritability
avoidance of appointments
low motivation and energy levels
feeling disconnected from ones body
difficulty expressing treatment preferences

A trauma informed lens can help to depersonalize challenging interactions and increase practitioners’ abilities to stay present and empathize while demonstrating healthy professional boundaries. Awareness of trauma doesn’t require RMTs to be experts in trauma; rather, it means they can recognize responses that are possibly linked to a traumatic history and respond appropriately.

“My RMT noticed when I started to feel uncomfortable and checked in with me right away. I felt embarrassed for having a reaction and I wasn’t sure if they would want to see me again. My RMT told me that it was perfectly understandable that I felt anxious and reassured me that if I wanted to, they were happy to continue working with me. That really felt good because I knew they accepted me despite my difficulties.”

— Patient, Intent Health

2. Safety and trust

Safety and trust can be established through various practices. For instance:

providing a welcoming intake process
offering a calm and non-threatening physical space through layout, decor and sound considerations
demonstrating an interest in patients’ experiences and narratives
communicating clearly and engaging in active listening
outlining professional boundaries with positive regard for patients to create a framework of clarity and respect. This may include skillful boundaries around conversation topics; ending treatments on time; and ensuring secure draping
informed and ongoing consent, and
creating reassuring predictability in both the treatment space and treatment itself

“I often feel stressed out when I’m in the waiting area at my Doctor’s office, not really knowing what will happen or how long it will take. At my RMT’s clinic I feel more relaxed when I walk in. The atmosphere is calming with soft music, plants and nature photographs. I know they will ask me questions about how I’m feeling and how I want the massage to go that day. I just like knowing what to expect. I can relax more.”

— Patient, Intent Health

3. Choice, collaboration and connection

Choice, collaboration and connection are established through interactions that foster self-efficacy, self-determination and empowerment for those receiving care. It could involve a variety of approaches, including:

asking patients about their treatment preferences
inquiring about what has worked best in past sessions
identifying areas of the body that are off limits during treatments on that day or over the long-term
checking in to see if there are areas where contact can now be explored and how best to proceed
checking in during the massage to see if needs and expectations are being met, and at the same time,
perceiving when too many options or choices could be overwhelming.

“At first it was really hard for me to even know what my body was asking for. My RMT talked about the different choices I could make about the treatment that day. We would chat after the massage about what worked for me, and if there was anything I would try differently next time. Sometimes I didn’t know. We didn’t always get it right, but what mattered was that they cared about my experience and were open to making changes as we went along.”

— Patient, Intent Health

4. Strength-based skill-building

This involves assisting patients to identify their own strengths so they can develop self-efficacy and resiliency. To do this, RMTs skillfully reframe situations from a strength-based perspective. For instance, a practitioner can ask patients questions about self-care practices that are working for them, and what strengths, interests and skills they can call upon to work towards meaningful, patient-selected goals.

“I was feeling pretty depressed and thinking I might not get better. My RMT helped show me the progress I had made in strengthening my body. They weren’t overly cheerful about it. They knew it was hard for me, but they had a gentle way of chatting about the successes I had in the past. We set goals together that were realistic and meaningful for me.”

— Patient, Intent Health

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RMTs in the trauma-informed space

For RMTs working in a clinic using trauma-informed approaches, it’s important to recognize the need for self-care and personal growth. Attending to our own personal traumatic histories and practicing self-regulating strategies allows us to provide better care for ourselves and others. For insight and support, RMTs might consider working with a counsellor, speaking with a mentor and exploring learning on these subjects:

The Trauma-Informed Practice Guide also contains questions for self-reflection.

Remember, we don’t have to be experts on trauma to apply the principles of trauma-informed practice. However, if we use this term to describe our approach, we need to have received additional training that equips us with the skills to communicate and be present with people who have experienced traumatic events.

As an RMT, learning about a trauma-informed approach to massage therapy can help us grow as individuals and applying it skillfully in practice can result in real benefits for our patients and clients.