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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!”
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, 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)
- acts of violence
- disrupted attachment and neglect in childhood
- medical procedures
- natural disasters
- sudden unexpected loss, and
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
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 looking for support, please consult mental health professionals and organizations in your community who work with trauma. Our Registered Massage Therapists have taken extra training to be able to provide trauma informed massage therapy. Here are some ways we've been able to help:
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:
- avoidance of appointments
- lack of motivation, and
- resistance to treatment
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.
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, such as ending treatments on time and ensuring secure draping
- informed consent, and
- creating reassuring predictability in both the treatment space and treatment itself
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.
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.
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-reflection and self-care. Processing our own personal trauma histories and practicing self-regulating strategies allows us to provide better care for ourselves and others. For insight and support, consider working with a counsellor, speaking with a mentor and exploring learning tools on these subjects:
- attachment theory
- co-regulation of our nervous systems
- transference, and
- unconscious bias
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. Learning about this approach is a lifelong journey that can benefit patients, practitioners, our families and our communities.
References and resources
The College of Physiotherapists of British Columbia webinar series on trauma informed practice:
- Part 1: Integrating a trauma-informed approach into routine physical therapy practice;
- Part 2: Avoiding and managing difficult situations;
- Part 3: Client disclosure of past trauma and treatment sensitivities: Inquiring and responding effectively.