The Role of Massage Therapy in Trauma Resolution

The Role of Massage Therapy in Trauma Resolution

July 16, 2010, 7:55 pm
Filed under: The Value of Touch

By Lee Cartwright, M.A.

Life on planet earth is unfortunately often dotted with a number of potentially traumatizing events – accidents, surgeries, natural disasters, physical and/or sexual assault, chronic debilitating illness, difficult birth.  The key word in the above sentence is potentially, because not everyone exposed to the same event becomes traumatized.  Studies show that only 20% of individuals exposed to overwhelming events in fact develop the symptoms of Post Traumatic Stress Disorder (PTSD).  When PTSD does develop though, it can be debilitating.  Possible symptoms include intrusive flashbacks/nightmares, exaggerated emotional and startle responses, panic attacks, difficulty creating and maintaining emotional intimacy, diminished interest in life, immune system disorders and substance abuse.

The key to understanding the experience of PTSD is that the individual processes the trauma as an ongoing, contemporary event.  The individual’s body acts as if the accident, the crime or the difficult birth is continuously happening now.  It is not surprising then that PET scans of the brain reveal that the activity of the hippocampus (the part of the brain that allows us to say an event is over) is often suppressed in individuals diagnosed with PTSD.  Put simply, the nervous system loses access to the ability to put the trauma into the past.

The negative consequences of experiencing the trauma as an ongoing event can be devastating.  Because the body experiences the trauma as a continuous reality, the body continuously creates the autonomic nervous system activation necessary to respond to the perceived danger.  Although the person might now live in a safe environment, the nervous system instructs the body to perpetually create the hyperarousal necessary to allow a “successful” fight or flight response – adrenaline release, increase in heart rate and blood pressure, restriction of blood flow to digestion, increase in blood flow to major muscles, dilation of pupils, and so forth.

In response to this chronic heightened arousal, individuals suffering from PTSD often experience life from a 1) hypervigilant stance, continuously monitoring for danger, 2) a disassociated perspective in an attempt to manage their fear of attack, and/or 3) a helpless, frozen posture where they feel incapable of responding to life’s demands.  PTSD sufferers are literally living in the past – but not because they are lazy and simply need to use their wills to “get over things.”  Rather, individuals suffering from PTSD need help in turning their sympathetic nervous systems off.

Is massage therapy the answer to PTSD?  The answer is no.  Can massage therapy be an important part of a comprehensive program for treating PTSD?  The answer is emphatically yes.  When appropriate, massage therapy can help an individual re-establish a sense of safety in the body.  By strengthening the flow of energy in the arms for example, massage therapy can help re-establish congruent “fight” responses.  By increasing the flow of energy in the legs, massage helps the person regain access to effective “flight” responses.  In short, by helping individuals

re-connect with the natural resourcefulness of the body, massage helps individuals gradually turn their sympathetic nervous system off.

At the same time massage therapy is not designed to resolve specific traumas.  That is the realm of psychotherapy.  Instead, massage nourishes and releases the natural healing forces of the individual.  By helping the person re-establish a sense of physical safety and connection with internal resources, massage therapy supports the individual in indirectly resolving the hyperarousal that is at the core of PTSD.  Some of the characteristics of effective massage therapy for PTSD include:

1. As the practitioner, aligning your awareness with the capacity of the client to resolve the trauma rather than the trauma itself.  Focus on the fact that regardless of how much trauma an individual has undergone, she (assumed throughout the rest of this article) is an expression of a deeply knowing, resilient, self-correcting energy.  As well, remember that you cannot solve someone else’s trauma.
2. Before beginning your work, ask the client about the parts of her life that are going well (children, friends, work, family, pets).  Why?  Because you may need to reorient the client to these “resources” if she slides into a reenactment (re-experiencing) of the trauma during a session.
3. Help the client develop a sense of safety.  Ask her how she would like to lie on the table and where she would like you to start working.  Tell her you are going to touch her before you do.  Offer her a blanket to help enhance her sense of personal space.  Ask for feedback during the session to assure she is comfortable with your work.  Allowing a client to take control of her experience during sessions helps her learn to take greater control of her life outside of sessions.
4. If you know the areas of the body where the trauma occurred, don’t just go there. Only go to an area where a trauma has occurred after you have established rapport with the client (which may be after several sessions).  Move slowly knowing that it is better to under rather than overstimulate.  Don’t enter directly into the area where a trauma occurred but rather start at the periphery.
5. Be aware that individuals who have tendencies toward dissociation often request massage strokes using intense pressure.  Although intense pressure may be appropriate at times, it can also exaggerate dissociation.  Work with clients to find a level of pressure that both works for you and helps them meet your touch.
6. Help clients develop the experience of physical comfort.  If necessary, discuss the mistaken belief in “no pain, no gain.”  People who have experienced trauma often don’t have internal permission (or even know what its like) to be comfortable.
7. Create a safe container through your therapeutic relationship.  Help clients experience good boundaries by starting and ending sessions on time and avoiding dual relationships.  Keep client communications confidential and don’t discuss your personal problems during sessions.
8. In contrast to old theories that encouraged people to go back and fully re-experience traumas, current research suggests that this only etches the trauma more deeply into the brain.  Thus, if clients slip into reenacting the trauma, your main jobs are to be wholly present and act as a lifeguard by bringing them back to present time.
   1. Be truly with the client by holding a compassionate, neutral presence.  Respond with empathy to the client’s suffering AND align your awareness with the deeper part of them that can resolve the trauma.  Aligning your awareness with the client’s pain only results in 2 people being lost in the trauma.  Don’t fall into the trap of thinking that when traumas come up on your table they are meant to be resolved on your table.  Trauma reenactments by nature often occur at the least appropriate times.
   2. Assist the client in regaining control of her experience by acting as a lifeguard.  If a client slips into a reenactment, she has left your office.  Your job is to bring her back into present time.  Ask her what her name is; looking at the clock, ask her to tell you what time it is; ask her to look at your face and tell you what color your eyes are; ask her to tell you about her children that she loves to play with (see #2 above).  Breaking trauma reenactments in process gives the client the experience of controlling her trauma rather than the trauma controlling her.
9. At an appropriate time after a reenactment, discuss how reenacting the trauma often isn’t the best way to resolve it.  As well, support the client in not pressing to figure out exactly what happened in the past.  Research indicates that making sense of the trauma does not reset the nervous system from tracking danger to tracking pleasure.  Instead, explore with the client how you can work together without triggering reenactments.  If you find this is not possible, refer the client to a practitioner specifically trained in trauma resolution.

10.  Help the client be aware of (and if appropriate connect with) other resources in the community.  Techniques that support a more direct resolution of trauma (and are often supported by good bodywork) include Eye Movement Desensitization and Reprocessing – EMDR (emdria.org), Somatic Experiencing (ergos@earthlink.com) and Hakomi Somatics (hakomisomatics.com).

11.  Stay abreast of current developments.  Consider reading Waking the Tiger by Peter Levine or Traumatic Stress by Bessel A. van der Kolk.

Lee Cartwright, MA, is the developer of Shifting Consciousness through Dimensions®, a neurological system that promotes the rapid resolution of trauma and other personal limitations. He has written articles and presented at major conferences since 1999.

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