Trauma Informed Yoga and Trauma Informed Massage Therapy

One of the benefits of being both a yoga therapist and massage therapist is that I am able to bring the wisdom of these backgrounds into my sessions. A topic dear to my heart of late, is trauma informed practice as it is apparent to me that more people than we have previously acknowledged have experienced trauma of some sort. I am very privileged to work with a team of psychologists who support me in sharpening my own skills on this matter and I would like to share some thoughts I have been having with them around this important conversation. In particular, this article is written for massage therapists as most RMT trainings focus on safe practice for the musculo-skeletal system. Just as important is practice that makes our clients feel emotionally and mentally safe and supported.

How do you know if your client has experienced trauma? What are the signs? How do you approach treatment in a safe and sensitive way without labeling and stigmatizing?

A safe assumption to make is that everyone has experienced trauma and that all clients should be approached in this way. Especially if your client gives signs that they feel nervous about the appointment, have experienced disappointment with a previous session or indicate that they need to feel in control of what is or isn’t happening.

Informed consent is important, not just at the beginning of the session but throughout the session. Just because you have been given permission for one area, does not guarantee that your client is ‘OK’ with you moving into another region.

1. Ask for permission at beginning of session. Is there any where you would like me to focus? Where feels most safe and supportive for you? Is there anywhere that does not feel comfortable for me to massage? Is there anything you have responded well to in the past? Is there anything you have responded negatively to?
   
2. Maintain this dialogue throughout the session. Let your client know each time that you are about to move to a new area. If constant verbal communication is a trigger, you can offer your client, the option that you will tap their shoulder each time you are about to shift and that you will look for a positive response from them before moving on, such as a thumbs up. It is about you serving them and them feeling supported in being fully in control of what is happening to their own body.
   
3. Set an intention at the beginning of the session. ‘This is what I would like to work on. I envision doing A, B and C and then moving on to M, does this sound comfortable for you?’
   
4. When you move from A to B and so on. 'I feel like I am done with A now, do you feel like you need more time there? Would you feel comfortable with my moving to B?’ It is so important that you stick with the intention that was discussed. Deviating from the intention, takes power away from the client.
   

Working with chronic pain, trauma sensitive touch and the role of the nervous system
When supporting an individual who has experienced trauma, who suffers from chronic pain or whose nervous system or endocrine systems are in a state of stress; some important factors need to be considered.
It is not always possible to feel what the nervous system or endocrine system are doing through the muscles. It is important to not make assumptions that the pressure you offer is appropriate because you feel a knot or don’t feel any resistance. In the case of emotions, the nervous system and the endocrine system, a lot more can be observed when there is movement. Just as we perform proper orthopedic tests prior to treatment of musculo-skeletal issues as RMTs, we must perform certain emotional tests. Do not just talk to your client and get them on the table.
If there are indicators for trauma, chronic pain, nervous system or endocrine stress, as above, lean into questions around what has and has not worked for them in the past. If they indicate holding tension in a certain area, talk to them around what their pain free range of motion is, not just on the musculo-skeletal level. For example, a person experiencing depression, may feel safe with their shoulders in a protective and closed stance. Can you, through gentle questions and invitation for movement, assess what their comfort range would be to open up their shoulders. Forcing such an individual into a deep backbend, could trigger a panic attack.
When the nervous system and endocrine system have experienced trauma, it is similar to physical pain, it overtime can become a chronic issue, meaning that less stimulus is needed to trigger a response and the response effect will ring for a longer period of time. When we work with such individuals, it is about re-patterning the nervous system, letting them know that areas they deemed unsafe are now safe. This is done slowly over time by challenging their current pattern at their edge of comfort, never beyond it.
I would love to discuss this further with all of you. Have you had any experience in this area? Do you have any insights of your own?