Supporting Clients with Trauma: Best Practices for Massage Therapists

A trauma-informed approach to care acknowledges that healthcare providers need to understand a patient's life circumstances—past and present—so they can deliver the most effective care with a healing focus.

Trauma-informed care in massage therapy is especially important because it helps therapists understand how trauma affects the body. With this knowledge, therapists can use gentle, mindful techniques to help clients feel safe, begin releasing tension, and regain a sense of control. This approach builds trust, safety, clear communication, and collaboration between therapists and clients, which helps reduce the risk of inadvertently causing more harm.

Trauma-informed bodywork gives clients choice and agency, helping them regain control over touch and their bodies. While not every massage therapist may specialize in trauma work, having a basic understanding of trauma and its effects can support all therapists in navigating a wide range of client experiences. Therapists who are trained in this field can help clients release somatic trauma symptoms and guide them toward healing and overall well-being.

I’ve noticed a growing recognition of trauma-informed practices in therapeutic professions over the past few years, especially since around 2020. This is a positive development for the field of massage therapy, as it helps us support clients in deeper, more effective ways.

In addition to the many events and situations that can cause trauma, recent natural disasters like Hurricane Helene have had a huge impact on communities here in North Carolina and neighboring states. This has created an urgent need for trauma-sensitive services in our area.

Understanding Trauma in Massage Therapy

Trauma is an emotional response to a distressing event that overwhelms an individual's ability to cope. It can result from various experiences such as accidents, natural disasters, violence, or abuse. Symptoms of trauma can include shock, denial, flashbacks, strained relationships, and physical issues like headaches or nausea.

Trauma can also lead to long-term mental health challenges, such as post-traumatic stress disorder (PTSD), anxiety, and depression. The impact of trauma can vary widely among individuals—some may experience severe, lasting effects, while others recover more quickly.

There are different types of psychological trauma, including physical, emotional, environmental, and historical. Trauma can also be categorized as acute (from a single event), chronic (from repeated traumatic events), or complex (involving multiple types of trauma).

Who is vulnerable? Anyone can be affected by trauma. People of all ages, genders, and backgrounds can experience psychological trauma. Marginalized groups may also experience generational trauma, which is passed down through discriminatory systems, such as racial profiling. Survivors in communities with strong stigmas against mental health struggles often face additional barriers to seeking help.

Trauma can manifest in the body through various physical and cognitive symptoms. These can include chronic pain, numbness, dissociation, and heightened physiological responses like anxiety and agitation. Stress hormones released during trauma can affect the autonomic nervous system, leading to exhaustion and other symptoms.

A client’s response to touch can be deeply affected by trauma. Even gentle, caring touch can trigger painful memories or increase fear. It’s important to understand how trauma affects the body and mind when working with clients. Creating a safe environment for those who have experienced trauma is essential to building trust.

General Tips for Working with Trauma Survivors in Bodywork

Start with Sensitivity and Open Communication

• Encourage open conversations about boundaries before and during the session.

• Use clear, compassionate language, and offer options to adjust the session if needed.

Foster a Safe and Comfortable Space

• Prioritize a non-judgmental environment. Clients should feel they are in control and can express discomfort without fear of judgment.

• Ensure privacy and physical safety during the session.

Maintain Consistent Communication

• Check in regularly with clients to make sure the pressure, touch, or techniques used are comfortable.

• Remind them that they’re in control at all times.

Be Mindful of Body Language and Energy

• Non-verbal cues play a huge role in how the session unfolds. Encourage relaxation by keeping your body language calm and grounded.

• Be aware of your own emotional and physical energy in the space.

Respect Boundaries

• Trauma survivors may struggle with setting boundaries. It’s vital to validate their boundaries and respect their choices, no matter what.

Take Breaks if Needed

• Offer clients the option to pause or take breaks during the session. Sometimes trauma survivors may become overwhelmed, so giving them space can be crucial.

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Trauma-Informed Certification

There are several certifications available for massage therapists interested in becoming trauma-informed. These include Trauma-Informed Care training, Somatic Trauma Therapy, and courses related to PTSD. These certifications dive deeper into the understanding of trauma and equip therapists with specialized techniques.

While certification can be a valuable addition to your practice, any massage therapist can create a trauma-sensitive environment by applying the principles of trauma-informed care. I encourage all therapists to continue educating themselves about trauma and how to provide healing touch, regardless of whether they’re certified.

Options for Certification and Training

Trauma-Informed Care Certifications

• The Trauma-Informed Care Institute offers both online and in-person courses.

• The NCBTMB (National Certification Board for Therapeutic Massage & Bodywork) offers approved courses in trauma-informed bodywork.

• Somatic Experiencing (SE): A certification program that focuses on trauma healing techniques.

• TCTSY (Trauma Center Trauma-Sensitive Yoga): For therapists who want to integrate yoga-based techniques into their practice for trauma healing.

Specialized PTSD Training

• If you want to specialize further, there are certifications available through organizations like The National Center for PTSD or The American Psychological Association.

The Local Context: Supporting Trauma Survivors Post-Hurricane

We can’t ignore the recent events like Hurricane Helene, which have greatly affected our community. Loss of housing, loved ones, and essential resources like water, utilities, and roads contribute to collective trauma. Many people in our area are also dealing with survivor’s guilt.

These disasters result in acute and chronic trauma for many survivors.

How Therapists Can Help Post-Disaster

• Understand that disaster survivors may be grappling with grief, shock, displacement, and stress that affect their emotional and physical well-being.

• Offer gentle, grounding techniques, being mindful of heightened stress levels.

• Be aware that clients may experience hyperarousal or dissociation as a result of trauma.

Community Outreach

• Collaborate with local disaster relief organizations or offer pro-bono or discounted sessions for those affected by the hurricane.

• Building trust and providing a sense of safety for these communities can play a vital role in their healing process.

It’s crucial that we, as massage therapy professionals, create a trauma-sensitive practice for all clients. Even without specific certification, therapists can make a huge difference by practicing awareness, sensitivity, and flexibility. Continuous self-education—both professionally and personally—can ensure that our massage practices remain compassionate and effective when working with trauma survivors.

What Are Your Thoughts?

How have you experienced working with trauma-impacted clients? I’d love to hear your insights and experiences. Feel free to share in the comments!