Can A Bodywork Practice Be Trauma-Informed While Staying Within Scope Of Practice?
The term “trauma-informed” or “trauma-sensitive” is a recent term in our culture that has been rapidly growing in popularity. This rapid growth reflects how our culture as a whole is becoming more aware of phenomena such as PTSD, complex PTSD, developmental trauma, and how Adverse Childhood Events (ACE) affect physical and psychological health as adults. This is a positive step, but along with the popularity of the term also comes misconceptions, the most common misconception being that “trauma-informed” refers to “trauma treatment.” But these two terms mean very different things. Trauma treatment is something that only mental health professionals can provide, whereas providing trauma-informed services is something that every individual, institution, and business can (or should) do.
Being trauma-informed is analogous to being ADA-compliant. Any business can be ADA-compliant. A bank, grocery store, or amusement park may install wheelchair ramps to be ADA-compliant, for example, but they are not performing hip surgery. Furthermore, everyone would agree that those businesses SHOULD be ADA-compliant. The same is true for being trauma-informed, particularly if the business works with people. This includes helping and educational professions such as social workers, massage therapists, medical professionals, chiropractors, teachers, etc.
Being trauma-informed is also analogous to being trained in First Aid and CPR, which is required in most states for licensing in a health or educational profession. Everyone understands that knowing CPR and First Aid is not an out-of-scope medical training but rather accentuates the professional’s skills by providing them with the necessary skills to work with whatever might come up on the job until a medical professional can take over. The same is true for being trauma-informed. If a massage therapy client hears a loud noise outside and this creates a “flashback” to events they experienced during military service, it would be negligent to just leave them to suffer on their own, just as it would be negligent to wait for an EMT to arrive before starting CPR. We need to be able to perform “trauma first-aid” so they can “get off the battlefield” and “get back into the room”. In a massage therapy context, knowing how to perform “trauma first-aid” before referring to a mental health professional is not only the humane thing to do, but it also may allow the client to continue with a massage session that they wouldn’t otherwise be able to continue.
All health and education professionals should be trauma-informed because all human interactions have the potential to bring up trauma wounds. A professional should be trained to be able to optimally work with clients (or students) when those trauma responses arise, and perhaps no professional needs to be as trauma-informed as much as a massage therapist does. This is because of the following:
- Touch has an enormous impact on the nervous system, and no profession offers as much touch as massage therapy.
- Massage can remind clients of being touched in violent or unpleasant ways, which then makes clients guarded during a session or resistant to receiving one.
- Massage can remind clients of being touched in caring and supportive ways that they haven’t experienced since childhood.
- Clients seek out massage therapy mainly to reduce pain and stress, so whatever caused their pain or stress in the first place is part of the whole picture. If their pain is from a car accident, for instance, it’s quite likely that strong feelings might arise in the client, either because of the horror of the incident, the fear of not being able to feel ok or function the same again, or the emotional relief in getting relief from pain.
- The calm and relaxation that often occurs from a massage therapy session can result in a client becoming aware of difficult feelings that their busyness and stress was specifically aimed to distract them from.
- Power differentials between client and therapist can bring up issues in clients.
- Many clients have challenges around setting boundaries or asking for what they want due to their childhood experiences, but asking for what they want is essential in massage therapy.
Any massage therapist who is not aware of these (and many other) issues is simply going to offer sub-optimal care to many clients. For instance, an un-informed massage therapist may think their client is being difficult when their client doesn’t ask for what s/he wants and then complains later that s/he didn’t get what s/he wanted. A trauma-informed therapist is going to understand not only why the client has this issue but how to more effectively work with the client so that s/he can get the massage session better tailored to his/her individual needs.
A massage therapist, or any healthcare professional, should hone their skills in building the client-therapist relationship and optimizing their communication skills. For a massage therapist, this is just as important as one’s touch skills, because great touch skills without good communication skills will reduce the client’s sense of safety and thus the quality and efficacy of the therapeutic interaction. All massage education involves some training in client communication, and that training should include trauma-informed communication skills.
There is probably no better way to learn trauma-informed communication skills than to be trained in NARM(™), since it was developed specifically for developmental trauma. NARM(™) principles are relevant to communicating with anyone, which is important because clients often communicate something, and as therapists we can’t just not respond. We have to respond in some way, so we should make that response effective. This is not small-talk nor psychotherapy. It’s effective “bedside manner.”
Applying NARM(™) principles in any person-centered venture is going to make that venture function more effectively. As a massage school director, I restructured my entire curriculum after being trained in NARM(™). The result is a much more functional classroom. The reason applying NARM(™) principles makes the classroom more functional is that just being in any classroom brings up a lot of issues that are relevant to developmental trauma:
- Some students have had very negative experiences in school.
- Some students struggle with being told what to do.
- Some students struggle with issues of feeling supported and fears of failure.
- Some students struggle with speaking up in class and striving for what they want.
Most educators are unaware of these issues and are navigating rough waters while being poorly equipped to do so. Incorporating NARM principles into the classroom makes for a more effective classroom because those issues come up less often and require less time and energy to address.
Just as applying NARM(™) principles to massage education can make the student-teacher interactions better, applying NARM(™) principles to massage therapy sessions is going to make the client-therapist interactions better. If those interactions are better, the whole session is going to be more effective. Clients will feel safer, which means that their muscles will be less guarded, their pain relief will be greater, and they will be more likely to be a returning client because they felt more cared for than they would be with an uninformed practitioner.
In summary, being trauma-informed and applying NARM(™) principles to any helping profession is not stepping outside of that profession’s scope. Every individual or business can, and SHOULD, be trauma-informed.
Mark Olson, Ph.D., LMT
Director, Pacific Center for Awareness and Bodywork and Affinity Wellness Education