Trauma Informed Massage Therapy

Working with Terra Wellness is changing my life. It is providing me with a sense of meaning, clarity, and direction to the things held in my body and mind. Each session, we explore, while Tara holds a space where I feel both safe and honored. She asks questions, checks for consent, and we gradually unlock what is there. And it turns out that change and healing is possible. 

-L.B. Tucson, AZ

What is trauma-informed massage therapy?

Trauma informed or nervous system informed massage therapy is an approach to practice and not a technique. This approach is based on the understanding that trauma deeply impacts the body and mind. Like most approaches to therapy, trauma informed bodywork involves fostering trust, safety, clear communication, and collaboration with clients throughout the course of treatment. One of the main intentions of this work is to reduce the chances of inadvertently causing additional harm. According to Intent Health, “care provided in a trauma-informed manner is beneficial for all clients.” It should be applied as a universal standard of care, regardless of trauma history or disclosure (Intent Health).

“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

In an article written by Intent Health, a massage + bodywork practice in Canada that specializes in trauma-informed care describe the four principles of this approach to practice, outlined below. You can read the original article on their website here.

The four principles of trauma-informed massage therapy

1. Trauma awareness
2. Safety and trust
3. Collaborative choice and connection
4. Strength-based skill-building

1. Trauma awareness

Trauma-informed LMTs are aware of the impacts of trauma, and how people may adapt their behavior 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:

• anger
• avoidance of appointments
• irritability
• 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 LMTs 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
• 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, LMTs 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 goal

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