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As
published in Massage Magazine - November/December 2003 -
Issue 106 By
Donna C. Cerio
The belief that time heals all wounds is definitely not
applicable to the wounds of sexual abuse. Healing can
be, and usually is, a lifelong process. Years after
abuse, people may find themselves experiencing chronic
body pain, negative behavioral patterns that seem
impossible to change, a pervasive underlying anxiety, a
severely damaged self-concept, a fear of intimacy, and
many other debilitating results. Throughout my 23 years
as a health-care professional, I have specialized in
working with clients who are dealing with the aftermath
of recent and past sexual abuse. I have found massage
therapy to be an effective and powerful tool in
assisting the recovery of these clients. Massage therapy
played a significant role in my own personal healing; as
a result, I began using it to assist clients with a
similar history. Sexual abuse, as I am using the term in
this article, includes but is not limited to: incest,
rape, sexual assault, child molestation and sexual
assault by an authority figure.
Even if you do not
specialize in clients with a history of sexual abuse,
statistics indicate there is a strong likelihood you
will encounter them in your practice. Consider the
following statistics from the 2002 California
Coalition Against Sexual Assault Report on Rape and
Violence:
An estimated
302,100 women and 92,700 men are raped each year in
the United States.
Nationwide, one
rape occurs every six minutes.
In 1994,
3,140,000 children were referred to [Child Protective
Services] in the United States for child abuse and
neglect. Of these, 113,960 were victims of sexual
abuse.
Of the 22.3
million adolescents in the United States, 1.8 million
have been victims of serious sexual assault.
These statistics lead us to the conclusion that there is
a significant number of people suffering from emotional
and psychological wounds incurred from sexual abuse
and as the massage profession grows, it is
increasingly likely that clients affected by sexual
abuse will enter your practice.
Massage therapy
can contribute significantly to the recovery of clients
who have been sexually abused. But because of the nature
of this abuse, massage therapists have an ethical and
legal need to work in partnership with appropriate
licensed professionals in the care of theses clients.
When you have established that sexual abuse is in the
history of a client, I suggest obtaining written
permission to confer with their other licensed
health-care professionals. This could be a physician,
psychiatrist, therapist and/or psychologist, among
others. If the client is not under the care of a
licensed health-care professional, I explain to the
client that it would be to his or her benefit to explore
this option. I always have a list of referrals on hand
in several appropriate areas of specialty for this
purpose. As a massage therapist, partnering with a
licensed professional gives you confidence that your
client will have whatever care she needs, while you stay
in the context of your own scope of practice.
The Wounded
Client
In my experience,
there are three categories of clients with a history of
sexual abuse: The first is open and direct with you
about their history and desire to heal. The second group
is aware that they were sexually abused but do not tell
you for a variety of reasons. They may feel shame and/or
fear of being judged or rejected. Or, as a survival
mechanism, they may have minimized the impact abuse has
had on them. The third type of client has been sexually
abused and has no recollection of it. He may have
separated the traumatic event from the conscious mind in
order to tolerate what happened.
How a person is
affected by sexual abuse depends on several factors: the
age at which she was victimized; her relationship to the
perpetrator; the duration and consistency of the abuse;
and the type of abuse. Even so, there are common effects
that most sexual-abuse survivors experience. According
to health-care experts, the most common conditions this
population is at an increased risk for are:
post-traumatic stress disorder; eating disorders; drug
and alcohol abuse; depression; anxiety disorders;
significantly poor health; and chronic pain. These
conditions affect both the body and the mind.
"I spent years in
chronic physical pain, severely limited in what I could
do," says sexual-abuse survivor and massage client Lina
R.* "My mind was often in chaos, and I felt unsettled.
With massage therapy I am experiencing enhance mental
clarity and emotional peace. I can work on my computer,
do yard work and hike. After years of physical and
mental limitations, I can use my body and mind freely
again."
There are clues,
such as those mentioned above, that clients with a
history of sexual abuse will present, whether or not
they reveal the abuse to you verbally. Additional
indicators of sexual abuse will be covered throughout
this article.
Whether or not you
know that a client has been sexually abused, or if you
suspect past abuse based on the indicators listed
throughout this article, use the following guidelines to
provide hands-on therapy that prevents re-traumatizing
the client and opens the door for the deepest healing
possible.
The four stages of
touch or PECE:
P: Prepare
yourself for each session using techniques that assist
you in clearing your body, mind, emotion and energy, and
bringing your focus completely to the client. I suggest
breathing exercises and setting an intention regarding
how you want to approach the client. Your intent, for
example, could be, "I intend to be completely present
throughout the whole massage and hold this client in the
highest regard at all times."
E: Enter
your clients physical space with awareness, realizing
that there is a transition taking place from the time
the client walks through your door to the time the
session begins. I suggest opening with an
energy-balancing technique to allow for the transition
and to make the beginning of hands-on work. This also
creates comfort and builds trust between you and your
client.
C: Work at
the contact point. This is a point in time,
rather than a point on the physical body, when a direct,
high-quality link is established between you and your
client. Staying focused, aware and present will help you
reach this contact point.
E: End the
session by affirming the existence and ongoing nature of
your therapeutic relationship with the client;
acknowledge her progress by pointing out what you
observed; and assure her that she is responding to the
work.
Landmines
Sexual abuse
leaves deep imprints. Physically and energetically they
are stored at the most basic level of structure, encoded
in the cellular levels of the human body. Any touch can
activate these "landmines," trigger cell memory and
re-traumatize the client.
While we cannot
always prevent encountering a landmine, we want to do
all we can to avoid triggering its effect. And
when we do encounter one, we want to approach it so that
the greatest amount of healing can occur. As massage
therapists, we need to be aware of the landmines that we
may encounter with this client population. Stimulus in
any environment, from direct hands-on therapy to common
everyday situations, can be a trigger, causing a
flare-up in the effects listed above.
I have worked with
clients who have had landmines triggered by such common
events as a routine medical exam, a dental procedure, or
a firm pat on the back by someone who intended to be
friendly. Even instances where physical contact does not
occur - such as verbal altercation with a friend, a
conflict with a clerk in a department store, or
witnessing an accident - can trigger landmines.
Due to its
hands-on nature, massage therapy is an arena where there
is a high likelihood of encountering these landmines.
Any touch therapy can feel invasive and abusive to the
client if it stirs up buried responses from the initial
abuse. Because the client's experience may be internal
or not even come to his attention until well after the
session, the inexperienced or untrained practitioner may
not realize anything has been triggered unless told so
by the client. For the client, the experience may seem
surreal or imaginary. This may confuse her and create a
feeling of being traumatized without understanding why.
Often due to her confusion, shame and inability to set
limits, the client may not inform the practitioner about
the experience at all. That is why it is important to
take precautions with all clients that you suspect may
have a history of sexual abuse.
The following
behaviors may indicate landmines are present:
Micro-managing her
session
Longer recovery
time for injuries
Apprehension about
being touched
Intensified
reactions to common health-care procedures
Undeveloped
boundary system
Self-destructive
behavior
Problems setting
limits
Problems asking
for what she needs and wants
If you encounter
any of the above, you may be in territory that
necessitates further training, to provide increased
awareness and guidelines to modify your approach.
Participatory
Health Care
Clients who have
experienced sexual abuse have particular need to be an
equal partner in their health care. This is essential in
order to promote and ensure safety and sustainable
solutions.
Sexual abuse is
done to a person without consult or consent. It is
usually a result of being overpowered by size, verbal
threat or authority. You represent authority in your
field, and this alone may activate your client's
landmines. Including her in the therapeutic plan helps
prevent this from happening. I call this approach
"participatory health care."
One of the most
important things you can do is to set aside the client's
first session for intake. In doing so you promote client
authority, which is an antidote to being a victim. This
also gives you and your client the opportunity to begin
building trust and partnership and set the pace and
style of approach together, by gathering information and
setting a foundation and intentions for future sessions.
Throughout the years, clients have told me that the
intake session gave them a foundation for feeling safe
and building trust.
Sexual abuse
changes how a person responds to touch. For some, the
idea of being touched in any way is so repulsive or
uncomfortable that they shy away from all or most
physical contact. Others set no limits with touch. These
extremes are common in sexual-abuse injury, though, of
course, many variations exist. Clients may seek massage
therapy to overcome the inability to be touched, as well
as to experience safe touch.
One of the
beneficial results of massage therapy is that it can
give the client an experience of safe, appropriate touch
that, according to research and heal-care experts
working with this population, will eventually override
the imprint of the traumatic touch from the sexual
abuse. Massage therapy is touch that the client has
sough out and chosen for herself, consented to, and
participated in how it will be received.
"At first I was so
unfamiliar with safe, self-chosen touch that my body's
response was to separate me from the experience," says
sexual-abuse survivor and massage client May S.*
"Massage has helped reclaim myself. With consistent
sessions, I can now feel nurtured from being touched.
This has impacted my life significantly.
"I now have a
healthy relationship, a more satisfying work life and
more confidence to connect in meaningful ways with
others," she adds.
Gradual Touch
How you approach
touching your client is important. This client
population responds best to gradual touch. Putting your
hands on these clients too quickly often feels abrupt
and sudden to them and can trigger fear, confusion and
other negative reactions. Also, gradual application of
pressure is more likely to be accepted by their bodies.
I have the client use sound and breath as I work, which
empowers him as a partner in the session and puts him at
ease.
Watch for signs of
apprehension and reluctance. If you notice them, you
have encountered the client's protective field. These
signs can be both obvious and subtle. Examples are: A
history of dissatisfaction with previous bodywork
sessions with other practitioners; stiffening up when
you start the session; muscle tension that will not
release; and a worried facial expression. When I
encounter a client's protective field I give the
following message, sometimes verbally and sometimes
non-verbally: "I respect your reluctance and/or
apprehension; I am glad to wail until you are ready; or
I am willing to restructure the session to make you more
comfortable; and I will be patient." I remain fully
present with the client. I detach from any need to
proceed, let go of my agenda and quietly wait for the
client's signal to go forward. Presence, patience and
choice are the keys to encourage the client to open into
trust. When the client develops the ability to trust in
the therapeutic relationship, she can transfer it into
her daily life.
Specialization
It is important to
be aware that you are often working on multiple levels
of the person at the same time. You may encounter
aspects of the person's past, such as the wounded child,
the hurt teen-ager or the harsh critic, who are much
younger and less developed than the adult body you are
working on. Be aware that these are not pathologies, but
rather the parts of the person that had to deal with a
horrific situation and developed protection as best as
she knew how. When I encounter this protective field in
a session, I recognize it as part of the brilliant
design of human makeup: adaptive, with a strong will to
survive and astoundingly creative. The best way to
approach the protective field is to acknowledge it,
accept it, and offer it a respectful invitation to heal
and change through touch.
Often the
monitoring system of a client with a sexual-abuse
history tends to under-function. This causes her to have
underdevelopment boundaries. The client may not let you
know that something is not working for her in the
session. She may not even know this herself until long
after the session is over. Developing a feedback
strategy - a plan the client has constructed with you in
the initial intake session - is profoundly helpful. With
this plan in place, your client has a comfortable way to
let you know when she needs something. The plan also
provides a controlled place to practice strengthening
the boundary system.
Customizing the
approach and pace of your massage techniques is
essential. Since the cellular and energetic imprints
that result from trauma are often deep and very close to
the surface at the same time, any quick, unexpected
touch might be felt or interpreted as abrupt and/or
rough. This can awaken deeply buried emotional, mental
and/or physical responses from the time of abuse.
Customizing the
Session
In the United
Stats, bodywork practices have only recently been
accepted as viable, effective health care, and
specialization within our field is relatively new.
Working with clients with a history of sexual abuse is a
specialty that needs to be defined and developed.
Clients with a history of sexual abuse benefit
significantly from massage therapy. By knowing how to
approach these clients, you ensure that they receive
work directly applicable to their healing with the least
risk of being re-traumatized.
I have presented
some of the basics of this specialty to you in this
article. The main points are: have an appropriate
intake procedure that begins the building of trust in
the therapeutic relationship; stay alert for signals
that you may be approaching a landmine; practicing
patience, acceptance and a nonjudgmental attitude will
encourage the client's trust; let go of your agenda;
promote client authority and participatory health care;
meet the client's protective field with respect and
care; and, importantly, work in partnership with
licensed health-care professionals.
*The names of
clients have been changed to protect their privacy.
Donna C Cerio
served as founding director of the Holistic Health
Program at the University of California, Santa Cruz, for
20 years. Her work,
Intentional
Touch™, addresses the needs of people recovering
from sexual abuse, suffering with serious illness, and
dealing with chronic emotional, physical and/or mental
pain.
Note: The
information and suggestions in this article are not a
substitute for training. Readers are urged to seek
training to make sure they have sufficient education and
experience to understand the information presented here
and to safely apply it to clients who are sexual-abuse
survivors.
To Learn More
Training
The Cerio
Institute
P.O. Box 65
Soquel, CA 95073
(831)475-5472
www.thcerioinstitute.com
health@thecerioinstitute.com
Offers
training in
Intentional Touch™, which addresses the needs of
people recovering from sexual abuse and dealing with
chronic emotional, physical and/or mental pain.
This article reprinted by permission of
Massage Magazine. |
