Massage Therapy Journal Fall 2025

44 • Massage Therapy Journal

AMTA Continuing Education

reduce their pain. This is one of the reasons that emotionally vulnerable clients seek massage therapy. 78,79,80

because of the potential for massage therapy to trigger transference and projection. Vulnerable clients may have difficulty separating their experience of massage therapy from their personal history with touch and nurturance, causing touch-triggered responses. 84,85,86 Alternatively, massage also represents an opportunity for clients to become familiar with their reactions and to reframe their earlier experiences related to touch. How easily a person receives massage therapy boils down to how safe a person feels in the world. If the person has always felt loved, protected and safe, then any number of mishaps, accidents, or puzzling or fearful interactions may occur in the treatment room and still not disturb the client’s sense of self. But for clients who have felt unloved or frightened of people in positions of caregiving or authority, the power of touch may render them once more as vulnerable as any tiny child. In such circumstances, clients become voiceless, defenseless and dependent, a considerable responsibility for any massage therapist. Attachment and Transference When considering attachment systems and massage therapy, recognizing the vulnerability of insecurely attached individuals to develop transference is important. 87,88,89 After receiving reassurance from massage therapists when feeling unsafe, clients with insecure attachment may feel deeply reluctant to let go or move on. Clients may be surprised to learn that many massage therapists follow a clinical treatment model similar to physiotherapy. If a massage therapist decides massage is no longer required and announces this to a client who feels bonded or attached, the massage therapist may inadvertently invoke that client’s attachment system. The client may believe that the therapist denies their importance as a client. This unspoken assumption could leave the client feeling rejected, hurt and mistrustful and shaken by the massage process. Some clients who experienced inconsistent or frightening care when they were children may try to charm massage therapists because of a need to be liked. Some may need extra reassurance, seek advice, look for favors or ask for special treatment.

“In this climate of profoundly disrupted relationships the child faces a formidable

developmental task. She must find a way to form primary attachments to caretakers who are either dangerous or, from her perspective, negligent. She must find a way to develop a sense of basic trust and safety with caretakers who are untrustworthy and unsafe. She must develop a sense of self in relation to others who are helpless, uncaring or cruel. She must develop a capacity for bodily self-regulation in an environment in which her body is at the disposal of others’ needs, as well as a capacity for self-soothing in an environment without solace.” 81 Attachment and Massage Therapy Knowledge of attachment theory becomes significant for massage therapists when addressing the needs of emotionally vulnerable clients. 82 No matter what specific modality is employed by the massage therapist, an element of nurturing exists and the massage therapist performs the massage standing, professionally dressed and representing a position of authority. The client receives massage passively, undresses to their comfort level lying supine or prone while the therapist massages. This dynamic may be reminiscent of parental care of infant children. 83 From this perspective, it is easy to recognize the similarities between parental care and the therapeutic interaction that often happens during a massage session. When a child is maltreated, the effects stay with them throughout life. It follows that if clients were hurt, afraid, angry, inconsolable or terrified as children, then they may carry those emotions into massage therapy sessions that challenge their sense of security. Without needing the details of a client’s personal family history, massage therapists should recognize the presentation of basic attachment issues to ensure client safety and interpret client cues carefully. Insecurely attached clients may discover that massage therapy represents both challenge and opportunity. Touch therapy may be a challenge

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