Massage Therapy Journal Fall 2025

Fall 2025 • 45

Client Attachment Systems in the Treatment Room

Secure Attachment —Loving and Caring. • Client experience. Child learns caregiver will be available if the child becomes afraid; the child develops curiosity and capacity for self-regulation. • What it means for the adult client in the treatment room . Client can participate actively in intake, assessment, massage session planning and consent process, and direct therapist in client goals, client curiosity and engagement in massage process. Insecure Attachment —Neglect . • Client experience. Avoidant, “Nobody cares about me.” No one will help when child is afraid. Cannot depend on anyone. May become a loner. • What it means for the adult client in the treatment room . May have difficulty appreciating that the massage therapist is truly interested in client experience. May not be able to ask for what they need. Insecure Attachment —Inconsistent Caregiving. • Client experience. Inconsolable, “Nobody can help me.” Anxious and unsure about what will get the attention of the caregiver effectively. Becomes inconsolable with more

and more problems in an attempt to reach the caregiver and receive solace for the fear. • What it means for the adult client in the treatment room . Client may challenge the therapist with multiple problems. As soon as one problem resolves, another pain or problem surfaces, demonstrating that the client has needs that are not easily met. Insecure Attachment —Frightening or Abusive. • Client experience. Disorganized, disoriented, “Nobody feels safe to me.” Sense of chaos and fear surrounding interpersonal relationships, particularly those that imitate family of origin. Poor capacity for self-regulation. • What it means for the adult client in the treatment room . Experience of massage therapy frightening and confusing because its medium is touch yet intent wholly different from life experience. Difficulty trusting the therapeutic relationship. Potential for negative touch-triggered responses, guarding, high resting muscle tension, hyper vigilance and hyperarousal. Potential for dissociation.

Information adapted from Ainsworth (1979); Bowlby (1982); Crittenden & Ainsworth (1989); Main & Solomon (1990); Ruth (2003)

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Other clients who have histories of neglect may assume that therapists don’t really want to work with them or discount all that they say as not applying to them. When clients behave in charming or rejecting ways, massage therapists should guard against taking their attitudes and behavior personally. 90 Sticking to massage session frameworks, negotiating therapeutic contracts, creating explicit massage session plans, and recalling the transactional nature of massage therapy all promote safety and avoid enhancing client transference. Massage therapists have a professional responsibility to contain the therapeutic process.

When attachment issues surface : Do— • Offer choice and encourage clients to decide how to proceed. • Negotiate a stop signal and confirm your preference to stop if a client is uncomfortable. • Suggest techniques or modalities that are indicated for what client has said they are hoping to manage with massage therapy. • Avoid personal disclosure unless it bears directly on the client’s situation. Don’t— • Take client behavior personally, no matter how it presents.

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