Massage Therapy Journal Fall 2025

50 • Massage Therapy Journal

AMTA Continuing Education

implicit memory is invoked, the client’s ability to distinguish between “massage therapy” and “trauma” is compromised. 132 The massage therapy causes the client to feel like the traumatic event is happening again. Helping traumatized clients to remain consciously in the present and to avoid kindling implicit memory are two essential principles for massage therapists who work with vulnerable clients. 133,134,135,136 Continuing to massage in the face of a touch-triggered response becomes equivalent to re-traumatizing the client. Caution is Necessary When Working With Clients With Histories of Trauma Some clients seek massage therapy to explicitly help with processing implicit memories or to learn to self-regulate while experiencing touch. The trauma literature acknowledges that the only

way past the effects of trauma is to move through the implicit memories, and yet exploring the story behind a somatic response lies outside of a massage therapist’s scope of practice. Clients with sufficient narrative memory of their trauma may request to process or talk through implicit memories while massage therapists provide massage therapy. This is where massage therapists may blur the lines between massage therapy and psychotherapy. Helping clients to process or talk through their implicit memories is psychotherapy—not massage therapy—and requires a different set of skills. Using massage therapy to help clients process trauma requires explicit negotiation and informed consent, particularly in sensitive areas or regions where they experience triggers. Helping clients

Therapist Diary: Invoking Implicit Memory in the Treatment Room

Suddenly, the client sat up and wrapped her arms around her knees. She looked down at the floor as if she recalled a frightening scene. I asked her if she was alright and she paused. While still staring at the floor, she told me in a quiet voice that she had just remembered being assaulted from behind while walking home at night from university. The attacker grabbed her neck from behind, and she thought she was going to choke from the tightness of his hold. “I thought I had forgotten that experience,” she said. “I was only 18. It was a long time ago. But when you sat behind me and put your hands on my neck, it was as if I was right back there on the street that night.” This was one of the first times that I observed a somatic response to massage therapy. Since that time, I have seen it many times. This session taught me that massage therapy has as much power to trigger a client as it does to help them feel relaxed.

Early in my massage therapy practice, a 40-year-old woman came for treatment to help her get rid of chronic headaches. After interviewing and assessing her pain patterns, I discovered that her headaches fit the exact trigger point referral pattern for the sternocleidomastoid (SCM) muscle. When I began to treat the SCM with holding, stripping and pressure on the trigger points, the client suddenly choked and began coughing uncontrollably. She also became quite emotional, tears streaming down her face. She had no idea why she was crying, why she felt choked or why she needed to cough so violently. She asked what I had done to create this reaction. I had never seen such a sudden response, but I didn’t think I had done anything out of the ordinary, having simply sat behind her head, holding her occiput in my left hand and stripping through SCM with my right fingers.

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