Massage Therapy Journal Fall 2025

52 • Massage Therapy Journal

AMTA Continuing Education

learn to self-regulate and become comfortable with accepting therapeutic touch lies within the scope of massage therapy practice. 137 Still, massage therapists risk client safety if they attempt massage therapy with vulnerable clients without extra training and careful attention to scope of practice. The risk of harm increases when clients have limited access to narrative memories about what happened. In these circumstances, clients cannot explain why they want to try massage therapy to manage their trauma symptoms because they cannot talk about their symptoms or sensations. If they cannot talk about how their trauma symptoms occur in their bodies, they are at risk of reenacting their implicit memories. For clients with trauma histories to remain safe during massage therapy, massage therapists should seek skilled supervision and obtain advanced training in somatic presentations of trauma. With client permission and appropriate training, massage therapists may work collaboratively with the client’s psychotherapist. Clinical Pearls of Wisdom: What Can You Do If A Client Experiences An Implicit Memory? Stop and investigate. If a client appears in distress as a result of massage, it’s possible that you have invoked implicit memory through a kindled somatic response. Consider client responses carefully. If a client cannot tell you what is wrong, then further massage is contraindicated until the client can make eye contact, remain fully present and state they are willing to continue. Renegotiate consent for treatment. Do not proceed with massage until the client gives you full permission to do so. Consider somatic responses to massage therapy as “red flags” that need further investigation. It may be necessary to refuse further massage sessions until counseling or

of trauma are encouraged to keep secrets or never tell what happened, it is easier to try to “forget” or to put the event out of mind than it is to constantly remember the experience. Unfortunately, forgetting life-changing events is very difficult. The challenge of blocking awareness to trauma may result in a variety of “tension reducing behaviors,” 138 including addiction, eating disorders and self-injury. In addition to self destructive actions, clients may find other ways to approach and then avoid treatment. For example, traumatized clients may ignore bodily signals of distress, resulting in massage therapists not being alerted when massage is painful. They may arrange for a session and then “forget” the appointment, or they may begin a series of massages only to abandon it as soon as they feel triggered or reminded of the trauma. Some clients deny that what they endured was traumatic. They may not recognize the high-resting muscle tension associated with the consequences of trauma, or they may suppress pleasurable reactions to touch. Clients in denial often discount the seriousness of a traumatic event or history, believing instead their experience is normal. Clinical Pearls of Wisdom: What Can You Do If A Client Exhibits Avoidance Timing is everything. Clients get to choose when they are ready to face their histories of trauma. Implicit memory may be triggered but should never be forced. It is not a massage therapist’s job to force clients to re-experience traumatic memories. Avoidance strategies exist for a reason. Avoidance occurs when clients don’t feel safe enough to face trauma. This self-preservation strategy should be respected. It is not the massage therapist’s job to force a client to face a traumatic experience. Trauma and Dissociation Dissociation represents one of the most surprising ways in which massage therapists may observe the effects of implicit memory. 139,140 Dissociation is a way of distancing from traumatic events by doing one or all of the following:

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psychotherapy can be arranged. Trauma and Avoidance

The experience of trauma encourages avoidance or distancing strategies to help victims forget or discount what happened to them. When victims

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