Massage Therapy Journal Fall 2025

54 • Massage Therapy Journal

AMTA Continuing Education

should continue for clients who dissociate until additional psychological support is in place. 149,150 This does not mean that dissociative clients should avoid massage therapy. In fact, massage therapists can play an important role in establishing self-regulation by gently challenging client holding patterns and shallow breathing, facilitating a return to normal resting tension. Nevertheless, to work safely, clients who dissociate must remain consciously aware and present in the treatment room. Only regions that feel safe to the client should be massaged. To allow or encourage dissociation during a massage session is not therapeutic and only serves to further kindle the client’s implicit memories and somatic responses. 151,152,153 The Search for Control: How Tension-Reducing Behaviors and Avoidance Work in Trauma There are so many circumstances where a person’s sense of his or her rightful place in the world may be broken. The consequences for abusers may

seem light to nonexistent, as long as victims keep the secret and remain silent. Yet, what amounts to a brief and often forgotten encounter for an abuser becomes a lifetime legacy of secrets and shame, especially for children who are victimized. 154,155,156,157 The earlier a child is exposed to trauma, the harder it is on the child’s normal development. 158,159,160,161 Multiple exposures to trauma result in a complex response that inhibits self-capacities, especially regulation. 162,163,164,165 In the face of extreme abuse-related stress or trauma, survivors may engage in activities that numb, soothe, interrupt or forestall painful experiences. These behaviors include high-risk sexual encounters, substance abuse, binging, chronic overeating, spending sprees, risk-taking behaviors and self-harm. 166 Because massage therapy can help clients become aware of their own sources of pain

Therapist Diary: Avoidance and Denial of Trauma

She joked, “I guess I almost died that day. Didn’t make it to my meeting either!” The client had no fractures or other visible injuries, yet she couldn’t understand why she felt so tense and sore all the time. When I asked if the explosion might have contributed to her body’s reaction to the accident, she said, laughing, “I don’t think so. It was kind of pretty.” The client agreed to a series of six massage sessions to help with her chronic pain and stiffness. Days later, she called to cancel all subsequent appointments, saying, “You won’t believe it, but I don’t have any pain anymore.” Given the five years of chronic pain and stiffness that she experienced since the car accident, I believe the miraculous change in her pain status had more to do with avoidance than with actual and lasting pain relief.

One day, a client booked an appointment because she said she was in a lot of pain and her body felt extremely stiff. As I interviewed her, I asked if she had ever been in a car accident. She said “yes,” but suggested that it was “no big deal” because it had happened more than five years ago and she was able to walk away from it. When I asked for more details about the accident, she casually described sitting in the back of a taxi on her way to the airport. Suddenly, the cab was hit from behind, and the driver ran the vehicle into a ditch alongside the road. The client crawled from the vehicle and was able to stand up and walk across the road. Mere seconds after she made it to safety, the taxi blew up, its gas tank having been punctured.

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