Massage Therapy Journal Fall 2025

Fall 2025 • 55

Client’s Diary: Disassociation and History of Severe Trauma

Please don’t see me; I can’t look at you. You’ll see how bad and ugly I am. I am so dirty and unclean. I am nothing. I feel so bad. How can you want to touch me? I am disgusting! Look at all the marks on my body from being hit. Please don’t look. I can’t hide from you when I am on the table. You will see all the marks. I am just vibrating with fear before we even begin. Please don’t hurt me. I have had enough. I can’t take any more hits or abuse. I so want to die. I am on the table now, and I have split right in half. Maybe then she won’t see me. She can’t touch me way down here, but how am I going to walk out of here. I am divided in two. Oh, but that heat on my back feels so good. I feel warm and cozy inside. I am not so afraid. It feels nice, the heat. Maybe she won’t hit me after all. She is pretty nice, and I like her. Dear God, how am I going to get home? I am in pieces, and I am so tired. I can’t go on much more … I have to go now … I’m tired … I need to lie down.

This client’s diary entry was written hours after a massage therapy session. To the therapist, the client appeared to be somewhat guarded and shy during the session. At times, the client shut her eyes tightly and rocked. At others, the client appeared asleep. The massage therapist had no idea of the impact of the massage on her client, although she was aware of the degree of extreme abuse that the client endured as a child. The client was able to process her discomfort with touch, journaling her feelings after the massage session. She shared her discoveries with her psychologist, but this journal entry was not shared with her massage therapist until months later. I am scared shitless. Don’t touch me … I’m so afraid … don’t hurt me. Don’t look at me. I feel so ashamed. I want to die.

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Hyperarousal, Hypervigilance and PTSD Hyperarousal is a term used to describe a person who startles easily and is ready to run at the slightest sound, such as an unexpected noise, or the least movement, such as a light and unexpected touch. Hypervigilance , on the other hand, describes the guarded wariness of people who keep expecting something bad to happen. Hypervigilant people keep their backs to the wall, their eyes on the door, holding their breath, waiting for “the other shoe to drop.” Hyperarousal and hypervigilance are common symptoms of PTSD. 174,175,176,177 Teaching these clients how to breathe, focus and consciously relax their muscles in the face of traumatic memories can provide valuable self-care strategies, and help them become aware of the way that trauma surfaces in their bodies. Hypervigilance and hyperarousal are nowhere more evident than with military or security personnel, who are often repeatedly

and discomfort, clients who actively engage in tension-reducing behaviors may avoid massage therapy rather than face their pain. Clients may miss appointments, forget their sessions or cannot pay for treatment. They might also make up stories to excuse their behaviors. Clients who demonstrate negative attitudes toward themselves may show hatred for their appearance by self-injury, cutting, burning or other forms of self-harm. 167,168,169 It is thought that individuals self-injure to release soothing endorphins. 170,171,172 When these clients learn to receive healthy and nurturing touch, the hope is they replace their more high-risk behaviors with more positive approaches to self-care. 173 It is essential to recognize that if clients are actively engaging in self-harm, massage therapy may trigger self-destructive tendencies further. Caution must be taken not to touch self-inflicted scars without express permission from the client.

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