Acute stress puts the client in a state of heightened tension because he is in the thick of the stress response. If, for example, your client was caught in an unexpected traffic jam on his way to your office, he is going to be more tense than usual when he gets on your table. If the stressor was a minor situation like traffic, it might work well to start the session with some lighter relaxation work before diving in to deeper, more therapeutic work that is more like his usual session. On the other hand, if your client is undergoing a major life event like the death of a loved one or another major crisis, your work will be more effective if you primarily address the immediate state of the nervous system. Her body is likely coursing within stress hormones, in which case your time in the session is best spent addressing that alone with relaxation work. Lighter work will also make her feel comforted at a time when she might desperately need it. From a client relationship standpoint, knowing when to back off a little and take care of your client will further build the trust she has in you, and having an objective, trusted source for stress relief will make your client healthier. Attempting deep therapeutic work on someone in the heightened stress state could also backfire and end up causing that person more muscle tension and pain than he came in with because the fight-or-flight response is still predominant in his sympathetic nervous system. Working the soft tissue too aggressively during an acute stress episode can cause what is called a “healing crisis.” A healing crisis occurs when a client’s symptoms temporarily get worse before they get better as the body struggles to process information. Under normal circumstances, a healing crisis may be something you can explain to the client and prepare him for before it happens, but it is not appropriate under an acute stress situation. If you have a client who regularly receives deep tissue massage and comes in during a period of acute stress, you may have to explain what is going on in her nervous system, what a healing crisis is, and why deep tissue massage may not be appropriate for this session. You can put a positive spin on lighter work by suggesting that you want to try a different approach under the circumstances while emphasizing that you are looking out for her best interest. Explain what your client can expect from a massage session that is geared more toward calming the nervous system and relaxing the body in another way, and that you can resume the usual treatment at the next session (if appropriate). Remember that our clients come to us to make them feel better, not worse. Clients who are experiencing a traumatic emotional state like grief may also have an emotional release during the massage and begin crying or shaking on the massage table. If and when that occurs, the best we can offer is an empathetic touch and let them know that the treatment room is a safe space to let it out. Other clients may use the time and safe space to vent their feelings without judgment, which is something they may not get from family or friends. Sometimes the best stress relief we can offer is to listen and soothe as objective parties. On the other hand, chronic stress is another kind of beast to tame. It is the more rampant disease-causing problem and a Scope of practice and privacy Once you have built a trusting therapeutic relationship with them, it is not unusual for your clients to occasionally unload when they come to your office for a session. We have probably all had at least one client who vented about her frustrations the entire time that she was on the table, or another client who came in with a laundry list of diagnoses for her various medical conditions seeking more information from us. Though it may be tempting to offer advice, do not step outside of your scope of practice. Remind yourself of the power differential we learn about in our study of professional ethics that exists in the client- therapist relationship and that your clients may see you as an authority figure. Never profess to have more knowledge than you are legally entitled to have in accordance with the licensing
bigger concern for our collective national health. It is also one of the primary reasons that people seek massage therapy. Chronic stress leaves our clients depleted and irritable, and often in some degree of pain. This is where we, as massage therapists, can make the most difference with a safe, drug-free method. Our job is to provide relief, and it is something we can do without any more tools than our own two hands. As manual therapists, we are privileged to be at that intersection of the individual and the world, as our clients present with a variety of chronic stress-related challenges: TMJ problems, digestive disorders, sleep difficulty, muscle tension, pain disorders, emotional difficulties, environmental sensitivities, and autoimmune difficulties among them. Most of these problems defy single-session answers, and too much time can be wasted looking for a cause of what is really a much more global problem of a system burdened by patterned and chronic stressors. Our clients are looking for help. (Moya, 2017) When we build ongoing therapeutic relationships with our clients, not only can we see if or how much our work is effective in treating their problems but we also become a trusted source of care. As the relationship grows, we can tailor our work to best suit our clients’ individual needs. No pill can do that. Chronic stress situations are where we can pull out more tools from our toolbox, especially when we are thinking about making progress for the long term. One session of deep tissue massage probably will not eliminate a client’s pain, but several sessions working on the same affected area may greatly improve function and reduce pain over time. Clients often come to us hyperalert and hypersensitive after spending too much time in fight-or- flight mode, and they may present with a high level of muscular tension in one or more areas of the body. During the session, they may also become aware that they have more tension than they realized. How often do you hear clients on the table say, “I didn’t realize I had so much tension”? The massage table may be the only place where they allow themselves the opportunity to be fully present and listen to what their body has to say, if they are even capable of that. As you get to know their musculature, their symptoms, and their comfort threshold, you can begin to apply combinations of modalities that might work for them into customized bodywork sessions. Seasoned practitioners know there is no such thing as a one-size-fits-all bodywork technique. If a healing crisis, as mentioned above, should occur, clients who are not experiencing acute stress may be more teachable as to why this happens and what they can expect in terms of results. As your therapeutic relationship grows, ask for feedback as to what worked for your clients (on your table and in the days following) and what did not. Listen to their feedback with an open mind, work with their best interest in mind, and be sure to keep your ego in check. The goal is to create a mutually beneficial relationship and keep them coming back. (The long-term effects of consistent massage therapy on chronic stress will be discussed further in Section 4 of this course.) laws in your state. Never advise clients about medical conditions or medications or provide psychological counseling. Unless you also hold a medical license in your state, never give your clients medical or psychological advice because you are not qualified to do so. The only thing you have the authority and expertise to speak about is massage therapy, and even that can have restrictions according to the bylaws of your state licensing board. But you can speak about all the wonderful things that consistent massage therapy can do for your clients. Have open discussions about their expectations and goals with massage therapy, and explain results you may have seen in other clients with similar issues. If a client has medical questions, always refer him to his physician for answers—even if you know or think
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