In memoriam: Christopher Terrence O'Connor passed away suddenly on March 27, 2018. Massage Therapy Canada was fortunate enough to work with Chris over the years and share in mourning with his friends, family and the rest of the profession.
Post-traumatic stress disorder (PTSD) is increasingly being recognised in our communities. PTSD is no longer a condition specific to war veterans or those who have had major trauma in their lives. It is now widely accepted that any person who has suffered any kind of trauma can experience PTSD symptoms – and its effects can be overwhelming.
|Patients recovering from PTSD are taking a leap of faith in putting their trust in their therapists.
The word ‘trauma’ may be defined in a strictly physical/medical way, meaning simply a ‘wound’ or ‘injury.’ Trauma may also involve the psychological realm and mean, ‘a deeply disturbing, frightening or disquieting occurrence.’
It is now known that any person who has endured a traumatic event is susceptible to the disquieting effects of PTSD. War veterans, victims of motor vehicle accidents, victims of physical/sexual/psychological abuse, or natural disasters – all could suffer from PTSD. The Diagnostic and Statistical Manual of Mental Disorders 5 now includes: those who have directly experienced a trauma, those who may have witnessed a trauma, close friends or relatives of trauma victims, and those with repeated occupational exposure to traumatic events, as potential candidates for PTSD.
PTSD is a serious clinical condition that must be diagnosed by a qualified health-care professional, as its symptoms might not be easily recognized, even by those suffering. Flashbacks, nightmares, night sweats, altered sleep patterns, adrenal fatigue, irritable bowel syndrome, memory loss, muscle aches and general fatigue are just some of the symptoms that your clients might be experiencing. Many individuals do not make the connection between symptoms and trauma experienced because of the diversity of symptoms, their vagueness and, often, because of delayed onset of symptoms.
Although PTSD is a complex condition requiring diagnosis and treatment by properly trained medical professionals (far outside the scope of RMT practice), RMTs can learn to recognize PTSD and refer clients appropriately when symptoms are evident.
Taking care with assessment
When preparing to assess or treat individuals with PTSD, it is imperative to have clarity about what is being assessed, how it will be assessed, how it will be treated, and what will be left to the medical professionals.
After more than a decade treating sensitive cases, it is still crucial for my clients and me to strictly maintain treatment boundaries. More than just the obvious adherence to standards of practice, treatment boundaries are vital on a personal level for PTSD clients and should not be compromised. Many PTSD clients are learning how to assert themselves for the first time, and may have a very difficult time recognizing what their comfort levels are.
Alexithymia, or an inability to feel one’s emotions, is a common co-morbidity with PTSD. Victims often cannot discern what emotions they are feeling, are skilled at not feeling, or do not even know how their emotions feel in their bodies.
Massage, executed carefully, can play a very important therapeutic role here. Care must be taken to ensure treatment is led by the client – not by the therapist. Trust is paramount with this demographic. Failure to gain and maintain trust will jeopardize the efficacy of your treatment and impede your client’s recovery.
I remember the first time I treated a client who had suffered years of sexual and physical abuse. Her emotional discomfort was palpable the moment she entered the room. This woman found herself in a room with no windows, no phone (just an empty phone jack on the wall), no intercom, and a 240-lb male massage therapist between her and the closed door.
While I heard myself instructing her to disrobe and lie face down under three millimetres of sheets, as I had done with hundreds of clients before, I realized for the first time just how vulnerable this position must be for our clients. Recognizing the magnitude of the leap of faith I was asking her to take – to trust a stranger – taught me a valuable lesson.
We come away from our massage therapy training knowing that basic marketing skills are necessary to build a practice. I had not realized that it would be necessary to “sell myself” even after a client was in the treatment room. Trust is extremely difficult for those who have been traumatized, and the quality of trust that is required may not be earned after one visit.
The key to the success of this particular initial informed consent/assessment was making sure, beyond a doubt, this client knew and understood she was in complete control of every aspect of the treatment. It was a very empowering event for this client. As a result, she continued on with me – and booked several more treatments. She also trusted me enough to refer her to a therapist in her hometown after her hospital stay was completed.
Hypervigilance is another common symptom of PTSD. Being aware of this and allowing the client to regain control of a triggering situation, while also letting them be vulnerable can be tricky but important. People in authority may have taken advantage of these individuals, imagine how important your role as a manual therapist becomes.
Treat the person
I often tell people that I have never treated a hand, a foot, an arm, a leg, a back or a neck. I usually get a perplexed look until I clarify that I treat people, rather than body parts in isolation. I also do not treat conditions recorded in medical files.
One of the most meaningful encounters I have ever had with a client took place ten years ago. It was a very busy night, booked back-to-back, and I was rushing to ensure that everyone was getting their full treatment times. I was streamlining my intakes and was reading the forms just enough to find the client’s name, date of birth (it is always a good practice to wish clients a happy birthday), the history of their massage treatments, and the primary area for their treatment. It may not have been my most professional night, but it forever changed my way of treating.
The client came in, and it was obvious from her severe scarring, and the eye patch she wore, that she had been through a significant trauma. As I went through the consent process she just nodded and said very little. Throughout the treatment she was very quiet and was nearly inaudible when I checked-in about pressure and comfort. The treatment ended, she left as quietly as she had arrived and she rebooked before she left. Our second treatment was much the same as the first, but on the third treatment I decided to change the treatment plan. I suggested that I work on her head and face – an approach that I felt would prove beneficial. She consented and I went to work.
After the treatment, this client came out of the room crying. Worried that I had done something wrong, I immediately asked if everything was okay. She said that I was the first medical professional in 15 years, since her bear attack, to touch her face without asking what had happened.
I discretely picked my jaw up off the ground, made sure she was fine to leave the treatment area, and returned to her initial intake form. There it was in black and white: “Reason for treatment: bear attack.”
I often wondered if I would have treated her differently had I known. I cannot ever know how different the treatment could have been, but I do know that this case taught me two things: read intake forms carefully, then forget what you read and treat the person.
Power of touch
Those with PTSD have survived traumas, and many have lived for a long time since. Sadly though, many have been missing significant parts of the human experience – distracted by their condition. Helping a client reconnect with their physical body may also help them to overcome obstacles in their emotional/spiritual selves.
It is quite common for clients to present with physical pain connected to their trauma. Some of these traumas occurred decades earlier. A client once reported that he was experiencing inexplicable pain in the low back and gluteal region. During his treatment he revealed that, in a group session earlier that day, he had been retelling the story of being spanked in his formative years. This is called intrusive re-experiencing and is a core symptom of PTSD.
In all of our communities, there are people working through a post-traumatic stress recovery process. As a medical professional with years of experience working with this population, I hate to think of any sufferer going unnoticed. It should be easy for each PTSD client to find, and network with, qualified medical professionals. Just like those suffering from addiction, these individuals need the highly skilled hands and minds of manual therapists to help them become reacquainted in a healthy way with their bodies.
Once a client is diagnosed with PTSD, they may feel labeled. A client diagnosed with PTSD, with such a wide range of delicate and difficult-to-treat symptoms, may feel helpless and destined to suffer in silence. When we reach out to this group we can make a tremendous contribution to our communities, and bridge the gaps that exist among health-care professionals.
Ongoing education is the key to gaining a greater understanding of the process of post-traumatic stress recovery. We live in a world with a wealth of information at our fingertips that ignorance about a condition as prevalent as PTSD is difficult to fathom. Keeping ourselves informed and sharing information with colleagues can do nothing but broaden the support network for people in need.
As massage therapists, sometimes we don’t see ourselves as sales people but sales are nothing more than asking questions, providing a service and letting people know how to access it. My hope in writing this series is that, as a profession, we will start seeing areas in the population we treat that are being under serviced, view them in a new light and take action to remedy the situation. (Edited by Heather MacRae)
Chris O’Connor is a registered massage therapist, public speaker, osteopathic practitioner, provider and instructor of contemporary medical acupuncture. For more information, visit www.chrisoconnorconsulting.com .