Trauma Informed Practices (That Just Make Sense!)
- Kirby Clark, MMT
- Apr 1
- 5 min read
Since at least 2023, I have made an effort to make my massage therapy practice as trauma informed as possible. The following are a few examples of the options I offer in the interest of being trauma informed.
Before we begin, we should acknowledge that "Trauma Informed" has become something of a buzzword lately, so it is worth defining what it is we are talking about in the first place.
According to the training I have received in the subject, there are 4 levels of Trauma Informed Practice. In order, they are Trauma Aware, Trauma Informed, Trauma Sensitive, and Trauma Specific. At a minimum, when I say "Trauma Informed" I mean that I recognize the overwhelming prevalence of trauma and its effects on health and behavior of individuals. I also adhere to the 5 principles of Trauma Informed Practice: Ensuring Safety, Being Trustworthy, Providing Choice, Engaging in Collaboration, and Empowering my clients.
Being Trauma Informed is especially important for massage therapists because as my instructor has pointed out, a persons trauma may have happened in their past but it lives in their body presently. Making my practice more Trauma Informed helps reduce (but not eliminate) the risk of re-traumatization.
Not Dimming Lights
I begin every massage session with a customized intake with every client. Regulars and New Guests alike, we will take out time to sit down and at least briefly review health history and goals for that day's session. This intake is done with the lights in my room undimmed. I leave the lights at full brightness while my client's are in Prone (face down) position. I do this so that any client could choose to look up from the face cradle at anytime during their massage and see everything that is happening in the room. I wait until preparing the client to transition into Supine (face up) position before dimming the lights and then only to half-way. I let the client see the adjustments I make to the table and which body region I will be starting with in the new position before I dim the lights to three-quarters down. And of course, all of this practice with lighting is subject to the client's preference- I am just describing my standard practice.
Leaving The Door Open
I work in a franchise currently, but even when I was attempting sole-proprietorship, I've always worked in a space shared with other practitioners. But leaving the door to the treatment room open during the massage session is an option not many clients (and especially therapists) have considered. If a client has been subject to prior trauma, being alone with a stranger (or even a longtime trusted therapist) has the chance to be re-traumatizing. If having the door open during the massage would reduce that risk and help the client feel more comfortable and empowered during our time together, why is it such a hard option for some therapists to consider?
Sound Optional
In my treatment room, I am fortunate to have many options to create what I call a "cocoon of sound". Table fans, Sound Machines, and Music all help drown out the real world beyond the treatment room and give most clients something for their psychic mind to travel through and focus/meditate on. Furthermore, in a franchise or shared space, you never know how loud other guests and staff will be in the hallways, I want to protect my clients from as much of that and protect their zen with no resource spared. Not to mention the sounds of my humanness; my breathing, stomach growls, swallowing, etc... can all make for a less than relaxing experience. However, these sound options are just that optional ways to enhance the massage session. Not mandates that I will enforce. I've often had clients request one, two, or all three of these devices silenced during their treatment. It's an easy accommodation for those that may be prone to overstimulation or wish to be able to hear more of the world around them. But beware of the hallways and the sounds of my humanity.
More about the Intake
I encourage eye-level and in-depth intakes when working with clients. I ask clients to have a seat in the room because I will also be sitting for this process. Sitting and getting comfortable helps get the clients shift gears into a slower speed and sets the stage for the precious and restful time we will be spending together for the next 50-80 minutes.
I start each intake with a standard formula that can be customized with follow up questions based off whatever the individual discloses to me. My non-negotiable questions for a successful intake include;
Introducing myself by full name and my credentials (Massage Therapist Instructor and Board Certified in Therapeutic Massage & Bodywork)
More importantly, I let them know that my only agenda for the next hour is to support their peace and their healing and I ask them to tell me what their agenda is (why are you here? how can I best support you today?)
I repeat back a summary of what I heard the client say and allow them to confirm or correct my summary to ensure we are both clear on expectations.
I ask about any past Injury, Trauma, or Medical Conditions to discuss. This leaves much latitude in the client's discernment to determine what they consider injury, trauma, and a medical condition. It also allows them the autonomy to choose what information to volunteer and share with me.
I am sure to thank them for sharing any information about that previous question with me and tell them that it helps me form a clearer picture of their overall health (or holistic health). Again, I may ask clarifying follow up questions, summarize, and ask them to confirm or correct my understanding of what I heard (after all, there's always a difference between what was said and what was heard)
I provide them a couple opportunities to ask me any questions. Some therapists go out of their way to avoid answering questions about their personal life for fear of engaging in transference (and within reason, I also make that call on a case by case basis on protecting my safety and the safety of my family). But establishing trustworthiness and building a rapport with clients requires an openness and honestness to at least receive inquires of all kinds. How a therapist navigates answering those questions is their own choice.
I let the client know that I want them to feel encouraged and empowered to bring up anything they may need to while we're working together; thoughts, questions, concerns are welcome. Similarly, I follow up by ensuring them that we can modify or stop anything we are doing at any time and for any (or no) reason whatsoever. All I have to do is hear about it.
Finally, I describe to the client how to get on the table as explicitly as I can (even pointing my hand through the face cradle hole to show where their head should rest and pulling the top sheet and blanket back to show which layers they should position their body between).
Before leaving the room, I ensure there are no last minute questions, ask them to take deep breaths, try to relax their body (no stiffness in muscles/joints) and let them know I will knock before re-entering the room.
These are my practices that I have adopted to make my work as trauma informed as possible, but this list isn't exhaustive or complete. What trauma informed practices do you incorporate for your practice?
Accompanying Vlog: https://www.tiktok.com/@kirbyclarkellis.mti/video/7352916782992133419?is_from_webapp=1&sender_device=pc&web_id=7356954434540471851
Peace and Healing,
Kirby Clark Ellis, MTI, BCTMB
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