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Half-way through the massage, Patrick turns onto his back. As he does, the oil bottle that I have carelessly left on the couch begins to fall. I dive to catch it and there is a sharp in take of breath from Patrick. His eyes are wide open, he has stopped breathing and I can tell he is not really present. Slowly, I lower myself onto my stool, to be on the same level as him and say “Patrick? What’s happening?’’ As if coming out of trance, he whispers “I thought you were going to hit me’’. First I apologize, to affirm his reaction. “I’m sorry, I moved too fast and it startled you.’’ Then add “I think you had a body memory’’. He nods. “And it is not happening now?’’ Again he nods. I can tell that Patrick’s sympathetic nervous system arousal is subsiding because he is breathing more easily, and his muscles, which had gone quite rigid, are softening. I stay with his experience, gently encouraging him to notice his breathing. To reinforce the here and now, I suggest he looks round the room and names familiar objects. When he has settled a bit more, I give him the choice about what happens next. “Shall we stop here? Or would you like me to massage your feet or your hands?’’ I know that these are ‘safe’ parts of his body.

This episode happened about two months after I began to work with Patrick, a middle-aged manager of a successful business and former rugby player, who began to have panic attacks when his second wife left him. Thinking he was going mad, he consulted a Psychotherapist. A history of terrible neglect and physical abuse from early childhood emerged. Inside, Patrick was a frozen, terrified and furious child. Therapy worked well but there came a point when Patrick and his therapist decided massage might help with his fear of touch and difficulty relaxing.

Patrick suffered from complex, or Type II trauma (Rothschild 2000),[1] resulting from prolonged, overwhelming and very early abuse and neglect. Many sufferers appear to lead normal lives alongside inner devastation. Compared to Type I trauma, which refers to a single or series of unrelated traumas that occur when normal brain functioning is well established, there is evidence that Type II trauma actually alters the way that the brain functions, especially the ability of the cortical (higher) brain to make sense of sensory and emotional input from the ‘lower’ brain centres.  (summarized in Ogden, ed. 2006.)[2]

Understanding the effects of complex trauma was crucial. Here are some of the things I took into account. I had to remember that Patrick’s experience or understanding of things that happened in the massage room might be unusual, as in the example mentioned. I was careful to explain fully all that would happen, and check that Patrick understood and consented. In my role as massage therapist I accepted unusual responses without judging or needing to know what they were all about – that was for his Psychotherapist. We had an agreement that Patrick took any material coming up during massage to his therapist to discuss, also that I could liaise with his therapist and vice-versa, with his informed consent.

Establishing boundaries mattered for Patrick’s sense of safety. Before I did any massage at all, we spent two sessions talking. We discovered which parts of his body he could sense and which he could not, using body visualization. We’d talked about what made him feel good and how that felt inside and what made him feel bad and how that felt. This internal felt sensation for ‘I don’t feel good’ was an important marker that Patrick learned to use so he could control what happened in the massage session. Knowing that he could ask me to stop mattered, as did learning to make choices. I never said ‘What would you like next?’ because the open-endedness was too much for him, but offered concrete choices instead.

In the first proper massage session, I asked Patrick to imagine himself on the couch. He saw himself on his back, under the towels, fully clothed, so we went with that. With the couch adjusted so he was half sitting and could see me, he could allow me to massage his feet through socks. Gradually, he took more risks until he could allow his back to be massaged, and after some months, his whole body. We had to go slowly, constantly checking his internal markers and ability to tolerate the massage. Understanding all aspects of the stress response, fight, flight and, especially with Patrick, freeze, helped me to recognize when his body was happy with what I was doing, and when he was present or not, and, as above, to help him recognize this too. Having worked through many of his trauma based reactions to touch and being in his body, Patrick still has regular massage. It has become one of the pleasurable resources in his life.

References

1.    Rothschild B. The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment. New York. Norton. 2000.
2.    Ogden, P. Trauma and the Body. A Sensorimotor Approach to Psychotherapy. New York. Norton. 2006.

NB. ‘Patrick’ is not a real person. This fictitious case study is based on my years of experience working with trauma survivors.