The Therapeutic Relationship in Post Traumatic Stress Disorder

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A growing awareness is emerging among massage therapists and other healthcare workers that traumatic experiences are widespread. It is very common for people who have been traumatized to develop medical and psychological symptoms associated with their experience. People who experience or witness life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents or violent personal assaults often re-live these experiences repeatedly. This can occur through:

Nightmares
Flashbacks
Difficulty sleeping
Feelings of detachment or estrangement
Development of physical pain from the mental/emotional impact of the event

One’s life is usually significantly affected and impaired when post-traumatic symptoms are chronic and severe.

Known as Post Traumatic Stress Disorder, or PTSD, the stress caused by trauma has a neurobiological basis that can significantly disrupt and alter brain chemistry, influencing one’s behavior, feelings, and thought processes. An estimated 70 percent of adults in the U.S. have experienced a traumatic event.

PTSD is common; 6 out of every 100 people (or 6% of the US population) will have PTSD in their lifetimes. Approximately 12 million adults in the U.S. have PTSD during a given year. However, this is only a small portion of those who have gone through a traumatic event.

About 8 of every 100 women (or 8%) develop PTSD sometime in their lives compared with about 4 of every 100 men (or 4%). The PTSD Alliance, a multidisciplinary group of professionals and advocacy organizations, states that three categories or “clusters” of symptoms are associated with PTSD. They are:

Re-living the event through recurring nightmares or other intrusive images that occur at any time. Extreme emotional or physical reactions such as chills, heart palpitations or panic when faced with the memory of the event. One or more of these symptoms must be present for diagnosis.
Avoiding reminders of the event, including places, people, thoughts, or other activities associated with the trauma. Feelings of emotional detachment, withdrawal from friends and family, and loss of interest in everyday activities. Three or more of these symptoms must be present for diagnosis.
Being on guard or hyper-aroused at all times, including feeling irritable or sudden anger, having difficulty sleeping or lack of concentration, being overly alert or easily startled. Two or more of these symptoms must be present for diagnosis.

A diagnosis of PTSD, according to the Alliance, may be considered if:

A specific number of symptoms from each of the three clusters that have lasted for one month or longer

AND

The symptoms cause severe problems or distress in personal life, at work, and generally, affect daily life.

Massage therapists and other bodyworkers are in the position to recognize physical symptoms and emotional issues affecting one’s basic needs in those with PTSD. For example, frequent physical complaints include chronic pain, fatigue, stomach pains, respiratory problems, headaches, muscle cramps, muscle aches, or low back pain. Other indicators of PTSD include emotional absence or unresponsiveness, depression, exaggerated startle responses, extreme ticklishness, numbness, or hypersensitivity to touch. In addition, people with PTSD may experience symptoms of physical pain, disassociation from self, their actions or body, irritability, outbursts of anger or crying. In “Transforming the Pain: A Workbook on Vicarious Traumatization”, Saakvitne and Pearlman state that the traumatic experience undermines five basic human needs:

The need to be safe.
The need to trust.
The need to feel some control over one’s life.
The need to feel of value.
The need to feel close to others.

Massage therapy and other forms of bodywork can offer a profound sense of peace to those who are present in their bodies enough to let go, relax and receive. However, for traumatized people, a massage treatment’s intimacy may increase fear and/or trigger painful memories. Certain kinds of touch, even gentle and caring touch, can have unpleasant associations for the client, particularly if they are survivors of sexual or physical abuse. In these cases, clients may not even be able to feel certain parts of their bodies or give feedback on how they feel physically or emotionally. In addition, those who have suffered traumatic accidents may have feelings associated with the event locked into the musculature, which manifests as physical pain.

Treatment considerations for those with PTSD involve obtaining and evaluating the information about the traumatic event and how the symptoms may manifest in the client. The massage therapist must work with any scope of practice regulations that could influence this evaluation. With all clients, but especially with PTSD cases, establishing a sense of trust is paramount. A commitment between therapist and client to work together toward the client’s wellness by creating a caring and safe environment for healing, and developing an agreed-upon treatment plan, is essential for any therapeutic relationship. For people with PTSD, communication about these components, along with a well-defined and predictable massage routine, increase the effectiveness of treatment and reduce the potential for conflict and inadvertent re-traumatization by the therapist.

With a safe, trusting and therapeutic healing environment, several treatment protocols may be effective when working with those with PTSD.

Polarity Therapy is unique in its comprehensive exploration of multiple dimensions of the human condition. It effectively bridges the full spectrum of life experiences, including body, mind and spirit. Using an energy-based approach, Polarity Therapy offers effective methods for supporting a safe and sound therapeutic relationship and helping clients build the inner resources necessary to manage their stress and trauma.

Polarity sessions do not require disrobing and involve both touch and verbal interaction. According to Mary Sullivan, author of The Institute for Integrative Healthcare Studies’ Polarity Therapy Manual, Satvic touch, or touch that is very still and non-intrusive, is helpful for PTSD. This type of touch is used in Polarity to bring about awareness of one’s resistance to letting go of the tension, pain and fear stored in the tissues due to trauma. Ms. Sullivan states, “When you touch a place that has held trauma for a long time, the psyche responds by remembering scenarios that have brought on the pain.” Therefore, with the re-emergence of memories associated with the trauma, the client may feel uncomfortable with touch in that area.

Respecting the client’s process and wishes and moving on to related reflex areas is imperative. Maintain a conscious, loving intention in which unconditional acceptance of the client and where they are in this process are held constant. The fact that the therapist consistently remains present and accepting of the client will have an enormous impact on the ability of the client to release, balance and heal.

Therapeutic Touch (TT) is a contemporary interpretation of several ancient energy healing practices, which consciously directs or sensitively modulates the client’s human energy field to restore health and well-being. Research has shown that TT alleviates pain and induces a relaxation response. In addition, TT is known to ease the anxiety associated with prolonged fear or trauma. A series of TT treatments may help diminish defense mechanisms constructed to block awareness of physical and emotional trauma and allow for a more profound sense of self-awareness and body consciousness.

Myofascial Release and/or Myofascial Unwinding are techniques that initiate release in two ways:

Release of the fascial tissue restrictions held in the body from the trauma.
Release of the emotional origin of the physical holding patterns.

As a skilled therapist holds and unwinds these tissue tensions, memories begin to surface and release, causing the body to spontaneously “replay” body movements associated with the trauma’s memory. As the body relaxes and fascial restrictions release, the nervous system takes over and releases stored tensions like the uncoiling of a spring, allowing trapped nerves to elongate and restore normal function. Repressed memories are brought to conscious awareness allowing the client to look at them in a new way and experience the choice to transform them.

A holistic approach to therapy for recovery from PTSD is advantageous because instead of facilitating a structural change in the body, it helps to create a whole-body centered awareness. This awareness allows for positive personal growth and the possibility of resolving physical and psychological restrictions, emotions, and belief systems that impede one’s health and well-being. Massage therapists take the role of listener, teacher, coach, and caregiver. The therapist must be educated and prepared for the commitment required to see someone with PTSD through their course of therapy. Supervision from a more experienced therapist can be of great assistance in helping a practitioner remain focused on their intent and clear any unconscious motivation that may surface for the therapist during treatment.

A skilled massage therapist who is willing and able to remain committed to the therapeutic relationship can help clients restore their basic human needs – safety, trust, control, self-worth, and intimacy. In the presence of the therapeutic relationship, the client can learn the value of safe and caring touch and re-emerge from the wounds of trauma.

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