What is Bereavement Massage?
By Ronna Moore
Loss is a universal human experience, with the accompanying grief the expected and natural outcome. Over time, most people will manage to negotiate the turbulent terrain of loss, grief and bereavement, and steadily find the means to adapt to living with their loss. However, access to a variety of supportive practices (not necessarily limited to counselling) throughout the intense experiences of grief and bereavement can be of significant value for most grieving people, including for the 7% at risk of developing complicated grief.1
That massage therapy, a conduit for relief and comfort through its skilled application of touch, could be a beneficial contributor in this setting is not really surprising. Approximately 1600002 people die in Australia each year. It is therefore likely that many therapists in their day-to-day practice will encounter a client experiencing grief. Other significant loss, such as the end of a relationship or job, may also result in a client experiencing grief. For this occasional occurrence, the already established competencies and skills, particularly with regard to therapeutic relationships, will enable therapists to provide effective support. To listen, acknowledge and empathise with pain and suffering are the basic ingredients of a compassionate presence and, hopefully, this is a bedrock capability of all massage therapists.
However, the situation is somewhat different when the actual target population for massage therapy is the grieving and the bereaved. As for all areas of specialist practice, additional knowledge and training equip therapists with more skilful means, in this case, to contribute to the current and future wellbeing of clients suffering loss.
Introducing Bereavement Massage
What is the clinical rationale for the inclusion of massage therapy in grief and bereavement support? What might such a specialisation look like?
The example of Bereavement Massage in practice described here is drawn from the experiences of the massage therapy component of the bereavement support program delivered by Melbourne not-for-profit specialist palliative care service, Eastern Palliative Care (EPC).
EPC has a 6 member team of Massage Therapists providing service to its palliative clients and their caregivers. Included in this model of service is access to bereavement massage therapy for bereaved carers for up to 13 months after the death of their loved one.
Support for grieving and bereaved carers constitutes a standard requirement within palliative care services (Standard 6 of the National Palliative Care Standards). In meeting these standards, and with a long established massage therapy service in place for its palliative clients (oncology massage), EPC extends this service to its caregiver population. The inclusion of massage therapy specifically, though, rests on an appreciation of the “whole person” impact of grief and reflects the general biopsychosocial approach to care intrinsic to the organisation.
The two quotes below illustrate the clinical orientation of bereavement massage therapy:
“To ignore the somatic aspects of grief in favour of psychological ones is to incompletely address the needs of the griever.” Dr Therese A. Rando Clinical Psychologist, Thanatologist, Traumatologist – Grief, Dying and Death: Clinical Interventions for Caregivers
The Effects of Grief
Physical manifestations of grief may include:
- Indeterminate pain (generalised or specific)
- Gut dysregulation
- Immune suppression
- Appetite and weight loss/gain
- Dyspnoea (difficult/laboured breathing)
- Extreme fatigue
- Physical weakness or restlessness.
While expressions of sadness are expected, other less apparent but common psychological, emotional or behavioural responses include:
- Panic attack
- Flat affect/mood
- Dysregulated anger
- High levels of distress
- Feelings of abandonment and loneliness
- Intrusive images
- Social isolation
- Emotional exhaustion
All EPC staff members, including massage therapists, receive comprehensive bereavement education. This means there is an evidence-based knowledge framework guiding the services delivered.
Within the EPC program, a grieving person may seek massage therapy for the everyday issues of pain and discomfort familiar to therapists in general practice. However, any of the above more challenging and bereavement-related (psychological) presentations may also serve as triggers for a referral to massage therapy and this indicates the benefit of a broader scope of practice and a broader range of skills. Goals of care and treatment are underpinned by an understanding of the nature of effective bereavement supports.
For example, within a society not particularly comfortable with death, many bereaved people are overwhelmed by the multiplicity and strangeness of their responses. Simply providing information about the stress response, the impact of trauma and its various physical and emotional manifestations can often bring immeasurable reassurance and comfort. Thus, somatic and psychoeducation forms part of the therapists’ remit. Encouragement for self-care, guidance in attending to the physical body, exploring coping strategies (e.g. relaxation, breathing or meditation techniques) may all be folded into a Bereavement Massage session. Thus the massage practice serves to:
- Facilitate the Relaxation Response
- Promote a sense of physical wellbeing
- Validate and “normalise” feelings and thoughts
- Create and “hold” a calm, safe space for emotional expression and reflection
- Provide grief education
- Encourage self-agency and explore coping strategies
- Monitor for referrable indicators (e.g. for counselling or medical review).
This latter point highlights the value of working within an interdisciplinary team. Whilst the role of the massage therapist is not as a counsellor, a key skill is in assessing when counselling may be indicated.
In order to evaluate the experiences of the recipients of Bereavement Massage at EPC, a survey was recently conducted with encouraging and illuminating findings. 94% of the respondents rated the service as specifically beneficial to their bereavement needs. The perceived gains for emotional or physical wellbeing were rated about the same. Key words and themes to emerge in the qualitative responses were:
My presentation at the ACGB Grief and Loss Conference in Sydney in 2018 – The Role of Skilled Compassionate Touch in Grief Support – prompted a great deal of interest from bereavement health professionals at the conference, with a general acknowledgement of the impact of grief upon the body and a curiosity about access to massage therapy for this cohort.
This application of massage therapy clearly has rather challenging characteristics, but it is both a clinically interesting and deeply rewarding area of practice and an area of significant potential for interested massage therapists to pursue. The Australian Centre for Grief and Bereavement runs workshops around Australia and hosts regular webinars to support greater learning about grief and bereavement.
1. Source: Kersting et al Prevalence of Complicated Grief in a Representative Population-based Sample (2011)
2. Source: Australian Bureau of Statistics
About the Author
Ronna Moore is a remedial, oncology and palliative care massage therapist and lymphoedema practitioner. Ronna has been in private practice for over 30 years, in addition to her work with Eastern Palliative Care. Ronna is currently a PhD candidate in Public Health/Health Promotion in Palliative Care, with her research project looking into the prevalence, distribution and other characteristics of massage therapy in the palliative care arena.