Cultural Safety for Massage Therapists

By Karen Wyld

Whether you provide massage therapy in your own clinic or as part of someone else’s business, learning and applying cultural safety principles will strengthen your client-focused skills, and enable you to provide culturally appropriate services for Aboriginal and Torres Strait Islander people.

The Australian Indigenous Doctors’ Association (AIDA) states:

“To improve health outcomes for Aboriginal and Torres Strait Islander people, health service provision needs to be responsive to cultural differences and the impacts of conscious and unconscious racism. Aboriginal and Torres Strait Islander people are more likely to access and will experience better outcomes from services that are respectful and culturally safe places.”

AIDA’s Cultural Safety Factsheet

What is cultural safety?

Cultural safety was developed in New Zealand in the 1980s under the leadership of Dr Irihapeti Ramsden, Māori nurse and educator. With similar health disparities to First Peoples in Australia (further information here), NZ health practitioners knew there had to be a more effective way to provide quality health care that was culturally appropriate.

The model they developed has now been adopted worldwide, across broad sectors such as health, family and child services, and education.

In the health setting, principles of cultural safety include:

1. Know thyself: practitioners are self-aware.
2. Expand your knowledge: practitioners understand key factors that can influence or impact on discrete populations.
3. Client focused: practitioners treat each client as an individual, putting their needs first.
4. Provide an environment where everyone feels welcomed and safe, and that their cultures are respected.

The Culturally Safe Practitioner

Cultural safety is underpinned by practitioners using culturally responsive inter-personal communication to build a respectful and trusting rapport with their client.

A culturally safe practitioner has undertaken self-reflection of their worldviews, values, belief structures, and (often unconscious) cultural biases. And they would have a sound understanding of micro-aggressions and power and privilege.

The practitioner would have sound knowledge of historical and political factors that have impacted on First Peoples, from colonisation to contemporary times. And they would be aware of social, health and wellbeing disparities within Aboriginal and Torres Strait Islander communities.

However, it is important to not make assumptions or unconsciously stereotype people. Everyone is unique. A culturally safe practitioner takes time to get to know the client as an individual.

How can cultural safety be applied to massage therapy?

There is a vulnerability to being touched, even if the other person is a qualified practitioner. Building trust with the client allows the massage therapist to deliver a better service. But there can be barriers to trust, including some that practitioners may not have previously considered.

Australia is a diverse nation, but navigating racism, paternalism and discrimination is a common occurrence for many Australians. Due to these experiences, a new client might enter your treatment room with a sense of hesitancy. Applying cultural safe principles will enable you to build trust.

In addition to developing sound client-focused skills, culturally safe services make simple changes to the space. For example, signage, decor and artwork that are inclusive of other peoples’ cultures can assist people to feel comfortable.

An environment that is safe for people: where there is no assault, challenge or denial of their identity, of who they are and what they need. It is about shared respect, shared meaning, shared knowledge and experience, of learning, living and working together with dignity and truly listening.

Williams, Robyn (1999). Cultural safety: what does it mean for our work practice? Australian and New Zealand Journal of Public Health. 23(2) pp 213-214.

Strengthening skills

A good starting point to becoming more culturally respectful is to learn identity terminology. Summer May Finlay, a Yorta Yorta woman and PhD candidate in public health, provides excellent terminology advice for practitioners in this short video.

Accessing resources to help you increase understanding of Aboriginal and Torres Strait Islander health and wellbeing is highly recommended. As is learning about the complex social determinants of health that are linked to colonisation, inequity, racism, and intergenerational trauma.

Building relationships

Reading resources and online learning are excellent places to start but forming relationships will broaden your understanding and empathy.

Visiting Aboriginal or Torres Strait Islander cultural centres may be of interest. And attending cultural events, such as during NAIDOC or Reconciliation Week, is highly recommended.

In addition to annual celebrations and events, there are numerous anniversaries. For example, 13 February it is the 10^th anniversary of the apology for the removal of Aboriginal and Torres Strait Islander children. You may want to learn more about the Stolen Generations or participate in a memorial event.

You might also consider volunteering. Massage therapists are often welcomed at local Aboriginal and Torres Strait Islander community/health events, or pampering days. To find places to volunteer, contact your local Aboriginal and Torres Strait Islander health centre, cancer support group, or Elder support service, and start a conversation.

Never underestimate the power of conversation in developing respectful relationships with Aboriginal and Torres Strait Islander communities, organisations and individuals. Having a respectful relationship will enable you to provide better quality, culturally safe, services for Aboriginal and Torres Strait Islander clients.

More information

There are many types of cultural frameworks that are used in the health sector. All have commonalities, enabling health services and practitioners to deliver better quality health care for Aboriginal and Torres Strait Islander clients.

Indigenous Allied Health Australia (IAHA) use a framework called Cultural Responsiveness. As stated on their website: “The Framework offers a practical, action-based way forward for individuals, organisations and systems in order to improve their capability to meet the health and wellbeing needs of Aboriginal and Torres Strait Islander peoples.”

Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSIN) embed cultural safety within their practices and support mainstream services to learn culturally safe principles.

Australian Indigenous Doctors’ Association (AIDA) has been working with their members and Medical Colleges to strengthen cultural safety practices in both the teaching of medicine and delivery of health services. They have a range of resources on their website, including a Cultural Safety Toolkit.

Services for Australian Rural and remote Allied Health (SARRAH) have useful resources on their website, including an online Cultural Safety Learning Package.

Australian Indigenous Health InfoNet is a good source of information on a broad range of Aboriginal and Torres Strait Islander health topics. They also provide Yarning Places, where practitioners and allied health workers can get advice, share information, and increase skills.

The Health InfoNet also hosts The Healing Foundation’s free online healing portal, which was developed in partnership with Edith Cowan University.

About the author

Karen Wyld is a freelance writer, consultant and training facilitator of Aboriginal descent, based in South Australia. Karen has a broad professional background, including working in Aboriginal health, Elder support services, drugs & alcohol, community development, and research. Karen has taught Indigenous Health units at Flinders University School of Medicine and School of Nursing & Midwifery. Karen was also a finalist in the 2017 Richell Prize for emerging writers.