Working With Clients Who Have Experienced Assault Part 2

Content Warning: assault, sexual assault.

By Robert Libbey

On Those Bad Days…

Everyone is dealing with their own life challenges in the best ways they know how. Many patients with an assault/sexual assault injury are managing with some level of Post-Traumatic Stress (PTS). Some days are worse than others. On these days, a patient can present feeling various levels and mixtures of anger, grief, guilt and sadness amongst others. PTS moments can and will occur during treatment. When a PTS or similar moment occurs, it’s important to recognise and realise what the person in front of you has gone, or is going, through.

If they express anger towards you, don’t take it personally or as a sign of disrespect. Be concerned and caring. This is where listening skills, empathy and understanding come to the fore. Recognise that you have done nothing wrong and that today may or may not be a good day for treatment. Ultimately, the patient must be made aware that it is their choice if they want to continue with the treatment and that they can stop the treatment at any time.

If the decision is made to stop treatment, it’s important to ensure that the patient is capable of leaving your office feeling safe and that they have somewhere safe to go. In many cases, I’ve requested who the patient’s main “In Case of Emergency” is and permission to contact them. Remember your confidentiality when speaking about your patient. If given permission, I make the phone call while the patient is still with me.

Are There Any Areas of the Body That Should Be Avoided?

As part of informed consent, the discussion involves confirming boundaries both legal (defined by your regulatory body) and areas that the patient has deemed off limits. One of our greatest strengths as massage therapists is that we are skilled in treating with clothing on or off. There are many techniques that never require the patient to remove much, if any, clothing. A common comment I receive from patients is “I never realised I could receive a massage treatment without ever taking my clothes off!”

Once treatment boundaries are established, part of gaining informed consent is having both parties agree on how accessing certain body areas within the boundaries will happen. Typically, only undraping the area of the patient’s body where treatment is delivered is required. (Editor: Refer to the draping guidelines in the AMT Code of Practice.) Many times during treatment, other areas are determined to require treatment. When this occurs, revisiting the discussion on boundaries and consent to treat strengthens trust and minimises the power imbalances of the therapeutic relationship.

Which Topics of Conversation Should Be Avoided?

It’s professional to say that it’s outside your scope of practice to offer advice and that you don’t have the professional training to help in this area. Then make the appropriate referral either back to the patients’ G.P. or onto a clinical counsellor or the like.

Do You Use Any Scents in Practice?

Generally, I have a scent free environment. The connection of scent to memory is strong and you never know what experience or memory a certain scent will trigger in any of your patients. I also avoid strong food scents for the same reason. Save the fragrant herb and spice foods for home.

What Do You Do About Noises in the Treatment Room?

Sometimes you can control the noise environment and sometimes you can’t. Outside world sounds, such as traffic, can be difficult to block out. In an office, sounds such as voices that travel from one treatment room to another can be challenging to control. With my assault patients who have great sensitivities to sounds, I do my best to schedule them at a time of day when the clinic tends to be quieter.

What Music If Any Do You Play During Treatment?

As with smells, music has strong memory and emotional connections. With all patients, I typically avoid any mainstream music from any decade or genres. Generally, I play original instrumental music unless the patient requests certain music. Some patients prefer to have complete silence; I meet patients where they are at on that day.

Does Gender of the Therapist Play a Role in Treatment?

As much as we would love to live in a utopian world where all things were equal, this is not the case. You never know why someone feels more comfortable with one sex over the other. To be honest, it doesn’t really matter to me. All I’m concerned with is that the person is receiving treatment from someone whom they trust and believe is the best fit for them in that moment.

True story
About 15yrs ago, I provided 12 treatments to a female assault patient. On the 13^th visit, she revealed that I was the only male in her group of medical professionals that she was currently receiving treatment from. Even her veterinarian was female. She asked if she could switch to one of the female therapists in the office since a majority of the issues she had originally reported were feeling much better. She confided in me that she never really felt comfortable with a male therapist. As I had been recommended to her and as she recognised that major positive changes were being made, she hadn’t wanted to slow the progress of positive change that was being made. In that moment, I felt completely saddened. I knew that if she had felt completely safe and comfortable, that the positive treatment outcomes could have been dramatically more beneficial and potentially gained in less time. Changing to the female therapist quickly amplified her outcomes and shortly thereafter, she no longer required help.

Never be offended by a patient who has a preference for whom (male or female) they wish to receive treatment from. They’re advocating for themselves and getting help. That’s all that matters.

Put Yourself First

In order to best help those around you, you must put yourself first. Self-care is a part of our profession that typically focuses on our physical abilities to provide treatment but health care providers need to focus more on learning how to achieve/manage better mental health.

When patients confide in you, it can seem overwhelming. Adding this information to what you are already managing in your life can slowly pick away at your coping strategies.

Caregiver fatigue is common among health care professionals. Psychology and physiology are intimately linked. When you need help and don’t give yourself a break, your body goes into survival mode, and your cortisol levels increase, exacerbating your stress. You can start to feel worn down, need a holiday or feel exhausted and you may even start to lose the joy you have for helping others. Distancing yourself is an instinctual coping strategy that may work short term, but long term it’s noticeable to your family, friends and patients. This means pulling in reinforcements from parts of our brain reserved for things like love, connection and contentment. When you overextend one part of you, everything (and everyone) suffers.

If you are unable to cope physically, mentally and socially with the challenges we all face in daily practice, it’s vitally important that you ask for help. It’s a sign of strength so that you may continue to help others.

Why Should Massage Therapists Embrace the Opportunity to Work with Victims of Sexual Assault?

This is not an easy question to answer. It’s really no different than asking why a therapist prefers to work with athletes, elderly, paediatrics, orthopaedics, oncology, central/peripheral nervous system injuries and so on.

Many therapists’ professional interests are varied and tend to shift over their career. It’s a constant process of reflecting on what your practice is about. Ask yourself: who do you want to serve, what do you want to give to the world, what do you want to stand for, what do you find meaningful, what are you passionate about, what brings you joy? Sometimes it’s just about looking at who is “NOT” being served by your profession and recognising the impact that can be made in their life.

If you make the decision to work with victims of assault, it’s important to educate yourself first and set up your own sources for treatment. Focusing your practice in this area is challenging. As discussed earlier, you must put yourself first in order to continue to help others.

Become knowledgeable on the facts around assault and the benefits of massage therapy. Contact and connect with other medical professionals who focus on treatment of assault. These relationships are vital to providing a multi-dimensional treatment approach to provide comprehensive care.

Today, there is an ever-growing population of people seeking massage therapy in order to recover from traumatic body memories and reclaim the capacity to receive nurturing touch. People who have experienced assault suffer greater psychological distress, physical symptoms, experience interpersonal and sexual problems, PTSD, and dissociation compared to those who have never experienced assault. They often experience the loss of feeling safe, the loss of caring relationships with others, and the loss of an internal sense of wholeness. An important part of recovery is reclaiming and reconnecting the physical, psychological and emotional aspects, reducing dissociation and physical symptoms, improving quality of life.

Massage therapy allows people to experience positive, non-violent touch in a therapeutic environment. Research has documented that massage has been shown to help people experience a somatic release of trauma, increased self-awareness, feel an increased mind/body/spirit connection, decreased depressed mood, decreased anxiety, and provides feelings of safety and control.

About the Author

Robert Libbey has been a Registered Massage Therapist (RMT) in Canada for over 25 years. He has been a Senior Clinical Examiner instructing Orthopaedic and Neurological Examination. He teaches Ligamentous Articular Strain Techniques (LAST) at international conferences and online. Along with teaching and lecturing, Robert maintains a full-time practice. Robert has a passion to advance and improve Manual Therapy education, encouraging innovation in manual skills and inspiring therapists to incorporate research into practice to better serve their community. Learn more about Robert and his courses here.