Massage in the Time of Bushfire Crisis
By Tim Clark
Like many, I have watched the Australian bushfires with a sense of helplessness and heartbreak for those affected.
How can we best work with people who may be dealing with huge losses, trauma, anxiety and any number of ongoing stressors?
I’ve thought about some questions that massage therapists might have about working with affected people, and I invite people to add other questions in the comments, especially if you have been working, or are planning to work, in these areas.
Should I bring up the bushfires with my clients?
As a rule of thumb, I wouldn’t recommend raising the topic if your client does not. You’re in a position to offer rest and respite to people whose day-to-day experience may be filled with reminders of the fires. That said, I can imagine there might be situations where it’s like the elephant in the room and not raising it could feel awkward. Your client might notice if you are deliberately avoiding talking about the fires and think they can’t bring it up even though they want to.
Follow your client’s lead. Stay attuned. They may relish the opportunity to talk about it and have their feelings witnessed. Or they may relish the opportunity not to have to think about it at all.
If my client brings it up, what do I say?
You’re not obliged to say much at all. By all means, let your massage do the talking.
If it seems like your client does want to talk about their experience, be empathic:
“That sounds really hard.”
“That’s a lot to deal with.”
“You’re safe here.”
“Good on you for taking this time out for yourself.”
Sympathy is okay too:
“I’m really sad/sorry to hear that.”
– but some people might take that as a sign they’ve brought you down, so keep it brief.
Focus on being warm and accepting and providing a space for your client to feel whatever they are feeling. You don’t have to be upbeat and optimistic, nor do you have to be solemn and morose.
Avoid getting involved in blaming or political discussions. Maybe your client has something they want to get off their chest? Let them, but avoid anything judgemental, even if you’re in agreement. Let it be a time for observation rather than judgement.
Avoid talking about hypothetical fire-related situations e.g. “If you’d stayed…”, “If you’d done things differently…”) and definitely don’t ask “Were you insured?” The last thing you want is your client lying on the table wondering about whether they made the right decisions under life-threatening conditions.
What advice do I give my clients?
Be aware they may well be getting all sorts of advice from all sorts of people. Don’t feel obliged to add to it. If it feels appropriate, encourage clients to keep up their self-care and their social connections, e.g. talking to trusted friends and relatives.
Therapists might want to print up copies of this information sheet from the Australian Psychological Society that outlines self-care strategies for bushfire recovery. (They’re good for therapists too!)
What if my client gets upset at some stage during the treatment?
Do what you would normally do (check in, offer a break if necessary), but you may need to be a little more attuned than usual. It might be the first time in a while your client has felt safe enough to ‘let their guard down’ and emotions can spill over. As much as possible, just let your client feel what they are feeling, without trying to move it or fix it.
Show support through actions, rather than words.
Offer tissues, water, tea or whatever is appropriate, but don’t offer hollow reassurances such as “It’ll all be okay”, which can sound like you’re minimising the immense challenges your client may need to face before normality returns.
What if it seems like your client is traumatised or at-risk?
Keep an eye out for trauma symptoms. Watch particularly for clients who tell you they are having:
- Recurrent intrusive and unwanted thoughts or flashbacks
- Difficulties with concentration
- Ongoing sleep problems
- Persistent irritability
- Prolonged feelings of anxiety.
If you think the client may have trauma that has gone unrecognised: refer, refer, refer.
Details about government-funded mental health services for bushfire recovery can be found here.
Always remember your boundaries and scope of practice: they are there to protect both you and your client.
Keep the following list of numbers handy and pass them on to clients if you suspect they are depressed, suicidal or otherwise at-risk:
- Lifeline on 13 11 14
- beyondblue on 1300 224 636
- MensLine Australia on 1300 789 978
- Suicide Call Back Service on 1300 659 467
- Kids Helpline on 1800 551 800
- Headspace on 1800 650 890
- QLife on 1800 184 527
Should I change anything about how I massage these clients?
As always, check your client’s preferences before the massage. Give them plenty of autonomy and choice in how the massage goes. They may have had a string of recent experiences that have robbed them of choice. You have an opportunity to re-empower them, even in this small way.
Be aware that your client may be experiencing hyperarousal or hypervigilance. Their nervous system may be set permanently to alert because they have experienced a life-threatening situation. Living in hyperarousal for a prolonged period can cause severe fatigue. Vigorous or sudden applications of pressure may exacerbate symptoms of fatigue and cause muscles to guard rather than relax.
Try instead to move your client from sympathetic (fight-or-flight) to parasympathetic (rest-and-digest) dominance by using a regular rhythm, long, slow strokes and moderate, even pressure. You might encourage your client to focus on their breath, counting 4 in and 6 out, to further relax the nervous system and quieten the mind.
How long will the effects of the bushfires last?
Recovery, including emotional recovery, from disasters like these takes a long time. Generally, the most difficult time for people will be when it feels like the public interest has died down but the challenges remain, and disillusionment sets in. It may well be about three years before life returns to a sense of normality and stability, perhaps longer. Anniversaries of the event can be particularly difficult during the recovery phase.
This diagram gives an idea of a typical trajectory of the emotional recovery process. Notice that the lowest point is not (necessarily) the impact of the disaster itself but the depths of disillusionment.
We always need to remember that everyone has their own way of recovering. There’s no right or wrong way to do it.
What if I find myself getting upset, depressed or exhausted?
Take your own self-care seriously and be a model of self-care for others.
Be realistic about your limits. Don’t expect perfection. It’s admirable to want to do as much as you can but exhausting or traumatising yourself isn’t only risky for you; it also puts your clients at risk.
You are not responsible for making everyone feel better. You have an opportunity to contribute what you reasonably can to a very big problem. That is all anyone expects of you. It might feel small or inconsequential but for the people you treat it will be a huge gift.
Listen to your body. If it’s telling you you’re tired, stop, even if only for half an hour. If you ignore your body, it will find its own way to make you stop. Watch for signs of burnout such as:
- Catastrophic thoughts
- Social withdrawal
- Absence of positive emotions.
If you are in a situation where you are regularly treating bushfire victims, start by taking precautions such as spacing out your treatments to include substantial breaks, limiting the length and number of treatments you do in a day, and having a trusted friend or colleague to regularly debrief with, especially if you notice feeling emotionally triggered.
Trauma is contagious. Just hearing stories of trauma can be traumatic and, if you’re hearing them on a regular basis, the effects of trauma can accumulate. This often happens outside our awareness and we only know it has happened when we find ourselves broken down and unable to continue.
Build pleasurable activities into your day in a deliberate way. Set aside time to read a book, listen to music, go for a walk or play a game. Find someone to do a massage swap with. Be disciplined about it.
As long as we can do it in a way that keeps everyone safe – ourselves included – we have a wonderful opportunity to make life easier, happier and better for people who have experienced great hardship. It’s what we do!
About the Author
Tim Clark is a massage therapist and psychotherapist in private practice in Melbourne’s south-east. His research paper, ‘The Psychotherapeutic Relationship in Massage Therapy’ was published last year in the International Journal of Therapeutic Massage and Bodywork. You can read it here.