Why should domestic and family violence matter to massage therapists?

By Dr Sarah Fogarty

Domestic and family violence (DFV) is any violent, threatening, coercive or controlling behaviour that occurs in current or past family, domestic or intimate relationships that causes the person experiencing the behaviour to feel fear. It can include behaviour such as physical injury, including homicide, sexual assault, direct or indirect threats, financial control, social isolation and emotional and psychological torment.(1, 2)

Domestic and family violence is a significant issue in Australia, with alarming statistics underscoring its prevalence and impact.  In 2021-22, over 1 in 4 (27% or 2.7 million) women had experienced DFV since the age of 15, and over 1 in 8 (12% or 1.1 million) men had experienced DFV since the age of 15.(3)

We are bombarded with news reports featuring traumatic details of DFV and it’s a pervasive fixture of political and social discourse as a result.  

Why it matters

Domestic and family violence should matter to massage therapists because a client presenting for massage therapy who is carrying the trauma of abuse may look the same as any other client who comes in for a stiff neck caused by work stress. Domestic and family violence, either current or historic, may be influencing the way our clients present and how they respond to our treatment and care.

A survivor may not disclose that they have been abused because this may not feel relevant. However, as therapists, we need to be aware that the presentation of pain or that stiff neck might have more than just muscular origins.

If we think about the side effects of domestic and family violence, especially the long-term impacts which are poor health, anxiety and stress, these are the complaints that often lead people to seek our services, potentially making us more likely to see clients with a history of domestic and family violence. Additionally, as massage therapists, we often see individual in higher risk groups such as the elderly, pregnant individuals, First Nations people, and individuals with a disability.

Negative experiences can occur during a treatment for clients that have experienced or are experiencing domestic and family violence. A small study of 10 respondents by Hickson (2005) found that 70% had been triggered or experienced memories of abuse during a massage session.(4) It’s important to note here that the massage session was not provided specifically for domestic and family violence related issues. Also, 30% of participants felt unsafe with their massage therapist at some point during their treatment.(4)

Massage therapists need to be aware of the nature, extent and impact of domestic and family violence given that being triggered during a massage is far from an uncommon experience. A client who is unable to relax their body due to fear and disassociation while being touched is unlikely to benefit from treatment.

The unique role of the massage therapist

Massage therapists might very well see the signs of abuse before these signs are visible to others. This is partly due to the nature of our treatments, where we often require clients to partially disrobe so that we can see their body and potentially see those signs.

However, it is more than just the physical signs of domestic violence we may recognise. We professionally treat areas of our clients’ bodies that other people don’t often see or touch and this creates a level of connection and trust over repeated visits, often leading to the fostering of safe and strong therapeutic relationships. This means that our clients may share things with us that they may not share with other health care providers or other people that they are close to.

Research from Smith et. al. (2009) found that clients valued the following elements of the massage encounter:

• Time for care and personal attention.
• An engaging and competent therapist
• The trust, partnership, holism and empowerment
• Effective touch and enhancing relaxation.(5)

And the researchers in this study found four modulators to those particular valued encounters: comfort, contact, connection and caring.

Our work often comprises both touch and talk, and the management of clients’ feelings and emotions. These elements place us in a position where our clients may open up about what is happening in their lives.

Massage therapists are also natural helpers in the community, and that’s because we do not occupy a primary health care position: we are often able to create opportunities for discussion around important health issues that may not occur in a primary medical setting. For example, we can be seen as an untapped resource for dermatological interventions given that we are uniquely placed to detect potential skin changes and encourage skin checks. Similarly, we may also see or hear about injuries that might be signs of domestic and family violence.

In both of those scenarios, we are not required to be experts in the field. However, the context and manner in which we work provides an opening for a conversation where the  client might take our referral advice and go get that skin check or seek support.

Being the best therapist for your client/colleagues/co-workers

There are situations where awareness of DFV might change how you respond or understand the risks, such as the tyranny of distance. There are often less DFV resources in rural and or regional areas and possibly less chance of anonymity if accessing these services. Knowing this might change the service that you suggest to a rural or regional client or co-worker.

We all want to keep our workplace safe and keep those that come into our workplace safe. Domestic and family violence changes the way that victims see the world and can alter their interactions with you as a massage therapist and people in your workspace.

The long-term impacts of domestic violence may affect our clients and colleagues long after the violence has occurred. Understanding the impacts of DFV can help you cultivate a safe and supportive workplace for those who have experienced or are experiencing DFV.

Conclusion

I believe that most massage therapists follow the adage “do no harm” and that we want to avoid negative experiences related to domestic and family violence for our clients, colleagues and employees.

Our clients are more than just a sore knee or tight shoulder. If we want to provide holistic care, then we need to look at the whole person and the impacts of all things on their health. Research shows that there are long-term impacts of domestic violence that may affect our clients long after the domestic and family violence has occurred.

The experience of being traumatised through sexual or domestic violence is life altering. Issues reported by survivors range from self-esteem struggles and difficulty in trusting one’s perceptions to an inability to feel safe when alone and with others.

In terms of the workplace, our staff, colleagues and coworkers are more than just workers. If we want to provide a healthy, safe workplace then we need to look at more than just our colleagues time and health at work.

Growing your DFV skills

Sarah has developed  a series of modules on ‘Domestic and Family Violence for the Massage Therapist’. The training aims to equip massage therapists with the skills, knowledge and resources to:

• understand the nature and prevalence of domestic and family violence
• understand the impact of domestic and family violence
• make your treatment space safe for disclosure
• respond to a disclosure
• ask about domestic and family violence
• understand safety and privacy considerations in the clinic and
• consider and respond to the impact of domestic and family violence in the workplace
• write a workplace domestic and family violence policy.

Please watch Sarah’s introduction to these training modules here:

The training is available free to members of AMT. Non-members can also access the content for a fee.

Please complete this registration form to access AMT’s Domestic and Family Violence training. 

References

1. Victorian Government. What is family violence? : Victorian Government.; 2021 [updated Reviewed 07 May 2021. Available from: https://www.vic.gov.au/what-family-violence.

2. Department of Families, Fairness and Housing. What is family violence? : Victoria State Government;  [updated 01/02/2018. Available from: https://services.dffh.vic.gov.au/what-family-violence.

3. Australian Institute of Health and Welfare. Family and domestic violence. https://www.aihw.gov.au/family-domestic-and-sexual-violence/types-of-violence/family-domestic-violence

4. Hixon A. Examining the Benefits of Massage Therapy for Survivors of Sexual and Domestic Violence. Dissertation.com: Clayton College of Natural Health, Birmingham, Alabama.; 2005.

5. Smith J, Sullivan SJ, Baxter GD. The culture of massage therapy: Valued elements and the role of comfort, contact, connection and caring. Complementary therapies in medicine. 2009;17:181-9.

About the author

Dr Sarah Fogarty has been in practice for over 24 years and works in a clinic with a women’s health focus. She has published over 40 research papers including papers on pregnancy massage, massage and miscarriage, bereavement massage, and fertility massage. She has presented her research at both national, international and local conferences and massage organisations. 

Sarah is an adjunct fellow at Western Sydney University. She was awarded a Massage Foundation Massage Research Grant in 2022 and is only the second recipient to be awarded the grant outside of the United States of America. She is currently serving as an associate editor for the International Journal of Therapeutic Massage and Bodywork.