{"id":2016,"date":"2019-09-04T09:00:19","date_gmt":"2019-09-03T23:00:19","guid":{"rendered":"http:\/\/blog.amt.org.au\/?p=2016"},"modified":"2019-09-03T14:47:17","modified_gmt":"2019-09-03T04:47:17","slug":"working-with-clients-who-have-experienced-assault-part-2","status":"publish","type":"post","link":"https:\/\/blog.amt.org.au\/index.php\/2019\/09\/04\/working-with-clients-who-have-experienced-assault-part-2\/","title":{"rendered":"Working With Clients Who Have Experienced Assault Part 2"},"content":{"rendered":"\n

Content Warning: assault,\nsexual assault.<\/em><\/p>\n\n\n\n

By Robert Libbey<\/h2>\n\n\n\n

Read Part 1 of this article here.<\/a><\/p>\n\n\n\n

On Those Bad Days\u2026 <\/strong><\/h4>\n\n\n\n

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\u2019s important to recognise and realise what the person in front of you has gone, or is going, through. <\/p>\n\n\n\n

If they express anger towards you, don\u2019t 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. <\/p>\n\n\n\n

If the decision is made to stop treatment, it\u2019s 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\u2019ve requested who the patient\u2019s main \u201cIn Case of Emergency\u201d 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. <\/p>\n\n\n\n

Are There Any Areas of\nthe Body That Should Be Avoided? <\/strong><\/h4>\n\n\n\n

As part of informed consent, the discussion involves\nconfirming boundaries both legal (defined by your regulatory body) and areas\nthat the patient has deemed off limits. One of our greatest strengths as massage\ntherapists is that we are skilled in treating with clothing on or off. There\nare many techniques that never require the patient to remove much, if any,\nclothing. A common comment I receive from patients is \u201cI never realised I could\nreceive a massage treatment without ever taking my clothes off!\u201d <\/p>\n\n\n\n

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\u2019s body where treatment is delivered is required. (Editor: Refer to the<\/em> draping guidelines in the AMT Code of Practice<\/a><\/em>.) 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. <\/p>\n\n\n\n

Which Topics of Conversation\nShould Be Avoided? <\/strong><\/h4>\n\n\n\n

It\u2019s professional to say that it\u2019s outside your scope of\npractice to offer advice and that you don\u2019t have the professional training to\nhelp in this area. Then make the appropriate referral either back to the\npatients\u2019 G.P. or onto a clinical counsellor or the like. <\/p>\n\n\n\n

Do You Use Any\nScents in Practice? <\/strong><\/h4>\n\n\n\n

Generally, I have a scent free environment. The connection\nof scent to memory is strong and you never know what experience or memory a\ncertain scent will trigger in any of your patients. I also avoid strong food\nscents for the same reason. Save the fragrant herb and spice foods for home. <\/p>\n\n\n\n

What Do You Do\nAbout Noises in the Treatment Room? <\/strong><\/h4>\n\n\n\n

Sometimes you can control the noise environment and\nsometimes you can\u2019t. Outside world sounds, such as traffic, can be difficult to\nblock out. In an office, sounds such as voices that travel from one treatment\nroom to another can be challenging to control. With my assault patients who\nhave great sensitivities to sounds, I do my best to schedule them at a time of\nday when the clinic tends to be quieter. <\/p>\n\n\n\n

What Music If Any\nDo You Play During Treatment? <\/strong><\/h4>\n\n\n\n

As with smells, music has strong memory and emotional\nconnections. With all patients, I typically avoid any mainstream music from any\ndecade or genres. Generally, I play original instrumental music unless the\npatient requests certain music. Some patients prefer to have complete silence;\nI meet patients where they are at on that day. <\/p>\n\n\n\n

Does Gender of the\nTherapist Play a Role in Treatment? <\/strong><\/h4>\n\n\n\n

As much as we would love to live in a utopian world where\nall things were equal, this is not the case. You never know why someone feels\nmore comfortable with one sex over the other. To be honest, it doesn\u2019t really\nmatter to me. All I\u2019m concerned with is that the person is receiving treatment\nfrom someone whom they trust and believe is the best fit for them in that\nmoment. <\/p>\n\n\n\n

True story<\/em><\/p>

About 15yrs ago, I provided 12 treatments to a female assault patient. On the 13th<\/sup> 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\u2019t 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. <\/em><\/p><\/blockquote>\n\n\n\n

Never be offended by a patient who has a preference for whom\n(male or female) they wish to receive treatment from. They\u2019re advocating for\nthemselves and getting help. That\u2019s all that matters. <\/p>\n\n\n\n

Put Yourself First <\/strong><\/h4>\n\n\n\n

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. <\/p>\n\n\n\n

When patients confide in you, it can seem overwhelming.\nAdding this information to what you are already managing in your life can\nslowly pick away at your coping strategies. <\/p>\n\n\n\n

Caregiver fatigue is common among health care professionals.\nPsychology and physiology are intimately linked. When you need help and don\u2019t\ngive yourself a break, your body goes into survival mode, and your cortisol\nlevels increase, exacerbating your stress. You can start to feel worn down,\nneed a holiday or feel exhausted and you may even start to lose the joy you\nhave for helping others. Distancing yourself is an instinctual coping strategy\nthat may work short term, but long term it\u2019s noticeable to your family, friends\nand patients. This means pulling in reinforcements from parts of our brain\nreserved for things like love, connection and contentment. When you overextend\none part of you, everything (and everyone) suffers. <\/p>\n\n\n\n

If you are unable to cope physically, mentally and socially with the challenges we all face in daily practice, it\u2019s vitally important that you ask for help. It\u2019s a sign of strength so that you may continue to help others. <\/p>\n\n\n\n

Why Should Massage Therapists\nEmbrace the Opportunity to Work with Victims of Sexual Assault? <\/strong><\/h4>\n\n\n\n

This is not an easy question to answer. It\u2019s really no\ndifferent than asking why a therapist prefers to work with athletes, elderly, paediatrics,\northopaedics, oncology, central\/peripheral nervous system injuries and so on. <\/p>\n\n\n\n

Many therapists\u2019 professional interests are varied and tend\nto shift over their career. It\u2019s a constant process of reflecting on what your\npractice is about. Ask yourself: who do you want to serve, what do you want to\ngive to the world, what do you want to stand for, what do you find meaningful,\nwhat are you passionate about, what brings you joy? Sometimes it\u2019s just about\nlooking at who is \u201cNOT\u201d being served by your profession and recognising the\nimpact that can be made in their life. <\/p>\n\n\n\n

If you make the decision to work with victims of assault,\nit\u2019s important to educate yourself first and set up your own sources for\ntreatment. Focusing your practice in this area is challenging. As discussed\nearlier, you must put yourself first in order to continue to help others. <\/p>\n\n\n\n

Become knowledgeable on the facts around assault and the\nbenefits of massage therapy. Contact and connect with other medical\nprofessionals who focus on treatment of assault. These relationships are vital\nto providing a multi-dimensional treatment approach to provide comprehensive\ncare. <\/p>\n\n\n\n

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

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. <\/p>\n\n\n\n

About the Author<\/strong><\/h4>\n\n\n\n
\"\"<\/figure><\/div>\n\n\n\n

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<\/a>.<\/p>\n\n\n\n

Need Help?<\/strong><\/h4>\n\n\n\n

National<\/strong><\/p>\n\n\n\n

1800 RESPECT<\/a> (National Sexual Assault, Domestic Family Violence Counselling Service): 1800 737 732<\/p>\n\n\n\n

Bravehearts<\/a> (child protection): 1800 272 831 (limited hours)<\/p>\n\n\n\n

Lifeline: 13 11 14<\/p>\n\n\n\n

ACT<\/strong><\/p>\n\n\n\n

Service Assisting Male Survivors of Sexual Assault (SAMSSA):\n02 6287 3935<\/p>\n\n\n\n

Canberra Rape Crisis Centre<\/a>: 02 62472525<\/p>\n\n\n\n

NSW<\/strong><\/p>\n\n\n\n

NSW Rape Crisis Centre<\/a>: 02 9819 6565 or (outside Sydney) 1800 424 017<\/p>\n\n\n\n

Domestic Violence Line (NSW Department of Communities and\nJustice): 1800 656 463 (24 hours)<\/p>\n\n\n\n

NT<\/strong><\/p>\n\n\n\n

Sexual Assault Referral Services (SARC)<\/a>:<\/p>\n\n\n\n

Alice Springs: (08) 8955 4500 (Mon-Fri 8am-4.21pm) or\nafterhours 0401 114 181<\/p>\n\n\n\n

Darwin: (08) 8922 6472<\/p>\n\n\n\n

Katherine: (08) 8973 8524<\/p>\n\n\n\n

Tennant Creek: (08) 8962 4361<\/p>\n\n\n\n

QLD<\/strong><\/p>\n\n\n\n

Brisbane Rape & Incest Survivors Support Centre<\/a>: (07) 3391 0004<\/p>\n\n\n\n

Sexual Assault Help Line<\/a>: 1800 010 120<\/p>\n\n\n\n

SA<\/strong><\/p>\n\n\n\n

Yarrow Place Rape & Sexual Assault Service<\/a>: 1800 817 421 or afterhours (08) 8226 8787<\/p>\n\n\n\n

Tasmania<\/strong><\/p>\n\n\n\n

Laurel House<\/a>: <\/p>\n\n\n\n

Launceston (03) 6334 2740<\/p>\n\n\n\n

North West: (03) 6431 9711<\/p>\n\n\n\n

Afterhours: 1800 697 877<\/p>\n\n\n\n

Victoria<\/strong><\/p>\n\n\n\n

Sexual Assault Crisis Line<\/a>: 1800 806 292<\/p>\n\n\n\n

WA<\/strong><\/p>\n\n\n\n

Sexual Assault Resource Centre (SARC)<\/a>: (08) 6458 1828 or (country areas) 1800 199 888<\/p>\n\n\n\n

Waratah Support Centre<\/a> (Bunbury): 1800 017 303 or (08) 9791 2884<\/p>\n\n\n\n

References\/Further Reading<\/strong><\/h4>\n\n\n\n

Recovering from Rape and Sexual Trauma<\/a><\/p>\n\n\n\n

In Safe Hands – Massage and PTSD, by Ian McCafferty (2016 AMTA Massage Therapy Journal<\/a><\/p>\n\n\n\n

Healing Through Massage (2017), Domestic Shelters<\/a><\/p>\n\n\n\n

Body-oriented therapy in recovery from child sexual abuse: an efficacy study, Cynthia Price, PhD, Altern Ther Health Med 2005; 11(5):46-57<\/a><\/p>\n\n\n\n

Massage and bodywork with survivors of abuse, Ben E Benjamin PhD<\/a>.<\/p>\n\n\n\n

Fact Sheet: Violence Against Women and Girls, (2002) Canadian Research Institute for the Advancement of Women<\/a><\/p>\n\n\n\n

Gender Equality and Violence Against Women<\/a> by Liz Wall, Australian Institute of Family Studies<\/p>\n\n\n\n

Fact Sheet: Violence Against Women In Canada, (2013) Canadian Research Institute for the Advancement of Women, ISSN 1917-8581<\/a> <\/p>\n\n\n\n

Fact Sheet: What is sexual assault?<\/a> (2019) Victorian Centres Against Sexual Assault (CASA) Forum <\/p>\n\n\n\n

Field, T., Seligman, S., Scafidi, F., & Schanberg, S. (1996). Alleviating posttraumatic stress in children following Hurricane Andrew. Journal of Applied Developmental Psychology, 17, 37-50<\/a>. <\/p>\n\n\n\n

Field, T. et al., Effects of sexual abuse are lessened by massage therapy, Journal of Bodywork and Movement Therapies (1997) 1(2), 65-69<\/a> <\/p>\n\n\n\n

Frank, DS. (2013) The Well-Embodied Professional: Attitudes around Integrating Massage Therapy & Psychotherapy when Treating Trauma<\/a>. <\/p>\n\n\n\n

Global\nand regional estimates of violence against women: prevalence and health effects\nof intimate partner violence and non-partner sexual violence, (2013) World\nHealth Organization<\/a> ISBN 978 92 4 156462 <\/p>\n\n\n\n

Massage Therapy Lessens the Effects of Sexual Abuse<\/a>, (2009) Massage Therapy Magazine <\/p>\n\n\n\n

Multi-country Study on Women\u2019s Health and Domestic Violence against Women, (2005) World Health Organization<\/a> ISBN 92 4 159351 2 <\/p>\n\n\n\n

Price C. Body-oriented therapy as an adjunct to psychotherapy in recovery from childhood abuse: a case study. J Bodywork Move Ther. 2002;6:228\u2013236<\/a> <\/p>\n\n\n\n

Price C. Characteristics of women seeking bodywork as an adjunct to psychotherapy during recovery from childhood sexual abuse. J Bodywork Move Ther. 2004;8:35\u201342<\/a> <\/p>\n\n\n\n

Price C. Body-oriented therapy in recovery from child sexual abuse: an efficacy study. Altern Ther Health Med. 2005; 11(5): 46\u201357<\/a>. <\/p>\n\n\n\n

Price C. Body-oriented therapy in sexual abuse recovery: a pilot-test comparison. J Bodywork Move Ther. 2005<\/a><\/p>\n\n\n\n

College of Massage Therapists of British Columbia Standards of Practice<\/a>, covering boundaries<\/a> and consent<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Robert Libbey RMT shares practical advice for massage therapists working with clients who have experienced assault and sexual assault in part 2 of our series. Content warning: assault, sexual assault, rape<\/p>\n","protected":false},"author":1,"featured_media":2020,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[110],"tags":[482,486,488,487,47,10,325,490,145,491,125,481,489],"class_list":["post-2016","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-clinical-practice","tag-assault","tag-boundaries","tag-draping","tag-informed-consent","tag-massage-therapist","tag-massage-therapy","tag-music","tag-noise","tag-robert-libbey","tag-scents","tag-self-care","tag-sexual-assault","tag-victim"],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/09\/aaa-windo.jpg?fit=1101%2C561&ssl=1","jetpack_likes_enabled":true,"jetpack_sharing_enabled":true,"jetpack-related-posts":[{"id":2010,"url":"https:\/\/blog.amt.org.au\/index.php\/2019\/08\/28\/working-with-clients-who-have-experienced-assault-part-1\/","url_meta":{"origin":2016,"position":0},"title":"Working With Clients Who Have Experienced Assault Part 1","author":"admin","date":"28\/08\/2019","format":false,"excerpt":"Robert Libbey RMT shares his experience of working with clients who have experienced assault and sexual assault in part 1 of our 2 part series. 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Who was the standout presenter? And who is going to the 2019 AMT Conference?","rel":"","context":"In "AMT Conference"","block_context":{"text":"AMT Conference","link":"https:\/\/blog.amt.org.au\/index.php\/category\/amt-conference\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2018\/10\/1.jpg?fit=996%2C414&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2018\/10\/1.jpg?fit=996%2C414&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2018\/10\/1.jpg?fit=996%2C414&ssl=1&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2018\/10\/1.jpg?fit=996%2C414&ssl=1&resize=700%2C400 2x"},"classes":[]},{"id":845,"url":"https:\/\/blog.amt.org.au\/index.php\/2018\/06\/06\/join-us-for-the-29th-annual-amt-conference\/","url_meta":{"origin":2016,"position":5},"title":"Join Us for the 29th Annual AMT Conference","author":"admin","date":"06\/06\/2018","format":false,"excerpt":"Earlybird registration is open for the 2018 AMT Conference, to be held in Sydney. With a phenomenal lineup and a great location, there's plenty to get excited about, not least of which is the opportunity to spend time with other massage therapists.","rel":"","context":"In "AMT"","block_context":{"text":"AMT","link":"https:\/\/blog.amt.org.au\/index.php\/category\/amt\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2018\/06\/crowd-2457732_1920.jpg?fit=1200%2C800&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2018\/06\/crowd-2457732_1920.jpg?fit=1200%2C800&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2018\/06\/crowd-2457732_1920.jpg?fit=1200%2C800&ssl=1&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2018\/06\/crowd-2457732_1920.jpg?fit=1200%2C800&ssl=1&resize=700%2C400 2x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2018\/06\/crowd-2457732_1920.jpg?fit=1200%2C800&ssl=1&resize=1050%2C600 3x"},"classes":[]}],"_links":{"self":[{"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/posts\/2016","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/comments?post=2016"}],"version-history":[{"count":3,"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/posts\/2016\/revisions"}],"predecessor-version":[{"id":2023,"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/posts\/2016\/revisions\/2023"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/media\/2020"}],"wp:attachment":[{"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/media?parent=2016"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/categories?post=2016"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/tags?post=2016"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}