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This topic came up during a discussion on another thread about pressure and pain.  I know just a little about this phenomenon.  What I've learned in MT school is that people will dissociate - leave their bodies - when pain or emotion becomes too difficult to deal with.  There are different forms of this, everywhere from "go to your happy place" (instructions to one of my riding students from her DT MT) to a friend who ended up pretty much just leaving altogether with no consciousness remaining for a few seconds.

 

In SomatoEmotional Release we talk about dissociation, and strive to keep people present in their bodies for the work that is happening.  However, in some circumstances we might choose to have the person dissociate for a brief period of time if the issue they are dealing with is too emotionally charged.  After some of the emotion has subsided then they are brought back into their bodies.

 

It's also possible for the therapist to dissociate.  One of my colleagues can do 8 hours of really deep DT work a day because she dissociates so completely.  Not good for her or her clients!

 

Thoughts?

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The 2nd most popular reason (after sexual offenses) that MTs have been jacked up by our massage board is for acting like they're qualified to be counselors/psychologists when they in fact are not. My advice is for the therapist to remain grounded and present and if the client disassociates, so be it. They'll come back when their hour is up and you give instructions to take their time getting dressed. My education is in psychology and I completed a 2000 hour counseling internship during my master's program, plus an additional 120 hours of emotional stress relief work, and I still refrain from "having a person disassociate" or anything else that smacks of psychological work because that is not why they are coming. They are coming for bodywork. They may "disassociate" or they may be "in the zone" or simply be profoundly relaxed and taking a nap--and there are many MTs who don't know the difference. I also taught psyche-soma in a massage school for five years and I've witnessed it all many times. The APA and massage boards spell out what is within the scope of practice of their respective professions, and the scope of practice of massage does not include "encouraging" people to disassociate. If emotional release or other phenomena occurs, our job is just to be present for the client.
Laura, you have profound knowledge, wisdom and experience.  Thank you so much for your thoughts on this; it really works for me.  I have never done dissociation with a client, instead I do what you have suggested.  I will continue to work that way - I much prefer your approach.
Presence is something few professions offer. It has great value on its own. It may be all the client needed. But we as a profession offer presence, touch (contact & tactile sensation), bodywork. What a package!

Actually, I also refrain from counseling because I figured out along about hour number three of that internship that I am not tactful enough to counsel people. When someone is 40 and still blaming everything on their parents my usual inclination is to say grow up and assume responsibility for how the rest of your life is going to go :)



Therese Schwartz said:

Laura, you have profound knowledge, wisdom and experience.  Thank you so much for your thoughts on this; it really works for me.  I have never done dissociation with a client, instead I do what you have suggested.  I will continue to work that way - I much prefer your approach.

Tact is so very difficult! :)

 

I would like to post a disclaimer; I would have done it 90 minutes ago but I was working on a client.  I am very interested in thoughts on dissociation but I should make it clear that the word dissociation has never been brought up in my SER classes.  That is the word I have assigned to some of the thoughts they have about sessions but they have never said it.  I would like to say that I may have the concept incorrect in my head and I wish very much to not take away from what I was taught and the good work being done because I have incorrect word usage.

Again, I am interested in thoughts on the phenomenon, just wanted to put that out there.

 

Daniel, it is quite a package!  When people figure it out they get "addicted"! :) 

I like you.

Laura Allen said:

Actually, I also refrain from counseling because I figured out along about hour number three of that internship that I am not tactful enough to counsel people. When someone is 40 and still blaming everything on their parents my usual inclination is to say grow up and assume responsibility for how the rest of your life is going to go :)



Therese Schwartz said:

Laura, you have profound knowledge, wisdom and experience.  Thank you so much for your thoughts on this; it really works for me.  I have never done dissociation with a client, instead I do what you have suggested.  I will continue to work that way - I much prefer your approach.

Dissociation is a real phenomena, and massage therapists need to pay attention to the state of their client at all times. We are treating a person in a real-time process, not just massaging soft tissue. With that said, I agree with Laura that massage therapists should not engage in counseling or processing a client's dissociative experiences. At the same time, it's not as simple as just letting the client "come back" into their body at the end of a massage/bodywork session.

Dissociation can be mild and insignificant, like when a client drifts into a semi-sleep state. It can also be more pronounced or even extreme. It is not beneficial for a strongly-dissociated client to continue to receive massage, as they are not able to adequately take in or process the somatic input. In some cases, continued touch while dissociated can  drive trauma deeper into the soma. A client in this state may not even be able to communicate their experience or their needs to the therapist. At that point, the massage is no longer producing therapeutic benefits.

When the therapist notices the client is no longer "present" -- different from that soft, drifty-kind of state that is common among massage clients -- the therapist should pause their hands-on work, and check in with the client. If the client seems detached from their bodily experience, is having difficult communicating, looks pale, or is otherwise "not there", the therapist should take time to gently bring the client's attention back into their body, into eye contact with the therapist, and into a normal, full breathing pattern.

Once the client is able to make the shift back in and is stable there, the therapist should ask the client if they want to continue the massage session (as originally scripted at the beginning), modify the remainder of the session, or end the session. A one-time occurrence may not be a cause for alarm (unless it's serious), but any kind of repeating pattern of dissociation is a strong indication for a referral to an appropriate mental health professional who is experienced in working with this phenomenon. Finding and treating the source of dissociation is out of the scope of practice for massage and bodywork therapy.

By the way, I'd pay money to see Laura "counseling" clients in a show like Dr. Phil. ;-)

 

Rick Rosen, MA, LMBT

I was not familiar with the term. But after looking it up I can say I've found this with a few clients. I agree with the view that specifically treating this is beyond the scope of our profession. However, what we do, as others have pointed out can be a trigger. We can be there, which may be enough. How it comes into play during massage for trauma victims, I believe, should be part of the core massage therapist education.

The definition

~

 

I second this.  I can hear her now, "Bless your heart."  :-)

 

Kris



Rick Rosen said:

By the way, I'd pay money to see Laura "counseling" clients in a show like Dr. Phil. ;-)

 

Rick Rosen, MA, LMBT

Hi Daniel

thanks for this definition, did I use the term incorrectly on another thread when trying to explain how it is possible for a therapist to palpate and know (by experience) that the condition of the tissues as palpated should be feeling very tender or even extreamly painfull. But the client reports no pain?????

Is this wrong to use this terminology or is this indeed a form of dissociation. ?????? 

Daniel Cohen said:

I was not familiar with the term. But after looking it up I can say I've found this with a few clients. I agree with the view that specifically treating this is beyond the scope of our profession. However, what we do, as others have pointed out can be a trigger. We can be there, which may be enough. How it comes into play during massage for trauma victims, I believe, should be part of the core massage therapist education.

The definition

I think of this topic mostly in relation to physical and/or sexual abuse, often from childhood.  My social service oriented friends and colleagues tell me that this type of abuse occurs in almost epidemic proportions, and they say that the majority of victims are women. 

So I try to be aware that the client on the table could be harboring some very deep trauma that could be triggered unexpectedly, with dissociation being one line of defense.

 

On a much more mundane level, I figure that our mind can't keep track of every bit of trauma and pain it's experienced, so it shuts things off to be able to deal with the here and now. Part of my focus in a session is to gently bring  awareness to the various parts of a persons' body so their healing mechanisms can kick in.

I think we ought to do a skit at the AFMTE. I'll be Dr. Phil and you can be my patient! LOL

Rick Rosen said:

Dissociation is a real phenomena, and massage therapists need to pay attention to the state of their client at all times. We are treating a person in a real-time process, not just massaging soft tissue. With that said, I agree with Laura that massage therapists should not engage in counseling or processing a client's dissociative experiences. At the same time, it's not as simple as just letting the client "come back" into their body at the end of a massage/bodywork session.

Dissociation can be mild and insignificant, like when a client drifts into a semi-sleep state. It can also be more pronounced or even extreme. It is not beneficial for a strongly-dissociated client to continue to receive massage, as they are not able to adequately take in or process the somatic input. In some cases, continued touch while dissociated can  drive trauma deeper into the soma. A client in this state may not even be able to communicate their experience or their needs to the therapist. At that point, the massage is no longer producing therapeutic benefits.

When the therapist notices the client is no longer "present" -- different from that soft, drifty-kind of state that is common among massage clients -- the therapist should pause their hands-on work, and check in with the client. If the client seems detached from their bodily experience, is having difficult communicating, looks pale, or is otherwise "not there", the therapist should take time to gently bring the client's attention back into their body, into eye contact with the therapist, and into a normal, full breathing pattern.

Once the client is able to make the shift back in and is stable there, the therapist should ask the client if they want to continue the massage session (as originally scripted at the beginning), modify the remainder of the session, or end the session. A one-time occurrence may not be a cause for alarm (unless it's serious), but any kind of repeating pattern of dissociation is a strong indication for a referral to an appropriate mental health professional who is experienced in working with this phenomenon. Finding and treating the source of dissociation is out of the scope of practice for massage and bodywork therapy.

By the way, I'd pay money to see Laura "counseling" clients in a show like Dr. Phil. ;-)

 

Rick Rosen, MA, LMBT

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