What have you learned about dissociation?

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Permalink Reply by Stephen Jeffrey on July 26, 2011 at 4:58pm

Hi Rick

you seem to have put the phenomena and definition together very well, was this part of your massge training or something learnt whilst in another profession.?

 

You say

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.

How often in your sessions has this happened to you?

As massage therapists we are taught many manual skills that are learnt in a purely physical way. The concentration on technique/stance/pressure etc often keeps us too focused on physical aspects, when in fact, many a satifactory resolution to pain is because we have correctly (all be it unintentionally)  engaged/freed the mind. 

regards steve  

 

 
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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Permalink Reply by Rick Rosen on July 26, 2011 at 5:19pm

Stephen,

Thanks for that acknowledgement. I started out as a massage therapist in 1978, and soon crossed paths with Ron Kurtz, a pioneer in the area of body-centered psychotherapy. His work became known as Hakomi Therapy, which continues today. (Kurtz passed away in January of this year). After my initial training with Kurtz, I went back to school and earned a master's degree in psychology from West Georgia College, which had a strong Humanistic Psychology emphasis in the department.

In both private practice and teaching, I've always held a focus on the interrelationship of body, mind, emotions and energy.

This discussion thread is important, in that it brings attention to the therapist's ongoing responsibility to not only track and attend to the state of the client's experience, but also their own. Michael Shea, PhD, a noted scholar and clinician in our field who has published books on Somatic Psychology and Biodynamic Craniosacral Therapy, suggests the "80/20" guideline: that the practitioner maintains about 80% of attention on their own present-centered experience during the session, and the other 20% on the client. While this may seem counter-intuitive, it's based on findings that it is the psychosomatic state of the therapist that is the most powerful factor in influencing the client's well-being and healing process.

When I hear anecdotal stories about therapists "going unconscious" and grinding out too many sessions in a day, or allowing distractions to regularly divert their focus, it suggests that our field still has a long way to go to bring a truly healing framework to the client-therapist relationship.

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Permalink Reply by Stephen Jeffrey on July 28, 2011 at 3:06am

Rick,

this is of great interest, have you any more links or articles you can guide us to ?

Flotation tank therapy was very trendy a while back, was there any problems with dissociation and psychotic episodes given the conditions when inside the tank? (if I'm completely off track with this then I apologise) 

Rick Rosen said:

Stephen,

Thanks for that acknowledgement. I started out as a massage therapist in 1978, and soon crossed paths with Ron Kurtz, a pioneer in the area of body-centered psychotherapy. His work became known as Hakomi Therapy, which continues today. (Kurtz passed away in January of this year). After my initial training with Kurtz, I went back to school and earned a master's degree in psychology from West Georgia College, which had a strong Humanistic Psychology emphasis in the department.

In both private practice and teaching, I've always held a focus on the interrelationship of body, mind, emotions and energy.

This discussion thread is important, in that it brings attention to the therapist's ongoing responsibility to not only track and attend to the state of the client's experience, but also their own. Michael Shea, PhD, a noted scholar and clinician in our field who has published books on Somatic Psychology and Biodynamic Craniosacral Therapy, suggests the "80/20" guideline: that the practitioner maintains about 80% of attention on their own present-centered experience during the session, and the other 20% on the client. While this may seem counter-intuitive, it's based on findings that it is the psychosomatic state of the therapist that is the most powerful factor in influencing the client's well-being and healing process.

When I hear anecdotal stories about therapists "going unconscious" and grinding out too many sessions in a day, or allowing distractions to regularly divert their focus, it suggests that our field still has a long way to go to bring a truly healing framework to the client-therapist relationship.

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Permalink Reply by Therese Schwartz on July 28, 2011 at 1:26pm

Thanks to Daniel for posting the link to the definition.  Like Stephen I think I had a misconception about dissociation and I'm really glad we are having this discussion!

 

Rick, your work sounds fascinating!  I thought I'd be done with taking Upledger CranioSacral courses after SomatoEmotional Release 2 because I didn't think my clients would need me to take more than that to get them somewhere good.  I was wrong, and will be taking the 2 remaining classes!  The focus of them is to have the therapists work on each other so that we "can bring better therapists to the table".  I heard somewhere that we can only get people as far as we have gotten in our own personal growth.  So I work really hard on myself as well.

 

Stephen, one I can hear you say "it should be "have got in our own personal growth"! :)  Decades later I'm still confused on that particular grammatical construct having got/gotten it wrong on both sides of the Atlantic!  OK seriously now, the sensory deprivation tanks make me queasy just thinking about them.  I'm fairly sure that I would be quite traumatized by being in one.  But then I'm one of the childhood abuse people who has issues with many aspects related to dissociation (well, it used to be a lot worse.  I've worked hard!).

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