No matter what the diagnosis, in the inpatient rehab setting the perspective of the massage therapist is to provide caring touch to vulnerable people. Understanding how to appropriately assess and treat rehab patients prevents therapists from potentially doing harm.
Benefits of Massage Therapy during Rehab
The reason massage therapists may be employed at rehab centers is the tremendous benefit that safe, caring touch offers patients.
- Relaxation: Physical relaxation by activating the parasympathetic nervous system
- Mind-Body connection: Addicts and people with eating disorders in particular tend to be disconnected from their bodies
- Stress release: Rehab is a transformative and stressful time. In massage patients are encouraged to let go of their stress.
- Good touch: Many patients in rehab have experienced bad touch, often as children. They may fear touch. Massage provides a safe, controlled setting to experience good, healthy touch
Scope of Practice and Communication
In the mental health setting it is essential for massage therapists to remember they are not counselors or mental health practitioners. It is inappropriate and potentially harmful to ask questions that might evoke an emotional response. Keep in mind that patients in rehab are constantly put in situations where their emotions can come out.
During the massage session, it is their time to be quiet, present and relaxed. Patients may talk if they are nervous about the experience. If possible, put them at ease and redirect that energy to breathing. Otherwise, respect the patient's right to make his/her own choices about the session.
When working with rehab patients, there are additional considerations for the intake and treatment process. Before beginning the massage make sure to get a thorough subjective intake. Find out if the patient is feeling stressed, tired etc. Find out what he wants to get out of the session. Does he/she have pain somewhere, or just want to relax?
Plan the Session
Discuss what areas of the body are okay to touch and which are not. Many eating disorder patients will have specific fears about parts of their bodies being touched. Never force the issue and only touch where permission has been given.
Be as explicit as possible about what will happen during the massage before the client ever gets on the table. Some clients will not feel comfortable getting on the table at all. In that case, they may sit in a chair while you administer massage to hands, feet, and scalp – or whatever is comfortable.
Be Clear and Specific
"Are there any areas that you do not want me to touch? Is it okay to touch your back? Your legs? Your belly?" - When first asked many clients will say they do not care where they are touched. That is why it is important to name specific body parts.
"I am going to leave the room and wash my hands. You will undress to your comfort level and get onto the table, under the top sheet. That means that you can take all of your clothes off or leave all your clothes on. Whatever is comfortable for you." - It is very important to stress that it is the patient's choice to undress or not. It is perfectly acceptable to perform massage over the clothes.
"I will knock before I come back in. I will start working on your back, then each leg. After that I will ask you to turn onto your back and I will massage the front of your legs, your arms, your belly, your head, face and neck." - Assuming that it will be a full body massage, remember to outline what will happen. The predictability will put patients at ease and help them relax.
End with Kindness
Complete massage therapy sessions by wishing patients well. If the client is in a calm, centered place, ask him/her to take notice of how he/she feels in that moment, reminding him/her to can carry this feeling through the day.
Occasionally, patients will be agitated at the end of a massage session. The experience may have triggered memories and emotions. Do not take it personally and let them know that this is normal. If necessary, direct them to a counselor for support.
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