Why Trauma-Informed Training Is Essential in Massage Therapy Education
“It’s inconceivable to me that massage is normally taught without a trauma-informed approach. This is significantly more essential than learning muscles. It seems profoundly inadequate, unprofessional, and irresponsible to not include it.”
These words, spoken by one of my students after completing my trauma-informed massage training, resonate deeply with me and many others who have gone through the program. It’s a sentiment that captures the essence of what I believe about the vital role trauma awareness plays in education in general and massage therapy education in particular. In this essay, I'll explore why trauma-informed training is essential for massage schools and the challenges that stand in the way of its widespread adoption.
As trauma awareness grows in our culture, many institutions have taken steps to become trauma-informed. Integrating a trauma-informed approach makes sense in any setting where people interact, and it’s particularly vital in schools where issues of achievement and self-worth play a significant role. Among all educational programs, however, massage therapy education stands out as the realm where a trauma-informed approach is most essential.
Why Trauma-informed Education is Essential to Massage Therapy
A trauma-informed approach uniquely benefits massage education because massage inherently contains several trauma-relevant elements, particularly that of touch. Touch is relevant to trauma because it’s psychologically potent and because many people have had either too many negative experiences or not enough positive experiences with it. Touch can also remind adults of nurturing experiences that they haven’t encountered since childhood or that they never encountered.
In addition to the touch element, massage requires clients to express their needs, which is difficult for many clients with trauma. Massage also enhances pleasant feelings and embodiment, and there are complex psychological dynamics that can arise when pleasant, expansive experiences intersect with feelings of worthlessness, paradoxically turning those positive experiences into contracted, negative ones.
The responses to all of these challenges often create negative outcomes in the classroom if their basis is not understood and anticipated by school staff. Too often massage is taught as a set of facts and techniques like any other topic, but the process of touching and being touched on a regular basis creates unique challenges that require a trauma-informed mindset to navigate effectively.
What Trauma-informed Massage Therapy Education Should Include
A trauma-informed massage therapy training would include the following:
Academic Foundations in Neuroscience and Psychology: The curriculum should provide a comprehensive understanding of the impacts of trauma, drawing on neuroscience and psychology. It should clearly differentiate between shock trauma and developmental trauma and include lessons on attachment theory. This could be provided via lectures from guest experts if school staff are not qualified to teach this material.
Practical Skills for Responding to Trauma: The training should equip students with the skills to respond to trauma in ways that avoid re-traumatization. This includes differentiating between techniques for regulating the autonomic nervous system in cases of shock trauma and relational approaches for addressing developmental trauma. Students should become adept at navigating relational dynamics—both their clients’ and their own. Delivering this aspect of the training effectively requires a combination of lectures and interactive exercises, and finding instructors with the necessary expertise can be particularly challenging.
Integration of Trauma-Informed Principles into School Culture: A trauma-informed approach should permeate not just client interactions but also the school’s policies, practices, and daily interactions with students. For this to be successful, the school’s director and staff must possess a deep understanding of trauma-informed care and the skills to embed these principles into the school's culture.
Obstacles to Trauma-informed Massage Education
Given the pervasiveness of trauma and its relevance to bodywork, many would agree that becoming trauma-informed makes us better massage therapists. However, to become trauma-informed, one must receive education in trauma-informed care—ideally from a trauma-informed massage school. Unfortunately, very few schools attempt to integrate a trauma-informed approach, and even fewer succeed in doing so adequately.
Below are four reasons a massage school may fail to become trauma-informed.
Psychophobia: Some schools focus narrowly on massage theory and technique, avoiding psychological content due to an overly strict interpretation of their scope of practice. However, trauma doesn’t care what you think about trauma. Bodies are being touched, boundaries are being navigated, power differentials exist, needs are being addressed, care is being provided, and personality dynamics are at play. Trauma is present in the room, often more so than in a psychotherapy setting, influencing both the therapeutic relationship and the session itself. The more we address these topics and learn to navigate them effectively, the better. Schools that shy away from these issues are also likely to rely on outdated models of pain, focusing on the mechanics of muscle and fascia while ignoring psychology and the nervous system—the same lenses necessary to understand trauma.
Out-of-scope: On the opposite side of the spectrum are those schools that have an explicit or implicit philosophy of “the healing is in the feeling”, and in one way or another encourage clients to “go into” their feelings. This can easily go outside scope of practice by unknowingly colluding with protective strategies and opening a can of re-traumatizing worms (a la primal scream therapy or “rebirthing”). Such education promotes contacting states of aliveness and expansion that were previously suppressed without realizing why (or even that) this will backfire in some clients who will likely experience a contraction in the form of pain, depression, anxiety, or projection soon thereafter.
Failure to Integrate Principles Into School Culture. It’s possible to design a program that teaches all the relevant trauma knowledge and skills yet fails to apply these principles to its own structure. Creating a supportive classroom environment, sequencing lessons thoughtfully, and delivering content with trauma awareness are all crucial. Failing to apply trauma-informed principles in the classroom diminishes the quality of the educational experience and the depth to which students can internalize the content. Tracking emotional expansion and contraction is key, as is recognizing that a massage program may be inherently challenging for individuals with early trauma, even if they believe it’s a dream come true for connecting with others.
Lack of Qualified Instructors: A significant barrier to implementing trauma-informed training is the shortage of qualified instructors. Despite the growing popularity of the term, few individuals possess the expertise to teach this material, especially within a massage context. Among those who do, few live or work near a massage school. Additionally, many massage directors may not know where to find such an instructor, nor understand why many cognitively-oriented psychotherapists may not be well-suited to teach trauma-informed approaches in a massage setting. Integrating this material into a program requires considerable effort, particularly when the director is not personally familiar with it and there is little incentive from state agencies or massage organizations to do so. Ultimately, this challenge is the most difficult to overcome, and one could argue that it may be better not to attempt trauma-informed training at all than to do so inadequately.
Conclusion
In conclusion, trauma-informed massage therapy training is not just an enhancement to education—it is a necessity for creating competent, compassionate practitioners. The unique challenges presented by touch, combined with the prevalence of trauma in our society, make it imperative that massage therapists are equipped with the knowledge and skills to navigate these complexities. However, the path to implementing trauma-informed education is fraught with obstacles, from outdated curricula and a lack of qualified instructors to the difficulty of integrating these principles into school culture.
Despite these challenges, the benefits of a trauma-informed approach are undeniable. It creates a safer, more effective environment for both therapists and clients, ensuring that the profound power of touch is used to heal rather than harm. As the field of massage therapy continues to evolve, prioritizing trauma-informed education will be key to fostering a more holistic and empathetic practice.
Author
Dr. Mark Olson holds an M.A. in Education and a Ph.D. in Neuroscience from the University of Illinois, specializing in Cognitive and Behavioral Neuropsychology and Neuroanatomy. His research focused on memory, attention, eye movements, and aesthetic preferences. Dr. Olson is also a NARM® practitioner, aquatic therapist, and published author on chronic pain and trauma-informed care. He offers a variety of courses at Dr-Olson.com that provide neuroscientific insights into the human experience and relational skill training for professionals and curious laypersons.