Originally published in Massage & Bodywork magazine, Jan/Feb 2010. Associated Bodywork and Massage Professionals. All rights reserved.
Even the most experienced massage therapist can feel unsure how to touch the medically fragile individual. Techniques of conventional massage--effleurage, petrissage, friction--can damage the fragile tissues of people of advanced age or infirmity. And while most massage therapists learn the contraindications to these techniques, they do not learn how they can touch the frail and elderly. The simple, instinctual work known as Comfort Touch is a vehicle for that understanding, arising out of the basic human need to care for others who long for connection.
The nurturing style of acupressure known as Comfort Touch developed from my work as a massage therapist with HospiceCare of Boulder and Broomfield Counties in Colorado. In the fall of 1989, I began to offer massage to patients with terminal illness. Because they were being cared for in their homes, I needed to change my approach to massage in order to provide a safe and appropriate experience.
To work with these patients, who were usually elderly and compromised by pain and illness, I had to adapt to their setting. For safety reasons, massage tables were not used, and client was most comfortable in his or her own bed, wheelchair, or recliner. I adjusted the kind of pressure and techniques I applied, and because the client was clothed, lotions and oils were not used.
I repatterned my body mechanics in order to be safe and comfortable. This emphasis on self-care for the practitioner--both physical and emotional--has become integral to the practice and efficacy of Comfort Touch.
Since 1991--in workshops, classes, and in-services held across the United States--thousands of people, including massage therapists, other health-care professionals, and family caregivers, have been introduced to the basic principles and techniques of Comfort Touch. It brings the benefits of touch to a broad range of people--in hospices, hospitals, skilled nursing homes, and general wellness massage businesses.Principles of Comfort Touch
Comfort Touch is based on several key concepts that inform the practice. Summarized by the acronym SCRIBE, they are: slow, comforting, respectful, into center, broad, and encompassing. These words serve as a reminder to the practitioner of Comfort Touch regarding the rhythm, intention, attitude, and techniques of this modality. They also guide the practitioner in creating a nurturing experience for the client, as well as themselves.Slow
The first principle of Comfort Touch is slow
. The giver of touch first quiets down internally, creating an atmosphere of safety and trust for the client. The techniques are practiced slowly, in a relaxed manner, which contributes to the calming and sedating effect. The slow pace of contact allows ample time for clear communication and ensures that the client does not feel overwhelmed or surprised with an unexpected touch.Exercise 1. Connecting with the Partner's Breath
Practice this with a partner who is sitting in a straight-backed chair. Place a folded towel over the back of the chair, so that your partner sits in a comfortable posture. This provides an easy way to help someone relax quickly.
Stand behind the person, placing your hands on her shoulders. Your palms should rest lightly on the thickest part of the trapezius muscle directly below the ears (Image 1).
Maintain this contact, noticing the movement in the body created by the person's breathing. Imagine you are listening to the breath with the palms of your hands, lightening your contact with the inhalation, and adding some pressure with the exhalation. (Make sure you are breathing fully, which allows you to feel the person's breath. It is not necessary to ask the person to take a breath.)
Maintain this connection through 3-4 cycles of your client's breath. She will appreciate, albeit subconsciously, that you are listening and paying attention to her in a profound way.
Bring your hands away from the client's shoulders, holding them about an inch away from the body for 2-3 seconds; then, bring your hands away and down to the side of your body. Comforting
The second principle of Comfort Touch is comforting
. The intention is to offer physical and emotional support through the use of proper positioning, appropriate techniques, and skillful communication. The intention is not to try to fix, change, or cure the individual. Healing and change may occur, but that is secondary to the purpose of being present with the individual in the moment.
The word comfort
is derived from the Latin prefix com
, meaning "with," and fortis
, meaning "strong." Its original English definition means "to encourage or support." Through our touch, we offer encouragement, supporting people to feel stronger in their ability to cope with physical, mental, and emotional challenges. Touch is offered in a way that provides assurance and a calming cloak of comfort.
Both the client and therapist should be comfortable. In working with those who are elderly or medically fragile, it is the job of the therapist to adapt to the clients' situations, ensuring that they are in the most comfortable positions possible. Whether they are in a wheelchair, hospital bed, recliner, or regular bed at home, the therapist learns to figure out how to make them most comfortable. It is not necessary, or desirable, to transfer the client to a massage table to offer Comfort Touch effectively. Still, you can make generous use of pillows and/or towels to help support the individual (Image 2).
It is important to be physically comfortable when you are practicing Comfort Touch. The individual receiving touch will feel it if you are uncomfortable or in a compromising position. In Comfort Touch training, you learn efficient body patterning, making use of small stools and/or chairs to ensure comfort.
Your care and concern are also conveyed through the words you speak and the tone of voice you use. One client put it this way: "It's always so comforting to hear your voice." You can speak your intention to the client by saying, "I'm here to offer comfort. Let me know how I can help you." Exercise 2. Developing Empathy
Practice this with a family member or a friend at home. Have your partner lie in a bed, or sit on a chair or recliner. This exercise will help you build empathy as you explore options to make your client more comfortable. With practice, you will notice that you feel better in your own body, as you make adjustments for your client.
Look at the client and ask yourself: Would I be comfortable sitting or lying like that? Is there anything I would do to be more comfortable? Try using pillows or towels to help with the alignment of the client's body or to provide better support. Ask your client for feedback and respond to the answers.Respectful
The third principle of Comfort Touch is respectful
, which characterizes the attitude one maintains when offering touch. Your manner should be compassionate and nonjudgmental, contributing to a safe and healing atmosphere for the client. This honors the client and acknowledges the uniqueness and wholeness of the person.
Appreciate the vulnerability the individual may feel about being touched, as it can evoke feelings ranging from pleasure to pain. Touch can elicit memories, fears, longings, and/or curiosity. When we touch another person, we are not merely touching a body--we are touching a lifetime of experiences that are recorded in the nervous system. We contact that reservoir of sensation when we connect through touch, acknowledging the wholeness of one's being. One woman spoke these words after receiving Comfort Touch: "During that hour, I felt like I was the most important person in the world."
A respectful attitude involves accepting people as they are, without judgment or blame. Consider this example: you begin to massage a person's shoulder, and comment, "Wow, you are really tight!" You may be well-intentioned, but you might also be conveying the message, "You are not OK the way you are." Even if the client agrees with you, you are reinforcing his or her own self-judgment. Rather than tell the person what you notice, you could ask, "What do you notice here?" Be sensitive to the client's feedback to your touch. A respectful, nonjudgmental attitude also contributes to a more satisfying experience for the therapist (Image 3).Exercise 3. Letting Go
Here is an exercise to help you feel at ease with the world around you. By practicing letting go of judgments and attachments, you become less controlled by them. Sit comfortably and close your eyes. Begin to notice your breathing. Don't try to change your breathing; simply continue to breathe, letting go of each exhalation. As you notice other bodily sensations or feelings, observe them and let them go, as if watching clouds pass by.
Observe thoughts and let them go. Don't push them away; simply let them go. If judgments come into awareness, observe them and let them go. You may notice judgments of yourself or judgments of others.
Do this exercise for 10 minutes a day for one week and notice how it impacts your life. Notice when a judgment comes into your mind during the day. See if you can let go of it. You may need to acknowledge the thought and dialogue with it for a while before letting it go. Cultivate a sense of humor and don't take your thoughts too seriously. Remember the bumper sticker that says, "Don't believe everything you think." Into Center
The fourth principle of Comfort Touch is into center
. This describes the direction of pressure the therapist applies relative to the surface of the body of the client. This awareness is key. It describes a safe way to touch the person, as well as an effective way to bring the benefits of touch to those in need. The specific direction of pressure and focusing inward of intention allows for a penetrating touch, even with light to moderate pressure. Both the giver and receiver of touch experience a profoundly deep sense of connection.
Pressure is applied perpendicularly to the surface of the skin, thereby preventing tearing of the skin or bruising of the tissues (Image 4). The focus of intention is into the central axis of the part of the body being touched. Apply firm, broad, even pressure to the area at a 90 angle from the surface of the skin. Slowly and deliberately direct the pressure through the layers of body tissues into the center of the part of the body you are touching. Let the pressure of your contact sink into center. Do not push. As you work slowly, you will tune into the client's body, feeling how much it will let you in.
The phrase "into center" does not mean you are directing pressure toward the heart. This distinguishes it from some conventional massage strokes. If you are applying pressure correctly, there is no friction or pulling on the skin. This is one reason that lotions or oils are not required. If your angle of pressure is correct when you work through a client's clothing, you will not wrinkle the fabric or push it in one direction or the other.
When following this principle, you are respecting the integrity of the layers of body tissues and acknowledging the wholeness of the body. Begin direct compression by contacting the surface of the skin, then continue to let the warmth of your contact sink into and through the layers of the superficial fascia (adipose layer), the deep fascia, the muscle layers, and ultimately the bone. This work is sedating to the nervous system, because the focus of intention and the broad, encompassing contact are felt deep in the part of the body being touched. In contrast, touch that only stays on the surface or rubs the surface is stimulating to the peripheral nerves, which can be irritating, ticklish, or even painful.Broad
The fifth principle of Comfort Touch is broad
. In general, contact is made with broad, even pressure. This optimizes the feelings of soothing warmth, comfort, and connection. While the pressure may be firm, the broadness of contact prevents the likelihood of injury or discomfort. Let the entire surface of your hand make uniformly even contact with the client's body. Imagine your hand is melting into the person's body.
Your primary contact with the client's body is through your palms, with the digits gently wrapping or resting on the body. As you touch different body parts, adjust your contact so that it is as broad as possible. "Listening" with the palms of your hands, your contact is deliberate and firm, never pinching, poking, or ticklish. Image 5 demonstrates the use of broad, contact pressure on the back of the client.Encompassing
The sixth principle of Comfort Touch is encompassing. Let your touch surround the part of the body you are touching. Be aware of the space between your hands. Hold the person in that space. While this principle describes a technique, it also describes an attitude. Encompassing touch contributes to a feeling of wholeness and connection. The giver of Comfort Touch holds a nurturing presence, which allows the client to feel cared for and acknowledged as a worthwhile human being.
As you touch your client with both hands, let your hands conform to the shape of each part of the body. For example, as you hold the person's hand between your own, let your hands wrap around that hand, molding to its shape. Likewise, as you hold the person's arm, your hands wrap around the arm, applying an even, broad pressure as they conform to the shape of the arm (Image 6, page 53).
When touching a large area, such as the back, let your touch acknowledge the shapes and contours of the body. One client described it this way: "It is like receiving a hug to every part of the body." Encompassing touch conveys a feeling of acknowledgment, safety, and support, in much the same way a parent would hold a child (Image 7, page 53).Exercise 4. Giving, Receiving Comfort Touch (into center, broad, and encompassing)
Practice this exercise with a partner. Let your partner sit in a chair. Place a chair beside your partner and sit so you are facing your partner's side. With your thumbs parallel and pointing upward, wrap your hands around your partner's upper arm as in Image 6. Apply a broad, encompassing, even pressure directly into the central axis of the arm, in toward the bone. (You can think of this as the even pressure that is applied with a blood pressure cuff.) The palms of the hands and the broader surfaces of the base of the thumb exert a uniformly even pressure around the client's arm, thereby avoiding poking with the tips of the thumbs. Hold for a few seconds. Ask for feedback. Was the pressure even? Was it into center? Was it broad? Was it encompassing?
Practice on other parts of the body--the shoulders, the arms, or the back. Continue to listen to your partner's feedback. Trade roles and repeat the exercise. It is very important to practice this exercise with a partner, not only to practice giving broad, encompassing pressure into center, but to experience how it feels to receive this touch. Only when you comprehend the quality of touch that underlies these principles in your own body will you be able to fully convey that quality of touch to your clients. Let The Words Guide You
The principles of Comfort Touch can become a model of how to live your life in the present as you let the meaning of each word influence your actions and attitudes throughout the day. These words can guide you to live a more meaningful life, mindful in each moment of the healing affect you exert on others in the world around you.Mary Kathleen Rose, BA, CMT, is an authority in holistic health education and is internationally known as the developer of Comfort Touch nurturing acupressure. An ardent advocate for the elderly and the ill, she provides training and support for massage in medical settings. She is author of the textbook
Comfort Touch: Massage for the Elderly and the Ill (Lippincott Williams & Wilkins, 2009) and DVD of the same title, as well as numerous articles. She can be reached at 303-651-9375 or through www.comforttouch.com.