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Comfort Touch
Nurturing Acupressure Massage for the Elderly and the Ill

By Mary Kathleen Rose

Originally published in Massage Bodywork magazine, December/January 2004.
Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.


"The tiger is ready to go. That was grrrreat!" These are words spoken by an 82-year-old man who had recently been released after a month in the hospital. He had just received his first session of Comfort Touch. Peg, the massage therapist who relayed his story to me, had recently attended my workshop "Comfort Touch for the Elderly and the Ill."

Another therapist, Kathleen, shared her experience of using Comfort Touch in a hospital: "It is incredible. You look in the eyes of the patient, knowing you made a difference."

For more than 12 years now, I have listened to the stories of both the givers and the receivers of Comfort Touch. I am grateful for the many massage therapists and other healthcare providers who have been participants in my classes and contributed to the understanding of this work as I developed it. All have been a part of this journey of discovery about massage with the elderly and the ill.


The Beginning
My story began in 1984. I was a student at the Boulder School of Massage Therapy, and I had decided to practice massage in a skilled nursing facility for my fieldwork placement. Over a period of 10 weeks I had the opportunity to offer massage to many of the residents. They represented a range of ages, physical conditions and emotional states of being. I remember bracing myself for the experience as I walked in the door of the building for the first time, not knowing what to expect, unsure of how I would touch the people I met.

In school I worked with other healthy, and relatively young, people like myself. Now I was confronted with individuals who were in wheelchairs or hospital beds. Some could speak and communicate their needs. Others could not. Some could get around with the help of walkers; others were bedridden, or recovering from strokes or major surgeries. I remember the looks of pain, sadness and loneliness. I remember the ramblings of those suffering with dementia. I remember the sweet smiles of those who were simply grateful that someone looked at them and noticed they were alive. They had no idea what to expect from me. The administration and staff were also unsure if massage would be useful.

And so I began with the notion that they could benefit by being touched. Isn't this a basic human need, as essential as food, water and shelter? An inner compulsion guided me as I met the patients, and I trusted my intuition to let me know how to touch them safely and appropriately.


Hospice
In 1989, I began to volunteer to give massage to patients of our local hospice, an organization that provides comprehensive, compassionate end-of-life care. Again, as with the residents of the nursing home and clients in my private practice, I found myself responding to the needs of these patients, often with little idea of what approach I would take. There are considerations about the physiological conditions of the elder populations, and/or those living with chronic disease, that require significant adjustments in technique to ensure the massage is both safe and appropriate.

Unlike the work for which most massage therapists are trained, I was working with those who were bedridden or had limited mobility. So I worked with them in their beds at home or in hospital beds if they were in a facility. To be effective in offering touch, as well as to prevent injury or discomfort to my own body, I had to learn how to adjust my core mechanics.

I also developed a greater understanding of the importance of non-verbal communication and how to respond not only to the physiological needs of the client, but to respect the emotional and psychological processes that people are experiencing as they deal with life-threatening illness. Most people who are active in this field also acknowledge the personal work they must do to stay clear in their own boundaries. While offering compassionate care, it is important to take care of one's own emotional being.

Beginning in 1991, the staff of HospiceCare of Boulder and Broomfield counties asked me to teach others what I knew about massage in this context. I had spoken with other massage therapists who had offered massage to hospice patients over the years. Our local hospice had been a pioneer in the use of massage and, coupled with graduates of the Boulder School of Massage Therapy, had initiated a program in the late 1970s. But there had been no real supervision or training. Now, as more massage therapists indicated interested in the program, it became obvious that it would be valuable to establish some guidelines and offer specific training. Since that time, I have trained hundreds of massage therapists, as well as other healthcare professionals (from the fields of nursing and physical and occupational therapy) and hospice volunteers in the style of massage that is referred to as Comfort Touch.


Comfort Touch
So what is Comfort Touch and how can it be distinguished from other forms of massage and bodywork?

- Safety concerns and the condition of the client: Comfort Touch is a form of bodywork designed to be safe and appropriate for a broad range of people, for whom other styles of massage would be contraindicated. For example, in the elderly the skin can be very fragile and Swedish massage strokes of effleurage or petrissage can actually tear the skin or cause bruising of the blood vessels.

- The setting of the massage: Comfort Touch can be practiced anywhere. No special equipment is required. The client can be fully clothed in a chair, recliner or on a bed of any height.

- Body mechanics for the giver of touch: The therapist must adjust to the client by adapting her body mechanics to maximize effectiveness of the contact and ensure safety. During the training, stools, chairs or cushions are used by therapists as they work. Practitioners must be comfortable in their own bodies to offer comfort, and in some situations will need to limit what they do in order to respect their own bodies.

- The positioning of the client: Comfort Touch is usually performed with the client in the supine position. The prone position is contraindicated due to the limited mobility of the client, as well as concerns about breathing. It is also difficult to communicate with a client in the prone position. Techniques are adapted to be performed in the supine position, as well as the seated or side-lying positions. Pillows and towels are used liberally to position the client comfortably.

- Specific techniques of Comfort Touch: The techniques of Comfort Touch are largely derived from Asian bodywork (shiatsu and acupressure), which gives great adaptability and flexibility to the work. It incorporates an understanding of the energetic qualities of the meridian system of the body, as well as major motor points of the muscles.

- Principles and intentions of Comfort Touch: This work is characterized by the intention to offer comfort. Other general principles that govern the work are described below.


The Principles of Comfort Touch
There are six principles that guide the practitioner of Comfort Touch. An easy way to remember them is to use the acronym "scribe," which relays the intention and quality of touch used in this work. Comfort Touch is:

- Slow -- Relax and be present in the moment, letting your own breath be full and deep. Moving slowly creates a restful atmosphere and allows for a safe and appropriate experience for both the giver and receiver of touch.

- Comforting -- Make the person comfortable and offer a soothing, nurturing touch. Your intention is to ease pain, not to try to cure or fix the person. The word "comfort" literally means "with strength." To give comfort one must come from a place of inner personal strength and share that strength and support with the person who needs it. To comfort also means to acknowledge the individual's inner strength and resources.

- Respectful -- Always maintain a respectful attitude toward your clients, appreciating the vulnerability they may feel about being touched. Listen to what they tell you, verbally and non-verbally. Be sensitive to their feedback about your touch. A respectful attitude that is compassionate and non-judgmental contributes to a safe and healing atmosphere for the client.

- Into Center -- The direction of pressure in Comfort Touch is in to the center of the particular part of the body you are touching. Pressure is applied perpendicularly to the skin, thereby preventing tearing of the skin or bruising of the tissues. The focus of intention is into the core or central axis of the part of the body being touched. This specific direction of pressure and accurate focusing inward of intention allow for a penetrating touch, even with light to moderate pressure. Both the giver and receiver of touch experience a profoundly deep sense of connection.

- Broad -- In general, all strokes are applied with a broad even pressure. This contributes to a feeling of soothing 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, especially including your palm, make uniformly even contact with the part of the client's body you are touching. Imagine your hand is melting into the person's body.

- Encompassing -- Let your touch surround the person's body. Be aware of the relationship between your two hands and the energetic field that exists between them. Hold the person in this space. When touching a large area, such as the back, acknowledge the shapes and contours of the body. When touching a limb or a toe, for example, encompass and enfold that part of the body. Encompassing touch contributes to a feeling of wholeness, of being cared for and acknowledged as a worthwhile human being.


Technique and Training
Techniques for practicing Comfort Touch follow the principles described above, using broad, encompassing contact applied to the part of the body being touched. While the techniques are simple, it is important that they be practiced accurately for greatest effect. Comfort Touch is not a light form of Swedish massage. It does not use effleurage, petrissage or kneading, as these strokes can damage the tissue of the person whose body is compromised by age or ill health. More importantly, Comfort Touch acts on the nervous system in such a way that it causes deep relaxation by sedating the nervous system. This also accounts for its effectiveness in relieving pain.

There are many specific techniques that can be used in this work, given the condition of the client and the training and skill level of the practitioner. I will share two with you.

- Encompassing -- This technique is especially suitable for the limbs. A good way to begin a session is to encompass the hand and/or the arm. Hold the body part (arm, hand, leg or foot) between your hands. Let your thumbs be parallel to each other, to avoid poking pressure from their tips. Use the full surface of your hands to contact and encompass that body part. Pressure is firm and evenly distributed.

Example: Client may be either seated in a chair or lying on a bed. To massage the arm, begin by encompassing the upper arm, gently pressing into the center of the arm with both hands. Continue to move down the length of the arm, releasing pressure between each placement of your hands. Maintain a steady and easy rhythm of contact as you sequence down the arm. Encompass the whole surface of the hand, including the thumb and fingers.

Intention and benefit: Comfort, assurance, provides a sense of connection, alleviates tension in the muscles.

- General Contact Pressure -- This technique is used to apply pressure to a specific area or series of points. Pressure can be applied with the whole hand, the palm or heel of the hand, or base of the thumb.

Example: With the client seated in a regular chair or wheelchair, stand at his left side with your left hand gently holding the left shoulder. Place the heel of your right hand at the top of the erector spinae muscles to the right of the spinal column. Press into center, at a 90-degree angle to the surface of the skin. Hold the pressure for 2-5 seconds. Release, and continue to move down the erector spinae muscles, pressing with each placement of the heel of your hand. Let the client move forward as you continue to support him with your left hand, and apply pressure to the erectors with the right hand. Move down until you reach the base of the back. You may then apply pressure directly to the sacrum.

Move to the other side and repeat the sequence while standing to the client's right, with right hand on his right shoulder. Apply pressure to the erectors of the left side of the back. End with the sacrum.

Intention and benefit: Relaxation to the muscles of the back, generally calming.


Communication and Consent
It is always important to state your intention to the client. I introduce myself, saying, "I am here to offer Comfort Touch. Is there anywhere you would particularly like me to work?" Throughout the session I ask or listen for feedback, whether verbal or non-verbal. I let clients know that this touch should feel good. It should not be uncomfortable or painful. I notice their breathing and watch for facial expressions and other movements in their bodies.

Sometimes people shy away from touching the most seriously ill person or someone who is in the hospital surrounded by medical equipment. They refrain from touch because of their fear and lack of knowledge about how to touch in a safe and appropriate way. Yet, I have seen the most profound responses to touch, sometimes from people who were labeled as comatose, or from those who are termed uncommunicative because of dementia, or otherwise unable to speak. Even in these situations I introduce myself, stating my intentions to the person I am about to touch. I listen and watch for their response.


Precautions in the Use of Touch
When people ask me "What are the contraindications for Comfort Touch?" I answer, "There is only one: If a person does not want to be touched." Otherwise, there is a way to touch them using these principles and guidelines. The touch may be very simple. For example, it may only involve holding the hand, or gently holding and encompassing the feet.

There are certain conditions, however, where touch is not recommended for specific areas:

- the site of tumors or lumps

- the site of recent surgery

- deep vein thrombosis (This situation often arises following surgery and it is advised to avoid touch below the waist until cleared by a doctor.)

- phlebitis (inflammation of a vein)

- fractures

- burns, rashes, undiagnosed or contagious skin conditions or areas of skin irritation

- open sores or injuries

- areas of infection or inflammation

- any area that is painful to the touch

- areas of acute pain, or pain of unknown origin (Use caution in working with people with arthritis, headaches, fever and edema.)

In these situations it is best to have further training, and/or the guidance of another health professional who can assess the situation.


Applications of Comfort Touch
While this work is specifically designed to be safe and appropriate for the elderly and the ill, it has a much broader range of applications. Because of its adaptability and the specificity of the contact, I have found it useful during pregnancy and labor. I have used it with newborns, infants and children. Many of my students who work in the professions of nursing and physical and occupational therapies have incorporated it into the work they do in medical settings.

The principles and techniques of Comfort Touch also lay a foundation for the practice of other forms of massage and bodywork. The attitude, intention and techniques of this practice give a starting place for establishing a healing intention. Bret Williamson, who teaches Deep Tissue Therapy, incorporates this awareness in his practice: "Comfort Touch should be in everyone's toolbox. 'Encompassing' and 'contact pressure' ground the client, helping to integrate the other modalities. It is a beautiful way of balancing deeper work."

Comfort Touch is a much-needed healing balm for a world filled with pain and suffering. The intentions and attitudes of comfort and respect become a way of interacting with others, whether through physical touch, a caring presence or a conversation with a friend. While it can be used to ease the physical and emotional pains of the elderly and those in medical settings, it can also enhance the quality of life for anyone in need of a caring touch.


Comfort Touch in the Supine Position
The client can be in a bed, with or without a head lift. Pillows are used to support the neck and spine in proper alignment and allow for the comfort of the client. Soft pillows give the greatest comfort to the neck. Place pillows under the knees to support the lower back.


Photo 1

1. Place one hand under the base of the neck, supporting the area around the seventh cervical vertebrae. Let your hand be full and soft, allowing the tension to melt. Place the other hand on top of the shoulder to encompass the whole cervical and shoulder region. The pillow is positioned for support.







Photo 2
2. Gently do a butterfly press of the upper arm. Move on to a general press and hold the lower arm.







Photo 3
3. Hold the hand and generally press into it, then into the palm of the hand.







Photo 4
4. Work down to a general press of the hip and upper thigh. Encompass the knee, then encompass and general press the lower leg.






Photo 5
5. Remove the client's socks, if necessary. Encompass and general press the foot from ankle to toes, then replace the socks.







Photo 6
6. Encompass the abdomen and low back. The left hand is placed under the client in the small of the back. Allow the weight to sink into your hand. The upper hand rests on the abdomen, rising and falling with the client's breath. Make light contact with the abdomen and upper chest. Hold for 10-12 seconds to balance the breath and energy in the body.







Photo 7
7. Make light contact with the abdomen and forehead. Hold for a few seconds.







Photo 8
8. Place one hand behind the client's neck and rest the other hand lightly on the forehead. Hold for a few seconds to encompass the head.


Mary Kathleen Rose, CMT, has more than 25 years experience in the holistic health field. She supervises the massage therapy program at HospiceCare of Boulder and Broomfield counties in Colorado, and offers trainings in Comfort Touch in various massage schools and medical settings. She can be reached at 303/449-3945 or rosevine@comforttouch.com.


Resources
Rose, Mary Kathleen. The Gift of Touch -- Comfort Touch: Massage for the Elderly and the Chronically and Terminally Ill.

Hospice of Boulder County, 1996. Available at www.comforttouch.com






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