By Stephanie Mines, Ph.D.
Originally published in Massage & Bodywork magazine, October/November 2001.
Grandfather, Look at our brokenness. We know that in all creation Only the human family Has strayed from the Sacred Way. We know that we are the ones Who are divided And we are the ones Who must come back together To walk in the Sacred Way. Grandfather, Sacred One, Teach us love, compassion, and honor That we may heal the earth And heal each other. – Ojibwa Prayer
Secrets. They are the lifeblood on which domestic violence, and abuse of all kinds, thrive. They allow the violence to live unchecked — both in the present and the past. And they are the perpetuators of physical distress and disease.
Massage and bodywork, by their very nature, evoke secrets. A therapist’s hands bring out the hidden wounds, the untouched traumas and the unspoken truths. Whether a client’s secrets are articulated or not, the attuned therapist will see them emerging as changes in skin tone, muscle tension, voice intonation, gestures and quality of contact. What can you do when your client’s secrets begin to find life on your table? What should you do if you know your client is living a life filled with daily terror?
According to the FBI, violence is a regular occurrence for 1 in 4 couples. Six million American women are beaten each year by their partners. Fifty percent of all couples experience at least one violent incident. By the time you finish reading this article, 100 women will have been beaten in America. With statistics like these, it is inevitable that somatic therapists of all kinds will at some point have an opportunity to work with survivors of domestic violence.
Abuse knows no boundaries: racial, ethnic, religious or socioeconomic. It occurs among the very rich and the very poor. It afflicts the elderly, the disabled and people of all sexual orientations. It happens everywhere, in all parts of the world — to the highly educated, the talented and gifted, and the poor and illiterate. It also happens to the most at-risk — pregnant women. The president of the American Medical Association estimates more than one-third of pregnant women are abused, or to look at it another way, 25 percent of all women battered in America are abused while pregnant. According to the March of Dimes, battering during pregnancy is the leading cause of birth defects and infant mortality — more than the birth defects caused by all of the diseases for which people are routinely inoculated, combined.
It takes conscious commitment and awareness to change the violence permeating today’s family, even though most Americans have turned away from this issue with the same speed they employ to get to their nearest violent movie. The first step toward change is education. Given the magnitude of the issue and its impact on the entire population, anyone who is a health care provider, a caregiver, or a therapist of any kind has an ethical responsibility to educate himself or herself about abuse and its treatment. It is also the responsibility of institutions that train therapists to provide this education in their curriculum. Why? Because through the lifetime of your career, you will likely work with at least a few of these 6 million women. How will you react? How will you help? Being prepared for this client and her secrets will allow you to have answers for her, to have referrals for people who can help, to simply offer her the one safe touch in her day, or even, to potentially save her life.
How will you know what to do?
Shock: The Hidden Epidemic
Shock begins when we are confronted with an experience so stunning we are forced to disconnect from our bodies. A baby separated from its mother at birth; a child in need of attention who is ignored by busy parents; witnessing the death of a friend or loved one; losing everything in a natural disaster — these experiences are the settings for shock. In a micro-instant, we are frozen in time. Our nervous systems, lacking the resources to cope physically, emotionally or mentally, fail us. We freeze or act in panic. The degree of our vulnerability seals the experience in the cells of our bodies. The pain burrows inward and remains unnoticed until, like anything repressed for too long, it emerges elsewhere — in the form of mental, emotional or physical disease.
Some of the common physical symptoms which indicate unresolved shock is present include chronic fatigue, insomnia, chronic joint and muscle pain, and persistent weakened immune response. It is possible a broad spectrum of autoimmune diseases can be related to shock. Structural rigidity and hypotonicity of all kinds also point to shock as a potential causative factor. Whenever there is a resistance to healing or a difficulty in receiving benefit, it is worthwhile to investigate the possibility of shock as the missing key.
Shock robs us of our neurological capacity to act, or it forces us to behave neurotically or destructively. It creates obsessive patterns and addictive tendencies that steal our energy. Dysfunctional sexual patterns, relationship failures and criminal and violent behaviors often have as their source unresolved shock. Treatments that try to heal these conditions without addressing the underlying shock cannot succeed fully.
Differentiating Shock & Trauma
The responses to shock and trauma fall generally into two categories: hyper-arousal and fixation. Hyper-arousal is a sign of sympathetic nervous system dominance, whereas fixation is a sign of parasympathetic nervous system dominance. In order to resolve shock and trauma, these dominant responses need to be reversed in order to create the possibility for a healthy response to threat.
Shock is seen in the immediate and apparent, often chaotic, reactions to threat. It is assessed by very specific characteristics, most of which are activated globally and simultaneously. Trauma is much more organized and much more easily understood. The traumas of our lives are the themes we address in psychotherapy. The shocks we have experienced remain after therapy has been concluded and frequently reveal themselves in somatic discomforts for which it is difficult to find a solution.
Some metaphors serve best to differentiate shock from trauma. Trauma can be compared to breaking one glass in your set of heirloom china. Shock is breaking every piece in the set. If one light bulb in your house burned out, making it difficult to see in one room, this can be equated with trauma. If all the lights in your entire house went out, this is shock. When trauma occurs, resources may be difficult to access, but they eventually emerge. When shock occurs, resources disappear for a long time, sometimes forever. The combined impact of sexual abuse as a child and domestic violence later in life equals shock. Knowing the difference between shock and trauma and their different healing requirements allows a therapist to be exponentially more effective. Still, one of the most important things a therapist can remember is not to force insights onto the client, regardless if you know you are right. Healing must be embraced by the traumatized for it to be effective.
Clearing shock from the body is like clearing out the cobwebs from our nervous systems, our tissues, our muscles, our bones and our joints. As we do this clearing away, we begin to know what it means to truly live as we have never known before. We feel the joy of our movement and we enter into joyous relationships. We no longer hesitate to express ourselves. Life becomes a celebration as we step thoroughly into the present. The same is true for our clients.
In the healing arts, there are a multitude of systems that can address shock, but perhaps the most potent are the most subtle. Because shock takes its toll so dramatically on the nervous system and adrenal function, the interventions that regenerate most profoundly are those in the realm of subtle energy medicine. Careful touch, even minimal touch with maximum respect, invites transformation at the cellular level. It evokes the resources that were not available to us earlier — the resources of loving attention crucial to human development.
The interventions that are simultaneously calming and organizing for the nervous system, coupled with simple, educated dialogues, are the best interventions for survivors of shock; and almost all survivors of domestic violence are survivors of shock. Furthermore, sexual abuse and domestic violence are inextricably intertwined. Rape is a regular form of abuse in about 50% of violent relationships. Studies estimate 25 percnet-33 percent of men who batter their wives also sexually abuse their children. Up to one-third of battered women were sexually abused as children, generally by a male relative.
What this clearly points to is an epidemic of shock among survivors of domestic violence. What must be added to the equation is that domestic violence is rampant and affects everyone in our culture. Therefore the epidemic is societal. Battering is the most common cause of injury to women — more frequent than car accidents and muggings. Nearly 30% of high school students have experienced violence in a dating relationship. Abuse by a husband or partner is the leading cause of injury to American women between the ages of 15 and 44. More than 3 million children directly witness acts of domestic abuse each year. Children whose mothers are abused are six times more likely to commit suicide. Had enough? It’s difficult to think about, but we must. The time has come to discover how we can make a difference.
What Steps Do I Take?
What is domestic violence? There are many definitions, and legalities vary from state to state, but it all really boils down to this: Domestic violence includes all forms of violence between intimate partners used to exert power and control. The perpetrator manipulates others with abuse and threats, physical and verbal. Ultimately, domestic violence can be broken down into three primary phases: tension mounts, battering occurs and remorse and re-engagement hook the victim back into the cycle.
It is not the job of a massage therapist or bodyworker to get the client/victim out of her relationship, but the therapist can help in breaking the cycle. The therapist’s interactions with the client can open doorways of new understanding and resource; just having someone who “understands” can mean all the difference to the abused.
Bodyworkers are in a unique position with regard to the issue of abuse because, as Mercedes Lindenoak, an artist, safehouse board member and survivor, comments, “Shock and trauma are locked in the body. The entire story of abuse is in the body. Touch will activate it.” What is the best way for a somatic therapist to honor this history? “If you find resistance, don’t push,” Lindenoak said. “Don’t go deep if there is no support.”
Lisa Olcese, director of education at Boulder County Safehouse, in Boulder, Colo., offers this guidance in working with victims of violence. “Hold the container. Provide the resources. Listen. Acknowledge. Don’t ignore. The story the survivor tells is sacred. Honor it. Keep your boundaries clear. Have the phone numbers of the safehouse hotlines in your area. Use those numbers to get information and guidance, and give those numbers to the survivors you meet.”
Only medical doctors have an ethical responsibility to report domestic violence, but if a therapist can point the survivor in the direction of self-reporting, the survivor will be empowered. When a survivor reveals children are being abused, the dynamics of responsibility shift.
“Therapists can encourage survivors to report the abuse of their children themselves,” said Olcese. “They can portray Social Services as a resource. Wherever domestic violence occurs there is a real danger to the lives of the women and children involved. Because of this, the decision to report has to be undertaken with great care. We must support mothers in making smart decisions for their children. One of the best places to start is with the local safehouse hotline. Use that hotline for information, guidance and support.”
At Boulder County Safehouse, massage therapists, bodyworkers and healers of all kinds are offered the opportunity to serve in conjunction with receiving extensive training and feedback. Therapists can treat staff, as well as clients, after a careful screening process. Feedback is an important part of the education the caregiver can expect in this well-managed program.
The National Violence Against Women Prevention Research Center published a report on reducing post-traumatic stress responses in women who experienced violence, and they cited the most effective interventions as those that reduce stress and anxiety and encourage relaxation, such as guided imagery and meditation. Certainly, this can include non-invasive bodywork therapies, such as subtle energy medicine. A program called Safe Touch was used at the Brewster Center for survivors of domestic violence in Tucson, Ariz. The response from clients was positive, with the women reporting increased body awareness and a greater ability to trust themselves.
As a survivor, Lindenoak has hard-won wisdom to offer healers: “Being believed and respected is transformational. That in itself is a potent intervention. If this can be incorporated into the intention and consciousness of the therapist, whatever intervention is employed will be appropriate. I have found the modalities primarily organized around treating the nervous system to be the most helpful for me as a survivor. These include craniosacral therapy, Jin Shin, Aston Patterning, Feldenkrais, Alexander technique and acupuncture. These therapies retrain the mind-body and allow me to have the experience of my body as a pleasant and happy place to be.”
Olcese said clients at Boulder County Safehouse had reported positive responses to chiropractic, polarity therapy and qigong. Therapies that allow the client to feel spacious, honored, seen for herself (not objectified or judged), and in the center of her own life work the best. These tend to be the most non-invasive interventions.
Nailah Beraki, a licensed massage therapist and survivor in New York, offered her intervention advice. Her lifetime commitment to self-healing, she said, allows her to open to enormous compassion in her heart-centered approach. She said “being with someone with 100 percent of your awareness” is the most critical intervention she knows. She believes you cannot address domestic violence without treating the body. “We have to re-educate the nervous system in order to truly and completely heal,” Beraki said. “Talking does not address the body. By re-educating the nervous system we learn how to feel safe in our own skin. Even a small influence has a big impact on a survivor of domestic violence. Less is more in healing from shock and trauma.” Beraki feels she is protected from reactivation when she works with survivors because of her own focus on self-awareness. “When you don’t work on yourself, your blockages keep you from becoming healed.”
Laurie Ann Pearlman and Karen W. Saakvitne, authors of Trauma and the Therapist, said, “Lack of information and training increases the likelihood that therapists will impose their needs and conflicts on their clients.” When therapists in any field are allowed to offer their services without an education about domestic violence, shock and trauma, they are not only more likely to retraumatize their clients, they are also vulnerable to vicarious trauma.
The Balancing Act
Vicarious traumatization is a term used to describe the impact on the therapist when addressing trauma. This impact is a direct reflection of the therapist’s vulnerabilities and blind spots, or failures to be wisely self-protective. Massage therapists, bodyworkers and healers of all kinds are receptive to vicarious trauma, particularly when they are uneducated or unconscious about trauma itself. Vicarious traumatization is a natural outcome of being in the presence of trauma, especially repeatedly. It is an occupational hazard.
Here are four keys to avoiding vicarious traumatization:
1. Don’t work in isolation. Have professional consultation or supervision. Supervision and consultation should be built into the lives of massage therapists and bodyworkers. Their practices deserve the same honor and respect as those of psychologists or psychotherapists. Since, as the statistics in this article demonstrate, anyone who works with people is going to work with trauma; consultation and a support network is essential for all therapists and healers.
2. Know your resources. Know how to restore your own equilibrium. What allows you to feel whole? Make a list. For me, it would be dance, writing poetry, being with my family, being in nature, spiritual practice, receiving bodywork. Your list might include gardening, playing tennis, hiking or listening to music. Whatever allows you to feel open and unburdened — that is a resource. People who you trust and communicate with easily are resources. Resources put you more in your body than your mind. They make you smile. Now, ensure you do these things regularly and return to them when you are overwhelmed or stressed.
3. Do not overbook yourself. Put spaces in your schedule. An overbooked schedule leads to isolation and preoccupation, both of which make you exceedingly vulnerable to vicarious trauma. Know your human-ness and treasure it.
4. Do not use work to escape from your personal issues. Make sure you have opportunities for self-healing in your own life.
We should all have a great sense of respect for the capacity of the somatic healing arts to be potent interventions in ending the lineage of violence that afflicts us now more than ever before. Historically, massage therapy and its sister arts have been the source of comfort and regeneration from suffering for people in all walks of life. This has not changed. It is only that our awareness of the nature of suffering and the capacity of the healing arts to intervene must be brought current.There is a great deal of healing to be done, and those of us who have chosen this path are the very ones who can do it.