Kelli Wise has issued an August Blog Challenge, and this post is part of the my response to the challenge.
Can I write 31 blog posts in 31 days?
We'll see. I'm getting a late start, coming in on the 5th of August, but I think that's not going to be a problem. As she said, there are no blog police enforcing this goal.
Can I keep those blog posts to less than 350 words?
No, I can't--asked and answered. What I will aim for is to stay on point, and provide valuable information, rather than just indulging my long-windedness.
You'll be the ones to let me know how well--or not--I have succeeded at that task.
The people who wrote the Talmud, a Jewish religious text that dates from about the years 200-500, clearly wanted to convey a strong and unambiguous message to their audience about how they regarded the importance of human life.
One of the most famous lines reads:
מי שהציל נפש אחת - כאילו הציל עולם ומלואו
Whoever saves a single life is considered to have saved the whole world.
--Talmud, Sanhedrin 37a accessed 5 August 2012
The idea is that, by saving that one person's life, you also save the lives of that person's future children, and all the other people whom that person--thanks to your intervention--will be around for in the future.
You don't have to be religious to appreciate how profound that point is--the same point holds, taken from a systems science point of view as well, when you consider how many points of contact exist among people, and how many opportunities those contacts provide us to influence one another.
Most of the time, the effects we have on other people are not immediately life and death in the moment--but, occasionally, they can reach that point.
Whether or not we want to practice massage as healthcare providers, we can learn what to look out for as warning signs, and what we--in both our capacities as MTs and as caring human beings--can offer in the way of help to someone who may be at risk for suicide.
The first thing we need to do is to be clear on our role and our scope of practice. We have no business practicing psychotherapy in our role as MTs.
The Massage Therapy Body of Knowledge (MTBoK) states that clearly:
The following are NOT included in the Scope of Practice of Massage Therapists:
...
• Psychological counseling.
• Hypnotherapy.
• Guided imagery intended for counseling or psychotherapeutic processing.
...
• Intentional use of techniques to evoke an emotional response in the client
--MTBoK pp. 9-10 accessed 5 August 2012
If you have additional training in psychotherapy, that's a different matter.
But MTs in general do not have the training to practice psychotherapy, and our trying to analyze the cause of another person's pain, or telling them what they should do, is grossly inappropriate in our role.
What we can do is:
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Listen in a caring, attentive way;
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Reassure the person that you are there for them, and that you won't turn away from them in their pain;
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If needed, actively help the person to find resources in their community who can take a more active role in intervention than we are able to.
Although most of us are taught something about it in massage school, the very first time that someone breaks down emotionally on our table when we are practicing unsupervised can be a terrifying occasion for the MT. A large part of that fear on our parts lies in the responsibility we feel for taking care of that person and keeping them safe.
The good news is that in the vast majority of cases, an emotional breakdown or release in response to feelings that arise in response to a massage are not a danger sign. As the MTBoK explains:
Understand that emotions may surface for a client/patient during a massage, that this is normal and that emotions are not harmful.
--MTBoK pp. 27 accessed 5 August 2012
So how do you tell the difference between normal distressed emotions versus a danger sign that you don't want to miss?
There's no one-size-fits-all formula I can give you that covers every situation perfectly. You have to use your best judgment to act in the client's best interest in the unique situation you find yourself in.
The MTBoK, correctly, draws an important distinction in the knowledge they expect of an entry-level MT:
Differentiate between emotional and psychological processing (outside scope of practice for massage therapists) and handling emotions (in scope of practice).
--MTBoK pp. 27 accessed 5 August 2012
In a very general way, a part of what MTBoK calls "handling emotions" is knowing what you would expect to see in a normal emotional release during or after a massage.
Two important things that you would look for are:
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that the client does not lose touch with their surroundings, and
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that they feel better after the release has passed.
It's ok to gently check in with your client.
"Are you all right?" and "Is there anything I can do to help?", gently asked in a way that does not appear that you need for the client to compose themselves, is one way to be supportive.
Standing by silently and calmly is another way that you can support your client.
Being prepared in advance with tissues and with drinking water to offer are other ways of tangibly being there for them.
The message that you want to send is that it's safe and ok to experience and show these feelings in your presence--that you do not need for the client to deny their feelings, or seek to please you by acting as though things are different than they really are.
Most emotional releases that occur in massage sessions are self-limiting and not dangerous--but when should you actually be concerned?
If the client seems confused about where they are, or if they seem to lose touch with their surroundings in some other way, that may well be something to be concerned about.
If the client seems to feel worse, rather than relieved, after the emotional release, then that may also be something to be concerned about.
There are other warning signs that someone may be considering suicide.
The Mayo Clinic has posted a guide for laypeople--not specifically for healthcare professionals--but something that anyone can use to prepare how to handle the situation, if necessary:
Suicide: What to do when someone is suicidal. When someone you know appears suicidal, you might not know what to do. Learn warning signs, what questions to ask and how to get help. accessed 5 August 2012
You can use this guide to familiarize yourself in advance with the warning signs to look out for, and to make a plan about how to react, if you ever should need to do so. This is not practicing psychotherapy; it's being helpful, supportive, and caring as you aid someone to reach out for more specialized professional resources that can help them.
Additionally, you can line up a mentor or trusted colleague in advance, whom you can call on for help when you are not sure about situations that arise in your practice. There is no shame in not always having all the answers; we are all lifelong learners, no matter where we find ourselves.
The important thing is knowing how to reach out for help if you ever do need it. Making a plan in advance about what to look out for when emotional releases occur during a massage session, what to do if you ever find yourself in a situation that you think is more than just a normal emotional release, and knowing what resources are available for help for you or for your client, can be some of the most important things you may ever do in your practice.
You may never need them--most people won't ever face this situation. But if you ever do, then having made a plan in advance, and knowing who is in your community who can be of help--both to your client and to you--can lead directly to your saving a life. And saving a life, when you consider all the future events that will cascade from that person's effects on others, is as if you saved the world.
It's just that important.
