HACKING WITH CARE

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====== Emotional Release during Massage / Care - What is Happening and How best to respond ======

Massage (or other types of bodywork) can sometimes facilitate the (often healthy) release of suppressed emotions, manifesting for example, in cries, or other emotional outbursts. This can be impressive and frightening for both, but most of the times there is nothing really to be afraid of. With a little confidence and preparation, which I hope this article can provide, you both can go through this with calm and grace, and emerge stronger and refreshed. Like countryside after a summer storm. 



===== What is happening ? =====


An emotional release in massage can be closely linked to the modification in the pattern of breathing which happens when the person enters a state of relaxation. Deeper “abdominal” breathing may start, as opposed to more “upper”, “thoracic” pattern breathing found in action (or in its extremes, panic). 
As the diaphragm relaxes, as it dives deeper into the abdomen pulling in air, it also softens its role as a functional barrier, or dam, against the rise of intense emotions. Indeed, intense emotional outbursts could represent unwelcome disruptions in daily life activities or social interactions. This is why, consciously or not, we regulate (through breathing notably) the flow of our emotions or keep them in check altogether (yes, sometimes we catastrophically fail, but that is yet another story). Note that this is a general, regulatory, adaptive function of breathing, where the diaphragm, the bigger, stronger respiratory muscle, plays a lead role. It is neither good or bad //per se// : rather it is the adjustment (or not) of a person to their situation/surroundings through breathing that is interesting to consider here. 

So, in massage, the person might have an opportunity to relax. They might enter what is described as the **“Rest and Digest”** state/response, as opposed to the **“Flee or Fight”** response. In fact we somewhat hope that they do, as there is much soothing and healing potential there. And, **emotions have to be digested too**, just like the rest of what's been on our plates in the last days, weeks, and sometimes months. So, if some emotions have been “sitting" on your friend's "stomach” waiting for an appropriate time when their digestion (physiological and psychological) could resume, now during the massage could be a good time - or so will their body feel. Most of the time this digestion will happen smoothly, without you or them even really noticing that that's what's going on (but if you listen, you might hear peristaltic mumbling ! ). **Sometimes though, this process comes with a release, with an impressive intense, emotional out-burst**. Other times yet, it will be just a lone tear, silently pearling from the corner of an eye, like a jewel (My take on it : don't touch it, don't erase it, don't dry it with a tissue, let it BE). Last but not least, note that the release of emotions in massage can also be (often is) linked to the person (more or less consciously) feeling that they are, at this moment, in your care, in your good hands, in a safe space and time to do so. To release, to be free. Indeed, the Rest and Digest response generally does not happen (or remains partial, incomplete) when the person does not feel safe (which is why chronic stress and anxiety can end up being tough health issues as well). 

===== How to best respond to an emotional release in massage ?  =====

Following are some of advices, inspired by what I have learned, experienced in my years of practice, not only as a masseuse, but also as the person breaking down, raging or melting in tears, on the massage table. 

The best attitude to adopt according to me is to:

  * Stay **calm, composed, and positive**. By all means, find it in you not to be frightened by the other person's intensity of emotions. You've got this. 
  * Stop further stimulation, **don't do more massage**. But do not retract you care or benevolent presence. It is about making space and **holding the space** for what is happening, being reserved yet welcoming.
  * Gently **describe what seems to be happening**. Keep it minimal though. When you speak, be articulate, soft, warm. Say for example: “Hey NAME, can you hear me ? It's me NAME. It looks like you're feeling distressed. Are you ? (Yes or No, no much more). OK. It happens in massage sometimes, you know. Because you are relaxing, things start moving again, it's quite natural”
Then 
  * Ask them **if they want you to stay with them** as they go through this or  “do you want me to leave you alone a bit and come back in 15 min to check in on you ?” And/Or **Ask them if there is someone around, a friend, that they'd wish to see now**, and that you could get for them. If they wish for you to stay, you can say things like “OK, let's see this pass together. I am here. Here, turn on you side, I will help you get more comfortable...” If they don't know what they want, stay, then later, maybe, ask again the same question. 
  * Invite the person to **turn and lie on their left side, in the lateral recovery position**, with one leg folded the other extended (better than fetal position, which can be too regressive, and harder to emerge from later). Cover them with a jumper or plaid or blanket.
  * If you are staying with them, and if they are OK with touch (ask), **keep a warm, “motherly” contact with them**, preferably on their back. You can, for example, sit (and make yourself comfortable because it can last a bit) against their back, and stay there. Don't massage. Or, small, slow, circles, AT MOST. 
  * Don't talk the person out of releasing their emotions, but **don't encourage them into more release** either. You want to dose it bit, to keep the emotional release within safe boundaries/limits. Indeed, while a bit of emotional release is good most of the times, too much of it, too strong and/or too long can become unsafe (depending on who you and they are, where you are and what is around you), become very psychologically and physically draining for the person (for you even) and be hard(er) to recover from (see the end of this article for more specific advices on how to moderate the intensity). 
  * Do **not express approval or disapproval**, and in any case **do not contradict, negate, or minimize what they are feeling. Just listen..!** Yet for their own sake, be mindful/careful that **they don't reveal too much personal information** (see next point)
  * Do **not encourage the person to verbalize** (at least not during the emotional release). Do NOT make the person talk, other that, as in my examples, to have them say their name or yours, or very trivial, general things and feelings. This is especially crucial if the person you're caring for is someone working in sensitive contexts where there are important security issues, if they are, for example, an exposed or high profile activist (which you might not even be aware of). You are to keep them safe, and that includes to **keep them safe from having said, released, too much information**. This could leave them feeling anxious and terrible, who knows, it could keep them from sleeping at night, AFTER your session, ruining all the care and little trust that you had. Besides, it might also mean trouble and inquietude for you, having now in your possession information you would have been better NOT to have in the first place. Furthermore, and importantly, bear in mind the moment of intense emotion and relaxation is a moment of greater vulnerability and possible confusion. It is NOT the best moment to address, solve, or go into the particulars of important personal issues, for the reasons I have stated, and because there is too much de facto asymmetry in power between you (the composed caregiver in charge), and them (the weak poor soul breaking down on your table), that could all later feel like a breach of trust and privacy. Limit the talking. If necessary explain why you are not wanting to hear them talk too much, why you feel this is in the person's best interest (and not because you couldn't care less or something, which is untrue). 
  * If you are genuinely worried though, if you feel that something here is really wrong, that this person should address certain serious issues, **wait for after the massage to have a conversation** about it. And, either propose a conversation with you (if, and only if, you feel you have the availability, heart and shoulders for it) OR express your concern and **invite them to seek appropriate help** with friends, OR refer them to other caregivers or resources. If you are very worried, for example, if there has been mention of suicide thoughts or attempt, let one of their good friend know you are genuinely worried (without spilling details of your session), and insist that they follow up with their friend and have a conversation, and share whatever resources you have that you think could help them. Bear in mind though, that by going to their friend about this, you would be breaching privacy, so what you can do is tell the person you have given a massage to that you are going to share your concerns with their friend. 

==== Other things you can do to moderate or exit safely the intensity of an emotional release ====

  * If you've been playing some nostalgic or loopy music, you might want to stop it or turn it down. Likewise, you might softly, progressively **bring some lights back on**.
  * If the person is really distressed and degrading, not hearing you or your invitation to turn on their side, eyes closed, rapid breathing and so on, by all gentle means, **make them connect with you and with their surroundings**. Have them open their eyes, have them look you in the eyes, keep looking, have them look around, have them say their name, your name, listen to your voice, hang on to the continuous stream of kind words coming from your mouth etc. Here you might want to raise your voice a little and be assertive, although still soft and motherly. 
  * Bring them **a glass of water** and help them drink it. 
  * If you're lucky enough to have a garden or some patch of green near, gently but assertively **get them back up on their two feet, have them walk around**, and take them to that patch of raw earth. There. Grounded. Literally. If there is no green or grass, get them up and walking all the same indoors. Ground, ground, ground. 
  * If they are not calming down and this is going on too long and you are already feeling they are exhausting themselves through the emotional release, there's another thing you can try -it's a tricky one but if you feel like it : Get "angry", show "assertiveness". Like a LOVING, patient yet sensible and down to earth MOTHER would, say: "OK, **that's ENOUGH now**. Stop it. You're hurting yourself now. We can talk about this later if you want, and I will help you, but first you have got to calm down. Here, drink this water." And/or things like "It's good that you are feeling and exploring these emotions /events, but you CAN'T stay there forever. Come back to me, come back to the here and now, come be with us " 

//Emily King, August 2016 (reviewed by M.G)//

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