Treating Mentally Impaired Clients by Massage Therapistsby Jim Lev, LMBT

Massage therapy has been proven time and time again to be mostly relaxing and rehabilitating experience and treatment, however, massage also can evoke and bring to the surface emotions as well as symptoms of existing mental pathologies.

It is one thing to successfully deal with an outburst of emotions such as expressed in involuntary shaking and crying (mostly tearing), and a whole different experience when dealing with a violent outburst of anger, frustration or such.
As massage therapists we are not equipped, prepared or authorized to deal with a psychotic phenomena.

There are many people that seek massage therapy to relieve their distress. It is only natural that some of them are mentally impaired. We, the therapists have no way to know whether or not our patient is "in control" or not even if his initial intake reflects traumatic past, chronic depression or more severe condition like psychosis or sociopathology. By the same token - we are not prepared to deal with a diagnosed bipolar case or schizophrenic , even on medications (since we don't know whether or not these are indeed taken as ordered or are effective), a physical assault or a violent reaction, a haunting and stalking or criminal complaint against the therapist may result.

This by no means points out to a suggestion that if a patient states that he/she is say schizophrenic, bipolar etc. we should deny them our services. Mental and physical disease are each part of our human makeup, and we must keep in our mind that we ourselves are not inoculated against mental conditions. This is true regarding each and every one of us, be the reason whatever it may.

Maybe, so far, I have not told you much you did not already know, and I certainly do not know a fool-proof way to deal with a psychotic and other emotional outbursts.

We are taught in massage schools that massage is effective in speeding up the metabolism and causing toxin detoxification. Please note that while we consider detoxification as a positive by-product of the massage, it carries certain risks. When you clean your client's body of toxins, you may very well deplete the levels of vital minerals, vitamins and drugs. It is questionable, in my opinion, whether or not our well intended massage can cause hormonal imbalance, and affect also the blood levels of the Rx drugs our clients are on.

Mentally impaired clients are often on very powerful anti-psychotic drugs. Can we cause an imbalance leading to some sort of mental symptoms manifestations??? To the best of my knowledge we do not have any guidelines what massage types are more likely to cause RX drugs imbalance, and this issue should be researched. I strongly doubt whether a general physician (MD) knows much more on the matter.

Moreover, I recently learned that even mental health professionals are sometimes victims to assault allegations by their clients. Human beings are "balls of energy" who and how the balance of this energy is disturbed we do not know. However, the unfortunate bottom line is that it is the Massage Therapist out there, alone in his clinic (unless he works in a SPA or other public place) that has to deal with ANY situation.
Unfortunately, the Massage Schools sweep over psychopathology very superficially, if at all, and leave the MT unprepared, and although usually the rate of psychotic occurrences in the average clinics is rare (and reported even more rarely); you never know when it may strike you with possibly devastating results.

Consider the following: if you are assaulted and you protect yourself: if your patient has a seizure, a paranoid delusion etc, it's you who has later fight the courts and the Massage Board for your innocence. If you carry insurance - make sure that you are well versed in the small print of the policy exclusions. Remember: no matter how innocent you may be- it is your word - against his/hers.

Here are a few suggestions worthy consideration:

* Take your time discussing and writing the medicinal/mental history with every new client. Ask your patient for permission to contact his/her mental caretaker.
Do not allow your boss or your too dense timetable to jot down “Deep Tissue –rhomboids” and rush to the session.
* If your client indicates depression ask how it is being treated, whether they are seeing a mental health professional and whether, in a case of need (which you determine) you can contact and exchange your observations with them.
* You should know the names of the doctors and therapists taking care of your clients and their contact phone numbers.
* It is my personal opinion that the Massage schools should be instructed to include more mental health education - it is for you to write and request it from your State Massage Board.
* Since we cannot videotape our sessions without our clients informed consent, you should consider a legal way to do so: e.g. to make your client sign a waiver that he does not object to his sessions being videotaped from the moment that he/ she are draped - until the session's end. (DISCLAIMER: this is not a suggestion written by a lawyer, thus before any such step, consult your attorney what is legal and what is not).
* If you work from your own residence, properly register your clinic as LLC or "limited liability" - meaning that should in the future you face the misfortune of a law suit - the financial damages claim can be only against whatever is listed as part of the clinic. Do this part immediately, if you have done it yet. If you will attempt to protect your or your loved one's property after the incident took place - it may be too late.

If you wonder why I chose this topic to write about - it is something from my personal unfortunate experience that I wish to spare you. Keep in mind that you may escape such a bizarre case for years, yet that one single case, whenever, - may destroy your career, your health and...your life.

Jim Lev, LMBT.


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