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7 Things that Should Happen During a Massage, What May Happen Instead, and How to Self- Advocate.

(If you are neurodivergent and often have trouble reading articles, try the bionic reading chrome plug-in and see if that makes it any easier. Otherwise, I will also be presenting the content of this article in video format, so follow me on YouTube for when that video is released.)

If you've never had a massage before, it can be intimidating to schedule your first session when you don't know what to expect. It can be especially intimidating if you have a trauma history around touch, or any other factors that may make it difficult to relax when someone you don't know may be touching you. ⁠

It particularly curdles my coconut oil to hear stories of people that were already nervous to try massage, and then end up having a bad experience once they finally work up the courage to give massage a try, and then (understandably) don't see a therapeutic benefit to massage, and feel reluctant to try again. ⁠

So, I strive to be the best ambassador I can be to those I believe would benefit most from massage, it is my hope that I can help soothe the fears of those who may be nervous to try massage, and prepare folks to advocate for themselves should the need arise during a session with another therapist. ⁠

Image ID: Lavender tinted image of a bar of soap that says "massage", a towel, and a wicker basket, with a white overlaying cloud shape, and the text, "1) Your therapist should be ready to greet you by your appointment time"

1. Your therapist should be ready to greet you by your appointment time.

When you show up to your appointment, on time or approximately 10-15 minutes early if directed to do so, your therapist should be ready to greet you and take you back to the treatment room in a timely fashion. If appointments are scheduled with 30 minutes in-between sessions, this is a very simple standard to maintain for a therapist.

What May Happen:

However, if you go to a corporate spa, it's quite a bit more challenging for a therapist to stay on schedule due to a big factor beyond their control: time in-between sessions. At a corporate spa, in order to increase profit, a "one hour" massage is typically 50 minutes, and the therapist has the remaining 10 minutes for the previous client to get dressed and leave the room, strip the sheets off the massage table, sanitize the room, grab a new set of sheets, and remake the table for you. Theoretically, there are plenty of therapists out there who routinely accomplish this, but I'm not sure how without cutting corners.

There also seems to be some therapists out there that are particularly unbound by the concept of time, as I have witnessed some therapists I've worked with, on multiple occasions, greet their clients up to an hour after their scheduled appointment time. That scenario is generally pretty rare, but it does happen. If your therapist is consistently more than 15 minutes late greeting you and taking you back to the treatment room once you arrive, that may be a sign to find a new practitioner.

I would recommend for your first massage, to plan on having at least an hour of cushion after your appointment is scheduled to end before you're expected to be a person somewhere else. Even if it's just to come back to earth after floating up to cloud nine, it's best to plan for some wiggle room so you aren't worried about the time.

Image ID: Lavender tinted image of a small jar and a sprig of lavender on burlap, with a overlaying cloud shape and the text, "2) There should be an intake form to fill out, and an intake conversation where treatment goals are discussed."

2. There should be an intake form to fill out, and an intake conversation where treatment goals are discussed.

You may be asked to come 10-15 minutes early to fill out your legally required intake form before your first appointment, or it may be sent to you in advance. This serves the purpose of giving your therapist some information* about you so they can best meet your needs. At minimum it should ask about any medications you may be on, any health conditions you may be receiving treatment for, areas that may be bothering you that you'd like the therapist to work on, and a way to contact you and an emergency contact. Some intake forms may ask additional questions to give the therapist more information about you before your intake conversation.

There should be an intake conversation.

Especially for your first appointment, the therapist should ask you: 1) How you're feeling/areas of concern, 2) What areas are you comfortable having worked on, and explicitly name areas that are often opted out of, such as feet, glutes, hair, face, stomach, 3) If you have any questions.

After you've had all your questions answered, your therapist should tell you to dress down to your comfort level**, lay either face up or face down depending on their preference, and get underneath both the blanket and the sheet. Sometimes therapists, including myself, forget to explicitly say to get underneath the sheet, but even if they don't say it, you should get underneath the sheet and get comfortable until your therapist returns, usually knocking on the door to confirm that you are ready to receive your massage.

What May Happen:

As mentioned above, therapists at corporate spas don't have a lot of time in between sessions to juggle all of the other parts of massage therapy that should be a standard expectation, and the intake conversation is often cut short as well.

Shortly after getting my license, I went through training at a corporate spa before I accepted a job offer at a locally owned business, and the intake conversation I was advised to have each client went something like this:

Therapist: Scalp, face, hands, feet, glutes, all okay?

Client: Yes/no

Therapist: Alright, dress down to your comfort level, get underneath the sheet, and we'll start face down/up.

*Therapist leaves*

If you have questions you want answered before your first session, or want to make anything specific known to your therapist before your session, I would recommend going to a private practice or a locally owned spa. In my experience, everywhere except corporate spas allot 30 minutes between each client, which means there is MUCH more time for a relaxed intake conversation, a thorough cleaning between sessions, and your therapist will be empowered to be mentally present with you during intake, the hands-on portion of the session, and as you are leaving.

If you end up with a therapist that is rushing the intake conversation, don't be afraid to tell them to wait, and ask what's on your mind and make your needs and your boundaries clear. If something doesn't feel right, and you're at a spa with multiple practitioners available, you can ask to re-schedule with a different therapist. If you're with a therapist at a private practice and decide you don't want to proceed with the session, they may require a late-cancellation fee, but that's better than going through with a traumatizing session where your boundaries aren't respected.

Image ID: Lavender tinted image of a small jar in a saucer with blue crystals, and a sprig of lavender in the background, with a white overlaying cloud shape and the text, " 3) Your decision on level of undress should be respected."

3. Your decision on level of undress should be respected.

Your therapist should tell you to dress down to your comfort level, and they should never dictate the level that you disrobe for your massage. If you make the choice to leave on more clothing than expected, even be fully clothed, the therapist should proceed with the massage without comment.

I hope my feelings are clear on that matter. Any therapist worth their license should be able to give a massage to a fully clothed client. If clothing is an issue in regard to a particular treatment a client requested (for example hot stone massage), the therapist may inform the client of their choices with the treatment they requested and level of dress, but the choice should be given while honoring the client's choices.

For example:

Therapist: Hey Alex, I notice you kept your shirt on when you got on the table, if you want to stay clothed, that's totally okay, but since you asked for me to use hot stones in our session, I wanted to let you know that hot stone massage usually involves a lot of massage oil so that I can slide the stones quickly up and down the body. Would you still like me to do hot stones or would you prefer we do a standard massage while you're fully clothed? The choice is up to you.

Option 1:

Alex: Oh, I didn't know how hot stone massage worked, I think I'd prefer to disrobe so we can do hot stones.

Therapist: Okay, I'll step out for a moment and knock before I come back in to make sure you're ready for me.

Option 2:

Alex: I'd prefer to stay fully clothed.

Therapist: Okay, we can definitely do that. Thank you for expressing your boundaries to me. Now take a few deep breaths...

What May Happen:

Thankfully, I've never personally heard of a therapist insisting a client remove more clothing than they're comfortable, but that doesn't mean it's impossible. If such a thing happens, I would recommend you end the session and inform the spa. I have heard of therapists not respecting basic, obvious, touch boundaries such as underwear areas, and a therapist insisting a client remove clothing is not a sign of trustworthy behavior.

Image ID: Lavender tinted image of bamboo leaves and smooth stones placed in sand, with a white overlaying cloud shape and the text, "4)Your expressed areas of consent should be respected."

4. Your expressed areas of consent should be respected.

In the conversation with your therapist before your session, boundaries around what areas of your body you are comfortable being touched, or not, should be discussed and clarified. If this is your first session, your therapist should prompt you about areas of your body that may be a place where you would want to express a boundary around touch.

For most clients, this is often: scalp, face, hands, feet, glutes, and abdomen. I personally don't massage the abdomen unless the client requests, or there is a treatment goal we are working on that would benefit from abdominal massage, and even then, it is still discussed beforehand.

I also often work with transgender clients who may be coming in with the treatment goal of releasing tension from chest binding, in which case I would also discuss if they feel comfortable with me working pectoral muscle along the clavicle, along the side body while face down, and perhaps around the diaphragm, through the sheet. If they don't feel comfortable with me touching those areas directly, I can still offer support and release through stretching, so clients do not have to compromise the level of care they receive by expressing their boundaries around touch.

Don't be afraid to express boundaries around body parts that aren't "typical". I have a trauma history around my knees being touched in a particular way, so I make sure to express that to the therapist every time I receive a massage, and if a therapist doesn't abide by that boundary, I will never book with that therapist again. Maybe you don't like your ears touched; maybe you have an old injury in your back that your nervous system still feels protective of-- whatever boundaries you need to set in order to feel safe are welcome, wanted, and totally okay.

What May Happen:

There are some issues that benefit from work on typically "sensitive" areas. For example, tension in the glutes often contributes to lower back pain. Or there is a muscle called the psoas the attaches from your anterior pelvis to your mid lumbar spine, which is accessed through the oblique abdominal area, that may also contribute to lower back pain. If, for example, you express to your therapist that you're experiencing lower back pain, but you don't want your glutes worked on, they may explain this to you and discuss with you options to make gluteal work more comfortable. These can be options like working through the sheet with only closed fists and forearms, or doing stretches where glutes are not directly touched. A therapist with good intentions will just want to make sure you're aware of what may be contributing to your pain, so that you can make informed decisions about the session.

Remember, you always have the right to refuse touch at any point during your session, even if you had previously consented. And, it's never, ever okay for anyone to touch a groin or breast area without clearly expressed consent. In fact, in the US, even if a client gives expressed consent to touch those areas, it's illegal for a therapist to do so. I have unfortunately heard of therapists who have abused clients in this way, and I want as many people as possible to know that this is absolutely not okay behavior, and therapists should lose their license if they ever cross that boundary.

Image ID: Lavender tinted image of a jar filled with liquid and a few sprigs of lavender in the liquid, with a larger bunch of lavender next to it. Image has a white overlaying cloud shape with the text, "5) Your desired level of pressure should be respected."

5. Your desired level of pressure/treatments should be respected.

Even for your first massage, you should feel empowered to give the therapist feedback for your massage to be the pressure that works best for your body. The general rule I share with clients is that massage should never move past the "hurts so good" feeling, where you may feel increased awareness of the tension being held in an area, but you're still able to maintain deep breathing and a relaxed state of mind.

If you find yourself tensing up, moving away from the touch you are receiving, or holding your breath, it's too much pressure.

If you find yourself craving more sensation from the touch you are receiving, it may not be enough pressure.

Either way, your therapist should check in with you and ask how you are feeling about the pressure, but you should feel empowered to give feedback at any point in the massage if a different level of pressure would be more supportive of your needs.

Remember, no one knows your body better than you do.

What May Happen

Most therapists tend to have a "default" pressure they work in, but all of them should be able to make adjustments with feedback.

Sometimes client body language can be difficult to read, because, in short, bodies do things in deep relaxation: twitch, spasm, clients might deeply sigh or moan, and therapists want to create a non-judgmental space for the client to express themselves in a way that feels authentic while receiving massage, and every client's body is different, so it may be difficult for a therapist to know if the pressure is satisfactory if you don't tell them.

There are some therapists that, in my opinion, default to too deep much more often than they should. I have noticed a trend that therapists that tend to work with athletes or specialize in sports massage, often have a "more is always better" philosophy. It is my hypothesis that because athletes tend to be more sensation seeking when receiving massage (i.e. they want it to hurt a bit more than the average client), the therapists that work with them develop a style that works well for those type of clients, but can be received as a quite brutal to the average client, especially a client completely new to massage.

There are also some therapists that struggle to provide firm to deep pressure. They may not be using proper body mechanics to effectively utilize their weight during a session, or they may be older, or tired that day, or they don't like receiving deep massage themselves, so they tend to do light to medium pressure, which may be perfect for some clients.

If scheduling with a spa, it's helpful to communicate to the receptionist what kind of pressure you may anticipate enjoying, and if you are new to massage and may need a therapist that's more flexible with their pressure.

And remember, once you're in session, your needs matter. You are not being annoying by asking for the therapist to make adjustments. In fact, most therapists want you to express your needs. If you come across a therapist that is burnt out, having a bad day, or whatever their reason for not accommodating your needs, you always retain your right to end the session.

Image ID: Lavender tinted photo with a mortar and pestle with salt, image also contains a few amber tinted dropper bottles, and a bundle of lavender. Overlaying that image, there is a white, cloud shape with text that reads, "6) You should be given the accommodations you need to succeed (at relaxing)"

6. You should be given the accommodations you need to succeed (at relaxing)

There's all sorts of adjustments and accommodations that can be made to support you to be more comfortable during your session. Are you too cold, too hot? Does it hurt to lay down on your chest tissue? Is the face cradle the right height? Is your lower back comfortable? Is there enough space to comfortably rest your arms on the table?

Even if you don't quite know how to meet your need, a good therapist should be able to get creative with the resources they have to help you get more comfortable. It's amazing what a properly placed folded up towel, an extra bolster, or a pillow underneath the abdomen can do to increase client comfort. It's okay to speak up if something doesn't feel right, and give feedback that additional adjustments are needed as the therapist figures out how to accommodate you.

We want you to be able to melt like butter by the end of the session, let's figure out how to make the container perfect for you.

What May Happen

If you happen to get a therapist that is fresh out of school, they may not know the some of the special tips and tricks to help with certain comfort needs, so I've included below a couple of suggestions for how props can be used to make you more comfortable during a session.

It hurts to lay on breast/chest tissue:

-Pillow under the abdomen directly beneath chest tissue.

-folded up hand towels or full sized towels underneath glenohumeral (shoulder) joint.

-postpartum breast bolster (If the client is already on the table, this may require them to sit up and wrap themselves in the sheet an blanket while the bolster is placed underneath the fitted sheet.)

It hurts the abdomen or low back to lay face down:

-Pillow or bolster underneath the hips.

-Side lying "prenatal" bolstering with pillows or bolsters

Face cradle can't get low enough for neck to be comfortable while face down:

-Folded up hand towels or full sized towels underneath glenohumeral (shoulder) joint and across clavicle

-Pillow underneath chest

Image ID: Lavender tinted image that features a bundle of lavender, next to a container of lotion, on a wood paneled backdrop, with an overlaying cloud shape with the text, "7) You should be given evidence based, within-scope-of-practice advice (if any) at the end of your session."

7. You should be given evidence based, within-scope-of-practice advice (if any) at the end of your session.

You should be able to trust that the wellness advice being given to you by your massage therapist is evidence based, and that the advice being given is offered with your best interest in mind, as opposed to the therapist trying to meet a sales quota, which may be the case at a larger spa.

Often, after a session, the massage therapist may offer suggestions for some stretches or self-massage techniques you can practice in between sessions. They may also commonly advise you to drink water, and utilize hot or cold therapy at home to continue treating various musculoskeletal issues.

What May Happen:

Most folks that work in wellness are passionate about their field of practice, and may also pick up information about adjacent areas of practice either through their own wellness journey, through working with practitioners with complimentary expertise, or otherwise through continued study. Some practitioners continue to learn with a grounded, critical lens in regard to the information they are absorbing and passing on, and others may not have had adequate training in evaluating sources and research to effectively determine what's good information to be passing on to their clients.

If you feel like you're getting bad advice, it's entirely understandable to fact check before following a massage therapist's wellness advice, especially if it's regarding a subject matter they don't have any certification to validate their knowledge. Unless they have acquired additional training, massage therapists are not licensed to offer advice on supplements, skin care, fitness, or mental health care.

*Side note to my trans family, you do not have to put your legal name on your intake form, unless it's being covered by an insurance provider, which is a very rare scenario in the US

**most of my clients either keep their underwear on or go nude; most clients with chest tissue do not wear any garment on their upper body when receiving a massage, but ultimately it is up to your comfort level. If you feel more comfortable receiving therapeutic touch fully clothed, that is perfectly okay and your therapist should respect your decision.

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