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Expert Voices

Designing a Safe and Supportive Approach to Massage for Torture Survivors

Published May 22, 2024

Written by Dr. Jennifer J. Esala, CVT senior researcher and Sara Phillips, CVT social worker & massage therapist

If you’ve had the opportunity to receive a professional massage, you might imagine a tranquil atmosphere – greeted by gentle music and dimmed lights. The therapist provides firm pressure across your muscles, loosening knots with each pass. You breathe deeply, worries fading as you sink into a physical ease. 

This feeling of relaxation, however one cultivates it, is critical to our health and well-being. Massage is one potent way to engage the healing power of the relaxation response. However, massage is not accessible to everyone. 

At CVT, we’re working to make massage accessible and acceptable to our clients by developing an approach that’s culturally appropriate, linguistically adapted and trauma-informed. We call this approach TCI-Massage, which is short for Trauma-Informed and Culturally-Responsive Integrated Massage Therapy.

We are conducting a research study on TCI-Massage, which will assess how well TCI-Massage supports healing among CVT clients. While the core elements of healing touch and relaxation remain central, we adapted other aspects of the massage approach specifically for torture survivors from diverse cultural backgrounds. 

Our hope is to create a safe and supportive massage experience. These adaptations are essential to making massage accessible and acceptable for CVT clients. Here are some of the specific ways that massage at CVT is designed to meet the needs of our clients:

TCI-Massage is provided over time with the same massage therapist

TCI-Massage emphasizes building trust –  a core principle of trauma-informed care. 

Our overall approach to trauma-informed massage prioritizes these principles: 

  • Physical and emotional safety.
  • Building trust through consistency and follow-through.
  • Clients maintain autonomy over all healthcare decisions.
  • Ongoing communication between clients, massage therapists and interpreters.

When trust has been violated in the past through human rights abuses and other traumatic experiences, trust building is a gradual process that benefits from consistency. 

For this reason, the TCI-Massage model has the same massage therapist working with the same client over the ten weeks of massage treatment. 

TCI-Massage is integrated into psychosocial and health services 

The massage therapists at CVT are part of an integrated care team, including therapists, social workers and medical staff. This integrated approach supports massage therapists to better address the overall physical and emotional wellbeing of clients. 

As a part of a care team, CVT massage therapists can tailor sessions based on medical information related to health status, trauma history, mental health symptoms and even social conditions. 

As part of the research study on TCI-Massage, we will collect additional health information such as blood pressure and heart rate variability. This information will help us gain a deeper understanding of how TCI-Massage impacts overall health and can also be used to inform broader client healthcare.

Massage is provided over clothes

Wearing clothes during massage may not be typical in many practices in the United States, but it is common in some massage traditions like Thai massage and in many parts of the world. 

At CVT, massage is provided over clothing to account for trauma histories, cultural considerations and individual preferences of our clients.

For example, for CVT clients who have experienced sexual assault and torture, keeping clothing on can be an important signal of safety during the massage session. 

Many clients we serve also come from cultural contexts where disrobing or direct contact with specific areas of the body may not be customary or acceptable.

Wearing clothes during massage makes this service more accessible to clients from a wider range of cultural backgrounds. And, some people simply prefer massage while clothed, and this approach respects that preference in a clinic setting.  

Chair Massage is always an option 

TCI-Massage offers the choice of using a massage table or a massage chair. We offer the distinct options of using a massage chair for two reasons:

  • It increases accessibility for clients with physical limitations that make lying on a table difficult.
  • Many survivors of torture and other traumatic events experience heightened vigilance, which can make reclining challenging and feel unsafe. 

The massage chair allows clients to receive the benefits of massage, potentially supporting reductions in vigilance over time, while remaining in a seated position that fosters a sense of control and safety. The addition of chair massage has the potential to dramatically increase the accessibility of massage therapy.

Interpreters are a part of the massage therapy sessions 

Effective massage therapy relies on clear communication. Clients need to be able to express their comfort level and preferences about pressure, technique, body area being addressed and even the need to use the restroom or stop a session for whatever reason. 

When a language barrier exists, expressing these needs becomes difficult, potentially turning a massage into a stressful or even harmful experience. Since many of our clients don’t speak English, interpreters are a central part of TCI-Massage. 

Additionally, when interpreters share a cultural background with clients, they can also speak to cultural considerations related to massage therapy.

The therapeutic partnership with interpreters during massage sessions is crucial to providing effective, safe, and culturally responsive massage.

Pain education is a core component of TCI-Massage 

Given the high prevalence of pain among CVT clients (over 80% experience pain upon starting services), massage sessions incorporate pain education.

This education is based on the principles of Mindful Awareness in Body-Oriented Therapy, which focuses on breathing techniques, body awareness and self-compassion. 

Pain education is an effective way to enhance the benefits of massage on pain reduction. And, folding it into massage sessions supports an integrated and embodied approach to learning about pain management.

Self-massage training is also provided

An important aspect of CVT services is supporting clients to manage their well-being, both during and beyond our sessions. Providing training on self-massage equips clients with a tool they can integrate into their daily lives. 

Self-massage offers similar benefits to massage therapy by focusing on areas of tension and promoting a sense of calm. By incorporating self-massage techniques, clients can extend the positive effects of massage sessions.

TCI-Massage is a distinct approach to massage therapy designed for survivors of torture and trauma. The framework prioritizes adapting the usual approaches to massage therapy in order to be more accessible and acceptable for a wider range of people. 

By integrating components like clothed massage, a massage chair option and interpreter services, TCI-Massage expands the reach of massage therapy and its potential to support healing. 


We want CVT clients to have the opportunity to receive a professional massage. And, although it may look a bit different than other massages, we hope the result is the same: an opportunity to focus on breath and deep relaxation.

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