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Self-Care for Massage Therapists: Using Mindfulness

Self-Care: Mindfulness for Massage Therapists

Before Andrea Minick Rudolph, M.A., D.A.P.A., founder and director of Oryoki Zendo, a counseling and meditation center in Camp Hill, Pennsylvania, became a Buddhist priest, she worked as a licensed massage therapist for 27 years. During those years, she had a client who was perennially late, and who would still want to claim her full hour no matter how late she arrived.

One day, the client, already late, arrived at the back door of the health facility where Rudolph worked while Rudolph was waiting at the front. They did a Keystone Kops-type of routine, circling around each other and ultimately ticking more minutes off the therapeutic hour.

When Rudolph and the client finally connected, the client ranted angrily. Rather than responding in kind, Rudolph—who at this point already had begun a mindfulness meditation practice—gave her a hug: ‘What’s going on?” she asked. The client started to cry. Her cat had died, she said. Also, her car had died. “I’m so sorry,” the client then offered. “I didn’t mean to yell at you.”

Rudolph believed her response diffused a situation that very easily could have gotten ugly. “Instead of reacting in an angry way, I connected on a compassionate level and understood that she was suffering and sad,” Rudolph says. In fact, the client later wrote Rudolph a letter telling her how amazed she was that Rudolph had responded so kindly to her when she was angry.

This kind of compassion is the power of mindfulness, which, in simple terms, means being in the here and now, without judgment. “Mindfulness is a quality of sustained presence,” says Rick Hanson, Ph.D., a neuropsychologist and author of Buddha’s Brain: The Practical Neuroscience of Happiness, Love, and Wisdom.

There’s an awareness that you’re aware, as well as a nature of acceptance. “You may not prefer what’s happening, but you’re not fighting it, or shaming yourself about it,” Hanson says. Usually, warmth, kindness and compassion show up as well.

With a schedule packed with taking care of your clients, practicing mindfulness is a great self-care technique that allows you to take care of yourself, too.

Where to Start

Although the roots of mindfulness are in Buddhism, you don’t have to be Buddhist—or religious at all, in fact—to practice it. You don’t need incense, a mountaintop retreat or an esoteric degree. “You simply need to be human,” says Rudolph.

Hanson says that mindfulness practices often begin with a type of “steadying of the mind” practice, before moving into an “open awareness” practice where you bring your sustained presence wherever you go. “This is the traditional way—first build up the muscle, and then apply that muscle to opening out into everything,” he says.

For example, you can simply sit—on a chair or cushion—watching your breath, or thoughts, as they come and go. You can close your eyes, or keep them open. You might label your thoughts as they arise: “planning,” for example, or “worrying.” You can connect your practice to the divine, which is prayer. Or you can choose a secular practice, such as noticing the breath on your upper lip as you inhale and exhale.

Some people choose a mantra, even a simple one word mantra such as “peace.” Some might focus their attention on an image—a beach scene, for example, or a mandala. You can even meditate on a feeling, such as loving-kindness.

“When I meditate, I simply sit and observe my breath and what is going on in my body,” says Andrew Weil, M.D., Founder and Director, Arizona Center for Integrative Medicine at the College of Medicine, University of Arizona, and Director of Integrative Health and Healing, Miraval Resort. “I don’t try to stop thoughts—I try to note them, just witness them.”

What you are doing, says Hanson, is giving yourself a sanctuary, a place to anchor yourself. “For one moment, you don’t have to solve problems, impress anyone, be anyone. Just be here now, with your own experience,” he says.

The ideal practice, Hanson says, is simply the one that you will do. He challenges beginners to commit to just one minute a day. Even this brief amount of time—if you are consistent—can make a difference.

The Health Benefits of Mindfulness

Studies show that mindfulness can strengthen neural networks that are associated with resilience, compassion and well-being.

In a 2009 study, for example, published in the Journal of Cognitive Psychotherapy, participants who practiced mindfulness-based stress reduction for two months were less anxious and thought of themselves more positively. In another study published in 2011 in Psychiatry Research: Neuroimaging, participants in an eight-week mindfulness meditation program showed changes in parts of the brain associated with memory, empathy and stress.

Harvard-trained brain scientist Jill Bolte Taylor, Ph.D., was able to witness the workings of the brain from the inside out in the aftermath of a stroke—a severe hemorrhage in her brain’s left hemisphere—that she suffered in 1996.

Taylor noted with fascination how, during recovery, she felt an overwhelming sense of well-being. Her right brain—the side of creativity, compassion and expression—was compensating for the damaged, detailed-oriented left brain. Without the left brain’s chatter of judgments and criticisms, she felt connected to everything.

Taylor saw that much of the mischief the human brain gets up to—anxiety, distress, ruminating—was simply our neural circuitry on autopilot. Now she lectures and writes, as she did in the book My Stroke of Insight: A Brain Scientist’s Personal Journey, about the importance of staying with the compassion and integrity of the present moment. “Who do I want to be—right here and now? Not just who I am when I am running on automatic, but how do I want to respond differently?” she says.

This awareness is critical, especially today, with nearly around-the-clock demands on our time and energy. According to Weil, our body’s fight or flight mechanism—which increases blood pressure, heart rate and respiration and was essential to survival in prehistoric times—now is often activated by relatively benign things such as traffic, financial stressors or relationship woes.

“We are better off learning to accept those situations we cannot change, and to manage how we deal with stress by learning and regularly practicing appropriate stress management techniques that can protect body and mind from the harmful effects of stress,” he says. “Mindfulness is one such technique.”

Cleveland, Ohio-based massage therapist Mary Ellen Derwis-Balaz, began a mindfulness practice around 20 years ago when her young daughter became seriously ill. “[Before], I was a very linear kind of person, very precise,” she says.

Her daughter’s illness (from which she has made a full recovery) made her assess her life, including ways to reduce her stress. Eventually, this evaluation brought her to the Chinese martial and healing art Chi Kung, which focuses on aligning breath, movement and awareness. “I think we forget how important breath is,” she says. “We spend our lives not taking up too much space, not making too much noise.” We often “forget” to breathe, and shallowly take gulps of air in a fight-or-flight manner.

Mindfulness can help you take care of yourself in other ways, as well. “You know when it is time to stop, to rest, to hydrate,” says Derwis-Balaz. Rudolph agrees. “A lot of massage therapists push themselves beyond fatigue,” she explains. “If you don’t practice compassion for yourself, you can’t practice it with others. If you don’t pay attention to your own body, you won’t be able to pay attention to others.”

Mindfulness: It’s About Choice

You can practice mindful self-awareness throughout the day, whenever you feel yourself “activated,”—by stress, anger, even happiness. One of Taylor’s discoveries in her recovery was that our emotions and thoughts have a natural lifespan of about 90 seconds within our body’s circuitry. So all that worry about that argument you had yesterday? It’s likely you retelling the story, over and over again.

“Circuitry runs a natural course, and then it’s over,” Taylor says. When we keep paying attention to our thoughts (“How could my client do this to me?”) it reenergizes the circuits and stimulates the physiological responses.

“It isn’t always easy to find effective ways to change our daily stressors, but it is very important to identify healthy ways to manage stress,” says Weil. “When we cannot, we often feel its damaging impact through anger, depression, insomnia and a multitude of physical problems including inflammation, poor digestion, suppressed immunity and impaired cognition.”

Instead, make choices. Next time you get sad, angry or impatient with a client, observe yourself, Taylor says. Ask yourself, “What does it feel like inside my body when I get angry?”

“If you choose to observe, rather than engage, it fizzles out much quicker,” she says. “We have much power.” Who or what in your environment triggers certain responses in you? How do you respond when you are tired, hungry or hurt? How can you interact differently with the world to reduce the triggers?

Bringing your mindfulness with you wherever you go is ultimately the end game. “The Buddha, for example, said we should be mindful whether we’re seated, standing or walking around,” Hanson says.

Rudolph says mindfulness has helped her from simple everyday stressors such as traffic, to profound ones, as when she sat at her father’s deathbed and whispered to him that he could go now. “I was able to be there for him,” she recalls.

Ultimately, it is this connection, compassion and freedom to choose to stay in the present that makes mindfulness one of the greatest tools out there for increasing the quality of your life and your practice. “This is life. The right here, the right now,” says Taylor.

Andrew Weil, M.D.’s, relaxing breath

Andrew Weil, M.D., Founder and Director, Arizona Center for Integrative Medicine at the College of Medicine, University of Arizona, and Director of Integrative Health and Healing, Miraval Resort, shares one of his favorite mindfulness exercises.

“Every morning after I get up and brush my teeth I do some sitting meditation, usually breathing exercises,” Weil says. “I fi nd that starting my days this way enhances my sense of balance and helps me focus on what I need to accomplish during the day ahead.”

My favorite mindfulness exercise, and one that can often be performed at work, is the 4-7-8 (or relaxing breath) exercise. Here’s how to do it: Sit or lie in a comfortable position and place the tip of your tongue just behind your upper teeth throughout the exercise:

1. Exhale completely through your mouth, making a gentle “whoosh” sound.

2. Close your mouth and inhale quietly through your nose to a count of four.

3. Hold your breath for a count of seven.

4. Exhale completely through your mouth to a count of eight.

5. Inhale and repeat the cycle three more times for a total of four breaths.

“This is a simple exercise but an eff ective one, and you should do it whenever you can.”

Rick Hanson: Planting a Garden in Your Mind

Mindfulness is like a garden, says Rick Hanson, Ph.D., a neuropsychologist and author of Buddha’s Brain: The Practical Neuroscience of Happiness, Love, and Wisdom. “You can let be, let go, or let in. That’s it!”

However, mindfulness often gets overly identified with simply witnessing—the “letting be” part. But you are also being mindful when you are pulling weeds or planting flowers. In fact, if you can bring mindfulness to the planting of the garden, you can bring a wholesome quality to your brain and your life.

“Our brain is a mental neurogarden,” says Hanson, but its soil attracts “weeds.” Hanson says our ancestors needed these weeds—anger, fear, clinging, envy, stress—because of the competition. Either you ate, or were eaten.

Today our needs are diff erent, though. Hanson recommends people focus on “planting flowers” by mindfully taking in the good around you. The following four steps, using the acronym HEAL, can help you get started:

H: Have a good experience in the first place. And notice that you’re having one! Flowers are blooming, your cat is purring, your toothache is gone. Whatever feels good, notice it.

E: Enrich this experience by really staying with the positive experience. Let it become intense and stay with the body for at least 10 seconds or more.

A: Attend to the experience. Let it sink into you like water soaking into a sponge.

L: (This is optional). Let the positive and negative emotions pair up. Hold them both at once. For example, your cat is purring, but you’re running late for work. Make the positive more prominent than the negative.

Cognitive-Based Compassionate Meditation Training from Emory University

Jennifer Mascaro, Ph.D., co-author of the Cognitive-Based Compassion Training study at Emory University and the study’s lead teacher, Brooke Dodson-Lavelle, modified the following cognitive-based compassionate training for the readers of AMTA's Massage Therapy Journal.
1. Self-Compassion. Begin by finding a comfortable posture that allows you tofeel both stillness and focus.Take deep breaths, and as you do, pay attention to thesensations of each breath as it moves inthrough your nose. Now, notice how youare feeling and what you are thinking. Notice that your thoughtsand emotions change moment by moment, which refl ect that our views aren’t fi xed. Not only are your thoughts and emotions ever changing, but by recognizing them you also have the ability to change them in ways that are more healthy and positive.
2. Equanimity. Bring to mind three people: a close friend, someone you don’t know very well, and a person with whom you’re having trouble. In turn, imagine each of these three people standing before you. Notice how you feel toward each of them. Now, try to connect with them on a deeper level by noticing that all three of these people are like you in wanting happiness. Notice, too, that they are vulnerable to stress and suffering. As you imagine the person with whom you often have trouble, imagine a particular instance of strife you have had with this person. Think about whether the person you were having trouble with may have been suffering, and how this may have contributed to the strife. Take a moment to sit with this recognition.
3. Finally, cultivate your affection. Once you recognize the similarities in others, positive feelings arise and strengthen. Now, turn your attention to the things that you depend on for survival—including food and shelter. Notice the ways in which these essentials require the eff ort and kindness of others. Imagine the last meal that you ate and each ingredient that was included in the meal. Think about the effort and kindness that were necessary for each ingredient to make it to your table. By shifting your perspective in this way, you can come to develop a deeper sense of gratitude toward other people, which strengthens your affection and empathy.

Andrea Minick Rudolph’s Seated/Walking Meditation

Andrea Minick Rudolph, founder and director of Oryoki Zendo, a counseling and meditation center in Camp Hill, Pennsylvania, offers the following examples of seated and walking mindfulness meditations.
The length of both seated and walking meditation is entirely up to the individual, although she recommends beginners start with 10 minutes of the seated meditation and increasing the time gradually to whatever you are comfortable with. The walking meditation can be as long as you wish.
Sit comfortably on a cushion or a chair. You can begin the meditation with a cleansing breath known as the “wheel breath.” Bring the breath in just below the naval—a point called the “hara”—into the back of the body and up through the head. Then bring the breath down in front of the body and back through the hara point again. Do this for several cycles.
Keep your gaze soft, about four or five feet in front of you. Try not to close your eyes, simply because the temptation may be to fall asleep. Be aware of your surroundings and let thoughts come and go.
“The object isn’t to empty the mind but to be spacious with whatever comes up,” she says. “Understand that thoughts are just thoughts—they are not you.” She says that if a thought is strong or persistent enough, you can always return to it later. “This is a very calming practice. If you practice it every day, it becomes easier and easier to let things come and go,” she says.
You can do the same with walking, allowing thoughts to come and go in the same way.
Rudolph also recommends the following simple meditation, which can be done at any time of the day, perhaps even between clients. Find a quiet space. Sit and breathe deeply. “Center yourself in the moment, into the room,” she says. “Calm the body with the breath. One thing I always like to say to myself is ‘May I be open to all possibilities.’ This gets you out of your head, and gives you more awareness of what you are to do, rather than what you have done.” she says.

Mary Ellen Derwis-Balaz, LMT, Chi Kung Breath work

According to Cleveland, Ohio-based massage therapist Mary Ellen Derwis-Balaz, this simple breath work exercise, part of a discipline known as Tao Yin—which means “the path within”—can even be done lying in bed before getting up in the morning.
Lie on your back with your knees bent and feet on the ground surface. Tilt your pelvis and lengthen it. Close your eyes. Place your hands by your sides, palms down. Breathe into your lower naval. If your mind wanders, start breathing again into your belly. Don’t push thoughts away.
Derwis-Balaz usually practices for around 10 to 15 minutes in the morning before she gets out of bed—“the easier you make the practice, the more likely you will do it”—and then throughout the day as needed. “You can even do this between clients, or before bed, or in the middle of the night if you can’t sleep,” she adds.

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