5 ways that massage therapists can become more trans-affirming

Broadly recently featured an article entitled "For Trans and Queer People, Massage Therapy Can Be a World of Pain." The article covered some of the unfortunate barriers and negative incidents LGBTQ individuals have experienced with massage therapy. Mercedez, a massage therapist in Chicago, points out that:

Bodywork can be very clinical, and as many of us know, even skilled medical professionals lack the training to work with bodies that don't fit social norms. Often, queer and trans folk don't think we deserve to care for ourselves and heal, mainly because there hasn't always been spaces for us to do that. Structural oppression makes us ill both mentally and physically, and many of us go ages without care for our bodies, and end up doing more damage. Our own bodies can be such a huge source of trauma so it's nice to have people who are committed to being intentionally welcoming and inclusive.

Further, in “Holistic Health for Transgender & Gender Variant Folks,” herbalist and community-based healer Dori Midnight points out why offering “holistic care and education to individuals in a manner that honors the whole person” is so important,

Many trans people’s experience with the medical community has been negative- from the complicated diagnoses of Gender Dysphoria to the extreme medicalization of gender to humiliating and horrifying exams, it is easy to see why many trans folks choose not to engage with health care system at all.

Transgender people (especially trans women of color) are in the cross-hairs of a variety of threats from discrimination in healthcare, housing, and employment to horrific acts of physical violence. Bodywork can be a powerful healing modality that can counteract the physical effects of living in a climate that often keeps us in “fight or flight” mode. Massage therapists are in a unique position to offer affirming client-centered care. We are not here to diagnose, pathologize, or prescribe. Our work has the potential to facilitate healing in every system in the body and can decrease anxiety, improve sleep, and reduce pain.

So how can we as massage therapists become intentionally welcoming to individuals of all genders and gender expressions?

Numerous bodywork practitioners across the country have been paving the way in terms of gender-inclusive healing environments. For example, Freed Bodyworks in D.C. was founded with the goal to create a practice that "embraces the many ways that people's bodies are non-conforming" and has a diverse staff that understands the importance of radical inclusion. The list of such practices could go on...including Wild Seed Wellness, Third Root, and Holding Space Massage.

We can learn from examples like those to incorporate similar values into our own work. Here are five initial ideas to create a more affirming practice before clients even arrive at your door:

1. Addressing financial barriers

A 2015 report points out that “trans people are nearly four times more likely to have a yearly household income below $10,000” and “the numbers go up if a trans individual is a person of color.” Attuned, caring human touch is vital to our health and has been documented as a healing method dating back to 2700 BCE. We must make sure massage therapy is financially accessible and not just promoted as a luxury spa treatment for the wealthy few. One way to do this is to build sliding scale and low-income options into your business plan and budget. If you work at a high-end spa and don’t have control over the rates, consider doing offering mobile massage or volunteering to do chair massage at a local community center for a few hours each month. Also, advocate for and practice affirmative action hiring policies at your business or workplace.

2. Inclusive intake forms and language

If your business only has multi-stall women's or men's restrooms, consider adding a sign stating that your establishment is welcoming to all

Consider ditching gender on your forms. Or instead of a set of two check boxes for Male and Female, provide a blank space for self-identification (i.e. "Gender: __________"). Create a space for clients to provide their gender pronouns on your intake form (i.e. she, he, they). Additionally, instead of asking clients if they'd prefer a male or female massage therapist, simply ask something like, “Do you have a preference in terms of which practitioner you work with?”

3. Gender Neutral Restrooms

Mark your single-occupancy bathrooms as gender-neutral or unisex. If your business only has multi-stall women's or men's restrooms, consider adding a sign stating that your establishment is welcoming to all (see example). Many trans and gender non-conforming people have unfortunately been harassed in bathrooms, so having at least one gender-neutral restroom helps create a more safe and welcoming environment. (For more information on why this is important, check out this recent report by Fenway Health).

4. Educate yourself, your co-workers, and your students

Unfortunately there are gaps in this area of education across the board. A recent article, "How Medical Schools Are Failing the LGBTQ Community," noted that in regards to LGBTQ-specific health issues, medical students only received a median of five hours of instruction. And it’s not just about adding in a few hours on a “special population.” As history has shown, “on nearly every continent, and for all of recorded history, thriving cultures have recognized, revered, and integrated more than two genders.” Most of our course materials and textbooks covering topics of anatomy and physiology are simply giving us incomplete or false information by erasing gender diversity or pathologizing it (as often is the case when discussing intersex individuals’ bodies).

Instructors in the field of massage therapy can address this by speaking to these gaps as well as providing supplemental information. In the 6th edition of A Massage Therapist’s Guide to Pathology, author Ruth Werner does this by pointing out that anatomy and pathology often separates body parts and conditions according to whether women or men are likely to develop them. Further, pathology of the reproductive system,

...is predicated on the concept that a clear division between what is male and female is obvious. In fact, this division is not always clear. Our sex organs dictate our biological state, but our gender is the product of psychological reality, and many people’s gender identities don’t completely conform to the bodies with which they were born.

A wonderful place to start or resource to share with co-workers is a two-part article series written specifically for massage therapists by Kat Mayerovitch on Massage Business Blueprint: Part I and Part II. Additionally, seek out information on trauma-informed massage and learn more about trans experience at the intersection of multiple identities (i.e. trans and disability).

5. Center and honor the needs of our clients, always. Trans people have back pain too!

Along with addressing the pitfalls of a binary approach to anatomy, Ruth Werner stresses the importance of approaching all clients with unconditional positive regard:

If a client has a problem, that problem is the central issue, regardless of whether that client identifies as male, female, or other. Our job in this situation, as in all situations, is to honor the needs of our clients, and to create an experience of welcome, safety, and wellbeing. The unconditional positive regard that comes with being in a helping profession is an attitude that applies to every person, regardless of gender identity.

The goal is to provide a healing, therapeutic experience for all clients. Don’t make assumptions, and while it is essential to educate yourself, if the client doesn’t bring up their gender identity, do not bring it up in your session. As Dori Midnight points out, “it's a delicate balance of both holding space for what might arise, but not bringing more focus to it unless your client does.”

The focus should always remain on the client, not on your curiosity or opinions as the practitioner. As with any client, follow their lead in terms of language and never ask invasive questions about their bodies. Always respect client confidentiality. In an article published by the UCSF Center of Excellence for Transgender Health, the author brings into play the concept of cultural humility. This “is a concept through which individuals recognize that their own experiences or identities may not project onto the experiences or identities of others. Each patient should be approached as an individual with no preconceptions.” Further it is important to “meet patients ‘where they are’ without judgment or editorializing (including in some cases, even positive remarks about appearance)” and to limit “questions to those that are relevant to the current visit or problem.” Lastly, never "out" a trans person and always adhere to the same values around confidentially as you would with any client.

Providing an affirming, non-judgemental space will go a long way to ensuring that all clients have the opportunity to experience the full range of benefits that massage therapy has to offer.

Additional resources:

If you would like to learn more for your own practice or to better educate students my top recommendation is to seek out a professional development training or online course in these topics. The training doesn't have to be geared specifically towards massage therapy to teach useful concepts. For example in Boston, MaeBright Group LLC offers trainings to a wide range of healthcare providers and state agencies. Annual conferences such as the Philadelphia Trans Health Conference also offer professional development tracks.

In addition to what one can learn in the classroom or in trainings, there is a plethora of resources online. In terms of resources pertaining to the transgender community for an audience of bodywork practitioners here is an initial, not exhaustive, list:

Getting started:

Pertaining to Holistic Health and Bodywork:

From a healthcare perspective:

***Please note: these resources are designed for medical providers. Massage therapists do not need to know and should NOT ask a client directly about their sexual orientation, gender identity, or sexual history.***

Kindling: Writings on the Body